Gary Gerber (5:51)

Yeah, boy, that's a lot to unpack. You know, when you were talking about kind of looking back, would you get done last year? What are you doing this year? It's kind of like a New Year's resolution for a business instead of a person. And you can look back and you say, man, I wanted to lose weight and get in shape, but I didn't do it. So this year I'm going to hit the gym and I'm going to eat better. And then another year goes by and nothing happens. So if you say what's changed and what hasn't changed in the last 13 years, everything's changed and nothing's changed. Right. So I think we have to kind of look at it from two perspectives. One is industry and things like technology. Science is one piece and then the day to day running of a practice and what's different on the tactical strategic side of managing a practice and what are doctors doing differently? One question that I. One topic I was thinking about when you said what prompted the Power Hour? I think we were the first, well, definitely the first to do it live, where we would do it like a call and radio show. And as we mentioned, last time I was on the air with you, we did it with what was available at the time, which was conference call technology. And so what's changed with that is. I mean, who even heard of Zoom back then, if it was even available? I have no idea. 13 years ago. So, yeah, definitely technological changes. The thing that really kicked off the show was a marketing idea. How can we. How can we effectively get in front of more prospective doctors to grow the power practice client base by letting them know that we're out here? One thing I always thought that I did a lot of speaking, and there was always the meeting. After the meeting, you're done, you talk into a room with 300 doctors and have a Q and A session at the end, and five or six people raise their hand. But you got 300 people, you got to have more than five or six questions. And sure enough, as soon as it was over, shut the mic off, everybody runs up to the podium, and we start having a discussion. It was a really good discussion, and that's kind of where the action happened. So the thought was, how can I take that and broadcast that kind of meeting after the meeting? Dialogue, interaction, just conversational. That was the beginning of the show. Worked well. 13 years.

Eugene Shotsman (8:31)

Zoom in on what some of those conversations were. Gary, what were the hot topics in. I mean, let's see. So it's 2025. So rewind 13 years. We're in 20. So what are the hot topics that are hitting the industry in 2012?

Gary Gerber (8:48)

Yeah, so that's one of the things that hasn't changed. It's how do I, as. As an entrepreneur in your business, in a private OD. OD's business? It's how do I. How do I become more profitable? Like, that was always the. That's. That's the goal. And you said something in your kickoff that, you know, we're always trying to do better and better, trying to beat last year's numbers. Sometimes that's the curse of the entrepreneur, you know? Can. Can you just like, you know what? I had a pretty good year, and if I don't grow this year, it's okay. I'll probably have another good year. I can. I can probably coast. And you know what one of the challenges with coasting is? The CEO of Firehouse Subs is on the Treehouse Eyes board, and he once said to me, my partner, if you're not. If you're not growing, you're dying. And which. Which I think is an interesting perspective, and it puts a little bit of entrepreneurial pressure on. You don't have to grow by leaps and bounds. But, you know, I mean, last year, a great example with inflation, if you're not. If you're not growing. And if you're stagnant, you're definitely going home with less money. There's no question about you getting squeezed all over the place. So back then, you know, the topics were, how do I become more profitable? How do I deal with managed vision care? My staff is different. I have staff problems. Best time to bake, best time to bring in new technology. How am I going to pay for it? And those, those things really have not changed. I think the way that we address them now is different. I think about staffing. And certainly virtual assistants are pretty. I'm not going to say they're widely used now, but 13 years ago, I don't think we've been talking about them. It wasn't even an option. Maybe in other industries, but we certainly in optometry, we're not doing it in any kind of volume. Yeah, technology advances are just all over the place. I think, interestingly enough, the kind of defining trademark of optometry, our phoropter and checking for vision. Probably the one thing that hasn't had any significant change other than cosmetics. We're still, for the most part asking patients which is better, one or two. And still we're probably going to die without having the answer. So that, that, that I think is pretty interesting. And I'm sure there's going to be some technology guy who's going to contact me after this and say, haven't you seen my new device? You know, the kind of, kind of answer to that person is don't bother to contact me because whether I've seen it or not, the public at large hasn't seen it. And that's kind of really what matters. Right. Contact lens technology continues to get better. Obviously, I don't know what the percentage of daily disposables is, but that's a great example. But it's slow, man. It's a slog. I think a lot of it and I think a lot of the challenges when we talk about we're bringing this new technology, new devices, virtual assistants, the thing that hasn't changed is just a lot of inertia with my colleagues, just resistant to change. He said something else that triggered a thought. The book Atomic Habits. They talk about stacking habits, making a little change. Little changes give you compound. Little changes give you big results. And you say through the years we keep doing something new. Something new, something new. So that took us from 13 years ago up until today. So it took us from conference call power hour to doing this with cool backgrounds and visuals and better sound quality and broadcasting. It to Earth. I mean, you can listen to this any place now. You have an Internet connection or a cell phone. So. Yeah, and that didn't happen with the flip of a switch. Technology may have changed instantaneously, but the adoption was relatively slow. If it weren't for Covid, I think we could still be doing conference calls.

Eugene Shotsman (12:51)

