A Step–by–Step Guide to Hiring and Building a Team for Your Eye Surgery Practice

Growing a private ophthalmology surgery practice involves making strategic hires that align with your revenue levels. This guide outlines who to hire, when to hire, and why they are essential at each stage of your practice’s growth.

Stage 1: Pre-US$500K revenue
 

At this early stage, the emphasis is on maintaining efficiency, ensuring smooth operations, and freeing up your time to concentrate on surgeries and consultations. Each hire should either increase patient flow or alleviate bottlenecks.

• Appointment Setter/Sales Support
  
  When: US$100K–200K in revenue.
  
  Why: You need someone to handle incoming inquiries and book appointments so you can focus on delivering services.
  
  Salary range: US$35K–45K/year.
  
  Employment type: Outsource (part–time or virtual assistant initially).
  
  Key responsibilities: Answer calls and emails; schedule patient consultations; follow up with potential patients to ensure they show up for appointments.
   
• Administrative Assistant
  
  When: US$200K–300K in revenue.
  
  Why: Admin tasks like scheduling and paperwork can become overwhelming. An admin assistant ensures everything stays organized.
  
  Salary range: US$40–50K/year.
  
  Employment type: full-time.
  
  Key responsibilities: Manage patient data and insurance paperwork; schedule surgeries and follow-ups; handle front-desk operations and general office tasks.
   
• Technician or optometrist
  
  When: US$300K–400K in revenue.
  
  Why: A technician helps streamline the patient flow by supporting pre- and post-op care, improving overall efficiency.
  
  Salary range: US$45K–55K/year.
  
  Employment type: Full–time
  
  Key responsibilities: Conduct pre-surgery eye tests and measurements; assist with patient prep and post-op care instructions; help maintain equipment and surgical readiness.
   
• Marketing Coordinator
  
  When: US$400K–500K in revenue.
  
  Why: To sustain growth, you need a consistent stream of new patients. A marketing coordinator can manage basic marketing tasks.
  
  Salary range: US$45K–60K/year
  
  Employment type: Outsource (freelancer or agency) initially, transitioning to full-time as demand increases.
  
  Key responsibilities: Handle social media content and scheduling; organize local outreach and optometric partnership campaigns; manage email marketing and patient follow-ups.
   
• Cumulative wage cost estimate:
   
  • Total cost: US$125K–160K/year
     
  • Percentage of revenue: 25–32 percent of 500K revenue.

Stage 2: US$500K to 1 m revenue
 

At this stage, you’ll start to see increased demand, and it’s time to bring in individuals who can help grow the practice sustainably. Of course, you’ll likely need more front-line staff (see pre–500K) as flow increases. I advise you not, however, to create an army of helpers reporting to one leader (typically you). Instead, hire leaders.

Bias toward hiring leaders over foot soldiers

In the early stages of growth, hiring less expensive, entry-level staff to manage daily tasks can be tempting. However, I emphasize prioritizing hiring leaders who can build and manage teams. This approach ensures you create a business that scales effectively.

Why focus on leaders?

1. Multiplication effect. Leaders amplify your impact by managing and developing teams, allowing you to focus on high-leverage activities like surgeries, strategic growth, and patient care​.
    
2. Building systems. Strong leaders create systems, processes, and workflows that reduce dependency on you and increase efficiency​.
    
3. Long-term scalability. While entry-level hires may seem cost-effective initially, they require constant oversight. Leaders, on the other hand, establish structures that enable the practice to grow without collapsing under operational chaos​​.

• Sales and Marketing Leader
  
  Why: To increase leads and patient acquisition, a sales or marketing leader will develop strategies to drive growth.
  
  Salary range: US$70K–90K/year + commission/bonuses.
  
  Employment type: Outsource (fractional Chief Marketing Officer) initially, transitioning to full-time as demand increases.
  
  Key responsibilities: Develop and guide coordinator to execute marketing campaigns; optimize lead generation processes; set up tracking and improvement processes for key metrics.

Stage 3: 1–2 m revenue
 

Your practice is scaling, and operational efficiency becomes the bottleneck. It’s time to introduce systems and leadership to maintain quality and consistency.

• Director of Operations (COO)

  Why: As patient volume increases, you need someone dedicated to managing day-to-day operations and ensuring efficiency.
  
  Salary range: US$90K–120K/year
  
  Employment type: Outsource (fractional COO) initially, then full-time as complexity increases.
  
  Key responsibilities: Oversee patient flow and surgical scheduling; optimize workflows and operational processes; ensure high standards for patient care and compliance.

Stage 4: 2–3 million revenue
 

At this level, ensuring an excellent patient experience and reducing churn (for re-occurring revenue-based practices) are critical. The focus shifts to maintaining quality and satisfaction.

• Patient Experience Leader

  Why: A dedicated role for patient satisfaction is key to retaining patients and generating referrals.
  
  Salary range: US$70K–85K/year.
  
  Employment type: Full-time.
  
  Key responsibilities: Develop patient satisfaction programs; handle patient feedback and resolve concerns; improve follow–up processes to enhance outcomes.

Stage 5: 3–5 million revenue
 

At this level, sustaining growth requires financial oversight and solid people management.

• CFO (Chief Financial Officer)

  Why: A CFO provides financial strategy, budgeting, and planning to support growth.
  
  Salary range: US$120K–150K/year.
  
  Employment type: Outsource (fractional CFO) initially, then full-time as complexity increases.
  
  Key responsibilities: Oversee financial reporting and budgeting, optimize cash flow and manage financial risks; provide strategic advice on investments and cost-efficiency.

• HR Leader
  
  Why: Managing a growing team requires someone to handle recruitment, training, and company culture.
  
  Salary range: US$80K 100K/year
  
  Employment type: Full-time
  
  Key responsibilities: Develop hiring processes and recruitment strategies; manage employee training, performance reviews, and compliance; foster a culture of excellence and accountability.

Beyond 5 million revenue
 

With a solid leadership team in place, continue to build out specialized roles:

• Additional surgeons to increase capacity.
   
• Specialized marketing experts for content, outreach, and paid advertising.
   
• Legal counsel for contracts, compliance, and risk management.

Summary of outsource vs. full-time role
 

Roles to outsource initially:

1. Appointment Setter/Sales Support (pre–US$200K revenue).
    
2. Marketing Coordinator (pre–US$500K revenue).
    
3. CFO (at US$3–5m revenue, fractional CFO).

Roles to hire full-time:

1. Administrative Assistant (early hire at ~US$200K revenue).
    
2. Technician or Medical Assistant (at ~US$300K revenue).
3. Sales and Marketing Leader (at US$500K revenue).
    
4. Director of Operations (COO) (at US$1m revenue).
    
5. Patient Experience Leader (at US$2m revenue).
    
6. HR Leader (at US$3M–US$5m revenue).

Key insights on wage management
 

• Efficiency balance. Keep cumulative wage costs under 25–30 percent of revenue for sustainability.
   
• Outsourcing flexibility. Leverage outsourcing for early-stage roles to keep costs low and maximize flexibility.
   
• Gradual scaling. Outsourced roles will gradually transition to full-time positions for stability and control as revenue grows.

This approach ensures efficient growth and strategic scaling without overwhelming the practice’s cash flow.

Conclusion
 

Hiring the right people at the right time is crucial to scaling your refractive or cataract surgery practice. Following these revenue-based milestones ensures that each hire contributes directly to growth, efficiency, and patient satisfaction. This strategic approach helps you build a thriving, resilient and scalable practice.