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Power Hour Optometry
High-Touch vs High-Volume | Two Doctors. Two Philosophies. Two Exceptional Paths to Practice Growth
01:08:17
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- [00:00]
Dr. Julia Zaden
Foreign.
- [00:07]
Eugene Shotsman
Welcome to the Power Hour, Optometry's biggest and longest running show. I'm your host, Eugene Shotsman. And today's episode is a really interesting one because you're going to hear from two doctors who just met on the show, and they're both building exceptional practices, but in very different ways. My guests today are Dr. David Moore and Dr. Julia Zaden. And as the conversation unfolds, it becomes very clear to me that while they share a commitment to high quality care and using technology to elevate the patient experience, their philosophies for how to run and grow a business are actually quite different and almost from the core. And that's actually what makes this episode so interesting, because when we get into how they structure the exam, how they think about the pace and patient relationships, how they use technology as part of the conversation, not just as a tool, but really as part of the patient experience, how this trend translates to trust and treatment acceptance. We also talk about how they think about hiring consistency across doctors, what it really takes to scale a practice, and a lot of mindsets around how you build a business and what makes the whole concept of entrepreneurship really special. And then we zoom out into growth, adding locations, building, building new exam lanes, bringing on associates, and some fun, very honest lessons that they've learned along the way. I also want to mention that the episode is sponsored by advancing eye care as part of their practice Spotlight effort, kind of highlighting regular optometrists that are doing extraordinary things in practice. But I think this conversation is a perfect example of that, which is a very organic conversation without a whole lot of any sales pitch or anything like that. Quick reminder before we start is make sure you're subscribed on YouTube, Spotify, Apple Podcasts, or wherever you listen so that you don't miss any episodes. And, and as always, feel free to reach out to me with feedback, questions or ideas on future shows@eugene shotsman.com or the power Hour website. And with that, let's go to today's episode. All right, David, Julia, welcome to the Power Hour. Excited to have you both on the show.
- [02:05]
Dr. David Moore
Thank you.
- [02:07]
Eugene Shotsman
Yeah, so I think the easiest way to start this episode is just to get a little bit of background from each of you and your practice so that the audience has some context on each of your journeys. David, why don't you start, tell us a little bit more about your practice journey.
- [02:23]
Dr. David Moore
Sure. So I graduated from U of h almost 20 years ago, and I think I got my license in June of that of 27 or 07 and then I opened up. I think I saw my first patient in my. I just hung a shingle and started a practice. And I think I saw my first patient September 1st of 2007 in my own office and threw together some. We were in an old dental office and changed it to a optometric practice. And my patients. I just had one today comment on the old house that I used to practice in. So I thought I'd be there for like two years, and I was there for 10. So I'm now sitting in our new office. We. So we. I started this office 18 years ago. About 18 years ago. 19, I guess. Going on 19. And so it's a two doctor practice, sometimes two and a half to three, depending on kind of what we have going on and what associates are with us. And then I have another practice that's eight years old and one we just acquired a couple years ago. So I've got three practices. They're all in various stages of growth and maturity and actually in totally different settings. So one's in rural. The first one was rural. The second one was in. The second two are in the city. Two different cities, so.
- [03:48]
Eugene Shotsman
Got it. Interesting.
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Dr. David Moore
And I still see patients about 40 hours a week.
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Eugene Shotsman
Got it. And across your three locations, how. How many total ODs do you have?
- [04:00]
Dr. David Moore
We have. Currently we have three. We need a. We're looking for a fourth, so.
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Eugene Shotsman
Got it. Yep. You're certainly not alone. I'm sure many in the audience can relate.
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Dr. David Moore
That's a struggle, for sure.
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Eugene Shotsman
Yeah, we'll come back to that. Maybe some of the other challenges as you had expanded. Julia, what about your story? Give us a little bit of background and some context.