Well, it's interesting you say that, because there's actually a lot of things, and it's kind of like, you know, I always talk to my team about this, is that oftentimes necessity is really. And it's not always the mother of invention, but it's. But it's always the. It's. It's like the drill sergeant who kicks you in the ass of innovation. Because in some cases, you know, like, Zoom is a perfect example for the. For the COVID example, right? Like, some people went from never hearing about Zoom to being on 10 Zoom calls a day during the COVID months. We all quickly had to adopt and adapt because it's like if we weren't. If we didn't. If we didn't learn to use it, we'd be left behind. But it applies to the industry because I think about it, Gary, there are lots of things that are. It seems like they're gaining traction in today's environment, right? And I think about, like, how the world has changed. I mean, let's just be real in 2012. And I think about my industry from a marketing standpoint. That was the year that people started believing me because I was doing some speaking as well. That was the year that people started believing me that the patient might make a decision on their mobile device rather than their desktop computer. Because I think the Apple iPhone and the Samsung counterpart to it, like smartphones, weren't really a big thing up until about 2008, 2009, and it took a few years to, like, get some adoption. And, you know, back in 2012, at least in my world, you know, everybody was pouring marketing dollars into something, but what they were pouring marketing dollars was tv, radio, you know, things, direct mail and flyers and, you know, circulars. And I was kind of, like, stumping the. I was hitting the, you know, the. The podium everywhere I possibly could to say, guys, you know, there's this pocket device thing that, like, people have. And, you know, I really think a lot of patient decisions are going to be made on that thing, you know, and, like, how things look on that are going to be important to patients who are trying to make decisions. There might not be happening today, but it's definitely going to be happening in the future. And so I think about like we witnessed over the course of close to the last 10 to 15 years, we've witnessed I think really like humanity shift their, the way that they make decisions, the way that they have conversations. Their reliance on technology and their expectations for technology have really shifted in the last 10 to 15 years. And it's kind of weird to say that because it doesn't seem like such a long time. But in the course of how technology has evolved, at least for the common consumer and for us as day to day individuals, there are some things that I do now on my cell phone in a couple seconds that were unfathomable 13 years ago. So I do think that applies to some extent to our industry. And it also, if you think about the way that the consumer's expectations have shifted and the amount of information that consumers have at their fingertips and now a lot more of it accurate, I think that shifted as well.

Gary Gerber (16:10)

Yeah, 100%. So you bring up a really important topic. You can have a discussion with a doctor who has not embraced, let me just say mobile technology for say booking appointments, ordering contact lenses, asking questions. I mean pick a topic, right? And the doctor may think, well, you know, that's not being widely used in my industry. I'm going to make up a number, they're going to say maybe, maybe 15% of practices. And that's probably, I have on, have mobile phone contact lens ordering. So if I don't have it, it's not that big a deal. But it is a big deal because the, the, the patient, when they're outside your office, as a consumer with everything else, they instinctively now are going to their phones either for questions for AI or order something from Amazon. And you're not judged against what the other optometrists are doing. You judge what's happening with the rest of the patient's digital environment. So when a patient runs out of contact lenses, they can think, why do I have to call your office? Why can't you be like Amazon? You know, it's, it's, I just realized, it's, I took my last pair of contact lenses off. It's 1:30 in the morning, I have to go to work tomorrow and I don't have any contact lenses and now I can't, not only can I not order them, I can't call you guys other than maybe leave a message on an old fashioned voicemail system. And I hope you got it. And then if your customer service isn't good, you can call me back to confirm the Order. Why can't I just order it like right now? And if I don't have it tomorrow, I'll have it the next day? So you're judged against what's going on in the rest of the consumer's world, not what's going on with the OD down the street. And that's always been the case. And what's happened is that bar is getting higher and higher because there's more technology out there that we have to deal with. So, yeah, you're exactly correct. AI, I think, is a great example. The Triassic side of my life. We just launched our doctors in an AI generated clinical protocol. So all the doctors, doctors need to do is speak into their cell phone, give the clinical findings. I got a kid, he's 10 years old, he's minus one and a quarter, axial length is 22.4, he's Hispanic, his sister is myopic and he plays a lot of soccer. How should I treat the kid? And the AI engine is going to tell you, she used my site, use my site contact lens based on clinical data. So if you were to do that in front of a prospective parent who's considering treating their kids, as opposed to a doctor who doesn't have access to AI technology, all things being equal, which one you think the parents are going to want to be? Which doctor they want to treat their kid? The doctor that's up on all this technology that's going out there.

Eugene Shotsman (19:10)

Yeah, right, Because I think technology also implies research. Right. I think the trick with making that, because sometimes you're like, oh, well, the doc is just doing what the thing says. The doc isn't really listening to me in my unique situation and just following, you know, whatever the computer told them to do, why do I need to go to the doctor? Why can't I just go to the computer? Right? But I think the reality is that if you can equate the technology use with being up on all of the latest research, which I think it's true, like AI does allow us to take all kinds of information and then take that information and process it and make meaning out of it in a much more efficient way, right? Like, I don't know how many pages of clinical research are published in the, in the optometry space every, every year. But I bet that if you actually took the time to read all of it yourself, you probably wouldn't have another job and you wouldn't have time to see a single patient. So the truth is, you know, if the AI can read it and make meaning out of it for you then. And you can present that to, to the patient as hey. And I'm using this tool to make sure that your child fits into the latest protocol for and the latest data with the latest protocols for treating them and gets the best possible outcome. I think patients expect a certain amount of technology. But you know, if you go back, like, I don't even know what when you were first working with the power practice and when you were and even like, let's rewind again to 2012 or so, I mean, was the OCT even like out? I mean, could you do. Were you telling Doctors to charge $39 for a, for an imaging fee? And at what point in your career did that happen?

Gary Gerber (21:02)

Just, just one common AI before it jumps out of my head. So you're right, it's got to be back with data. We actually, on our AI engine, we actually conclude the presentation by saying it's based on our proprietary camp study. So it's all, it's 100 data driven.

Eugene Shotsman (21:19)

Nice.

Gary Gerber (21:19)

Did I ever tell doctors to charge 30 and I never told doctors charge $39 for anything because I never leave it working for free. All right, so 12, 12, 13 years ago, 39 was $50 in today's money, whatever that's still working for free with, with the cost of doing business. So no. Yeah, so what? So OCTs went the, they're out of visual field machines and the chemistry and everything else. It first came out and the doctors who jumped on there early paid this much for it. The doctors who came in later paid this much for the device. So you would think, okay, well smart to wait. But no, because the doctors who got it early paid this and were charging this and they got to keep this delta. This analogy is not going to work around hands. But when they charge this now, they only collected this because the more devices went out there put more billing events happen with insurance companies and reimbursements went down, down, down, down. So usually with technology, if it's got goods again, good science behind it, you're usually in 2013 or in 2025, you're pretty smart to jump in early. And are you going to pay a premium because you're first yet? You are, but if you're smart, you'll charge a premium. And the fact that I don't know about OCT specifically, but a lot of technology when it first comes out is not covered by insurance, which in most cases is a good thing. If the doctor knows how to discuss it with the patient, that's a bonus that is not covered. And Then once time goes on, more and more devices get out there, insurance jumps on the reimbursements kind of essentially disintegrate. So now you could be paying, I don't know, 50, 60 grand for an OCT and collecting 6 cents for a scan. That's an exaggeration, but you kind of get the idea. So yeah, that, I mean that hasn't changed except there's more, you know, more better technology coming out. So I'm still an advocate, do, do research. Obviously it's going to be, have, have clinical story to it, it's got a good science behind it. But if it does, the fact that it's not widely being used, if it's being sold by a reputable company, I would not have any hesitations to jump in early and charge appropriately to get your money back.

