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12 Month Case Study to Scale Smarter: Growing Revenue and Culture with Dr. Nick Lillie
01:01:07
Scaling a practice is never easy, especially when new growth often brings growing pains. But what if you could expand your practice, add associates, and increase profitability without losing momentum — or yourself — in the process?
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- [00:00]
A
Foreign. Welcome to the Power Hour, Optometry's biggest and longest running show. We're now in our 13th season. I'm your host, Eugene Shotsman, and we've got an awesome episode for you today. I really think you're going to enjoy this one. Dr. Nick Lilly has built an impressive practice in a smaller Michigan community. And he's just a complete powerhouse of implementation, which is why I respect him so much. So, quick story. Before the show, Nick and I were chatting and he said to me, you know, Eugene, there are three ways to grow practice. More patients, more revenue per patient, and getting patients to come back more often. And realizing that unlocked some serious growth in my practice. And for everyone who has heard me speak, you know how big my smile was when Nick said that to me, since it's literally one of my favorite J. Abraham concepts. But. But Nick has really embraced it. And here's what's truly impressive. What Nick has done in the last 12 months is just remarkable. Find me another practice that has 5 xed their dry eye treatment acceptance rates or cut their exam only in half or nearly doubled revenue per patient. And he has done all of that while seeing more patients and adding an associate and actually seeing fewer patients himself. So there are like, Nick is just kind of a remarkable person because there are people who go to conferences and they kind of get good ideas and maybe they'll implement something at some point in the future. And then there's Nick. He goes to see a study group at perc, and then he just implements. In this episode, Nick shares his playbook, his dashboard, how he motivates his team, how. How he's built a culture of accountability, how he gets his associates to perform at a high level. We also dive into his approach on video content, which kind of grew out of his passion for teaching and his unique way of presenting dry eye packages, moving away from discounts, and actually getting more patients to say yes. Overall, this episode is just jam packed with actionable ideas. And also not just ideas, but proof of what's actually getting done. I know you're going to get a ton of it before we get started. Just a quick reminder, make sure that you're subscribed on YouTube, Spotify, Apple Podcasts, wherever you listen, so you never miss an episode. And if you'd like to reach out with feedback, questions, episode ideas, or just let me know what you thought about the episode today, connect with me@eugene shotsman.com or on the Power Hour website. I love hearing from you. And now let's go into the conversation With Nick. All right, Dr. Nick Lilly, welcome to the Power Hour.
- [02:41]
B
Thanks for having me, man. I'm excited for the conversation.
- [02:44]
A
Yeah. So I am so excited to have you on the show because I think. And I was thinking about how to start the conversation and just to give people a little bit of context about your practice, why don't you just tell everybody where you're at geographically and kind of just a couple little points about your practice so that our. Our listeners can see themselves through you.
- [03:08]
B
Absolutely. So I'm in Allendale, Michigan, So Grand Valley State University is a D2 powerhouse for football, all D2 sports, actually. And that's Allendale, Michigan, about 15 minutes west of Grand Rapids. So I graduated in 2011, started cold, and for the first 13. Oh, geez. 13 or 14 years, 1600 square feet, and slowly learned the business, learned what I was doing. And this past October, I went from 1600 square feet to 3500 square feet. We have four exam lanes, two in addition to the four exam lanes, two dedicated dry eye suites, and added an associate this fall. We're looking to add another associate in the spring. So that's kind of us. We do a lot of three things. I try to focus on one, dry eye, ocular surface disease, ocular health, and wellness. So that's your MacD gen glaucoma, just health of the eye. And then we try to do optical. It's a big part of what we do. I don't want that to be the focus of where we're going in the future, but right now it's a. It's a focus of the. Of what we do. So those are the three things. But my passion is the interior segment, dry eye, and growing that practice.
- [04:29]
A
Yeah. So, Nick, the thing that happens to most practices after expansion is as you try to scale, your numbers get a little bit worse because, and this is true for most practices is that when you are one rock star od, which you certainly are, you put up some crazy numbers as a single OD before you got your associate. But in full disclosure for the audience, Nick and I work together, but I selected him for the show because his practice is truly, truly remarkable. And I. And I had happened to have the honor and the privilege of kind of having a back, back, I don't know, backseat view to some of your success. And so I want everybody to know what you're doing up there in the driver's seat. So the. The interesting thing is that, you know, you're a remarkable thing. I just want to contextualize for everybody what you've gone through. So you were a remarkable rock star. Single OD in your practice and then you, you know, let go of the doc a little bit and you invested heavily into increasing the size and scale of your practice. You brought in another OD as well. And as a result, most practices. Right, because you now have more to manage. You yourself, as the guy who was seeing patients and kicking ass, you now have more to manage a bigger operation, more people, more details, more things happening. So what happens with most practices when they go from that, from from A to B, you know, is a relatively simple operation now. It's a more complex operation now you got to deal with an associate now you got to, you know, and the associates never quite, you know, it's not never quite you. Right. So what happens to most practices is their numbers start looking worse. And your numbers have probably done one of the most remarkable, remarkable moves that I've seen in the last year in any practice. Give the, give the audience just a little bit here just because I enjoy bragging on you a little bit. But the reality is that you've gone from a 59.7 exam only rate this time last year, nick, to a 33% exam only rate this year. I mean, a 10 point move in a year is insane. You went from 59.7 exam only to 33 exam only. And change your, you know, you're still in Allendale, Michigan, still seeing the same patients. You know, like that's pretty, pretty, pretty remarkable. Your, your revenue per patient went from something like in the three hundreds to regularly exceeding 600 sometimes. Right. And you know, most of the time above 500. And your conversion rate for dry eye pickups or for dry eye treatment plan acceptance has gone from something like 10% to closer to 47%. So this is where we're going to spend the episode. I'm going to talk, I want to talk a little bit about these numbers first and then there are some other areas that I want to zoom into because you do a lot of things that are truly remarkable. But in this particular case, let's start with what you think contributed to this type of growth.