- [04:22]
Dr. Julia Zaden
Yes. Yes. Thank you so much for having me. When I started Pine Vision Care, I wasn't thinking about having, like, multi locations or anything big. I come from a family of entrepreneurs, and having my own practice has always been in the background. But the real turning point was when I graduated and I tried different settings of optometry. I worked at the va, multi locations, ophthalmology locations, corporates. And I just realized that something just didn't feel right, and it felt a little bit more transactional. There were some limitations, and that's what I realized, that I wanted to create my own practice, and not just to practice optometry, but rather create an environment where I can deliver the care that I. That I believe in. And that's how Fine Vision Care was born. And it's been about eight years at this point. And I expanded to two locations about two years ago. We Are in center Philadelphia, our first location, and then a little bit suburbs mainline in Newtown Square for our second location.
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Eugene Shotsman
Got it about.
- [05:38]
Dr. Julia Zaden
Yeah. About four doctors total, two full time, two part timers.
- [05:45]
Eugene Shotsman
Yeah, got it. Great. And when you said you wanted to deliver a different flavor of patient care than you had experienced from a corporate standpoint or in some of the other settings that you practiced in, go a little bit deeper and define that just a little bit more, Julia.
- [06:02]
Dr. Julia Zaden
Oh, yes. I think it's all about the pace. Right. So the pace been so challenging where patients are scheduled every 15 to 20 minutes. Like what can you learn in that small amount of time? Just like nothing. You need slow down and dig a little bit deeper to learn what kind of problems patients have and learn about their lifestyle and how they use their eyes. And I realized a lot of times patients don't even know how to explain what's going on with their eyes. So you truly need to spend more time and figured it out.
- [06:45]
Eugene Shotsman
Do you find that spending more time with patients tends to lead to a greater level of trust or maybe more a higher value of patient in general in terms of how much they spend in your practice?
- [06:59]
Dr. Julia Zaden
100%. It's, I guess when I want to take this practicing environment, it's not just about going through your checkpoint points and the prescribing glasses. Right. You learning a lot more how people use their eyes and then you provide like real solutions, like solutions to the problems that patients have. And when you spend more time with the patient, when you listen to them, it certainly builds. Builds the trust and it's a better flow and patients are more likely to proceed with the treatment and get the better outcomes.
- [07:32]
Eugene Shotsman
Yeah. Okay, so we're going to come back to this because one of my challenges that I've heard people talk about a lot is how you, the owner, can provide a certain experience for your patients. But how do you get your associates to do that? So we'll come back to you on that point, Julia, but David, I want to turn it over to you and maybe you comment a little bit on what's the flavor of care that you tend to deliver in your offices and is it consistent across all three or is the bigger one different than the other two you mentioned one's in the rural setting ones and the other ones are in city. So just talk a little bit about that and how you, you all deliver eye care services.
- [08:13]
Dr. David Moore
Yeah, I think for the most part they're similar. We tried to create. So I've. And I started three just to kind of go back because I enjoy the process and running a practice, kind of the overarching ideas and themes and how we care for patients and how we want it to look. But I don't enjoy middle management. So I was trying to grow out of, you know, when you're small enough, you kind of have to do, see patients, you can't focus on that as well as you should. And so we've tried to grow enough to where we have some managers over that, that are underneath me that do run operations. And, and in that we, we try to systematize everything across locations to where all the doctors are functioning in the same way. So whereas where one doctor doesn't, isn't having a patient worked up a different way than the other. And it's not all just dictated for me. We try to say, hey, look, if you see a problem or we want to do something differently, then let's all change the way we're doing it. Or if there's a new instrument out or however, whatever it is, we, we try to do it all the same. And, and that's just continuity of care. I practice in all offices for the most part, and so I can get an idea of kind of how things are going that way and how associates are practicing. But what we've learned is if we want everyone to be offering the highest care, we kind of have to hire that doctor that, that wants to do that because you, you know, you can that from school. The, the associates are trained to provide good care, but they may not do it and kind of have a basic knowledge, but they may not have the same relationship building skills. And I think that takes in my, in my rural location, it takes time to build relationships. And so those, we've had more time there. And so those relationships are deeper. Patients know me, I know them. Same with my associates. The longer they're with me, the more they build those relationships. And so, you know, it's not this, hey, we're selling you something, it's we, we trust you, we want to do business with you. I had a, one of my mentors said people have to like you to want to do business with you. And I find that so true and not like this fake idea, but of, of kind of who you are or this misrepresentation, but kind of a genuine relationship. And so we try to, we try to really kind of foster that across all of our locations and get our doctors to understand that the care that we're providing and the, the kind of more personalized, specific care that we, we do, it's, it's all built on relationships. So the patient's got to know you and you.