Eugene Shotsman (23:37)

Yeah, I mean, and I want to go back on something you said because, you know, there's so many practice consultants that really do believe in the, they swear on the fact that, hey, you know, your OCT is this, you know, is this machine that just prints money if you properly utilize it and you just got to hit the button and 39 bucks comes out. But somehow the industry has settled on $39 for, you know, for an imaging fee or whatever that is. And it seems like, it seems like anyone you talk to, that's their imaging fee. Now if they're doing an opt in model or an opt out model, that's where their imaging capture rate goes up and down. But let's talk to you since I've got you here, what do you advise for people, especially when you're talking about newer technology, what should the fees be and how do you maximize that imaging capture? It?

Gary Gerber (24:31)

Well, there's no single answer formula. The global answer to that is to keep raising until they stop buying. So if I was charging $39 for something today and I had 60% of patients saying yes, I would first, I would first make an assessment. Okay, 60%, is that reasonable? Let's say it is. I would raise it to $55 like tomorrow and I would track it and let's see what happens. And somewhere there, if you, if you charge $10,000 per scan, you'll probably get one person per year saying yes. If you charge $5,000, you'll get two people to charge $1,000, you'll get 10 people at $39. Are you going to make $10,000 doing this? So it's this, you're a numbers guy, death by spreadsheet, right? It's a simple price, volume Curve is all I'm really describing here. The challenge doctors have with pricing anything octs, I mean eyeglasses, eyeglass lenses, contact lenses, is that they, they pick a price and they stick with it and they never change it, and they let somebody change it for them, which means they sign up for a manual vision care plan, and then they say, well, I can't change my price anyway because I don't even set it. Well, whose fault is that? You're the one that signed it for the plan. And the response I get is, well, they don't sign up for the plan. I won't get the patient. That's not true. That's absolutely not true. You won't get as many patients. That's true. But you'll get patients who will be paying your full fee. That's something that has not changed that mindset, which is really frustrating for me because there's so much medical care that is not covered by insurance in other industries that patients readily pay for. Dental braces come to mind. Lasik surgery, premium IOLs, cosmetic surgery. And it just, it just. I don't even understand why, why most of I care is even an insurable event. To me, it's like having insurance for a scratch on your car. You should have insurance in case you really bang up your car. And it's thousands of dollars if your car gets scratched or it gets dinged by a shopping cart in the parking lot. Kind of sucks. That was a, that was a bad day. But I, I guess you got to pay for it. You got to go pay a couple hundred bucks and get it buffed out and get it fixed. If it's $5,000 worth of damage, that's a different story. But to me, optometry and most things day to day things that we do should not even be insurable, which I think that's an incredible frustration.

Eugene Shotsman (27:10)

And it's interesting that you say that, Gary, because it is absolutely true. And I look back now at the last year, year and a half of data that we have, and I will say that Lasik in the last year has suffered. Right there was probably one of the only elective procedures that truly took a big nosedive, at least in the first half of the year. And then it kind of recovered somewhere around October, but not nearly to the levels of, you know, I think their record was in 2021, March of 2021, we called it the, the COVID bump or whatever it was. But that's when everyone went out, got lasik for like 12 months straight. And it was Incredible time if you're in that business. But if you look at other things, aesthetic practices. So are people spending more on toxin filler? Yes, absolutely. Are people spending more on laser procedures for aesthetic purposes? Yes, absolutely. Are people spending more on elective medicine in general? Yes, absolutely. So these are all kind of elective trends. And you know what I'm seeing is that. And you know, while we're on the trends component, I just wanted to throw in a weird one that has been kind of interesting to me is that even though I think the patient experience going online is, is absolutely true, you know, like we do everything and we expect everything to be online, there is a preference that patients have expressed, and this is purely with demand numbers that I have, is that patients prefer to buy glasses in person. They do vtos tend to virtual try on experiences, tend to not do nearly as well as they did in terms of people seeking them out and trying them or whatever. But there was this period of time where there was this and it was also around Covid where there was this massive rush to all the online glasses retailers. And we saw that in demand data. How many times do people type something into Google? We saw that online glasses related purchase and and searches were at a record point. And again they've declined and declined and declined every single year since then. Every single year. Data shows that there's fewer people since that high point around Covid that people are buying glasses more or people are searching more for eye doctor and glasses in person than they are necessarily doing that online. So I think there's two things going on. Number one is they want to buy, they want to buy certain types of things and they want to get certain procedures in person. Number two is that they are willing to spend money to your point, and more willing I think than 13 years ago to spend money on elective medicine. And it seems like the data definitely supports that.

Gary Gerber (30:00)

Oh, no question. The thing that still amazes me is I don't know what the latest capture rates are for doctors. After defining it as after the patient gets an eye exam, that I buy glass, if they need glasses, that they buy it from the doctor, they had the exam. I haven't looked honestly probably eight or nine years back then it was like 60, 65%. I was always amazed at how low that is. And I think about what is so horrible with a practice that the patient drives to your office, they trust you for an eye exam, you give them an exam, they take, they taking a prescription to go someplace else, they have confidence in you that this prescription is Accurate and they're willing to take it someplace else. What is so terrible in your optical retail experience that they don't buy it from you? That fascinates me. The patient is in your freaking office. I mean, come on, right?

Eugene Shotsman (31:02)

They didn't go there just for fun. They went there because they have a need. And if you, and if for some reason they believe that you are an inferior provider of fulfilling that need, it means you didn't win their trust at other points in your experience. Right?