- [08:01]
B
The biggest thing is we made it a priority to focus on these things. When I go to, I'm part of a mastermind group P3, and I hear a lot of people talk. And Jamie Rosen, I know he's a good friend of yours, he loves the exam only rate. He said that's one of the most important metrics that he did. He focused on to grow his practices. And I'M smart enough to know that I don't know everything and to find someone that has done what you want to do and, and don't reinvent the wheel. So when he said that that exam only rate was one of the biggest, most important metrics, I said I have to measure it, we have to talk about it, and we have to go from there. So I have a weekly scorecard that we track. So every one of my opticians, every patient that we have, we have a spreadsheet that we put in what the outcome was. They came in was it exam only. And we're stricter than probably what you measure with. We look at if they had a contact lens eval and they buy a week later, they didn't buy that day. It's an exam only if they are not buying that day. That's our criteria. And I know a lot of people will get like, well, if they did this or that. I want the hard true fast numbers.
- [09:16]
A
That's fantastic. And by the way, that is exactly what I call an exam only. That's what Jamie and Jamie Rosen is the same person who taught me about the power of exam only and how unfortunately that metric isn't driven enough in the, in the industry. So yeah, I mean, even if they went home with trial lenses, that's still an exam only, right?
- [09:36]
B
Exactly. And that's how we approach it. And I meet with my front desk weekly, I meet with my optical weekly, and I meet with my, my associate weekly. But we talk about these numbers. It's, it's a report that my VA's put together. It's on everyone's desk. Monday morning we come in and then we're going to talk about those numbers. And, and the cool thing is my staff, you know when you're starting to get your messaging through is when they start repeating what you're saying and they'll say, hey, my exam only. Our exam rolling rate's a little higher. What did we do? Like, hey, it's a time you keep doing what you're doing. We, and we emphasize the principles like make sure we go over that they have a frame allowance. Make sure that they go over that they have put money towards this. Get them to buy, we have rebates, save the sale, we, whatever we need to do. Like, I know your supplies are a big thing, but if they're not going to get the year supply and they're going to walk get them that three month supply, what can we do to get them to make that purchase? Because at the end of the day when they're working with us, it's better for the patient. It's, we're easier to work with. We're going to stand by what we do and that's what we're doing. It's not, not only that, numbers, we want them to trust us like they do with eye care, with the products that we're selling as well. And that is kind of just one of our core values that we're emphasizing is that they trust us and we're going to take care of them. So we made it a huge focus and it's really what you measure, gets managed. And we measure it on a weekly basis.
- [11:05]
A
So what else is on your scorecard? You said there's a weekly scorecard.
- [11:09]
B
Yep. So we have exam only rate. We track our pre appointments. I like to say, especially to my associate, that's your bloodlines, you want to be busier, you pre appoint what you have now and a year later you're gonna have a full schedule. So we track our pre appointments, our frame capture rate, lens capture rate. We look at our dry ie valves, our advanced therapy signups, and then how many treatments did we do for the front desk? We look at fill rate, how many times they're getting multiple appointments made. So that's something that they're tracking. So farming. And then we track the, and this is more of a metric for, for the front desk. But how many charts each person makes. Because we were having an issue where we weren't preparing. But now when they look at the spreadsheet like I haven't made any charts or Alicia's made 10 charts, it keeps people going. We've been more efficient in that, in that aspect. We're making more, more like appointments for whole families. But it's something that we talk about and then we call it out like, hey, great job, you did a good job here. It's just something that they want to get the praise. We're emphasizing what they can control and, and then we're calling them out for it. So it's been really cool to see that, that transition because when we first started, I did it for about two, three months and the numbers were horrible. I said, this is now our standard, this is our baseline. And when we focused on it, I just saw the numbers like the percentage get move in the direction that we wanted just because we paid attention to it.
- [12:36]
A
So Nick, how did you go from getting your staff not looking at the numbers to like, was it just you sitting them down or was it like, how did you get the culture to shift in your office to be to start looking at these numbers.
- [12:53]
B
That was a conscious effort. And one of the things I had to do was we've always worked four and a half days a week. So we Monday, Tuesday, we work nine to noon on Fridays. I like to give them it off. We hit a point where I said, I cannot be in the exam room as much. So I work Monday, Tuesday, Wednesday for patient care. Thursdays, all I do is meet with the staff, meet with my team. I have one on ones right now. This is not scalable, but right now with where I'm at, I'm meeting with every single person in addition to my team meetings. And we're talking about looking at your numbers. And that's the thing about the scorecard. It's each doctor individually and every staff member. And it's not the sense that we're calling you out. But I had a staff member that had zero pair 50s, right? So we were looking for a second pair of sales, right? So she had zero. I'm like, hey, Abby, are you. Are you talking about this? What's going on? And she's a little shy, and she's like, I don't know. Well, last month I think she was at 24%. She had a great month, but that was six months of us talking about it. And when we do, I'm like, well, Alicia has a great percentage. What are you doing, Alicia? How are you doing it? And it allowed them to share. They took ownership. And it wasn't me telling them. It was them encouraging each other. And by them encouraging each other, it just built the culture of this is what we do. We're open about our numbers. If we're not where we need to be, we're going to help you get there, or what. What can we learn from each other? And that that's helped a lot as well.
- [14:24]
A
So it sounds like you're constantly looking for exceptions, and you're either on the positive or on the negative side, and you're looking to change the behavior behind the numbers.
- [14:38]
B
Yeah, absolutely. And it's one. They don't realize what the numbers are, but now they'll look at it. They look at what we do as an individual, as a staff, but they look at their own numbers, too. There's a sense of pride to that. And you have to be careful because if you make it too certain of a way, you can have people going against each other. But we always win as a team. So if we have a metric that we're trying to hit, if there's a reward Everyone wins. This is the techs. They talked about the sunglasses. They talked about it. The doctors, and then the opticians. It's not like the opticians get everything or the techs get everything or whatnot. We are a team. We rise and fall together. So that also has been very good, because if the. If the front desk sees that the opticians are doing X, Y, or Z, they know they're going to benefit from it as well. So it builds that culture that I'm trying to have where we all are working together, all rowing in the same direction.