- [11:01]
Eugene Shotsman
So let's go to some of the specifics. So what are the kinds of things that you do and how many, how many patients do you see per hour? Are all your associates the same?
- [11:09]
Dr. David Moore
We, everyone's the same. Yep. So we try to, we try to standardize that too. We see we have our techs currently that they don't refract, they do contact lens progs. But we, we do three patients an hour and then we do one progress visit. So whether that's a pressure check or dry eye visit or contact lens frog that goes in a 10 minute spot and then we try to offload as much of that onto our staff as we can. So we do lots of testing. So we do my mammography on everyone. We do optimap on everyone. We, you know, every topography on anybody that has astigmatism. So all those things. And then it, so it really, it streamlines our exam. We, we do the, you know, dry questionnaire prior to. So a lot of those things are done and then that way when we get into the room, we can kind of analyze everything.
- [11:57]
Eugene Shotsman
Yeah. Okay. And the conversations with the patients that I, I heard Julia say that you, that it's tough when you're really time constrained to have a super high quality conversation. So how have you standardized your conversations with patients? If you're saying your associates are doing something similar than you are and then how do you hold to that standard? Are you observing your associates? Are you? And really what's that patient experience that you're trying to go for?
- [12:28]
Dr. David Moore
Yeah, I think so. I read reviews. I don't, I don't observe the. Unless I'm just in with an associate on a, a day that they're there. I don't, I don't observe them. But I have a manager that does. My operations manager that's overall my practices. She, she's in touch with all those. So I, I kind of operate like a, like regular associate and just seeing patients and then, and then in my free time I kind of do some of those managerial things. But from a day to day basis, she's doing all of that. So, so she knows kind of how I want it to go. She knows how I do it. And then she's trying to get the other doctors to. And it doesn't have to be exactly the same. But even, even recently we have started, since we, we started doing Optilite and Optilift, we've started encouraging our doctors to Pull up my mammography first. So you tend to get the most patient attention whenever you're at the beginning of the exam. Right. So after refraction and that's kind of rattling to some patients or makes them nervous and then they're in this focus. So we try to get my biomography and optimap all those kind of topography, all those images that we're doing in front of the patient first. And so just from a standpoint of kind of organization of the exam, we, we don't make the doctors do that, but it's encouraged. Let's, let's all try to do it the same way. Cause there's gotta be a, there's gotta be a most efficient way to do this or at least in the way we do it.
- [14:08]
Eugene Shotsman
Okay, perfect. So Julia, back to you. Now maybe you comment on, you're talking about building relationships with patients and having kind of a meaningful conversation. What is your process, what's your patient experience and how do you keep your associates consistent?
- [14:24]
Dr. Julia Zaden
So we try to be, I guess, very intentional how we schedule, right. So we do not overbook. We see about two patients per hour and majority of that time is spent with the doctor. There are no texts. I like, we all like to do our own pre testing and that's the time where you start learning about patients needs. And I, and I love that fact. If we grow bigger, maybe we'll, we'll, we'll use some text. But for now it works out actually really, really well. And as you doing the pre testing, you actually already learning, you're listing the patient and you coming up with a plan and what's going to be next for this exam for the associates. How do I keep everyone on the same. I think it starts with really hiring the right doctors to join the practice. That's like number one step. We hire for personality really because doctors will graduate from similar schools and we have similar skills. But personality, what makes it different? And then the goals that, that the doctors have. So, so we all very, very similar to each other. And then the way we practice and then as far as the tools, there are the same tools and equipment through the, through both locations. So everyone kind of goes through the same flow. I typically train everyone on how we do things here at Pine Vision Care and it's. And like weekly meetings we do to make sure everything is, is done properly. Yeah.
