[Optometrist Unleashed] Part 1: Buying Practices, Metrics That Matter, and Prioritizing Initiatives

Dr. Wes McCann is the Founder of Doctors Vision Group, a network of 15 Ontario optometry practices delivering modern, full-scope eye care. He leads practice acquisitions, integration, technology investment, financial strategy, and team development. Dr. McCann is also an optometrist, educator, and speaker who has lectured at hundreds of industry events and published in Review of Optometry and Review of Myopia Management. A 2024 Contact Lens Institute Culture Award honoree, he is recognized for improving patient experiences and practice outcomes.

Here’s a glimpse of what you’ll learn: 

• [2:51] Dr. Wes McCann’s perspective on balancing business management with exceptional patient care
• [5:27] How Dr. McCann grew from one practice to a 15-location network
• [7:53] What Dr. McCann evaluates when assessing practice fit, culture, technology, and financial health
• [11:17] Why positive cash flow matters more than headline valuation multiples
• [16:04] Fee strategies, technology investments, and sustainable practice profitability
• [21:08] Dr. McCann shares strategies for motivating associates and strengthening team performance

In this episode…

Buying an optometry practice requires more than recognizing growth potential. Owners must understand what they are purchasing, which numbers reveal the practice’s true health, and where to invest first. How can they make those decisions with greater confidence?

Dr. Wes McCann, an optometrist experienced in acquiring and managing multiple practices, believes buyers should evaluate what a practice has already achieved rather than pay for unrealized opportunity. He recommends examining cultural fit, labor ratios, revenue per patient, dispensing rates, EBITDA, and post-financing cash flow before moving forward. Dr. McCann also suggests ranking technology and operational initiatives by their expected return, ensuring each investment covers its costs after associate compensation. This disciplined approach helps owners reduce acquisition risk and direct resources toward the improvements that matter most.

In this episode of Optometrist Unleashed, a Cleinman Connect Podcast, Dr. Trevor Miranda talks with Dr. Wes McCann, Founder of Doctors Vision Group, about buying and improving optometry practices. Dr. McCann explains how to evaluate acquisition opportunities, identify the metrics that reveal financial health, and prioritize initiatives by ROI. He also discusses pricing, technology investments, and team performance.

Resources mentioned in this episode:

• Kevin Wilhelm on LinkedIn
• Kim Carson on Linkedin
• Marketing4ECPs
• Cleinman
• Dr. Trevor Miranda on LinkedIn
• Dr. Wes McCann on LinkedIn
• Doctors Vision Group
• Dry Eye Summit
• Myopia Summit
• Eye Recommend
• College of Optometrists of Ontario
• Contact Lens Institute

Quotable Moments:

• “If we don’t manage our business well, we don’t get the opportunity to take the best care of our patients.”
• “So that creates a great patient experience, and better outcomes, and better care.”
• “The practice is only worth what someone’s going to pay for it.”
• “You don’t want to be doing it all for free yourself and just paying for the piece of equipment.”
• “We have a staff wage percentage target that we try to hit because that’s important from a budgeting perspective.”

Action Steps:

1. Confirm positive cash flow before buying a practice: A sustainable acquisition must cover loan payments while leaving room for unexpected costs and future investments.
2. Evaluate culture and willingness to change: A practice is more likely to integrate successfully when doctors and staff support modernization and continuous improvement.
3. Review the metrics that reveal financial health: Tracking revenue per patient, dispensing rates, labor ratios, and EBITDA helps uncover risks that headline revenue may hide.
4. Adjust fees to reflect your level of care: Pricing services appropriately helps cover inflation, staff raises, and the technology required to deliver better patient outcomes.
5. Calculate the ROI for every equipment purchase: Factoring in lease costs and doctor compensation ensures new technology supports patient care without weakening cash flow.

Sponsor for this episode…

This episode is brought to you by Marketing4ECPs.

Working with them is like hiring a full-time marketing professional who knows the industry and understands your goals. Except, instead of one experienced marketer, you get a whole team in your corner.

