Based on a PracticeCare® podcast conversation, Dr. David Kading on Getting More of the Patients You Want, with Dr. David Kading, optometrist and owner of Specialty Eye, with three offices in the Seattle area.
Do you really have to see every patient who walks in the door?
Yes, but the goal is to sculpt your patient population to be more of those you want.
Dr. David Kading, an optometrist and owner of Specialty Eye in the Seattle area, says the 80/20 rule shows up constantly in practice: roughly 20% of patients generate 80% of the revenue.
The other 80%, in his experience, are often patients chasing the lowest price, for example, the kind who’ll buy their glasses online instead of from the practice. They’re lower revenue, and it’s a signal they may not take treatment recommendations seriously, even for something more serious than glasses.
Kading isn’t talking about turning patients away. He’s talking about deciding who you want to shout to the world you’re built for.
What’s wrong with just keeping a full schedule?
Revenue per patient drops. When Kading and his wife opened their first practice, the goal was to fill the schedule. They saw anyone. As the schedule filled up, the time available to make specific, personalized recommendations shrank — and so did the value patients got, and the revenue that value generated.
His example: a patient who spends all day on a computer would likely benefit from computer-specific glasses and dry eye treatment. Explaining that takes time. Rush the visit, and you get a baseline sale instead of the full value for the patient or the practice.
Kading would rather see half the patients and generate twice the revenue per visit. Not for the money itself, he says, but because higher spend per patient is evidence they see real value in what the practice provides.
How did he start filtering for the patients you actually wanted?
With a specific test. Kading’s practice offers retinal photography as an alternative to pupil dilation — a service most patients preferred, and about 90% chose it. The 10% who declined turned out to be the same patients who never bought anything else from the practice and rarely returned for follow-up care.
So Kading made the photo close to a requirement. Insurance covered part of it for some patients; others paid out of pocket. Patients who genuinely couldn’t afford it got it free. But the shift created a small barrier to entry. That barrier quietly filtered out a slice of patients who weren’t going to be a fit anyway.
What specific patient types did the practice build itself around?
Four categories, which is why the practice is named Specialty Eye: dry eye, custom-designed contact lenses, myopia progression in children, and binocular vision issues.
Kading’s team took that message directly to other doctors in the community and built marketing around it, telling referral sources and patients exactly what the practice is built to treat. Primary eye care still makes up about 40% of the practice’s volume. The rest is the specialty work they set out to attract.
What results did this shift actually produce?
Within two to three years of consistently marketing around those specialties, Kading’s practice took over a primary-care optometry practice and nearly doubled its revenue within three years without increasing the volume of primary care visits.
The growth came entirely from revenue per patient, driven by the specialty services layered on top.
How should a practice think about what marketing is worth spending?
Work backward from patient lifetime value. For example, if a patient is worth $500 to $1,000 in revenue over three years, what would you pay to guarantee that patient walks through your door?
He treats his website and social media the same way. A website that hasn’t been updated in the past month, in his view, is already stale to Google. Social media isn’t there to teach people everything; it’s the hook that pulls people back to the website, where the real conversion happens.
What are the first steps for a practice owner who wants to make this shift?
Kading points to Simon Sinek’s Start With Why: figure out the why behind your work first, then build around it. His own is enriching people’s lives so they can reach their potential.
From there, it’s practical. Write down which patients you saw this week that energized you most. Figure out what your day would look like with more of them. Then take that list to a marketing agency and ask directly: help me find more of these people.
A final note from Carl White
This isn’t about narrowing who you’ll help. It’s about being specific enough that the right patients recognize themselves in what you’re saying. Kading built a thriving specialty practice by getting precise about who he was built for and saying it consistently, over and over, until the right people started showing up. That precision is available to any private practice willing to do the work of defining it.