- [16:07]
Eugene Shotsman
Okay, so that makes sense. What are the biggest wow moments where when patients say wow during your exam, like give me a couple examples that really kind of stand out in your mind.
- [16:19]
Dr. Julia Zaden
Yes. And we can tighten this up with the. With the technology. Right. That we have in the office that allows us to have those wow, wow. Moments for the patients. For example, it's the integrated slit lamp with a camera. Camera. Integrated slit lamp. And when I show the patients their meibomian glands, their eyes in. In. In focus and. And up close, they just. They always bowed by that. They say that they've never seen anything like that before. No one ever explained it the way we explain it to them whenever we do still aptos. So the picture of the back of the eyes and I zoom in, I play a little video. When you go through the pupil and you see the retina. So that's another bowel. A lot of times that's about moments. Yeah, yeah.
- [17:15]
Eugene Shotsman
And when patients see these things. So, for example, let's talk about the meibobian gland component. And does that lead to a higher treatment acceptance on something like a dry eye treatment? And what is your treatment acceptance rate for things like dry eye?
- [17:34]
Dr. Julia Zaden
Absolutely. Whenever the patient sees. So we can talk about what's going on with the eye, but when we can show it to them, it makes the patient understand it a lot, a lot better. Right. And in general, the flow of the exam becomes more seamless. You going from. Because I feel like in traditional optometry, everything is so like fragmented. You do one test and another test and another device and then you manually putting. Putting the recordings in the computer. But when you have an integrated system, it's a better flow for patients. It's a seamless exam. And definitely the trust. The trust goes up and. And they. The acceptance of the treatment goes up as well.
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Eugene Shotsman
Got it. And do you. Do you know your treatment acceptance rate or your capture rates in either treatments or in your optical.
- [18:36]
Dr. Julia Zaden
As far as the. The optical. So like with contact lenses and then the glasses sales. So we are about. About 80%. We're a little bit higher than I think than the average. We're about 80% for contact lenses conversion rates and then the glasses at about 50%. Currently something that we're working on with the dry eye. Dry eye and specialty treatments like myopia. Typically people find this already. Um, they either are referred to us or they've been. Majority of people actually are being referred. So. So the conversion rate for treatment, it's actually quite high. So for people who are already suffering and then they've been referred specifically to us for either dry eye treatment or for myopia management.
- [19:24]
Eugene Shotsman
So, David, has specialty been a big part of your growth over the last few Years.
- [19:31]
Dr. David Moore
Yeah, for sure. Over the last year. Yeah, I would say from COVID kind of forward we were, you know, we grow like 3 to 5% a year. And then last year we really kind of made a big push to implement technology, whether it's the Al myopia or the Optilite and Optilift to, to really implement those, get our processes down, get everyone trained on it. And that's been probably a six month process. And now I think we have like a three week waiting list for our Oculite and Lyft and then we do those in all three practices. Right now we actually, I have the same staff member that we've trained. She goes, she takes equipment to each office. So we haven't purchased individual equipment for that for each office yet, but that's working really well. Um, and I, I think probably for a larger location, last I looked, we were up 10 to 15%. And then in February when it seemed like really January, February is when some of those, the, our dry treatment plan and cut was fully implemented. And I, I want to say we're. For February, we're up like 18%. And for a larger practice, I mean, that's like great growth. You know, I couldn't ask for anything, anything more than that.
- [20:54]
Eugene Shotsman
So the, and you're saying your dry eye program is driving a lot of that growth?
- [20:58]
Dr. David Moore
Yeah, yeah. And we do. We were fortunate enough to, to get a. Your opticians obviously make or break your optical and your optical cells. I mean, the doctors. Right. You got to prescribe from the chair and all that. But you know, between the handoff and all those things, you still have to have very competent opticians. And, and so we were fortunate to get some really great opticians here recently. And so that, you know, immediately we saw our capture rate go up by about 10%.