Gary Gerber (31:18)

I mean, look, there's a lot of places it could break down. It could be kind of tangible. Inventory, presentation, merchandising, like that's possibility. Or the way your eye blood strains are presented to, to the patients is just not an attractive, appetizing buying environment. Your staff could be terrible. And it, it's just, it just, it's kind of mindboggling. I, you know, I'm a, I'm a musician in my kind of other life. And if I, if I walk into Guitar center sometimes, I could just be kicking the tires. I'm interested what's there. But I, but I went in there and I'm a pretty good prospect because I walk through the door. So it's their job to make sure I leave with something. To me, here's probably a better analogy. How many people watching this have walked into a restaurant, opened up a menu, looked at the menu, and then the waiter comes up to you and says, are you ready to order? And the person, no, I'm just looking. I'm just, I'm gonna leave, right? Nobody goes into a restaurant and doesn't buy anything. And how does it happen in an OD's office? They're coming in because, and, and I, I also believe that even though doctors said, well, the patient, the patient didn't want to get glasses. Yes, they did. You know, but hold on to take.

Eugene Shotsman (32:43)

That analogy one step further because I think it's such a, such a vivid and brilliant analogy. This one, one step further is how many people make a reservation at a restaurant weeks away, put the reservation on their calendar, get their, you know, get, make accommodations to show up, and then they actually drive to the restaurant, sit in the restaurant and the waiter comes and they're like, nah, you know what? We're not going to have anything. We're out. Thanks.

Gary Gerber (33:07)

Yeah, I'm going to go someplace else. I'm going to Costco. Costco hot dogs for a $50.

Eugene Shotsman (33:13)

Whatever they were $50. Yeah, there's, that hasn't changed. I think they've been a $50 for, you know, whatever it is, for. For 13 years.

Gary Gerber (33:19)

Well, that's okay. The OD hasn't raised his eyeglass price in 13 years either. That's all the same, but it really kind of speaks to a lot of this. So while all this is going on and the doctors are not changing, everything's changing around them. So has Warby. I don't know what the numbers are. I mean, her stock is up 65, 70% in the last year. So something's happening over there. I don't know if it's because of sales or Enron accounting, I have no idea. But it's. It's something that, that's kind of one thing that hasn't changed or what a. What a great opportunity for talk about what are you going to do for 2025 to change things. How about cleaning up your optical. How about having make. How about making a concerted attempt to increase the retail side of your business, which still, even with doctors. So I do a lot of medical billing. I treat a glaucoma, dry eyes, myopia. That's fine. Look at their P and l. At least 50% of the revenue is coming from optical retail. Right. So let's, you know, let's not forget, like how you're really paying your rent and let's not be embarrassed and let's attempt to provide a pair of glasses to a patient that you're proud of. They look great cosmetically. They look great, they're fashionable, the patient sees great. They were dispensed in a really great environment. You have staff who has kind of compassion and excitement around dispensing eyewear. To me, that's the basis of, of having a successful practice. You can do all the other stuff. You want to go buy the latest ocd, that's fine. Take the profit you made from your optical and go do medical eye care. Go do dry. Do my opium management.

Eugene Shotsman (34:58)

Right.

Gary Gerber (34:59)

That's something that, it's. It's just that that still amazes me. That's, that's such a. It's almost like there are doctors I've spoken to through the years. It's a badge of honor that they have no idea what's going on in their optical. I don't deal with that. My optician deals with that. It's almost, almost like they're embarrassed. It's crazy. Absolute crazy.

Eugene Shotsman (35:18)

Yeah, that's. And you're right, it's kind of a, it's a irresponsible thing to do to your business. And you know, the other way to look at it is. And of course there's other factors, right. It's the handoff between the doctor and the optician and the pre programming of the patient to buy glasses before they even walk in the door. Let them know that you're, that that is something that, that you make available to them. But I also think it's the mindset, right. There's so many doctors who really don't like the idea of what I guess I'll call sales. And so they'll try to, they or their opticians will try to play financial advisor for the patient. And I don't think it's our job in the optometric industry to play financial advisor for the patient, you know.

Gary Gerber (36:04)

No, that's something that hasn't changed in the last 200 years. You know, we look at the patient's wallet before looking at the rise. Yeah, that, that has not changed.

Eugene Shotsman (36:12)

Yeah. And that's the thing is that you, you, you don't, you know that that patient is just going to go spend that money on, you know, toxin filler. At least that's what the data shows. You know, why shouldn't they spend it in your optical. Because at least that thing, the thing that you're putting on their face is going to last for, and, and they're, and they're going to wear it on their face for 16 hours a day. And, and it's going to last and it's, and it could potentially make a better long term enhancement to their appearance than, you know, whatever, however many units of Botox that same pair would have bought.

Gary Gerber (36:46)

Yeah, this is the same echo chamber conversation I could have had with somebody 20 years ago, 13 years or 20 years ago. You know, pick a number, right? And you could say if we got on our game, on the optical retail game, online eyeglasses, even though they're still a small piece of the industry, they never would have even come to pass because there would have been such a strong bond with the physical retailer that the online guys would just not have a chance.

Eugene Shotsman (37:17)

You know what's interesting though, and this is one that I thought maybe it was just too, too early for their time. But I think about things that have been tried in the last 13 years. I also thought about things that didn't catch on. And Google Glass is, you know, one of those things. I think it came out in 2013, 2014, something like that. And then it took a while for the optometric industry to even like open up to the idea of looking at it. And then it just never really took Off, But I was at a hockey game this past weekend and my buddy was sitting next to me and he was like, oh, let me show you this really cool thing, you know, my glasses do. And I was like, oh, you're wearing the Metas, right? And he's like, yeah, you know, I had. And it was funny. He goes, my optometrist contacted me and told me that my benefits were going to expire and I could potentially spend them on something cool like this. He's like, I didn't need those, but I bought him. And I was like, good job.

