Growing from 5 optometry locations to 50 is not simply adding more of the same. It requires fundamentally different operational infrastructure, management approaches, and technology systems. The tactics that worked at 5 locations often break at 15, and what works at 15 can collapse at 40. This guide provides the phase-by-phase operational playbook for scaling optometry networks, based on the patterns that successful vision groups have followed.
The Scaling Phases
Optometry network scaling typically follows three distinct phases, each with different operational requirements:
Phase 1: Foundation (5-15 Locations)
Characteristics:
- Founders still directly involved in operations
- Mixed systems across locations (legacy from acquisitions)
- Informal processes, tribal knowledge
- Relationship-based management
Primary challenges:
- Standardizing operations across acquired practices
- Building management layer below founders
- Implementing consistent technology
- Maintaining culture while adding locations
Phase 2: Professionalization (15-30 Locations)
Characteristics:
- Professional management required
- Systems become critical infrastructure
- Formal policies and procedures
- Regional management structure emerges
Primary challenges:
- Reducing founder dependency
- Scaling training and onboarding
- Managing complexity without bureaucracy
- Maintaining patient experience consistency
Phase 3: Enterprise (30-50+ Locations)
Characteristics:
- Corporate functions fully developed
- Data-driven decision making
- Mature technology stack
- Clear career paths and org structure
Primary challenges:
- Preventing bureaucratic slowdown
- Maintaining entrepreneurial culture
- Continuous improvement at scale
- Integration of continued acquisitions
Technology Infrastructure by Phase
Phase 1: Foundation (5-15 Locations)
Priority 1: Practice Management System Standardization
The most critical decision is consolidating to a single PMS:
| Approach | Timeline | Cost | Risk |
|---|---|---|---|
| Migrate all to one system | 6-12 months | High upfront | Medium (change management) |
| Integration layer | 3-6 months | Medium | Higher (ongoing complexity) |
| Parallel systems | Immediate | Low | Highest (data silos) |
Recommended path: Migrate to single enterprise-capable PMS within first 18 months.
Priority 2: Basic Centralized Functions
| Function | Centralize Now | Why |
|---|---|---|
| Billing/Revenue cycle | Yes | Immediate efficiency gain |
| Credentialing | Yes | Compliance critical |
| Purchasing | Partially | Volume discounts available |
| HR/Payroll | Yes | Consistency required |
| Marketing | Partially | Brand consistency |
Priority 3: Communication Infrastructure
- VoIP phone system across all locations
- Unified messaging platform
- Shared calendar/scheduling visibility
- Basic reporting dashboard
Phase 2: Professionalization (15-30 Locations)
Priority 1: Enterprise Data Platform
At 15+ locations, spreadsheet-based reporting breaks:
Data Architecture:
[Location PMS Systems] → [Data Integration Layer] → [Central Data Warehouse]
↓
[BI/Analytics Platform]
↓
[Executive Dashboards]
Priority 2: Patient Engagement Platform
Centralized patient communication becomes essential:
| Capability | Requirement |
|---|---|
| Recall automation | Multi-location, centrally managed |
| Two-way SMS | Routed to appropriate location |
| Email campaigns | Branded, personalized |
| Review management | Centralized monitoring |
Priority 3: Inventory Management
Optical inventory across 15+ locations requires:
- Real-time inventory visibility
- Centralized purchasing
- Inter-location transfers
- Demand forecasting
Phase 3: Enterprise (30-50+ Locations)
Priority 1: Integration Platform
At enterprise scale, systems must talk to each other:
- API-first architecture
- Middleware/integration platform
- Real-time data flows
- Exception-based alerting
Priority 2: Advanced Analytics
| Capability | Value |
|---|---|
| Predictive demand | Staffing and inventory optimization |
| Patient risk scoring | Proactive retention interventions |
| Provider productivity | Compensation and scheduling optimization |