- [21:27]
Eugene Shotsman
And so let's, let's go through your numbers and then I want to kind of circle back to your point about three week wait list for your dry eye program. So let's start with optical capture rate and then maybe treatment acceptance rate for some of your specialties.
- [21:43]
Dr. David Moore
Yeah. So historically in a rural clinic, we've been like. And it goes up and down. So if I hire a consultant or I have a, you know, great optician at the time at, you know, we're over 50%. And then if I. And then we kind of baseline to about 45% capture rate. And that's not lens capture rate, that's full frame. So our lens capture rate is closer to 60%.
- [22:08]
Eugene Shotsman
We have a lot of lens Only.
- [22:10]
Dr. David Moore
Yeah, yeah. So we are, right now we're over 50% in just complete pair capture rate. But, and then contact lens, we're probably, we're over 50% but we're still probably behind a lot of people. We're 50% daily, 50% monthly or weekly. And, and then our, our city locations, we've got very experienced opticians that we've had for a long time that are career opticians. And so those Capture rates are 60%.
- [22:43]
Eugene Shotsman
Okay, so what about your specialty treatment plan, specialty acceptance rates?
- [22:49]
Dr. David Moore
I think we're probably 30% at this point. And I would tell anybody that's doing that it's really hard to. Until you kind of get your flow down and understand like, okay, what do we really include as a capture and who is our. To find the audience of hey, we're presenting this and did we capture that? It takes, I, I'm going to say it takes a year, takes at least nine months to figure out all those things. And so we're new to some of that like really being able to nail down our capture rate. That's just kind of a. Anecdotal. I feel like we're probably about there just based on our, our weight and that kind of when we started stacking patients up that needed a, needed extra treatment. But I would tell, I would tell you that our socioeconomics is a big driver for like those higher end or more expensive treatment plans for optilite and lift and also myopia control. And. But it's interesting our, one of our city practices and our rural practice have the same average, or about the same average household income. And our rural practice is far more accepting to the treatment plans that we present just because of the relationship that we have with them in the city. It's just harder to have those relationships because it's, it's, there's, there's more competition. Optometry is more of a, it could be commodities to some degree just with all the opticals and all of it. So, so rural definitely is easier to capture for sure. On.
- [24:34]
Eugene Shotsman
Well, that's interesting. That's an interesting observation. I've often heard the opposite, which is, hey, in our rural practices we have a harder time capturing because you know, those practice, those patients only come in when they absolutely need something or those patients tend to be more price sensitive regardless of average household income. But it's interesting that you're saying it's, you have a better relationship with them and therefore you actually have a higher capture rate. So what is in. I'm just curious about some of your learnings because you said you guys just deployed this dry eye program and, or you just got good at it. So what are the kinds of mistakes that you made along the way and what are the kinds of things that you're like, if I were to start over and I were to offer someone a shortcut to like do it right the first time, what are the kinds of things that you wouldn't have done? What are the kinds of things that you do now in your dry eye program that are kind of, that kind of bypass some of those mistakes?
- [25:34]
Dr. David Moore
Yeah, I think implementation and like a real realistic expectation of how long it's going to take to really kind of get that snowball. It's just like a snowball because it's almost like an annuity in the fact that people need continued treatment. Right. And it works. And so we are confident, we don't really shy away from offering the treatment. It's kind of like our first line of therapy now. And so patients are starting to learn about it. Maybe they said, hey, I don't want to do it this year, but I'll do it next. And so we're kind of seeing it in, in a long term fashion where we're going to educate patients on it and if they do decide to pass on it, we're still going to talk about it the next year because it's, we still believe it's the best treatment, but it takes a while. You know, it takes, it's going to take really. You should plan three months before your implementation of. I'm going to start gathering patients, we're going to make lists, I'm going to start educating them, I'm going to send them emails on new technology that we're bringing in that could help their problems. And then, and then it's going to take, you know, probably three months of really figuring out how do we work this into our practice flow because it, you know, it takes a long time to do, to do those, to do the screenings and then, and then for patients to come back on varying intervals. Just our, so our tech, we've realized like, okay, it's best for the person that's doing our treatments to, to also kind of control that schedule. And so we've made little changes along that, that time. And I would say really we started looking at the technology this time last year. We had it brought in three months later whenever it started becoming more available with production kind of issues from COVID and then, or whatever, whatever was, I think it was supply chain problems and, and Then they got roll in. So we brought it in and then really kind of nine months later, we're, we're, we feel like we're in good fit footing. It's, it's comfortable. It's almost like we've been doing it a long time. I think preparation and in advance a system and then being willing to like modify it and change it over, like really kind of analyzing how's it going and then making those changes over a six month period and somebody does that, you know, it's already, ours is already paying for ourselves itself. So that, but you know, for probably three to six months, you're gonna, that's that, that payment that you make is. You're gonna eat, eat that.