Whether you’re an optometrist, ophthalmologist, or optician, they can help you grow your business with a plan that’s completely customized for you. Learn more here.

Powered by Rise25 Podcast Production Company

Episode Transcript

Intro: 00:00

Welcome to Optometrist Unleashed, a Cleinman Connect Podcast with Dr. Trevor Miranda, a monthly doctor led discussion about everything surrounding the business of optometry.

Dr. Trevor Miranda: 00:15

Hey, everyone, and welcome back to another episode of Optometrist Unleashed, a Cleinman Connect Podcast. I’m your host, Dr. Trevor Miranda, coming to you from beautiful Vancouver Island, British Columbia. And today we’re talking metrics that matter in optometry, buying a practice, and maybe even 15 of them.

This episode is brought to you by Marketing4ECPs. Working with them is like hiring a full time marketing professional who knows the industry and understands your goals. Except instead of just one experienced marketer, you get a whole team in your corner. Whether you’re an optometrist or ophthalmologist or optician, they can help you grow your business with a plan that’s completely customized for you. Learn more at Marketing4ECPs.com. 

Today I’m joined by Dr. Wes McCann. We’re super excited. He attended Western University and Nova Southeastern University, where he earned three honors, bachelor’s of Science degrees and accelerated MBA and a Doctorate of Optometry. Sort of the classic underachiever there, Dr. McCann. Dr. McCann owns 15 practices in Ontario, Canada. He’s been on the faculty of the Canadian Dry Eye Summit, the Myopia Meeting, and Myopia Summit, just to name a few. He’s also lectured at hundreds of other events and conferences across various platforms on contact lenses, ocular disease, dry eye disease, pharmaceuticals and medical equipment. 

He is currently on the Board of Directors for Eye Recommend, as well as a Director on the Ontario College of Optometrists in Ontario. He has been published in numerous journals, including the Review of Optometry and the Review of Myopia Management. In 2024, he was awarded the Contact Lens Institute Award for Contact Lens Culture, recognizing his impact on fostering contact lens cultures that enhance patient experiences and business success. Wow. Thanks for taking the time for joining us, Wes. Welcome.

Dr. Wes McCann: 02:17

Thanks for having me, Trevor. Excited to be here.

Dr. Trevor Miranda: 02:19

Yeah. How are you doing?

Dr. Wes McCann: 02:21

Good, good. Yeah. Yeah. Busy day in clinic this morning. And, now get to work on my practice management stuff.

So fitting time to come talk to you.

Dr. Trevor Miranda: 02:28

You know, I love that you do it all. You. And with such balance and grace., you know, some people might say, hey, you’re juggling things, and I disagree. You’re really balanced.

You’ve got a family life. And, you know, you play tennis and you do all the things. So I love to see it. So thanks for taking the time out, Wes. I wanted to talk a little bit about your MBA alongside your OD. How did that come about?

Dr. Wes McCann: 02:51

Yeah. So in school, we had the opportunity to do it alongside our other degree at the same time. So when we’re in private practice so much certainly is, taking care of our patients and managing patient care. But a big chunk of it is also managing a business. And if we don’t manage our business well, we don’t get the opportunity to take the best care of our patients.

I think at the same time., and we hate to think that medicine is, is also a business, but it has to be. I mean, you have bills that you have to pay and you have lots of equipment that you have to invest in over time. And if you’re not running a business that’s sustainable, then you can’t invest and grow your practice into real, true medical care. The medical eye care by itself really doesn’t pay to run a medical eye care practice. 

 You need the whole full scope to be able to do it well.

Dr. Trevor Miranda: 03:37

Yeah. And it’s just like it’s balancing staff. It’s balancing technology and it’s, it’s balancing profits so you can reinvest in into patient care.

Dr. Wes McCann: 03:45

Exactly, exactly. And again, you want to have, the equipment and the technology that’s going to best take care of your patients. And so if you run a tight ship to be able to ensure patient flow, patient experience, and, your margins are well enough that you can invest in more stuff over time, then you’re going to be able to grow your practice and take better care of your patients. So I truly believe that you need to have some sort of business sense in your practice to be able to really excel and grow, for sure.