Gary Gerber (38:15)

It's probably a power practice client or national strategic client. Yeah. So, yeah, so that, I mean, that's a good example. So the first Google Glass, I mean, just functionally, and they look stupid and everything else. Right. But the new ones, my son's got a pair of those Ray Bans and they are pretty cool. They don't waste six pounds. Sounds like the first ones. They look like Ray Bans. Image quality is pretty good. Yeah. He just sent me some stuff last night from a concert he was at, and yeah, they're pretty good. So I think that stuff's going to take off. Now, whether or not I think the relevant discussion here, whether or not the bulk of the sales are going to happen at OD's offices, are they going to happen someplace else? That's a different story. I would predict they're not going to happen or know these offices, because doctors will probably think, I don't want to get involved with those. And they'll give you 100 reasons why they don't want to deal with it, instead of like three reasons why they probably do want to do, you know, 100 reasons are, well, the batteries are good. I don't want to have to repair them. It's going to be a pain. You're going to come in and ask me, ask me questions, how do I edit their videos? Or, you know, pick something. You know, my. My response would be, you know what? I would get a pair for myself. I learned everything about them. Somebody has a question, how do I edit the videos? I would sit down, I would show them how to do it. I would go above and beyond. So they tell their friend, yeah, I got these Ray Ban Meta glasses from Gerber's office and I had questions about the video. And his staff sat down and he showed me how to do everything with the glasses. It was like walking into Best Buy, but it was a doctor's office. I think, what an opportunity to position yourselves. And then I think by proxy, the patient makes the connection. Well, if you're that smart with these eyeglasses, you must be pretty smart with everything else you do here. So, yeah, I think those are, those are great opportunities. That's, that's a great example. The glasses may not be perfect. This is, I guess the Ray Bans are version three, two thread.

Eugene Shotsman (40:01)

Yeah. Yeah.

Gary Gerber (40:03)

So, yeah. So version four or five is obviously forthcoming. Smaller, smaller, lighter, faster, better or cheaper or whatever. And to me, it's like the ocd. Buy them now, charge a lot. I think now they're retailing for three or four hundred bucks. And you know what's going to happen is this. So why not do this? And you won't sell probably quite as many because you're the first one. Or you could sell a lot if you, if you promote it.

Eugene Shotsman (40:26)

Well, yeah, you can use them as a shiny object to get people to pay attention to you. People pay. I mean, novelty sells. We know that. We know that. From a marketing standpoint, we know that as, you know, just kind of instinctively as consumers. Novelty sells.

Gary Gerber (40:39)

Yeah, yeah. But, you know, those are some kind of getting back to the original premise of the show. That's something that, that has. Has changed and has not changed. So the technology keeps changing. You know, we're talking about, we used to have plain risky business Ray Bans forever, you know, for years, and now we have these cool meta Ray Bans and has what? I think what's happening is that technology's changing and ODs are kind of catching up and chasing instead of as soon as it comes out, they should be there and lockstep and change together instead of chasing it and getting the benefits by being there early.

Eugene Shotsman (41:17)

I think that goes to your earlier point of, you know, maybe things have changed, but have we taken the steps to adopt? So when we come back after the break, we're going to talk a little bit about what to watch for in 2025, what to really make sure you're taking advantage of and where. Where the industry is headed. Coming right up.

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Eugene Shotsman (42:31)

All right, welcome back to the Power Hour. Gary Gerber in the studio. And I feel like this is, this is always such a momentous opportunity for you and I to chat because, you know, you have such deep, deep perspectives. But also, you ran this show, you talked to the listeners, and you've helped people. And as we, as we've been talking, you know, it's kind of occurred to me that one of the big things that hasn't changed is that this philosophy that we are always looking for keys to growth. And, you know, that's, those are the comments that I get when I, when I publish a show, as people say, oh, that was a really great nugget that you gave me, you know, or I pulled something out of that and there was something from a keys to growth standpoint. And so I thought about it and I thought, you know, okay, well, we're talking about things that have happened over the last 13 years. Now we've gotten that perspective. Now let's talk about what's on the horizon for 20, 25 and beyond. And really, some of it, as my, as our conversation seems to be showing, is what's been here that you really got to make sure you pay attention to, because if you don't, you know, it might just pass you by.

Gary Gerber (43:36)

Yeah. So just kind of summarize. What's been here is going to continue to just be a bigger party practice. Like it or not, it's optical retail. So let's check that box.

Eugene Shotsman (43:44)

Right.

Gary Gerber (43:44)

I just, just, just accept it's part of your practice. The other thing that's been around for a while, specialty, specialty care, everybody talks about. A few guys do it. You've heard the term dry eye center of excellence many, many times. I don't know if you've ever walked into an office and seen one. I would bet there's fewer than 10 of them in the country. Right. So that's something that, Come on, guys, let's get her done. As Larry the cable guy would say myopia management, same thing. Something everybody talks about, obviously very close to me because of my triage eyes DNA. And I think what all these 2025 opportunities have in common is that it takes execution to get it done. So what you have to focus on is that the science around optical retail, the tactics, same thing with dry eye. To science. The tactics, myopia management. Pick any of those specialty contact lenses, bv, tbi. The science and the strategies are there. The challenge is executing them. So I think if you're going to make a commitment in 2025, you should commit to execution. How am I going to get this done? Like that's what it's about. All the tools are out there. In our case, if I could do a quick little commercial. We help you with the treehouse eyes model. We help you with the execution. Here's myopia in a box. Do this first. Do step one before you do step two and you can read ahead if you want. But don't do step seven until you do the first six. And we give it to you in a sequential order based on years of doing this and 8,000 plus kids in treatment. So learn how to execute. Take a class. Read a book on execution. One of my favorites is the Franklin Covey guys. Four disciplines of execution, I think is a great way to do it. They've got a quote in there. Maybe it's for somebody else. That execution each strategy for lunch. You have the best ideas and intentions which can't get them done. And myopia management's only one. I happen to believe if you're going to strategize with specialty care, it's the one you should do first. Because you have the largest base of prospective patients and you have the, the least amount of capital equipment expense. The only thing you really need, which you may not have, you need a corneal topographer and a biometer. So 20, $20,000 and you're, you're in. As opposed to if you want to jump into dry eye and you want to not dabble and do it the right way. You can spend over 100 grand on capital equipment by having all the individual pieces. Because obviously one treatment is not for everybody. Now guys, well, I can get an IPL and RF for 40 grand, okay, but that doesn't work. Everybody. There's other stuff you need to do. So I think, you know, have a, have an execution plan. Focus on one thing and one thing only. I think the more stuff you do, the less likelihood you're going to get them done. And I think. I think the big things in 2025, you know, hopefully it's the year of myopia. I was hoping that would have been 2020. That would have been so cool. Just because it was 2020.