- [28:09]
Eugene Shotsman
Whether it's no unless like you said, you kind of get started ahead of time and you say I'm gonna start, start the planning ahead of time, start the patient education ahead of time. And then by the time it makes sense to have our first payment, I've already made. And I think one of the big things you said is when you, the providers need to be super confident in it and need to feel like this is the right, this, this is the right thing to do for the patient and not try to manage the patient's wallet. Right. And try to more manage the patient's eye health. And so that makes perfect sense to me. I think both of you have talked about technology. Let's get specific. So Julia, you had talked about technology being a core differentiator in your exam. Why don't you just tell me what technology you have in your office and you recently opened your second office. Like what, what is the technology that you rely on day to day and how do you use it and why did you select that technology?
- [29:09]
Dr. Julia Zaden
Yeah, so with the technology, Technology for me has always been something that improves experience, improves patients experience in the office. So when I thought about when we first started our first like the first practice, I wanted to have that seamless, seamless integration right from, from the patient comes in, we check in their glasses, we're checking their auto refracting measurements and then we're doing the opto optimap. And then with the. This is by the way, another wow moment is when, when you take that little card, right, like the Marco card and you put it in your phoropter and all those, all those numbers go into the machine and people like wow. Like it went from the pre testing room to the exam room and it's all there, it's on the computer. So they, they've been wowed. By that. And that also makes just things so much easier. Right. And so much a much, much better flow. So. So that's to start with that something very simple. And then when you transferring the data from. From your machine to the computer to their chart, and then you're able to show what the current perception is. Touch of a button, you compare it with a new perception. So that's just little things like that makes a difference for the patient. And like I said, it builds the trust, better outcomes. We also have the slit lamp that has integrated camera. So. So this life recording made a huge difference for us. So as I'm recording and then the patients can see the big eyeballs on the. On the big monitor and then I can go in and show everything in detail. I can play the video, I can take pictures. So.
- [31:00]
Eugene Shotsman
Yeah, yeah. And it sounds like that's the. That that's a big part of why the patient chooses to come to you is that there's a high touch, high technology. And it also sounds like your exam is very visual. Let me show you. Let me explain to you. Let me play the video for you. That kind of thing. David, do you have a similar experience as a. Like, you guys do a lot of show and tell during your exams?
- [31:25]
Dr. David Moore
For sure. Yeah.
- [31:26]
Eugene Shotsman
We.
- [31:26]
Dr. David Moore
We kind of have the same. We follow the same ideology. If I'm looking at it, I show the patient. So optimap. So what we do optimap. My biomography Oct. All of those things are piped into the exam room topography. And so we'll pull all that up and go over everything, explain all those details. And that quite honestly, it's an easy differentiator from somebody that's doing. And I would obviously between Julia and I, we're. Our volume's different. Right. And kind of some different ideas there, but we still use the same ideas for. For show for using technology and showing patients or educating patients. I think the patient education aspect is really kind of the first idea, first concept of relationship because then they know because everybody's doing it. It's not like. It's not like ods or idoc. Ophthalmologists, optometrists are not looking at those things. Right. They're just not maybe explaining it or showing it to the patient. And so. So I think that's just an easy differentiator of kind of trying to build that relationship and trust and answering questions and slowing down a little bit to. To be able to do that. Yeah.