- [15:37]
A
Yeah. So what kind of incentives do you offer the staff? I heard you talk about call outs, which I think is actually super important from a culture perspective. What else do you do?
- [15:47]
B
Well, with the call outs, it's something. I come from a sports background, and you watch any football team, they have a good player. What not, they get a sticker on the helmet. Right. Little Michigan has their thing. The Buckeyes have their Buckeye there. Ohio State, Eugene.
- [16:04]
A
I went to U of M. I went to University of Michigan. My Ohio friends don't really like that about me, but we root for the same guys.
- [16:12]
B
I love it. We have little. I found little, like, pins. And then when we move to, like, scrubs, we have little, like, tie clips. But they get a pair of glasses that they put on, and they wear that as a badge of honor. So they're walking around with those. Those tie clips, and then people ask, like, hey, what are those for? And then they get to express it to the patients. They're like, oh, that's really cool that they get to see that. So they're talking about it. They see that amongst each other. We then take those things at our office meeting once a month, they turn them back in, and then they're entered for raffle prizes. So some of our core values will, like, I call it expertise. So they get to go out to lunch with the doctors, or they. They get to get a comfort food, whatever that is, and they get it for the whole office, or they pick a lunch for the whole, whole staff. Just stuff that they get to do with that. So those are little rewards that I didn't want to be monetary in value. I will hit percentages. So our baseline is a certain percentage. Like, I'll. I'll incentivize frame sales more than lens sales, because if we're selling a frame, we're selling lenses.
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A
Right?
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B
Right. So they'll get that. If they hit a certain percentage, they get, like $5 goes into the bucket. And at the end of the month. Everyone gets a little bit. It doesn't amount to too much for individuals, but they've had months where they've had $100 to each person, right? It. It really depends. But then I'm like, hey, the bar's moving. This is now our new standard. So I move it up 5% or I move it up another 10%. And they have tiers that they can hit, so we generally should be able to hit our minimum and they get a certain reward for that. But if they hit like 40% on daily lenses and that's a team effort for all of us to sell those to fit them or your supply sales, then they'll get a bigger reward. The bigger things that move the needle, I try to give a bigger incentive for. So that's just something that I do from a monetary perspective.
- [18:02]
A
So it's interesting because you're kind of following this playbook, and the thing that Jamie and I always teach is that, yeah, you have to be able to talk about the numbers. You want to talk about the numbers on a regular basis. You want to be really open about the numbers, but you really have to manage the behavior behind the numbers. What's interesting about what you're saying is that looks like you guys are identifying some of those behaviors and you're trying to replicate a lot of those behaviors. So I'm curious when it comes to exam onlys, and we're going to move on to some of these other metrics momentarily, but when it comes to exam onlys, Nick, what are some of the behaviors that you recognized that are now like, absolutely standard operating procedure that you weren't necessarily doing consistently a year ago, but by looking at these numbers and identifying the behaviors behind the numbers that you were able to track down.
- [18:50]
B
One of the big things starts with the doctor right in the exam room. We talk about where they have and we come to an agreement like, okay, so if I'm hearing you correctly, you like the progressive. You're on a computer. I want you to get the non glare coating and the anti fatigue lens. All right, good. And then when we go to the handoff, we're assuming the sale. We go in, tell the doctor or tell the optician in the handoff. All right, they're gonna get the non glare coating. They want the bullet filter. The last time they got a frame, it was a little too wide. Make sure the fit is good. And instead of asking which I hate, you want to look at frames today. Get up. Did you want them to have color or do you want to Be metal or plastic. Ask the question. Assuming they're going to get the, get the frame, and it's more of the assumption that they're going to. And then they kind of go along with it. When before it was more of like, do you want to do this? Were you planning on getting glasses? You know what I mean? It was, it was questioning. Now we assume we still, like, I wish we were better on our exam, only I know you give us a lot of props, but we, we constantly look at that like we could be better. We should be better here.
- [20:01]
A
Well, keep, keep moving. But I mean, the, the direction that, the improvement you've made in a year, that's the truly remarkable thing. To go from 59% to 33% is incredible, Nick. So keep, keep identifying more of those behaviors. And, but, but it sounds like that's one of the core scripts is what, is what the doctor talks about. But then one of the core things is, you know, what's the first words out of the mouth of, of the optician?
- [20:26]
B
Right, absolutely. And that, and that's just the mindset that we have is assume they're going to get that. And then we talk about, you know, if they say, I, when I started, I was my own optician, I started off as an optician, I will tell them this is what I like to do. When I had this, I would do this and just give them ideas. And sometimes they don't know, like, oh, that's okay to say that. It's okay to use that, that technique. Like, one of, one of the key things is like, they want to use their own frame. Like, do the math. Just so you're aware, it's only $50. We can get you the same frame, but then you have a backup. Oh, right. I didn't even think about that. Yeah, exactly. Because if something breaks now, we can just switch this over. But it's, it's encouraging them to use what they have. Even if they want to keep the same frame, we still have that on the board. And now you have a warranty on the frame. It's just little nuggets like that go a long way. And my opticians, none of them are from the industry, so exposing them, letting them know these little tips and tricks, I think has been very helpful for them as well.
- [21:30]
A
Yeah, it's awesome. So let's talk about your dry eye side of the equation. So, I mean, you're really committed to dry eye. Tell the audience a little bit about the sort of separate dry eye center that you've built and Talk a little bit about why you decided to do that. And then let's talk about what you've changed procedurally over the course of last year.