Dr. Trevor Miranda: 04:14

Wes, let’s go back in history to the first practice you owned. How did that come about? You know what, what, what made you buy a practice?

Dr. Wes McCann: 04:25

Yeah. So my plan was always to come back to London, Ontario, where I live, and to, purchase my father in law’s practice. So, that was the ultimate goal. I ended up coming back and was practicing. There wasn’t fully 100% busy.

I had a few days a week that were pretty full, but I could probably consolidate to three days and, and start somewhere else two days a week. So, went and interviewed at another practice and, explained kind of all the stuff we had changed from practice management standpoint at my father in law’s practice. And then, that Khaled was retiring and offered for me to buy her practice and, decided to jump in and do that and both practices. I was like, I could split my time between the two so I could easily do that. Much like I’m sure you were at the beginning as well. 

 And and then another opportunity came by where, I had an industry partner that approached me saying, hey, you know, I know another practice that’s, looking at transitioning out. And they don’t have anyone that would like to buy their practice. Are you interested in another one? So that was the big step going from I can, I can practice it to pretty consistently, but split myself between three gets harder because you don’t have as much continuity with your patients if you’re only somewhere one day a week. So, that was the big jump where I decided to go there and, and not practice there, but have associates that were working there as well. 

 So, that practice wasn’t too bad and it wasn’t difficult to manage remotely. We had a great team., and then again, third and fourth came along fifth and sixth. And like you said, now we’re coming up to 15 and, it’s, again, I haven’t gone out seeking practices. Largely. 

 It’s been people coming to us saying, hey, you know what? I like what you’re doing. And are you interested in, in our practice and this is what we have to offer. And, things have to be the right fit for sure, to fit our culture, but it’s been great. And, and again, every time we acquire a practice, we learn new things that we’re, we change and tweak. 

 I think the, our motto is there’s nothing consistent in life but change because we can always continuously evolve our best practices. And we learn something every time. And we can implement new things to every practice, because there’s a lot of uniqueness out there and some good things that are always worth integrating.

Dr. Trevor Miranda: 06:40

Yeah. I was going to ask you, Wesley, so these deals come to you. You don’t go seeking practices.

Dr. Wes McCann: 06:45

Right? So to this point, I haven’t sought out any practices. They’ve come to me. I’m asking to join our team. I think we’ve developed a good culture within our practices and a good, overall image of what we represent, what we really look for is kind of improving and elevating patient care.

We really care about what patients perception of us is and their experience. So we pull that to every patient to understand. Again, one of the metrics we look at to understand our patients experience is good. And is there anything we can tweak and improve?, and then the culture within the practice with the staff and the team makes a big difference as well. 

 So I think we’ve developed that, over time into a really, really great place where we’ve got a really high net promoter score for both our team members, our staff, and as well as our doctors through staff engagement surveys and doctor engagement surveys. So I think that brand we’ve developed over time has definitely helped us to, be a great option for, for people to come and join Wes.,

Dr. Trevor Miranda: 07:42

, when these deals come across your, your, your office desk, what do you look at? What are some of the metrics you look at in terms of evaluating this practice? If it’s a good fit for you?

Dr. Wes McCann: 07:53

Yeah. So when we come in again, we, our brand is very much up to date technology modernization and, making sure that we can practice full scope optometry. And so certainly practices that are already there is great and easy fit., some of them take more investment to get to that point. So, depending on where that practice sits in that spectrum is either more work or less work.

So more work, there’s more we have to put into the practice. So the acquisition price might be a little bit lower or somebody who is fully up to date, all new equipment, running, all cylinders very well then that looks different as well. So we kind of look at both of those, aspects of kind of where they are in that spectrum and are they a good fit for us from a culture standpoint, they have the same outlook on patient care and adoption of new technology or not or not., and how many doctors are there and are they all adaptable to change as well? And we don’t change everything in the practice. 