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Eugene Shotsman
And it's interesting because I once I was with a colleague when she was
- [32:55]
Dr. David Moore
doing a
- [32:57]
Eugene Shotsman
kind of a secret shopper slash practice consulting visit. And one of the things I observed is that the doctor is looking at a 17 inch screen or an 18 inch screen or something relatively small when they're talking, when they're, when they're reviewing, you know, and it's the same screens, got the chart, it's got the imaging. And even if they were to turn that screen to the patient, it's also small and kind of silly. It sounds like, Julia, you've got like a big screen that you're showing the patient.
- [33:26]
Dr. Julia Zaden
Yes, big monitor. And then Senesit is a small office. So in the city, spaces are tinier. So the patient can literally see the big screen right there. They can just turn their head and new down square location is a little bit bigger space. So I actually bring the chair to my desk, I sit them right here and then I blow things up right on the, on the big, on the big. I don't know how many inches is that? 50. The big screen. So they, they can see everything. And it's. Yeah, absolutely. It's just education is a huge, huge aspect. It's just like when each of us, right, we go to the doctor, like, I want to understand what they're talking about. And I remember like majority of the times you listen and then just doesn't stick. It doesn't stick. But when you show it to you, it's like, okay, that makes sense. I think it's just making sense. I think that's my philosophy. Everything has to make sense, sense. And then I constantly ask my patients, does that make sense? Like, can you visualize it? Does it. Is that. Are we on the same page? And they really appreciate that.
- [34:25]
Eugene Shotsman
Yeah. Okay, when we come back after the break, I'm going to ask each of you about your experience of opening the new locations or adding locations and kind of some of the technology decisions that went into that. So we'll be right back in the power hour.
- [34:36]
Advancing Eye Care Representative
Here's a question every independent practice owner is wrestling with right now. In a market this uncertain, what does it actually take to be build a practice that lasts? Economic pressure on independent optometry is real. Patients are more cost conscious than ever. Staffing is harder. And technology decisions made at the wrong time with the wrong partner can set a practice back years. The practices winning right now have one thing in common. They stopped treating their technology partner as a vendor and found a partner. Advancing Eye care is the largest ophthalmic technology and service organization in North America. But what makes them different isn't scale it's approach. Before they recommend a single piece of equipment, they start with a business analysis of your practice, your workflow, your patient mix, your revenue model. They'll tell you exactly what you need and what you don't. Their service team, the largest on the continent, doesn't wait for things to break. They're proactive, fast response, and built around a simple reality. Downtime cost you patience. When it's time to invest in technology, they structure financing around your ramp up and they stay with you long after the sale. The two doctors you're listening to on today's show, both building exceptional practices, both making smart technology decisions, both with the right support behind them. Today's episode is proudly sponsored by advancing eye care as part of their practice SO Spotlight series. Because they believe the most powerful case for partnership isn't made in a sales pitch, it's made by your peers. When you're ready to stop buying equipment and start building a practice, visit advancingicare.com
- [36:16]
Eugene Shotsman
we're back on the Power Hour. Julia, David, thank you for being here. And I want to talk about learnings with second location, third location, and in general, how you made decisions as you open these locations. So, Julia, I'll start with you. And it seems like, you know, you, you have an interesting business model. And I'm curious, not just second location, but like your first OD hire and then expanding your OD team because it seems like in your practice the ODs do a lot and they, and they deliver a higher level of care, but they also deliver that. But they also sounds like they do their own teching. They handle kind of all aspects of that patient visit. So how did you decide to hire your first optometrist in addition to your location? And then when did you decide you were ready to add another location and kind of. Let's talk about that journey.
