Every Optometry Practice is a Boat: Which One Are You?
By Matt Rosner
- 4 min read
Before we start, imagine your practice as a boat, navigating the unknown of the open waters.
Boats give fast, honest feedback. You feel it when the weight is off, when the crew isn’t aligned, or when the direction isn’t clear. Ignore any of it, and you don’t get much warning—you just drift or hit rocks you didn’t see coming.
Three things determine how your practice moves:
Crew — who’s on board and what they’re good at
Weight — patients, responsibility, and complexity
Navigation — clarity of direction and leadership
When one is off, things quietly get harder than they should.
Here’s where most owners get tripped up: different boats need different handling.
A solo OD, a small team, and a multi-associate practice aren’t meant to run the same way.
The important question isn’t which boat is “better.”
It’s which boat you’re actually in—and what it requires next.
Stage 1: The Kayak
A kayak is beautifully simple.
You see everything. You feel everything. You are everything — the engine, the navigator, the safety net. Decisions are fast because they all run through you.
And for a while, that works.
Crew
Just you. Which means you’re fast, flexible, and completely reliant on your own stamina.
Weight
Every added responsibility tilts the boat. A sick day? A broken autorefractor? A no-show in the morning? You feel the ripple instantly.
Navigation
You keep the entire vision in your head. And because you’re solo, that’s enough for now.
The kayak stage feels freeing. It’s also fragile. Growth shows up first as a small wobble: one extra staff member, one more exam slot, a new workflow that suddenly requires real-time attention.
That wobble isn’t a red flag; it’s the signal you’re outgrowing the kayak.
Reflection for Kayak Owners
When patients walk in, and when they leave, how do I want them to feel?
What’s one small change I could make this week to create more consistency?
If you can answer these clearly, you’re already preparing for your next boat.
Stage 2: The Pontoon
Add a few people, and you’re not in a kayak anymore.
You’re on a pontoon.
You’ve got an engine now. You can move faster, carry more patients, and stop paddling every second of the day. However, the boat is heavier, wider, and slower to respond.
Small problems don’t register instantly anymore.
Crew
A small team you trust — capable, well-intentioned, and eager to help. But “helpful” only works when expectations are clear. Otherwise, everyone is doing their best in slightly different directions.
Weight
The load multiplies. There are handoffs now. Coverage gaps. Lunch hours. PTO. Personalities. Communication styles. Complexity enters the picture.
Navigation
Here’s the moment every independent OD eventually hits:
Your vision can no longer live only inside your head.
Once your team reaches five or six people, osmosis stops working. What people used to absorb by watching you, now has to be said out loud.
Your “why,” your standard of care, and your approach to patients need to be written down — not to sound corporate, but to help everyone pull in the same direction.
This is where many pontoon owners feel the most tension. The work hasn’t gotten heavier, but it has changed shape.
The practices that find steadiness here realize something simple but easy to miss:
Sharing the mission can give your team momentum.
Reflection for Pontoon Owners
Ask your team at your next meeting (weekly huddle):
How do we know we’re doing a good job? Numbers, reviews, smiles, vibes?
If we could improve one thing this week, what would it be?
This is where clarity pays off.
The next stage won’t wait for intuition — it requires structure.
Stage 3: The Fishing Vessel
Give your pontoon enough time and enough growth, and eventually it becomes a fishing vessel.
You can’t see every ripple anymore. You can’t react to every wobble. The work that used to flow naturally now needs structure, roles, and intentional leadership.
Structure and clarity carry the weight that instinct alone cannot.
Crew
You now have layers. You have department leaders make decisions for their team, allowing the boat to carry more weight. Morale, culture, and small behaviors amplify faster than before. Success isn’t about everyone trying harder — it’s about each person knowing their lane and how it connects to the big picture.
Weight
The load is bigger: patient complexity, multiple associates, administrative depth, and demand that stretches across teams. What was manageable in a pontoon can create friction in a fishing vessel if clarity and alignment aren’t reinforced.
Navigation
Leadership now looks different. You can’t personally oversee every process — and that’s okay. Without clear ownership, clear expectations, and systems to catch issues, silos form and small misalignments can slow the boat or affect the patient experience.
Leadership here is about visibility and structure.
- Roles and ownership have to be clear.
- Department leaders need to understand both outcomes and expectations.
- Systems must catch problems before they become waves.
The bigger the boat, the quieter the wobble.
Reflection for Fishing Vessel Owners
Ask your leadership team:
When something doesn’t feel like our best work, who is responsible for improving it?
Which gaps are hidden in silos, and how do we surface them?
Where could systems or processes prevent friction before it reaches patients or staff?
Sometimes the best compass is a guide who’s already sailed these waters.
You Don’t Have to Navigate This Alone
Some ODs may think their challenges are unique, until they talk to someone who’s fought through a similar story as their own.
Whether you’re in a kayak, a pontoon, or a fishing vessel, someone else has already steered through these waters. They know where it gets shallow, where the currents shift without warning, and where the boat can wobble quietly before anyone notices.
Some lean on consultants who’ve seen these stages play out hundreds of times.
Others lean on tight communities where ODs compare notes in real time with honest experience.
Both give you something you can’t get from inside your own boat: perspective.
If you want your next stage to feel intentional instead of accidental, gather more input.
That’s how smart owners steady the boat they’re in and prepare for the next one — not by guessing, but by borrowing wisdom from people who’ve already crossed the water you’re headed toward.
About Me
Hi, I’m Matt Rosner — CEO and Co-Founder of NeuroVisual Medicine. I work at the intersection of healthcare, technology, and independent practice growth, focused on transforming how Binocular Vision Dysfunction (BVD) is identified and treated.
NeuroVisual Medicine has built the clinical pathway, training, and lens technology that allow optometrists to deliver immediate, life-changing relief using precision microprism care. Today, our network supports clinics across North America and helps tens of thousands of patients each year access care that previously didn’t exist.
If you’re curious to explore BVD specialty care for your practice, book a consultation here.