- [21:55]
B
Yeah, for sure. So we have Family Vision Optical as the main business. Currently we have a dba, so do business as Rejuvenation Dry Eye Center. We did that because we knew that it was hard for other opticians, other ODs, to refer to Family Vision Optical. We all are very, you know, we don't want to lose that glasses patient. We don't want to lose the family to the office. But Rejuvenation Dry Eye Center. Oh, I'll refer to there. We get a lot of referrals because they don't associate us with the family Vision Optical aspect. In addition to that, we don't want to take your patients. We want those Trainer X. We want the hard patients that you don't want to see because we really have fun with it. And I think one of the biggest things about that is me and my associate see eye to eye. We have an authentic passion for dry eye. So when they're talking to us, we're legitimately excited about this. When I go home and I'm reading about stuff or looking at it, this is the stuff that I enjoy. I'll sit in webinars. I literally took my wife for her birthday to Chicago to a conference about this. Like, hey, babe, it's a business expense, but we sat in and learned about RF and all that other fun stuff. I love what I do. My goal is to one day in the next year or two to have Rejuvenation be its own standalone center. I want it to be a referral center. And just for my own personal perspective, AI is a big talk. Like, AI is going to take over X, Y or Z1. AI, when you look at what they're doing, it's all posterior side. Even. AI doesn't care about the front of the eye. When you talk to my colleagues or, or any corneal specialist, they don't really care about dry eye. They don't. They want that. I'll take those patients. And one of the coolest things, Eugene, the thing that really gave me juice is we had a patient that got referred to us. Kalamazoo is about an hour and a half south. And the doctor referring said, you can go see the University of Michigan or Rejuvenation Dry Eye center in Allendale. And I, I made a big deal about this. I talked to the whole staff about. They said this. That's a testament to me and the other doctor that one were committed to this. But you guys, when they go to most offices, there's like one person they can talk to. Every single one of my staff members knows the commitment, knows the value. They can talk about the treatments. And I said that's huge. That, that's one of like, I haven't made it, but University of Michigan's a big time.
- [24:33]
A
Yeah, that's a pretty good, a pretty good stage to be on you and the University of Michigan. That's pretty good.
- [24:38]
B
So I, I just, that's so cool to me. So that, that's what I love about dry eye.
- [24:44]
A
And so Nick, on that topic, just before we even get into the way that you position dry eye to your patients, how did you let the doctors around? You know, and again, I mean, I, I mean I think anybody who does a little bit of checking isn't going to be fooled by the fact that you have a practice at the same address. Right? So like there's obviously an authentic component to yes, you refer them to rejuvenation, but we do have a practice at the same place and we're not going to steal your patients. So like talk a little bit about setting up that referral center, a referral program, what you did specifically and kind of how you continue to do that.
- [25:26]
B
Well, two things with that, Eugene is one, as you know, because I work with NSG in this sense is that we haven't even really started marketing it yet. We have good SEO. If you look at what I do, I do a lot of videos on YouTube and a lot of them have dry eye focus. Dry eye focus. And I've been doing that for five years. Every, every week we're putting out videos, we're putting out content. And I've been doing that for five years. Just one, because that has helped me discuss it with a patient. So any, any dry eye aspect. I have a way to say it because the person that helps me record that is my wife. And I'll say something and she'll be like, that doesn't make any sense. So I have to bring it back and make it so. So now you name something and I have a, I've had conversations about it. I can refer patients to the channel, but they. That's kind of helped us be found. And we haven't. Like I said, we haven't even really started marketing what we do on a bigger scale that's in the next quarter is what our plan is to blow that up. But just being out there, being able to be found with search has, has been probably the biggest way that they've found us through referrals.
- [26:47]
A
And so I want to speak to that for a little bit because I think that. And actually, as you know, I tend to point this out in some of the conferences where I speak. I actually use your practice as an example because what happens today and from a search engine optimization standpoint is that you still have patients who still type in keywords like dry eye doctor near me or eye doctor near me and they look for stuff. And obviously still we call it the snack Pack. Those pack of three people still look for that and click off of that on Google. And yes, you know, there is a small chunk that gets taken off by ChatGPT and a little bit that gets taken off by the Google AI search component. But the way to inoculate your practice against that, and Nick, you've done an incredible job with this is, is that to create truly authentic content. Because AI has a really hard time creating truly authentic summaries. Right? And also, and so what it'll do is it you get cited a lot when somebody searches idoctor or you know, even if we, if we say Dry Eye clinic near me, and we're not anywhere near Allendale, Michigan, but we're like, we're in Grand Rapids, which is, you know, a major town over, and we do these tests. So your geogrid just kind of explodes green. And, and the reason it explodes green is because we can link all of that authentic content that you create. All of those videos get linked up to all of your local snack pack searches so that Google still decides, oh, that guy has the most amount of authentic expertise. It's not just an AI written blog or it's not a AI written, you know, quick summary that, you know, some AI wrote for some other AI and now AI is referencing because what it's really looking at is saying, this is a video, this is a real content subject matter expert. And the truth is, Nick, you know, you started doing it. I think your videos look great. I do think that your channel has, you know, kind of the impressive flair that a traditional, you know, that, you know, a YouTuber would have potentially or traditional content creator would have you. You've invested a little bit, I think, into higher quality production as you go along, but it's not, I bet you would say that it's not that complicated to record it now. How long does it take you and how do you come up with your ideas and how long is each video, by the way? Just tell, tell the audience.
- [29:21]
B
So right now we've been I just so you're aware, I have four kids, three, five, seven and nine. I coaching football, five to seven, seventh and eighth grade football. And, and my time is really condensed. This Friday, in about an hour and a half, me and my wife just go into the office, she sets up a camera, she gets the lighting all set, and then we just go and record for about an hour and a half. And we got probably eight to 16 videos. And they last. They're shorts. We used to do longer form content, but, but that was just so labor intensive that we just went to shorts right now. So they're under a minute, really quick for the most part. And just the way we come up with content is one, we've gotten better at finding out what, what a hook is. So we'll sit down every, every Monday and we said, let's come up with two video ideas. We have a topic and what's the hook going to be? What, what do we want that hook to be? We come up with a hook. And then like we put that in the library. And then we had someone, you know, Ilka gave us a list of just questions that patients will ask. I'm like, those are videos right there. Just literally what, what to expect in an eye exam? What are you looking at in an eye exam? Why do my contacts get dry at the end of the day? It doesn't have to be rocket science. It's the same things that your patients are asking every single day. Just answer that in a video and it really goes. And I'll, I'll, I cringe when I look at some of my early, early stuff. It's hard. Like you talk about all day, but then you have this mindset that there's a camera on you, but you have to fight through that and get it honestly, if you do it every week for a month, you will get better. It's easier. And I used to have these long drawn up things. Literally, I'll have the question and I.