| Financial forecasting | Cash flow and budget planning |
Priority 3: Self-Service Tools
Reduce central team burden:
- Manager dashboards with drill-down
- Automated reporting distribution
- Employee self-service (schedules, time off)
- Patient self-service (scheduling, forms)
Organizational Structure by Phase
Phase 1: Founder-Led (5-15 Locations)
Founder/CEO
├── Operations Director
│ └── Location Managers (5-15)
├── Finance/Admin
└── (Often wearing multiple hats)
Key hires:
- Operations Director (first critical hire)
- Regional Managers (when approaching 10 locations)
- Finance Manager
Phase 2: Professional Management (15-30 Locations)
CEO
├── COO
│ ├── Regional Directors (2-3)
│ │ └── Location Managers (5-8 each)
│ └── Central Operations
│ ├── Call Center/Scheduling
│ ├── Training
│ └── Quality
├── CFO
│ ├── Accounting
│ ├── Revenue Cycle
│ └── FP&A
├── VP HR
└── VP Marketing
Key transitions:
- Founder moves from operations to strategy
- Regional Director layer critical for span of control
- Central functions become departments
Phase 3: Enterprise (30-50+ Locations)
CEO
├── COO
│ ├── VP Regional Operations
│ │ ├── Regional Directors (4-6)
│ │ └── Location Managers
│ ├── VP Central Operations
│ │ ├── Patient Services/Call Center
│ │ ├── Training & Development
│ │ ├── Quality Assurance
│ │ └── Project Management
│ └── VP Clinical Operations
│ ├── OD Relations
│ └── Clinical Quality
├── CFO
│ ├── Controller
│ ├── VP Revenue Cycle
│ ├── FP&A Director
│ └── Treasury
├── CHRO
├── CMO
└── CIO/CTO
Patient Retention at Scale
Patient retention becomes more challenging, and more critical. As you scale:
The Scale-Retention Challenge
| Network Size | Typical Retention | Top Performer | Gap Cost |
|---|---|---|---|
| 5 locations | 78% | 85% | $420K/year |
| 15 locations | 75% | 84% | $1.8M/year |
| 30 locations | 72% | 83% | $4.2M/year |
| 50 locations | 70% | 82% | $8.4M/year |
Retention often declines as networks scale due to:
- Standardization reducing personalization
- Provider turnover disrupting relationships
- Consistency issues across locations
- Loss of founder “touch”
Retention Systems by Phase
Phase 1 (5-15 locations):
- Implement centralized recall system
- Standardize pre-appointment reminders
- Begin tracking retention by location
- Establish retention benchmarks
Phase 2 (15-30 locations):
- Dedicated patient retention team
- Automated reactivation campaigns
- Patient satisfaction monitoring
- Provider-level retention accountability
Phase 3 (30-50+ locations):
- Predictive retention analytics
- Personalization at scale
- Integrated patient lifecycle management
- Advanced segmentation and targeting
Retention Metrics to Track
| Metric | Frequency | Target |
|---|---|---|
| Annual active patient retention | Monthly | 80%+ |
| Recall compliance rate | Weekly | 75%+ |
| New patient to return ratio | Monthly | 70%+ |
| Patient NPS | Quarterly | 50+ |
| Online review rating | Weekly | 4.5+ |
Operational Standardization
What to Standardize (and When)
| Area | Phase 1 | Phase 2 | Phase 3 |
|---|---|---|---|
| Exam protocols | Begin | Complete | Optimize |
| Scheduling templates | Begin | Complete | Optimize |
| Pricing/fee schedules | Complete | Maintain | Market-adjust |
| Staff training programs | Begin | Formalize | Certify |
| Patient communication | Begin | Automate | Personalize |
| Quality standards | Define | Measure | Benchmark |
Standardization Principles
Standardize the what, localize the how:
- Standard: “All patients receive recall communication at 11 months”
- Local: Timing and specific messaging can flex for regional preferences
Document before you scale:
- Written procedures required before adding locations
- Video training supplements written documentation
- Regular updates as processes evolve
Measure compliance:
- Mystery shopping for patient experience
- Audit scores for clinical protocols
- System reports for operational compliance
Staffing Models by Phase
Provider Staffing
| Phase | Model | OD Ratio |
|---|---|---|
| Phase 1 | Owner-ODs + early associates | 1-1.5 ODs/location |
| Phase 2 | Associate-heavy model | 1.5-2 ODs/location |
