Your First Associate: Hire When the Number Is Real

How many more hours a week does an owner spend on patient care than the associate they employ? Most owners say ten. The best national numbers put it at about two. This episode takes apart the belief behind every first-associate hire that did not work out: busyness is not demand, an associate multiplies demand but does not create it, and the number that decides the hire never shows up on a report. With real cut-ins from Dr. Carlos Grandela (Episode 092) on hiring before the patients existed versus hiring off a documented 8-to-12-week wait, and Dr. Kyle Maxam (Episode 089) on using your own patient base to fill a new doctor's column. Plus the 1962 Tusko story on scaling by the wrong input.
By the numbers: owner vs employee patient-care hours 1,828 vs 1,731 (AOA 2017). Net income $172,016 vs $101,457 (AOA 2017). Seven years later $243,650 vs $156,819 (Review of Optometry 2024, n=422). Widest ownership gap: doctors 4 to 6 years in practice, $59,716 apart.
One thing to count: every Monday for four weeks, write down how many days out your third open exam slot is. Under two weeks is a demand question, not a doctor shortage.