Eugene Shotsman (47:02)

But you're probably okay not to have 2020 be associated with the year.

Gary Gerber (47:09)

Exactly. Covid had other plans. Yeah, other stuff. I think on the customer service side, we have to start making our practice experience for patients more Amazonian and remove the obstacles to spending money. Now. He gave an example of buying contact lenses. There are tools out there where you could do that. The doctors need to look at them seriously and start embracing things like that. Virtual assistants we talked about, what can you do to drive cost out of your system? And the biggest cost usually is labor and rent. Those are the big ones, rent or mortgage. And typically you can't do too much about that other than a possible refi, depending where interest rates go. But short of that, on the labor side, just make sure your staff, if you don't go virtual, make sure they're doing what you want. I've always said to hire slow and fire fast. Doctors tend to totally flip that around. I think this would be a good year to look. Take a really good look at your staff. Are they producing like they should? If they're not, they need. They need to go.

Eugene Shotsman (48:16)

They need to get what's going on.

Gary Gerber (48:17)

Where they need to go.

Eugene Shotsman (48:19)

On that front, Gary, there are lots and lots of AI tools that can help make your staff more efficient and hold your staff more accountable. I mean, on the very simple side, and I think some. Some of the audience members may have heard me talk about this before, but truth is, it's so fundament. If you have any meetings in your practice, invite an AI assistant. The AI assistant is going to document him. He's going to know who's accountable. He's going to know. And then somebody can't be. Can't say, well, I didn't attend the meeting, so I didn't know what happened or what. Or you're not talking about the same thing three weeks later, and you're saying, why didn't this get done? Oh, I didn't know I was supposed to get done. Check the notes. Oh, okay. Well, you were. Okay, so we're not. I mean, that's the most basic thing. And then there's other things we're playing around, and we've been experimenting with what we call genie, the Office Knowledge Assistant. This is the person. Because you think about your most senior people in your office are usually the most valuable people, but they're also the most knowledgeable ones. So to pull to constantly pepper your office manager with questions of where does this go? And who knows that? And what's the number for so and so? And what do I do if I have a patient with this type of thing? If the office manager is constantly peppered with those questions all day long, take that off their plate, give it to Jeannie the assistant, which is essentially, which is essentially a chat bot built specifically for your practice that you've just loaded all of your office knowledge into. And then have the staff ask Jeanne first. And if Jeanne doesn't know, she says, oh, I go talk to the office manager. Then, then you pepper the office manager. But free up that valuable person's time. And also GENIE can give you a report. This is kind of something we realized is that GENIE can give you a report of who's asking the same questions over and over. And if they're asking the same questions over and over, maybe there's an opportunity for a coaching conversation. But. So that's, you know, one way to make staff more efficient. But this technology, again, it's available, it's in use. You know, we can, we can play with this. Now, AI note takers have been around for a while. I think this, you know, AI office support, again, this isn't necessarily replacing people. This is just making them more efficient. This is kind of like if you're a contractor and you're going to go build a house, this is someone just standing there making sure that you've got the right tool ready to go at the right time. So if you're absolutely best equipped to be hitting that hammer, they don't hit the hammer for you, but they're constantly handing you the hammer and the nails so that you don't waste a second in between hitting that, between what you're supposed to be doing. And that's kind of my, my, my thought about how you can make an office way more efficient using tools and technology that have been really developed. I mean, AI has been around for a while and machine learning has too, but it just hasn't really gone mainstream up until 23, 24. And so I thought 24 was the year of, like, presentation of AI and everybody heard a bunch of talks on AI, but nobody's still doing anything with it, you know, and so this is the time to kind of get around, get, get off the bandwagon of, okay, well, I'm just going to wait till someone figures it out and just try stuff, try Figure it out, use it. You know, talk to people who know what they're doing. Talk, talk to other ODs that have actually figured out. But this is such a huge. It's kind of like, you know, when I think about it, it's like, it's exactly like when the cell phone came out. And eventually all of us will be on it, and eventually all of us will, Will leverage it and all of our patients will be using it. And the truth is that you can kind of like what. Exactly what you said, which is that you need to lead and get a premium right now, or you can follow and kind of get a. And get the scraps.

Gary Gerber (52:05)

It gets into execution again. So here's the AI engine, this tool. Genie or Firefly or, you know, pick one. But you have to execute. You have to do it. So what you need is an execution plan to do this. And you could say, you know, my, my one goal for this year or for this quarter. I'm gonna, I'm gonna get this done just with my office manager. So other stuff around the office is gonna happen. You're still gonna be busy. You gotta pick up phones. The hydraulics in the third exam chair are gonna break. You gotta get it fixed. That. That doesn't go away. But you're going to say, we're not taking on any other new projects until we check this box and we get this done. We're going to make a concerted effort. Then you go on to the next one or next one. That's kind of atomic habits again. Right? Just do small little changes. But it's about execution. I think there's few people who would listen to this, who would challenge what you just said and say, no, that's not a good idea. Like, taking this stuff off my office manager's plate is a really bad idea. I want to have her overburdened and totally stressed out, so I want to.

Eugene Shotsman (53:13)

Have her burn out so she quits so that I have to do more stuff. Yes.