- [31:19]
A
Can just go, yeah. And it sounds better when it's authentic for sure. Nick. And the, and by the way, where Ilka got that list, because one of our employees or where she got that list is we tell doctors all the time, we say, hey, do me a favor. If you're looking for ways or looking for content ideas, just keep a freaking little notepad. And it doesn't even have to be a notebook, but keep a large, oversized sticky note in the drawer of your desk in every single exam room. And when a patient asks something that makes you, that's like fun to explain or it's not a question that you get every single day. Just jot one down. And you don't even have to type it up. Just snap a picture of the notebook and send it to us. And then we get these pictures from all over the practices from all over the country sometimes where they'll be like, oh, okay, cool. These are cool questions that patients are asking. But the reality is like, those are great. Those are those doctors. They're the ones that they find interesting. So when somebody asks you a dry eye question, you'll jot it down. You'll say, hey, yeah, that's a good one. I'll think about that. If you get a question about something you're not so passionate about, you may not, I don't know, you may like myopia, but if somebody asks you about that, you might be like, okay, I'm not going to write that one down. I didn't have fun answering that one. As much fun as I did answering that. But somebody who loves myopia management might drop that down. So my point is that, you know, everybody can. I don't think you have to look really far for the kind of content that you would be good at producing, because the stuff that you have fun explaining to patients, right? It's the spiel that you like giving to, to the patient that's sitting in front of you.
- [33:01]
B
Can I can tell a little story about that? So when I was, I'm looking to hire another doctor, right? And my, my current associate, I hit a home run. One in a million. Couldn't have asked for a better associate. And she is passionate about dry eye. Well, she's more reserved. I'm very outgoing. I'm always talking to the staff. I'm doing like, you know, the meetings, they're thought out and, and I can just go and talk forever. And she asked like, are you going to hire someone like you or someone like me? I go, like you? What does that mean? And she goes, I'm. I'm a little more reserved and whatnot. But we had just went to an ex Demby dinner and this or oxurate dinner. And this is about neurotrophic keratitis, right? And she was like a kid in the candy store. Her sitting next to me. She's like, look at that. The, the treatment group got better by like 33%. This has happened. I said, you realize that that's what motivates people. Authentic passion for what you do. And she goes, what are you talking about? I go, just tell the staff about That I go, and I'll say, I watched this video about X, Y and Z. And again, I literally did. But I know that they're like, man, he's a nerd, but he knows this stuff. She did that. She went into the exam room and someone had like, almost like a systemic thing. And she's going off about nutrients and stuff like that. And the patient's mom looked at her and goes, you really enjoy this, don't you? She said, yes, I do. I said, that's your fuel. That's your juice. Just be authentic and passionate and no one can duplicate that. And, and that's where she's really taken off because she's embraced that. And that's, that's what we need to do as clinicians is we, we try to measure ourselves with someone else's measuring stick. I'm supposed to do my opioid management. Supposed to do, you know, scleral lenses. No, do what you love and no one can compete with you. You're an N of one at that point.
- [35:01]
A
Yeah, I, that's so well said, Nick, because in my opinion, you know, it's like when it, you know, and you hear this all the time, is that when, when you really love what you do, you don't feel like it's work, right? And it comes across, it really comes across when you, when you love what you do. So when we come back from the break, I'm going to ask you some of the things that you do when you present your dry eye packages, because that acceptance rate is pretty impressive. And then I'm also going to talk to you a little bit about how you manage your associate because it tends to be the case that most associates have a hard time keeping up and yours got right in there. So we're going to talk about that after the break. We'll be right back on the Power Hour. All right. We're back on the power hour. Dr. Nick Lilly. So we were talking about your dry eye practice and referrals that you're getting from clinicians and the content that you've been creating. But the fact is still that about a year ago, you had four years of content. You had a bunch of referrals, but patients were accepting treatment at a rate of maybe 1 out of 10. Today, patients are accepting treatment at a rate of 47%. You had a remarkable, this is one of your other remarkable transitions, transformations over the course of last year. Tell us how you did it.
- [36:22]
B
So one, the dry eye center. Having that there has been, been a huge thing it. They Walk in. And it's not just something that we do in a closet. It's not something that we pull out there. It is a. It's a focal piece. So any patient coming in, when they see the office, they walk by that dry eye treatment room. And we do that on purpose. The door is always open, the lights are on. I'm like, I want the stuff to be seen. And it raises a question, right? And then from that, we invested and we got. One of the biggest things that we've made a change on is if you. If a patient comes in and they have pressures of like 28 or big nerves, you're. You're going to say, hey, you have glaucoma. We need to do something about this. No question. You act. We have interior segment on cameras. And we had a. My biographer before that we've added. But we do my biography on every patient 18 and older.
- [37:18]
A
Now.
