The Optometry Success Podcast helps private-practice optometrists build profitable, sustainable businesses with clarity and confidence. Hosted by Adam Cmejla, CFP—a financial planner and CFO to ODs nationwide—and Chad Fleming, OD, FAAO—a multi-location practice owner with decades of hands-on experience—each 20-minute episode delivers practical strategies and actionable insights you can apply right away. From leadership and financials to team culture, operations, and growth, this is your weekly dose of real-world advice for real-world practice owners. New episodes every Wednesday.
Not every patient relationship is worth preserving—and sometimes keeping the wrong patient creates more risk than letting them go.
In this episode of The Optometry Success Podcast, we continue our conversation about managing difficult patient relationships by tackling three situations every practice owner will eventually encounter: the chronically noncompliant patient, the repeat no-show, and the patient who crosses the line with your team.
We discuss when noncompliance moves beyond frustration and becomes a legitimate clinical and risk-management concern, why documentation and clear communication matter, and how Chad approaches patients who repeatedly ignore treatment recommendations. We also explore the important distinction between a routine vision-care patient who repeatedly no-shows and a medical patient whose failure to return could have serious consequences.
Finally, we tackle one of the most important responsibilities of practice ownership: protecting your team. Chad shares why practice owners need to establish clear boundaries around harassment, belittling, and inappropriate behavior—and why being willing to fire a patient can build tremendous relationship capital with your staff.
The goal isn't to look for reasons to get rid of patients. It's to recognize when continuing the relationship is no longer serving the patient, the provider, or the practice.
NBS (Next Best Step): Ask yourself whether your team knows—with absolute confidence—that they can come to you when a patient crosses a line. Make that expectation explicit, establish how those situations should be escalated, and make sure your team knows you'll have their back when it matters.
Have a question for us to address in a future episode? Submit it here!
Resources:
Learn more about Partners in Profit
Download the Practice Owner's Financial Toolkit
20/20 Money Ultimate Financial Success Masterclass
OD Mastermind Interest Form
Subscribe on Apple Podcasts: https://shorturl.at/Fq1Ro
Subscribe on Spotify: https://shorturl.at/jCtsk
30 Sept 2026
The patient isn't always right: How to handle difficult conversations
The patient may always deserve empathy—but that doesn't mean the patient is always right.
Every optometry practice has difficult patient interactions: the patient who shows up for an appointment that isn't on the schedule, the person demanding an exception to a policy, or the patient expecting the practice to absorb the consequences of something that simply isn't its responsibility.
In this episode of The Optometry Success Podcast, we role-play two real-world situations and break down how practice owners and their teams can respond without becoming defensive, immediately giving in, or escalating the situation.
We discuss the importance of tactical empathy, giving patients choices, anchoring expectations, and empowering team members to make decisions without unnecessarily involving the doctor. Chad also explains why doctors may actually be the wrong people to handle these situations: our desire to solve the urgent problem in front of us can cause us to forget everyone else affected by that decision.
That leads us to the "tyranny of the urgent"—when the loudest, most immediate problem takes priority over everything else. Saying yes to one demanding patient might simultaneously mean saying no to the eight other patients on your schedule, your team, your profitability, and your own sanity.
And sometimes, even after doing everything right, the patient still won't accept the answer. We leave that question for our next conversation: What happens when empathy, flexibility, and reasonable solutions still aren't enough?
NBS (Next Best Step): Identify one common situation in your practice where your team feels pressured to make exceptions for patients. Define the boundary, decide who has the authority to handle it, and give your team a framework for responding with empathy—without automatically saying yes.
Have a question for us to address in a future episode? Submit it here!
Resources:
The Optometry Success Podcast, Episode: Extended Warranty - Your Profits for Patient Peace of Mind
Book: Never Split the Difference
Learn more about Partners in Profit
Download the Practice Owner's Financial Toolkit
20/20 Money Ultimate Financial Success Masterclass
OD Mastermind Interest Form
Check out Adam's new book: How to Buy an Optometry Practice (https://a.co/d/0wv5uLn)
Subscribe on Apple Podcasts: https://shorturl.at/Fq1Ro
Subscribe on Spotify: https://shorturl.at/jCtsk
23 Sept 2026
Booked out doesn't mean you're ready for an associate OD
Being booked out for weeks might feel like proof that you need another doctor—but it could be giving you the wrong answer.
In this episode of The Optometry Success Podcast, we continue our conversation around associate ODs and tackle one of the biggest questions practice owners face: How do you actually know when it's time to hire another doctor?
We discuss why owners often hesitate to add an associate, the financial fear of giving up production and profit, and why adding another OD can actually create significant margin when much of the practice's overhead is already in place. We also get tactical about successfully integrating a new associate, including why established doctors need to intentionally move patients onto the new doctor's schedule rather than simply expecting the associate to build a patient base from scratch.
Most importantly, we challenge the commonly used benchmark of being "booked out" as the signal that it's time to hire. Two practices can both be booked out three weeks and have dramatically different levels of actual capacity.
Instead, we revisit schedule health and the numbers practice owners should be tracking: available appointment capacity, how much of that capacity is already scheduled a week in advance, and how many of those available slots ultimately turn into completed exams.
NBS (Next Best Step): Stop using "how far booked out are we?" as your primary measure of capacity. Calculate your schedule health using actual available appointment slots and completed exams. If you're consistently filling roughly 85% or more of available capacity in advance—and completed exams remain within about 10 percentage points of that number—you now have objective data to help determine whether it's time to seriously consider adding another OD.
Have a question for us to address in a future episode? Submit it here!
Resources:
Schedule Health Episode
Learn more about Partners in Profit
Download the Practice Owner's Financial Toolkit
20/20 Money Ultimate Financial Success Masterclass
OD Mastermind Interest Form
Check out Adam's new book: How to Buy an Optometry Practice (https://a.co/d/0wv5uLn)
Subscribe on Apple Podcasts: https://shorturl.at/Fq1Ro
Subscribe on Spotify: https://shorturl.at/jCtsk
Reach and audience
Public platform figures. Ratings count people who left a rating, not total listeners.
Apple Podcasts (US)
5.0 / 5
12 ratings
Spotify
5.0 / 5
4 ratings
Contact The Optometry Success Podcast
Guest appearances
Does not typically book guests
Based on episode analysis; this does not confirm that the show is currently accepting guests.
Pod Engine is an independent podcast discovery and analytics service and is not affiliated with or endorsed by this podcast. Artwork and show content belong to their owners. Full legal notice.
Explore this show Podcast research with Pod Engine
