For a multi-location optometry group, labor cost is not a single percentage to force every office to meet. It is the cost of providing dependable access, completing the required administrative work, supporting clinicians and optical teams, and keeping a growing network under control.

The more useful question is whether the group is paying for the right work in the right place. A location can look lean on a payroll report while callers wait in voicemail, staff postpone insurance follow-up, and managers spend their days repairing scheduling errors. Another location can look overstaffed because it is carrying work that belongs in a shared patient-access model. Neither picture tells leadership enough on its own.

This article is for COOs, operations leaders, and executives responsible for optometry groups with three or more locations. It offers a practical way to evaluate labor cost without treating patient access or local operating realities as an afterthought. For the broader service model, see MyBCAT’s optometry operations services.

Table of Contents

What Does an Ideal Labor Cost Look Like for a Multi-Location Optometry Group?

There is no responsible universal labor-cost percentage for every optometry group. Provider mix, optical volume, payer mix, market wages, hours of operation, call volume, technology, and the degree of centralization all change the answer. A benchmark can start a management conversation, but it should not become a staffing instruction without context.

An ideal labor cost is one that supports the operating standard the group has chosen. That standard should specify how quickly patient inquiries receive a response, who can schedule each appointment type, how intake and eligibility work are completed, what requires escalation, and how exceptions are documented. Labor is then evaluated against the work required to meet that standard.

This reframes the issue. Instead of asking each location to reduce headcount, leaders ask whether the network has enough coverage during demand peaks, whether tasks are assigned to the appropriate role, and whether identical work is being duplicated across sites. The American Optometric Association treats scheduling, recordkeeping, office procedures, and staff management as core practice operations, not isolated administrative chores. That is a useful foundation for a group labor review.

The target is not the lowest possible staffing cost. It is a stable cost structure that protects patient access, gives teams clear ownership, and lets leadership compare locations using the same definitions.

Why Do Labor Ratios Mislead Leaders When They Stand Alone?

Labor as a share of revenue is a useful financial signal, but it is a lagging measure. It cannot show whether a high ratio reflects temporarily lower demand, a new location ramping up, an acquisition with inconsistent workflows, a staffing gap covered by overtime, or a genuine productivity issue. It also does not show the access problems created when labor is cut without redesigning the work.

Groups need operating measures beside the financial ratio. Review inbound call volume by time of day, live-answer and callback performance, appointment requests reaching a documented outcome, scheduling corrections, intake completeness, overtime, turnover, and manager time spent covering front-office tasks. The point is not to build a large dashboard. It is to make the likely cause visible before changing staffing.

For example, a location with a high labor ratio and weak callback completion may not have excess labor. It may have too many people doing fragmented work without a clear queue owner. A location with a low ratio and frequent scheduling corrections may be relying on clinicians or managers to absorb front-office work that is not represented in the staffing model.

Review the denominator as carefully as the numerator. Revenue can shift with provider availability, seasonality, payer timing, optical demand, or changes in visit mix. A labor decision made from one month of ratio data can entrench the wrong response. Use a consistent period, review trends by location, and investigate operational variance before treating a number as a verdict.

How Should Groups Map the Work Behind Their Labor Costs?

Start with the patient journey and follow the work to its final disposition. Map how a new patient request, an established-patient reschedule, an insurance question, a recall response, and an optical inquiry move through the organization. Include the first contact channel, the role that owns each step, the system used, the required information, the escalation path, and the closure condition.

This exercise reveals labor that is easy to miss in a budget. A front-desk employee may be taking calls while checking in patients. An office manager may spend time clearing voicemails after hours. An optician may be interrupted to answer a routine scheduling question. A scheduler may wait for a location to clarify rules that should be available in a shared knowledge base.

The result should separate work into four categories:

  • Patient-facing work that needs to remain at the location, such as in-person check-in and immediate handoffs.
  • Repeatable patient-access work that can follow approved scripts, scheduling rules, and escalation paths.
  • Specialist work, such as complex billing or credentialing, that needs dedicated expertise.
  • Clinical judgment or sensitive exceptions that must go through the group’s approved clinical or local escalation route.

This is not an argument to centralize every role. It is a way to stop treating all front-office labor as one undifferentiated cost. Groups that want a deeper process view can use the multi-location healthcare intake guide as a companion to this mapping work.

Which Roles Should Be Covered Locally and Which Can Be Shared?

The answer depends on the work, not on the job title. In-person patient flow, provider-specific coordination, and immediate optical handoffs often need local coverage. Repeatable phone handling, routine scheduling within approved rules, callback management, basic intake follow-up, and recall outreach can often be managed through a shared team when the group has standard workflows and clear accountability.

The dividing line is authority. A shared team needs current appointment rules, access to approved systems, a documented handoff process, and a way to recognize when a request is outside its authority. It should not make clinical determinations, improvise coverage explanations, or override location constraints without an approved rule.

Centralization can reduce duplicated coverage, but only if it replaces duplication rather than adding another layer. If every location continues to maintain its own callback list, scripts, and scheduling exceptions while a central team does the same work, labor cost rises and accountability becomes harder to trace. The group needs one owner for each queue and one definition of done for each request.

MyBCAT’s overview of centralized scheduling describes the kind of shared protocols and reporting needed for that model. Before moving work, leaders should confirm which location-specific differences are legitimate and which are simply historical habits.

How Can Scheduling Capacity Improve Labor Productivity Without Rushing Patients?