- [37:19]
B
If there's an issue, if there's any dropout or gland loss, it's like glaucoma. There's no question about this. This is our standard of care. We're going to do something about it. So we actively have a discussion about their glands, what it means, and we come up with a treatment plan for them. And I've gotten better as I go because I used to be okay, I'm going to have you come back and do this. Why am I waiting? This is your problem. I have a solution. Let's sit down and talk about this right now. If they want to come back or think about it, we will. But if it was glaucoma, I wouldn't hesitate. We're going to have this discussion. We're really. Further testing. Treat it as that is the same thing. It's a disease that can affect their eyes, affect their vision. Everything that you do with glasses and contacts, treated as such. So we made it a priority. And every patient gets that look. They think it's amazing. They've never seen it. But the next step is talking about it in a way that they understand. So one of the things that I heard recently was you have to emphasize the importance of tears. The importance of tears. And your cornea does not have blood vessels because you couldn't see the red. You can see through blood. Your tears are how they get oxygen. Your tears have like per one drop, like 1500 antibodies. It's how they fight infection. Your eyes are getting red at the end of the day because they're not getting enough oxygen. Oh, man, that's bad. Like, they get that, right? Speaking in A way that they understand that helps. And then the other aspect that we've really got on and this. This came from a conversation with. With. With Mark, my marketing team. As I said, I want to start marketing dry eye. And their comment was, well, dry eye is more of a seasonal thing, that you're gonna pay way too much now. We want to do that in the fall. I'm like, that's ridiculous. I gotta find a way. So if I said to you, Eugene, you want healthier, fuller lashes without, you know, the prostaglands or whatnot. Yes, I want healthier fur lashes. Well, then we're gonna talk about cleaning the lids and lashes off, getting that debris off. It's the same conversation that you have, but I'm going through the side door. If you ask them about the bags on your eye, the bags, the hooding and the bags on your eyes, are those bothering you? Yeah, that is. Well, you know that because your lid is losing muscle tone, you're having a less efficient blink. I have a thing where I can tighten that up. You have a more efficient blink. It's also gonna treat your dry eye. But you're going to get the cosmetic benefits as well. Yes, I want to do that. They'll justify the treatment because of the cosmetic experience, you know, benefits. So do you like the redness on your cheeks? No, I don't like that. Well, that redness is actually going up to your lids. It's causing inflammation. I can get rid of the redness, but it's going to make your dry eye better. Sure, get rid of the redness, doc. It's how you're having the conversation in a way that they are receptive to it. Not a single patient in my office thinks they have dry eye. But they have these other things that are going on that we start the conversation with and then give them a solution to their problem. No one wants to buy vitamins. Everyone wants to buy the painkiller. If I have a headache, I will pay whatever it takes to get that to go away. So what is their pain? And that's what we've really done a better job of bringing to the forefront is what is their pain? And then them, specifically, how does it apply to them? Their glands, their video, their lids. That resonates with the patient versus a general talk about it.
- [40:55]
A
Yeah. Oh, I love that. And, you know, for. For the audience, just to restate, nobody wants to buy vitamins. Everybody wants to buy in the. Buy the painkiller. And it's true of our society is that, you know, unless and it's, it's such a, such an interesting observation because the vitamins I'll put off until a future date, maybe next year, maybe when I'm. Maybe when X happens, maybe when my lifestyle changes. Maybe, maybe, maybe. But the pain is here now, and if I can pay to get rid of it, I probably would. Right. So that's a really interesting point. So what you're telling me is that you're flipping the dry eye conversation. I thought you were going to say what Paul Karpecki said to me once when I was hosting a panel, which is that, you know, you. You do the. My biography, and then you say, this is something that concerns me. His words. I see something here that concerns me. And then as soon as the doctor is concerned, then you kind of get into serious mode and you get to explain. But what you said is that maybe you do some of that. But really the selling proposition starts with some of the aesthetic benefits, and then you transition to. And also it's going to help with your dry eye.
- [42:10]
B
Yeah, And I'm big about it. I want to treat their dry. I want to get that there. But the patients, the comprehensive patients that we're converting care more about that cosmetic benefit, the referrals that we get in the train wrecks. Those are the easiest patients because they're looking for an answer. They've been to four. Well, it's the average, like four and a half doctors that have tried X, Y or Z. It's, this is a plan, this is what we're going to do and go from there. And I think that one of the biggest mistakes I made early on is I bought an ipl. So I sold ipl. Right. If your only tool is a hammer, everything's going to look like a nail. One of the selling points that I have conversations with my patients now is I have all the tools. So I'm going to find the tool that's actually best for you. I'm not selling a treatment. I have a million ways to get where you want to be. It just may take longer, depending on the route you want to go. But I'm going to meet you where you're at and we're going to get there together. Are you in?
- [43:09]
A
So how do you position your treatment plans? Is it the same price for all of them? How do you set it up?
- [43:18]
B
Yep. So we used to be big on the discounts. Like, it was usually $3,000, but we'll get it for 2500. What we went to now is it's X amount per treatment. So 425 per treatment. You need four treatments, 350 per treatment. You need three treatments. We have a treatment, we have a number and go from there. That has lowered the barrier to entry. One of the other things that we used to do is half down to get signed up. Now just pay for your, pay for one treatment ahead of time. When you're done, you'll pay for the other treatment. So they're always ahead. One treatment, it's lowered the barrier to entry. And you know that the. I got this from my, my staff member. She's like, yeah, you know how it is. You know that $500 rule. And I'm like, tell me more. Like, if it's under $500, you don't have to consult your spouse. You can go ahead and make the purchase. So we've really embraced that. And they're like, yeah, it's just $500. Sure, let's go ahead. So they're paying the same amount, but it's broken up. So we've lowered that barrier. They have less, you know, ways to say no, that's really helped. And then in addition, we like to do what we call a white glove discount. Okay, so if you go to like Chanel, they're not like, oh, we'll discount this 50, 15, like if you spend 500 more, you're gonna get this free, like kit of makeup or whatever, you know what I mean? Or if you go to this five star resort, if you book five days, you get access to the gym. So what we'll do is we have our base treatment, whether it's tcs, ipl, call it rf, whatever you want your base to be. Then when we come up, I want them to get LLT and a zest treatment. Include that in their treatment. But we're going to do the IPLs, given these other things as free. Again, they see value, they see added value. Let's go.
- [45:07]
A
And it seems like it answers my question, which is that, you know, how many people put off getting the second and third treatment if there's an incentive to get the second and third treatment done? Because then I get all these freebies on the other side. That's a ninja move to, you know, essentially lower the barrier, the lower the pricing barrier and get the full retention of the patient. Right?
- [45:30]
B
Absolutely. And I haven't played with this yet, but, you know, one of the biggest thing is you never make the first visit free. You always make that second visit free. Whatever, whatever it is to get them, like if it's three times with you and you know, they will never go anywhere else. Well, make it, make it so they get to that third time. So you got them. So whatever we can do to get them to see us. I used to say, give me one exam and I'll have a patient for life. Right. What barrier do we have to lower to get them to see what we do differently, to get them to experience us, and we'll go from there. And that, that might be just the ignorance or the naivety or how I talk myself up, but I tell that to our staff. We do it differently and we have that mindset like, we're not the right flavor for everyone, but people that like what we, we. We taste like, they're never going to go anywhere else.