Gary Gerber (53:16)

And I have to train somebody else again myself and then lose money while I'm training. Right. So nobody's going to disagree with this. How do I, how do I. How do I get it done? Like, how do I execute is what they need to focus on. So if they're not historically good executors, which is typical for every entrepreneur, that's. That's not optometry. You know, we're just. We're born to put out fires. That's kind of what we do. The first thing you want to do is maybe the first quarter is learn how to execute. You know, do, do some reading, take some classes, do something else. What are your ways to get things done? And then you start using some of these tools. That's what it comes down to. And then the other thing to think about, I told clients for years, it's okay if you do something and it doesn't work, especially if you're a small business, because the risks are very, very small. So if you were to use this AI tool and for whatever reason it doesn't work in your particular office, it doesn't mean you should never use AI ever again. I kind of call my 70% rule. You get it right, 70% of the time, you're going to quadruple your business if you get that. So you don't have to go for what is it? Perfection is the enemy or good is the enemy of great.

Eugene Shotsman (54:23)

Perfection is the enemy of very good or whatever.

Gary Gerber (54:25)

Yeah, yeah, yeah, something like that. So get it right 70% of the time, if you, if you go to MLB and you get hit, 70% of the time you're in the hall of Fame, right? You get it right 30% of the time you're not. You get a hit, you're in a Hall of Fame. So, you know, you know, don't make yourself crazy. Just, just get started, pull the freaking trigger and try something if it doesn't work, okay, that didn't work. Let's, let's move on. I'm not going to do that again.

Eugene Shotsman (54:49)

I agree with your point, which is that, because I think a lot of people go the other way, you know, they say, you know what, the way I'm going to commit to this is I'm going to go spend the 90 grand and all the dry equipment, I'm going to pay for that and that way I'll have to do it. And then they're sitting there a year later and they've got, you know, 2% of their patients that they've enrolled in some sort of dry eye program, if that, and they're sitting there saying, you know, I guess I'll try to grow dry eye a little bit. Well, let's make sure that you have a plan for how to do that first. And what, what happens from a patient communication standpoint? What happens from the actual explanation of the, of the procedure in the, in the exam lane? What happens in a patient follow up standpoint? What happens even, you know, as simple as what happens on the phone, you know, does a patient even know that? Or can you get the patient to start Thinking about it before they even come into your office. Right. There's, I think there's just so many ways that, you know, execution can kind of turn into actual, actual leverage for practice. And you're absolutely right. But I, but I don't want to let people off the hook. But when they're thinking, well, you know, I'm in that 70%, I did something, and I did something because I spent the 90 grand, no, that's the worst thing you could have done without a plan. And the plan can't just be what the rep gave you. You actually have to say, okay, well, we're going to make some changes in order to be able to support this.

Gary Gerber (56:15)

Yeah. The easy, easiest thing to do with any of these is to go buy equipment. Right. And it's, it's like, it's, it's the shiny object. You write a check $90,000 two weeks later to create, show up, you have this brand new widget and what do I do now? And you're right. At the end of the year, it's going to be sitting in the back of the office with the dust cover on it. Because my patients don't want to do this because it's too expensive. So. Right. So what you want to do is exactly, you want to write down an execution plan. Everything from, how am I going to train my staff, how am I going to present it to patients, what am I going to charge for it? When they say, well, what do you mean? Insurance doesn't cover it. When all that stuff is done and you've done a couple walkthroughs without the equipment is do some mock walkthroughs. If you had all these steps in place, you had all your deliverables, things you're going to give to patients who say no. I just want to think about it. You could still trial this with real patients. And you could say to a patient, I'm going to make up the words because I'm not a dry eye guy. But you could say, I'm finding XYZ with your eyes. That's why they burn. At the end of the day, we have a new treatment available where I can make you more comfortable. It's going to really be life changing for you. Would you like to move forward? You say, what's it going to cost? And you say, it's going to be $3,300 for four treatments. Now the patient's going to say yes or no or maybe. Maybe is usually a no in these cases. If they say yes and you don't have the device, you could say something like, okay, we're training for this right now. I'm going to get the device delivered in about two months. As soon as it's here, I'm going to put you on a list and I'm going to call you. So now you say this to every dry eye patient that comes in over the next 60 days. You got a list of 100 people who said yes. Now when you go and buy the device, you're not going to get 100 for 100. What if only 20 show up? And I don't know what the number is, but if 20 show up, you just took in $60,000, you'll probably pay cash for it. You don't have to pay any financing fees. So there's no, there's ways. And the more important thing here is not the like, how do I pay for this in advance? Which is essentially what you're doing. You have the cash ready to go before you buy it. What you're really doing is you're testing out your execution plan. How likely is it for the prospective patient to say yes? You gave them something to walk out with. You have something up on your website. What kind of questions repeatedly come out that now you can get in front of. So maybe your presentation should be when they say, how much does it cost? It's $3,300. It's not covered by insurance, but we have in it, we have financing. It's only going to cost you 200 bucks a month. Because the last six patients, they heard $3,300 and they just went like this. And then maybe you get a higher acceptance rate, then maybe you go straight to, it's $200 a month. You don't even mention the 33. So these are all things to do before you write the check. That's like I said, that's the easiest part is to get the capital equipment. That's why I love myopia management so much. You have so many opportunities to try your language. We've already done that. For the doctors, the capital expenditure is way less. For a lot of doctors, it's zero because they have everything. Maybe don't have a biometer, so they spend 10 grand, they get a used biometer. It's three kids and they're rent, they're cash flow positive. Right? If, if they work with us, we're going to give them three kids to cover it. I mean, it's a no brainer. But all these fee presentation things and everything else, we've already done it and we've have it all buttoned up. Doctors can do it themselves. If they don't want to work with us, it's going to take them longer, but they can do it. And if they were going to do something for 2025, they should say, if I want to bring in a new service, I'm going to do it very systematically, very strategically. I'm going to work in execution before I actually do the clinical procedure and go out and invest all this equipment. So instead of buying a Jaguar. Yeah. Which I, which I could have bought for what they're charging for these things, I'm going to make sure this is going to work before I buy it. It's pretty basic, Eugene. It's really not that hard.