| Phase 3 | Mix of employed + affiliated | 1.5-2.5 ODs/location |
Provider retention at scale:
- Competitive compensation structures
- Clear career paths
- Ownership/partnership opportunities
- Clinical autonomy with business support
Support Staff Ratios
| Role | Target Ratio | Notes |
|---|---|---|
| Optician | 1-2 per OD | Varies by optical revenue focus |
| Technician | 1-2 per OD | Pre-testing, work-up |
| Front desk | 1-1.5 per location | Scheduling, check-in/out |
| Optical manager | 1 per 2-3 locations | Regional responsibility |
Centralized Staffing
| Function | Phase 1 | Phase 2 | Phase 3 |
|---|---|---|---|
| Call center | 0-2 FTE | 5-10 FTE | 15-30 FTE |
| Billing | 1-3 FTE | 5-10 FTE | 15-25 FTE |
| HR | 0.5-1 FTE | 2-4 FTE | 5-10 FTE |
| IT | Outsourced | 1-2 + MSP | 5-10 FTE |
| Training | Part of ops | 1-2 FTE | 3-6 FTE |
Financial Management by Phase
Revenue Benchmarks
| Metric | Phase 1 Target | Phase 2 Target | Phase 3 Target |
|---|---|---|---|
| Revenue/location | $800K-1.2M | $1.0-1.5M | $1.2-1.8M |
| Revenue/OD | $400-500K | $450-550K | $500-650K |
| Optical revenue % | 55-65% | 55-65% | 50-60% |
| Medical revenue % | 10-15% | 15-20% | 20-30% |
Margin Evolution
| Metric | Phase 1 | Phase 2 | Phase 3 |
|---|---|---|---|
| 4-wall EBITDA | 20-25% | 22-28% | 24-30% |
| Corporate EBITDA | 15-20% | 18-24% | 20-26% |
| G&A as % revenue | 8-12% | 7-10% | 6-9% |
Investment Requirements
| Phase | Capex/Location | Central Infrastructure |
|---|---|---|
| Phase 1 | $150-250K new, $50-100K acquired | $100-300K |
| Phase 2 | Same | $500K-1.5M |
| Phase 3 | Same + refresh | $1-3M |
Common Scaling Mistakes
Mistake 1: Scaling Before Standardizing
Symptom: Each new location operates differently Solution: Document and standardize core processes before adding locations
Mistake 2: Under-investing in Management Layer
Symptom: Founder/CEO is bottleneck for all decisions Solution: Build regional management at 10 locations, not 20
Mistake 3: Technology Fragmentation
Symptom: Multiple PMS systems, no unified data Solution: Consolidate to single enterprise PMS within 18 months
Mistake 4: Ignoring Culture at Scale
Symptom: New locations feel disconnected from network Solution: Invest in culture-building, communication, and shared values
Mistake 5: Acquisition Integration Shortcuts
Symptom: Acquired practices never fully integrate Solution: Formal 90-day integration playbook for every acquisition
Key Takeaways
Scaling optometry operations from 5 to 50 locations requires phase-appropriate strategies:
Phase 1 (5-15 locations):
- Standardize PMS and core systems
- Build first management layer
- Document processes before scaling
- Establish retention baseline
Phase 2 (15-30 locations):
- Professionalize management structure
- Implement enterprise data platform
- Centralize key functions
- Formalize training programs
Phase 3 (30-50+ locations):
- Full corporate infrastructure
- Advanced analytics and automation
- Self-service tools for efficiency
- Continuous improvement culture
Universal principles:
- Patient retention becomes harder at scale. Invest proactively
- Technology is infrastructure, not a nice-to-have
- Management bandwidth is the most common constraint
- Culture requires intentional cultivation
The networks that successfully scale are those that recognize when their current approach has reached its limits and proactively build the infrastructure for the next phase.
For retention strategies at scale, see our DSO patient retention strategy guide. For centralized operations implementation, review our centralized patient recall guide.
Scaling Your Optometry Network?
Growing optometry networks partner with MyBCAT for patient retention infrastructure that scales. Maintaining 80%+ retention even as you add locations.
Sources
- MyBCAT: Operational Efficiency in Optometry
- Charles IT: IT Essentials for Optometry Practice
- Adams Brown: Smarter Tech for Eye Care Practice
- Your Total Vision: Streamlining Optometry Operations
- Simbo AI: IT Management in Optometry
- Review of Optometric Business: Multi-Location Management
- Vision Monday: Eye Care Industry Trends