- [46:24]
A
You know, Nick, that's, it's. The culture is contagious. And just talking to you right now, right, Like, I'm sure our audience feels it, that you've got an undeniable energy that I'm sure your patients feel in the exam room, I'm sure your staff feel. And quite frankly, it's like, you know, you got this passion. So the question I have, and I want to shift gears to your associate now for a moment is you mentioned that she's a little bit of a different personality. You're a little bit more of an extrovert. She's a little bit more of an introvert. So how did you get this associate trained in your practice, on your culture, performing their own way? And I'll tell you why I asked this question, because there's a lot of, you know, I, I've been to Allendale, Michigan. It's a lovely place, but it's probably not the place that's like number one and everybody's list to go after they graduate optometry school, right? So there's a, there's a, There are major cities that draw a lot of people and it's really easy to recruit. But sometimes, you know, talk to somebody in a rural part of the country or in, you know, four hours away from the major airport like you, and they'll say, well, you know, it's great. However, you know, I got my associate and I'm just lucky to have them. So, you know, I'm not really going to push that associate that hard. They'll do what they need to do, they'll do what they want to do, but, you know, as long as they're seeing patients, I'm okay. What did you do differently and how did you get your associate to sometimes outperform you as far As I can tell.
- [47:59]
B
Yeah. Well, step one, she has allowed this to happen because she's been receptive and trusted me like she trusted what I was telling her. And then she's probably the best person I've ever been around for taking feedback. I've never been like, do it this way. But what we do is we have a weekly one on one. And I'll go, okay, go in, show me how you do your exam. And she'll do it. And I'll go, okay, come to my room and I'll show her what I do. And just a little nuanced difference. And she's like, cool. I didn't realize I was doing that, or I would go through all my list of patients. This is my thought process. This is how I did this. This is what I needed to do. And then the other thing was making it simple in the sense that efficiency was a thing that we talked about a lot. And I said, what are the basics? You're always going to do a refraction. You're always going to do a slip lamp, right? Regardless of what's going on, you have to get those out of the way. And then when you're going back and putting stuff in, then let them talk. Don't get caught up in too much of the talking and then learning. I'm just naturally good at directing the conversation. Hold on, let me take a look at your. Let me take a look. Because they think something magic happens behind that slit lamp. They stop talking. They're looking. You come back. Now, when you say something, what do you see, Doc? What do you do? They're engaged, right? So I kind of just showed her that. She trusted that. But the biggest thing out of anything that I'll say, and this is what I'm doing, I've learned this from her, is she's here because everyone that she was at, where she was at, told her they were going to do dry eye. And then they put it off. They put it off and put it off. Every doctor that I come in, I give them my vision. I ask them, what do they want? And one of the questions I didn't ask Dr. B, I kind of knew, but I asked the other Doctors. Now, in 10 years, what does your vision look like? What does this make this a success? Right. I'm going to create that environment. If they. If they jive with me, this is what we're going to make. And to Dr. B's credit, I probably bought two houses and whatnot, or a couple small cars of investment into this because I believe in her. I believe in us. We're building this together. And it's not only that I talked it, I was doing it. But we brought in another piece of equipment. I got her an interior second camera with me getting one. Like, we're both gonna do this. Let's go. The first, like I'll tell you, from October to probably maybe, I was just, like you said, growing new stuff. I said, all the dry eye patients, give them to her. She has to learn to cut her teeth. She has to figure out, fall on her face a few times, knock on more doors. That's how I learned. I said, I figured it out. And you learn how to communicate. Give them all to her. She'll figure it out. And now she knows how to do it. Has a conversation. One of the things she said is, we came out and I asked, how'd that go? And her comment was, well, the patient didn't sign up. So it didn't go well. I said, not at all. We do not judge ourselves based on outcome here. Did you do what you're supposed to? Did you give them the best, you know, X, y, or z? She's like, okay. And now she. She judges it on, is she doing everything she can that she can control? And knowing that this isn't where you throw the kitchen sink. You have to walk before you run. We know exactly what they need, but get a small victory. Build trust, see that win, and then expound on it. And now you have them, and they believe in what you're doing. And she went from trying to do everything all at once to connecting with the patient, understanding where they're at and meeting them where they need to be. Because she'd ask like, why are you doing this? Why are you waiting to do this? Like, because I have to. I have to build that trust. We have to get a small victory. And she kind of like, what do you mean? But then she saw it. She gave him everything. All right, but they were overwhelmed. But now she breaks into bite sized pieces.
- [52:04]
A
One of the things you said in the very beginning, which I thought was really fascinating, Nick, is that you almost, like, glossed over this. And I would be willing to bet that many people who are listening to the show don't do this. But it sounds like you guys observe each other all the time.
- [52:19]
B
Yeah. Oh, absolutely. We're a completely open book like this.
- [52:23]
A
You will sit in on her exams. She'll sit on your exams.
- [52:26]
B
She'll sit in on my exams more than I'll sit in on hers. I don't want to I don't want to make her feel self conscious with that, but I'll ask her. We'll go over the chart like, hey, what do you do here? Walk me through this. Okay, what can you do? And then we'll role play, like go in, I'll be the patient. What are you going to do? So that, that's that she sat in on my exams more than I've sat on hers. But that's more of a one. I want to build her up in terms of why is he sitting in here? I had a doctor tell me though, because with the new doctors I'm bringing on, they're going to be probably a new grad. Yeah, they're a great doctor, but they don't know our technology. So I'm going to monitor them in case the computer frees it up or whatnot. Oh, all right, that makes sense. I never want to take away credibility of the doctor, like they're being shadowed. But I'm going to help them with the technology that they are very new to. So I do plan on doing that more with the new hires. She had practiced for a couple years. I never questioned her doctor ability. But the presentation she had never been in where she had all the tools to this. How do you pick and choose.
- [53:30]
A
Discussion, like when you said role play or chart review, those kinds of things. I mean, how often are you doing that? Are you doing that at your weekly meetings?