Eugene Shotsman (60:17)

Well, and it's interesting because I would call this consistent, age old, tried and true philosophy for a 2025 world where we're constantly bombarded with new ways to try to do things. And all of the, and all the new technology and all of the new, new, new, new, new, new is kind of everything that, and it's, and it's constantly expedited because we're seeing shorter and shorter snippets of it because we have less and less attention span. And when I say we, I mean we as consumers. But this also applies to us as business owners. It also applies to our patients as, as consumers of our services as well. And so you got to think about how do you break through in that time and especially when patients are more and more comfortable taking advice from technology and treating that advice as, you know, okay, well, chat GPT is pretty darn good. You know, it's hidden, it's, it's not hallucinating nearly as much as it used to when it first came out. So you know, how, how do you actually stand out in the eyes of the patient? And I think that this is the year 2025, at least for me as a marketer. One of the things I want to really run a lot of experiments in is targeted patient communication to get the patient to understand the value of that service so that you can kind of use that as a step in the, in any execution plan. Right. So, and when I say targeted, I mean right now most times that practices send things to, to their patients, one of the things that they do is they have to kind of water down the message because it's got to apply to the, the 70 year old as much as it does to the, to the 20 year old. And so, you know, it's, so all that message has to be is Generally watered down so that you know, in the event that you have this and this and this and that. But what if the message actually reached out to a 40 year old man and said, hey, if you're a 40 year old man, you need to know this, this is what's going to happen in the next five years. This is your. When you start seeing, when you start doing the, I don't know what it's called the dinosaur arm or whatever the, you know, when people become presbyopic, this is why you need to see us. And this is why an eye exam is so important for you as a 40 year old man. And they're like, well if I'm a 40 year old man and I'm listening to that, I'm saying okay, yeah, like that's, that's directly for me at me. So I think with the prevalence of what's happening with technology now, I think practices can actually standardize standardized ways to talk to smaller patient cohorts. But do it more often. Right. Because it used to be difficult, manual, whatever. And with technology now you can pre plan like so for the same myopia patient. Like you don't, you can now really focus on parents and then you can even sub segment parents and you can have multiple patient avatars that truly, you know that technology helps you track in your system and pull out of your system and say hey, those are the people you got to talk to, not everybody. Because if you talk to everybody then the message isn't as salient. And yes, you're hoping that 20% will open and some percent will, it'll apply to and whatever. But here if you're talking, if you got a hyper specific message, you're going to get much larger percentage of people saying yep, that is for me and that doc knows me and I'm going to take action on that.

Gary Gerber (63:38)

Yeah. I think the other benefit now you talk about a sniper versus a shotgun. Right. Is really what you're doing. Right. I think the other benefit is the people who get the message who weren't interested are, yeah, it's very easy to click unsubscribe or block your phone or whatever. So you're giving them more, those that are not interested, more opportunities to blow you off. So when you finally do have something you want to communicate with them now you lost the opportunity. So yeah, it gets, yeah, it's, and it's, it's the same, it's the same thought process. When I was talking about executing to execute one thing instead of trying to do everything you know, try to do one thing really well and get it right. 70% of the time, you're going to, you're going to succeed. Instead of trying to do a bunch of little things and getting 10% of it done. And it never really takes hold when, you know, when doctors do that, they'll, they'll go to a, they go to a trade show to go to a state meeting. They come back, they're all jacked up to do something. They want to start doing specialty lenses because they sat through a lecture to get all excited. And I promise you, for as long as I've been doing this, if I was going to read the staff's mind, the staff is sitting there thinking, okay, we don't have to worry about this. In two weeks, it's going to be gone. We're not going to do this. And yeah, the reason they're thinking that, because historically it's always happened, but it's not the doctor's fault. They can't get it done because they're trying to do everything else. They didn't make a commitment to just do that. And the staff knows that all this other stuff is going to continue. The kind of whirlwind of being an entrepreneur doesn't go away. As opposed to if the doctor said, okay, here's, here's what's going to happen. We're going to, we're going to do myopia management, and between now and 60 days from now, we're going to get four kids treated. That's, that's the goal. And here's, here's how we're going to do it. This is step number one. We're starting today. And at the close of this meeting, it's going to say, our next meeting next week. Here's a, here's a preview of step number two. So they know that you mean business because you have a, a plan in place and you show them before the meeting's over. These are the 11 steps we're going to do between now and 60 days. And when you have your meeting a week from now to review how step one went, when a staff member says to you, I wasn't able to do it because I got really busy with the new eyemed forms or the new eyemed Change the rules again, what the doctor needs to say is, okay, I appreciate you working on imid stuff, but this has to get done. So you just don't back down. You have to find way to do both. You got to do the iMed stuff and you have to do this One task that was related to bringing in these, these four myopia management kids. So yeah, you're right. You're able to take a laser approach. We're going to focus on this one thing, not, not solely to the exclusion of everything else, but we're putting an inordinate amount of emphasis that we want to, we want to get this done. So I think if I was going to counsel anybody, what are you going to do in 2025? You're going to get something done, Something significant is going to get done.

Eugene Shotsman (66:38)

All right, so I'm going to summarize. You've got the things to pay attention to in 2025. Optical, retail specialties, myopia, dry eye, whatever, cost management, especially using newly available technology like AI. Then whether it's personalized or laser focused or just avatar based communication so that you're more relevant to your consumer so you can stand out from all the noise. And no matter what you do, really, you got to focus on the age old art and science of execution because execution is what's going to get it done. So no matter what you commit to actually build a plan to make it happen. Gary Gerber, thank you so much for joining me on the Power Hour today. It is an incredible honor again, as I've said before, to be carrying the baton Forward into season 13. Thank you so much for being on the show. Great to have you with me.

Gary Gerber (67:35)

My pleasure, Gene. Thanks. Anytime.

Eugene Shotsman (67:37)

Thanks for listening to today's Power Hour episode. The Power Hour is actually owned by the Power Practice. Power Practice is a premier consulting group who helps practices achieve freedom of time, confidently solve practice issues and grow their practices. They do this by having coaches and OD consultants, people who have actually done it, been there and they're ready to help. You want to learn more, go to Power. There's a bunch of free tools there. You can also get a whole bunch of information and decide whether it's right for your practice. Again, if you're looking for more time, you're looking to solve complex practice issues or grow the Power Practice might be right for you. Go to powerpractice.com to find out more.