 Every one of our practices have their uniqueness to them. Like a small community in Essex, Ontario is different than London, Ontario, which is different than Waterloo. Like all those communities are different. So we don’t it’s not a cookie cutter approach to everything, but everyone has to have that appetite for change and appetite for improvement and moving forward with what, what we think is great in optometry and modernizing practice. So if they have that mentality, then they become a great fit. 

 So we’ve said no to some that didn’t have that same mentality and that great fit even. It was a good opportunity., so that’s a really important part to us. But then metrics are definitely important., so I think one thing that I oftentimes hear from people that are looking at selling is they say, well, this is a great opportunity. 

 This practice is a great opportunity., you know, generally you look at opportunity and it’s a great thing to, to have opportunity to practice, but you don’t pay for opportunity necessarily. You pay for what has that doctor done to that point to bring that practice to where it is, and then we get to bring it to the next phase of, of life., and I think there’s great things that we can do for sure, but we’re kind of buying what’s there, right., and the history of what’s there. 

 So the metrics that we look at within that are certainly like the KPIs that we look at for regular optometry. So your dollar per patient, your dispensing rate, those normal things that we kind of look at to show what a healthy practice is., labor ratio is another one that I think oftentimes gets overlooked. And sometimes that can be one of the bigger challenges is we may have a practice that has a labor ratio that’s 35%, which is super high compared to what’s normal., and that eats away at a lot of the value of that practice because the, the value of that practice is a lot less because the EBITDA goes down, because you’re paying so much in terms of your staff, you have way too many staff than you do for your practice. 

 Now, there can be scenarios where maybe that year it’s a little higher because they lost an associate and they didn’t want to get rid of their staff. And it’s a transition period. So again, there’s things to consider in all of that. But that’s definitely a big metric that we see that has so much variation in it between practices.

Dr. Trevor Miranda: 11:01

And so, Wes, if you are willing to share, you know, what are kind of the multiple ranges that you have? Is it, is it EBITDA that you’re looking at? Is it one time? Is it gross revenue? What are how do you base your multiple what are the multiples in the Canadian landscape right now?

Dr. Wes McCann: 11:17

Yeah. So multiple is a hard one because there’s so much variability. And so, the multiple go from three times to five times, I would say largely, but also a multiple of what, like, what are you calculating your EBITDA as? So people can play with EBITDA to be a higher number or a lower number, depending on how you’re calculating it. But ultimately, in the end, the practice needs to sustain itself.

So if someone’s going to purchase the practice, when they go to get a loan to pay for the practice over ten years of its loan lifespan, the the practice still has to be cash flow positive. So ultimately that’s the end factor of if it’s not a cash flow positive practice when you’re paying off buying the practice, then then it’s not worth the wait. It’s what they’re trying to sell it for. So it really has to be cash flow, positive practice. And then, and then it’s up to us to make efficiencies to build in, the ability to invest in new equipment and do different things as well. 

 But certainly that cash flow has to be positive and there has to be a little bit of a buffer there as well, because things happen and, and such. So, it’s interesting because you can play with numbers all you want and come up with a number that you want, like that you could say a multiple of whatever., but ultimately, like the practice has to be sustainable afterwards. So I think that’s the biggest thing. And the practice is only worth what someone’s going to pay for it too. 

 So, so that’s a big consideration. And we have some great companies out there that do practice evaluations, and some have very fair evaluations and some have really high valuations. But again, it ultimately depends on, on what someone’s going to end up wanting to pay for it as well. And what can be sustainable.

Dr. Trevor Miranda: 12:54

Besides not wanting to change very easily? What’s a big red flag to you.,

Dr. Wes McCann: 12:59

, so yeah, resistance to change is one for sure., labor ratio is another one. So again, a practice that has like a, and we’ve seen it a couple times. Practice comes in and they have a 35% labor ratio and everyone’s been there for 5 or 10 years. So and if it’s a share sale, you’re buying the legacy of all those patients or the staff members as well.

And we don’t want to change so much. We don’t want to get rid of long standing like staff that are great. And they’re part of the identity of the practice. But it’s also a challenge because you need to create a significant amount more revenue to offset the staffing costs to make it viable as well. So those are challenges. 