- [53:38]
B
Yeah, oh, absolutely. We do a weekly meeting. We whenever we have a patient, we love to share. Like, hey, this is what I'm thinking. Why didn't you think this? It's so much easier to be on the outside looking in and bouncing ideas off of her.
- [53:50]
A
Her.
- [53:50]
B
Bouncing ideas off of myself. Just sharing, look at this. What do we do? Iron sharpens iron. We make each other better. And I know I'm accountable because she's doing it. And small secret here when I wasn't doing it and then she started converting that. You start to question, do I still have it? Like, oh, I'm going to show that I still have the ability to do this. So it just, it revs me up, it gives me juice. And I'm never competing with her. But we'll look at the numbers. Hey, how many supplements did you. Where are you supplement sales? Where are you on your supplies? Where are you on this? And it just pushes us to be better because if I can do it, she can do it. If she can do it, I can do it. And that's the environment we want. We want the next doctor to thrive in that if you aren't able to do that, you're not going to work well with us.
- [54:38]
A
Yeah. You know, and I, I think we could probably continue this conversation for hours, Nick, because the reality is that, that the fuel behind your transformation is, is really. It's just that it's, it's this energy that, this, this thing that you brought on. And it, and it seems to me you said this earlier on and kind of be my last question for you for today, and then I'll ask our audience if, if they have questions for you. Maybe we'll bring you back in a few months and see and continue on your journey. But my, you know, when you think about all of the stuff that gives you juice, gives you energy, as you say, what are the kinds of things that you do and that, that really energize you and that you, when you come back to, when you come back to your practice, you just, you know, you're just ready to fly.
- [55:31]
B
One of the things I've learned and when, if you've heard of eos, the core values and coming up with your belief, three things I do in everything that I do, whether it's coaching football with my family, with patients, I want to give people hope. I want to educate and I want to advise. So in everything, they're not always going to listen. But those. That's my core. Whatever I'm doing, I want to do those three things. When I'm, When I'm at home, in my free time, I'm either listening to podcasts, I'm always listening. I want to learn more and gather more information, but I'm always getting that. I'm like, how can I get a nugget to help someone else out? How can I get a nugget to share, to communicate better? When I'm working out in the morning, which I do, it's. I want to get better, I want to health as well. Right. If I'm not able to go hard or do what I need to do. So that hope concept is huge. Educate. I just love to learn and I love to share and teach and then advise. That's what we're doing and all that we have. And I always tell people I'm either a great example or a horrible warning. Either way, you're gonna be better off listening to what I have to say because you'll go one of two directions.
- [56:42]
A
Yeah. And it sounds like you've got a group of colleagues in that study group. What are some of the most valuable things that you've taken away from Some of that study group experience.
- [56:52]
B
Number one, there are so many more people that are five steps ahead of you. And doesn't mean that they're better than you. It just means that they've been on the path longer. But talk to them. Their mindset is so different than yours. I was talking to you at one of the meetings, and I said I was thinking about, you know, use it or lose it or this. And the big dogs, the people I want to be, are thinking 10 years down the road, they could give a crap about, you know, use it or lose it. Where are we going to position ourselves in 10 years? How can we make strategic moves now to be where we want to be? And I think that that's the biggest shift is I started thinking bigger picture. And when I started thinking bigger picture, you have a North Star, you know where you need to go. And you'll love this because it's. It's hormozy, right? What's the definition of strategy, Eugene?
- [57:46]
A
Go ahead.
- [57:47]
B
It's knowing what to say no to. And that is so crucial because everything's a shiny object. Everything hits a point of discomfort, of pain, of it's not going the way you need to. But when you don't look at the shiny object, don't jump to the next thing, and you keep going through, that's when you get breakthrough. That's when you have real growth. And that's what I love. And that's what I'm trying to do right now with. With this focus and building this dry eye center.
- [58:15]
A
And, you know what's interesting is I'll. I'll expand on your definition of strategy, because I've named, like, four companies with the word strategy in them. And so I've thought about the word a lot. I think that strategy is really the bridge between the goal and the tactics, right? So if you think of the tactics on one end and the goal on the other end, strategy is the shortest and most sustainable and the strongest bridge that you can build between those two things. The problem is that a lot of people, while they're building the bridge, they change the goal because of that shiny object syndrome, right? Like, oh, my God, I changed the goal. Well, now you got to build a whole new bridge, and you got a whole whole new thing that you got to do because the land moved right now we were going north. Now we're going northeast. And so you can't do that. And then people also get distracted by all the shiny object on the tactic side. And so all of a sudden, you're going, you're going in a different spot on the land as well, you know, so the. The idea is that you have to connect them in the most efficient and the sturdiest and the most sustainable way, and you build that bridge between. But. But you have to be able to articulate the goal and the vision kind of in the same way that you're talking about. The goal can't be like, you know, tomorrow I. This is what I want to do. That's a. That's part of the strategy. That's part of the implementation. Right. The goal is the big picture picture that you have to be able to see, and you've been able to visualize that incredibly well. But that's what gives you the power and the energy to be able to then say, okay, and then I'm going to make a scorecard to bring this all full circle. I'm going to make a scorecard knowing what I have to monitor every day, every week so that I can cross this bridge one step at a time and to know that I'm, you know, I'm still making the steps towards the right direction.
- [60:01]
B
Yeah. 101 of the last things I'll leave you with is that entrepreneurs, business owners, it's not our goals that drive us crazy. It's our timelines. Right. And that's. That's the biggest thing that I had to. To get is like, stop thinking about the now. Do the right things, get the foundation, and it'll take care of itself. And that's really what you have to focus on. That. That's. I think that's. If you take anything away from that, is that know the fundamentals. And if you're not having the right fundamentals, that's why you're not getting where you want to be.
- [60:34]
A
Yeah. Nick, thank you so much for sharing your knowledge, your wisdom with the audience. Just so proud and impressed of how far you've been able to come just in the short time that we've known each other. And I just. You're an incredible powerhouse. And thank you for teaching. Thank you for just constantly bringing the energy. And thanks for being on the Power Hour.
- [60:54]
B
Thank you. Look forward to doing it again.