Scheduling is where staffing decisions become visible to patients. When appointment templates, visit types, provider preferences, and escalation rules are unclear, a capable team spends more time asking for clarification, correcting bookings, and calling patients back. Adding staff may reduce the immediate pressure, but it does not solve the design problem.

Begin by documenting the appointment types that patient-access staff can schedule, the information required for each, the available locations or providers, and the situations that require review. Keep provider-specific constraints visible and current. If the rules change, update the system configuration, the playbook, and the training material together.

Then match coverage to demand patterns rather than a fixed staffing assumption. Review when calls arrive, when the front desk is busiest with in-person patients, when callback queues build, and when eligibility or form work must be completed. The best staffing plan may include protected local coverage at peak check-in times and shared coverage for phone or follow-up work during those same periods.

Productivity should not mean shortening conversations until patients leave with unclear next steps. A well-run interaction produces a documented outcome: booked, routed for review, waiting on a stated item, or completed. That reduces repeat contacts and makes the workload easier to manage. The patient access center model is useful when a group needs a formal operating layer for that repeatable work.

When Does Outsourced or Virtual Support Make Financial Sense?

External support makes sense when it solves a defined coverage or capability problem within a controlled operating model. It can help a group protect phones during high-volume periods, manage routine follow-up, staff a centralized queue, or add administrative capacity without creating a separate process at every location. It is not a substitute for deciding what the work should look like.

Before comparing a managed team with additional internal hiring, define the scope in operational terms. List the calls, scheduling actions, follow-up activities, systems, hours, escalation rules, quality checks, and reporting requirements involved. Identify who owns exceptions and who can change a rule. This makes the comparison about total operating cost and service fit, not only hourly wage.

The group should also calculate the hidden internal costs it is trying to address: overtime, interrupted in-office work, manager coverage, recruiting cycles, training time, and duplicated capacity across locations. Those costs do not automatically mean outsourcing is the answer. They do make the current model visible enough for an honest comparison.

For repeatable front-office work, review MyBCAT’s front desk outsourcing solution alongside the group’s own workflow map. For a role-based dedicated support model, the optometry virtual assistant guide explains the distinction leaders should evaluate. In either arrangement, documented workflows, privacy safeguards, and quality review are non-negotiable.

What Metrics Should an Executive Team Review Each Month?

An executive review should connect financial performance to patient-access work. Start with total labor cost and overtime by location or operating unit, then add a concise set of measures tied to the workflows the group expects teams to perform.

Useful measures often include:

  • Inbound demand and the percentage of inquiries with a documented outcome.
  • Live-answer, callback completion, and queue-age trends by location and time period.
  • Appointment scheduling corrections, reschedules attributable to administrative errors, and unresolved exceptions.
  • Intake or eligibility items completed before the visit according to the approved workflow.
  • Staffing coverage, overtime, vacancy duration, and turnover in roles that touch patient access.
  • Quality-review findings, including whether staff used the correct routing and escalation path.

Use the same definitions across the network. If one location records a callback as complete when a message is left and another records it only after a conversation, the comparison is not meaningful. The same issue applies to scheduled appointments, completed intake, and resolved exceptions.

Numbers should lead to a management question, not an automatic headcount action. A rise in missed calls might indicate a coverage issue, a broken phone workflow, an inaccurate schedule template, or demand that is concentrated in a short window. Review a sample of calls and records before deciding which explanation applies. MGMA’s guidance on centralized scheduling to support practice growth similarly frames scheduling as an operational design issue that requires coordinated process and accountability.

How Should Leaders Make Changes Without Disrupting Every Location?

Avoid a network-wide staffing change based on an average. Choose one workflow with a clear problem, such as callback ownership or routine rescheduling, and establish a baseline. Pilot the new role design or coverage model with a bounded group of locations, named operational owners, and shared definitions for success.

During the pilot, review real records and interactions as well as dashboard totals. Confirm that requests reach the appropriate owner, staff use the escalation path, locations receive enough context to finish an exception, and patients are given clear next steps. If a rule produces recurring exceptions, revise the rule rather than asking teams to remember another workaround.

Training needs to follow the workflow. Cross-training can help groups cover peaks and reduce single-person dependency, but it works only when roles have clear boundaries and staff know when to escalate. The American Optometric Association’s paraoptometric resources are relevant background for groups developing structured staff training and role support.

Expand only after the group has evidence that the process is understood, the receiving teams can handle handoffs, and the measures reflect the intended outcome. This controlled approach preserves local context while allowing leadership to build an operating model that can scale.

FAQ

Is there one labor-cost benchmark every optometry group should use?

No. A percentage without context can hide differences in provider capacity, service mix, centralization, demand, wage markets, and workflow maturity. Use financial ratios as a signal, then validate them against the work required to deliver the group’s patient-access standard.

Should every multi-location optometry group centralize scheduling?

Not necessarily. Centralization is a design choice, not an automatic cost reduction. It works when appointment rules, system access, escalation paths, and accountability are mature enough for a shared team to complete repeatable work reliably.

Can a group reduce labor costs without harming patient access?

Potentially, but the path is redesigning duplicated or unclear work before reducing coverage. Start by mapping demand, ownership, handoffs, and repeat contacts. Changes should preserve appropriate escalation for clinical questions and other requests outside a patient-access team’s authority.

If your group is evaluating staffing coverage, centralized patient access, or managed support across multiple locations, contact MyBCAT to discuss the operational requirements before changing the model.

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Sources

  1. American Optometric Association: Day-to-Day Practice Operations
  2. MGMA: Implementing Central Scheduling to Support Practice Growth
  3. American Optometric Association: Paraoptometric Resources