 I would say it’s something that takes people by surprise when they see that. And they, they, it’s a difficult thing to get around or get through, their head because they sometimes also feel like they’re short staffed, even at a 35% staff ratio., so that’s, that’s one, I would say, another one would be no investment in technology. So you’ve trained your patient base to not have what’s kind of standard in 2025 patient care. So retinal photography, OCD, things like that. 

 So if there’s no investment in that technology to date, it’s it’s tough to change that mentality of those patients coming in because you’re the new practice owner and you’ve introduced this new technology and there’s a hump to get over of getting by. And in terms of this is what 2025 care is, and these are all the diseases that we need this technology to manage really well. So getting over that hump can be a challenge sometimes. So again, if there’s no modernized technology that and again, depending on the province you are in or state, if we’re in the US, some things are covered, some things aren’t covered by insurance. So, that’s an interesting dynamic I would say to work through. 

, and then again, in Ontario where we are, we went off the dispensing fee model many years ago, but there’s many practices still on the dispensing dispensing fee model. And so that can be an adjustment for patients too. So it’s like looking at how many big adjustments will there be both to the staff and to the patients coming in. And it is that adjustment manageable, or is it going to be a lot for someone to take on? And those are the opportunities that you’re buying. 

 But there’s also risk as well. So you’re not paying for opportunity because you have to create that and you have to do it yourself. But there might be an opportunity there for that. But again, it comes with risk of training all your patients on, on what 2025 2026 care is.

Dr. Trevor Miranda: 15:27

Yeah. And I know you’ve proven the model in your own practices, right? So, you know, things are working, in your own current organization. So I think it’s easier to know that if you do X, Y, and Z, it’s going to work. My question to you is for me, when I’m giving advice to some, practice owners, I’m like, look at your, you’re like your eye exam fee.

You haven’t changed it in ten years., that’s low hanging fruit that can really add to the bottom line of each and every patient interaction. What are some of the things that you look for for easy changes to improve your net profitability of the practice that you take over.

Dr. Wes McCann: 16:04

Yeah. So, a couple of things. Certainly we do a market based analysis to find out what’s a regular eye exam in this area. And throughout our province. There’s not huge variability, but there is some in areas.

And, and again, I think we provide a really high level of care within our practices. And we focus a lot on disease and technology. So we kind of aim to be in the higher end of that because we do think offer a lot of technology within our practices, which costs money to deliver. But patients are very impressed by it. And, and they appreciate that investment. 

, some of the comments you usually get is I’ve never had such a thorough eye exam or you have so much cool technology., so that creates a great patient experience and better outcomes and better care. So when we’re, so those are big investments, but when you’re investing in that, yeah, you need to increase your fees to, to keep up with that. And everyone should be increasing their fees. Every year. 

 Everything goes up year over year. And so if you’re not increasing your fees to keep up with inflation, you’re actually making less every year as the owner and as, as your associates, as everybody in the practice, because you’re not keeping up with the cost of living. So we certainly want to give our staff raises every year. So we need to also charge for our services with inflation increases. So I think it’s an opportunity if they haven’t done it in a while. 

 And I will say patients largely don’t notice a big jump if it’s reasonable. And if you’re still in the market space, norm., so, that’s certainly an opportunity to help offset some of the costs of your investments of updating things too. So I think when you’re looking at buying a practice, one of the things you have to look at is what is the technology that I want to bring into the practice and how am I going to pay for that investment? So if I’m buying a practice, I’m cash flow positive with what it does right now. 

 And I want to invest in new technology. How will I be able to offset my leases every month on that new technology that I’m investing with the fees that I’m charging? So am I charging fees for the technology I’m investing in? And if I am, how many of those do I think I can do every week or every month? And will that cover my lease costs after I’m paying myself and my associates? 

, and then, same thing with exam fees, like, could that offset some of it? And I think we have one, one thing that I see in some practices is they include things like tea on a regular eye exam, but then they don’t have a place for a retinal photo and there’s value in retinal photo. So what do you charge and what do you include in a comprehensive exam? Because, I don’t I’m not a believer that every single patient needs an Oct in the industry. Like a 22 year old healthy person doesn’t necessarily need an Oct, but I think a retinal photo would be far more valuable to that patient. 

 So where does technology fit and where is it valuable on an everyday patient?, is there a clinical need for it. And when there isn’t on every patient, then we would charge for them. And and if you’re including something in your exam, make sure you’re charging for it in the exam fee too, because that technology costs money to implement. So you need to make sure you’re charging what you’re worth and you’re charging us to implement all that technology too. 

 So there’s a, there’s a lot of things that I see that sometimes get thrown into exams because it’s easier to do that, but you have to make sure that you’re covering your costs at the same time.

Dr. Trevor Miranda: 19:25

So you need an ROI, right? You need an ROI. Do you do a contribution margin calculation.

Dr. Wes McCann: 19:30

In terms of contribution in.

Dr. Trevor Miranda: 19:32

You know, in terms of how this purchase is going to affect your bottom line? Do you do analysis on every piece of equipment?

Dr. Wes McCann: 19:39

Yes. So every piece of equipment we figure out what’s the least cost and what’s the number of times we need to do this within the practice to be able to at least break even., but a lot of people don’t remember to factor in paying themselves and paying their associates. So if you’re paying your associates and yourself a for 21% of your gross billings. Then remove 21% of all those billings from your gross profit to make sure that you still have money left over to pay for that lease. 

, you don’t want to be doing it all for free yourself and just paying for the piece of equipment. So we absolutely figure that out and figure. Does this allow us to still be positive cash flow wise by investing this in this equipment. And it’s a great exercise for associates too. So if we have associate joining our team and we say, hey, you know what?

This is a new technology that we’re interested in doing. This is how many times you need to be able to do it a month for it to at least break even. Do you think you can do at least that? But our goal would be double that., so you think you can do double that? 

 Yes or no? If you don’t think maybe this isn’t the right time to invest in that, and if it’s not, how do we think we can get you there to invest in this at this point?, so those are good exercises for them to understand the cost of business as well., I mean, it’s amazing to have all sorts of technology in your practice, but it also has to like the money for it comes from somewhere.

Dr. Trevor Miranda: 21:00

So yeah. And do you, do you vary the compensation to the associate owed based on their sort of capture rate of some of these technologies?

Dr. Wes McCann: 21:08

No. So we do a pretty standard one. And, for us, I mean, every associate has the opportunity to make as much as they want or as little as they want. And it just depends on how complex care do you want to give, how complex in terms of disease management, do you want to get? Do you want to do any subspecialty, specialty contacts, etc.?

Like the sky’s the limit for you, and I’m happy to support you in any of those areas to get you to do what you want, as long as what we’re investing in will cover itself. And if it does, hey, I’m happy to get you to where you want to be in terms of that. And I’m happy to coach along the way to get you there too. But this would be the expectation as a bare minimum to be able to invest in this equipment. So yeah, I don’t vary the percentage because again, our margin stays the same no matter what. 

 So we want to make sure that they’re doing more. It’s like I would say, if we had a staff bonus, I wouldn’t give everybody the same bonus no matter what and give a target, but then don’t really care if you meet it or not and just give you the bonus period, right? So we all have a margin. We have a staff wage percentage target that we try to hit because that’s important from a budgeting perspective., and then we do staff bonuses and stuff and profit sharing and, and things like that on top of that. 

 So how do we create a scenario that’s going to be positive for the patient experience and then positive for our team culture and then positive for the doctors as well.

Outro: 22:33

And that’s it for this week’s episode of Optometrist Unleashed with Dr. Trevor Miranda and Dr. Wes McCann. We’ll have part two for you next week.

Outro: 22:41

Thank you for listening. At Cleinman, we take pride in helping our optometrists unleash their full potential. Subscribe to get the newest episodes or visit us anytime at Cleinman.com.