- [37:16]
Dr. Julia Zaden
Yeah, great question. I'll start from, I'll start from the start. So when I opened the first practice, I had two little babies. So I had a toddler, my two year old and then my middle, my middle boy was just born. So yeah, that was the beginning. And I worked a lot and for about a year and a half it was just me. And actually in the beginning, I'll tell you what, it was me at the front desk, me at the exam room, and me at the optician because I haven't done my first hire yet at that time. But a couple months in I did, I brought in the first person that I interview and the first person that I, that I hired. I Learned big lessons on hiring. I've never done it before, so I had to go through, through these challenges. And then. Anyways, so I worked for about a year and a half on my own. And then the kids were growing up and I wanted to spend more time with them. And I think at that time I might have been already pregnant with my third kid. It was like, okay, this is the time for me to start, step out and, and to go on an official return. Right? So I started. I don't, I don't know if I, I just, I was just pushed to look for another doctor. And I wasn't sure if I'm gonna bring someone part time or full time, but I started looking and I hired another female doctor. And I was still trying to go to the practice, but then early on I've noticed that the practice is, is. Is able to, to grow and sustain and grow with the new doctor and me not being there and even backtracked for that. When I started Pine Vision Care, the examples that I had around me were all the practices with the doctors who worked in these practices for a very long time. Like they worked for 20, 30 years. And then they slowly started to bring an associate for the exit strategy.
- [39:20]
Dr. David Moore
So
- [39:23]
Dr. Julia Zaden
I, I didn't think that bringing a doctor, an associate doctor to a practice early on was an option. And I thought that I needed to be there and build it myself first before I bring someone in. So what happened was the, the doctor we hired and not only the practice was able to survive, but the practice grew so much. And that was that neuron connection that I made in my brain that never left me. I was like, okay, this is possible. So not only that I was a doctor with my practice now I became a business owner. I think that was actually that, that light and bulb moment when I, when I thought of myself as a business owner. And I even. I even remember it was, it was a. I think it was. It was one of the seminars and I was a speaker and I prepared a speech about me being self. Semi retired. That's what I called myself. I thought in that moment that I was very close to my retirement. It was so funny because the practice, it was just so happy because the practice was working, someone else was working there. We were still getting amazing reviews and. And here I am with my kids and I was able to get to stay home to take care of my kiddos while they were little. And I was, wow, like, that was such an amazing moment. And then that moment gave birth to the next neuron connection. Is what okay, so how can I improve my business? How can I. How can I grow it now? So that's when I really started looking into, you know, like the measurements and KPIs and systems and processes. Because then I became a little bit more. I wanted more like it was growing, but now I wanted more growth. And that's where my like business owner journey started. So.
- [41:36]
Eugene Shotsman
And then the new location, what was it like opening that new location was
- [41:41]
Dr. Julia Zaden
a little bit different. New location is so close. First of all, it's so close to where I live. It's like within 10 minutes. So it's very easy for me to get to. And I'm still able to take my kids to school, pick them up, take them to their soccer and all the extra activities that they have and then being able to. So I feel like I'm a little bit more in charge of my schedule here. And then I can even see patients like on the fly. Like, if someone wants to make an appointment, I'm available. I can always get to my practice within 10 minutes. So my front desk can call me and say, Dr. Zarina, this patient wants to be seen. Can I bring them in in an hour? It's like, sure, I'll be there for this practice. I haven't brought an associate just yet, but I'm planning, planning for it. And I brought another doctor who is a part timer in pine. In senecity location. And then she wants to expend her days and hours with us. So honestly, soon, I probably think in next month I will give her an extra day in this practice. And that's going to be the beginning of adding an associate to the second location.
- [42:52]
Eugene Shotsman
Got it.
- [42:53]
Dr. Julia Zaden
And there's also, you know, there's also. I feel like there's like this psychological moment when you bring a new doctor. You feel like you need to bring more patients in. So that just. That's gonna push me and that's. That's something that works with me. I'm the one that's gonna burn the. Burn the bolt to get. To get somewhere. So I, I do that. But, you know, sometimes it works.
- [43:20]
Eugene Shotsman
Yeah, no, it makes perfect sense. But David, you had a different journey. Talk a little bit about yours.
- [43:26]
Dr. David Moore
Yeah, so I'm kind of the old model of. And I. We're probably. I don't know. When. When did you graduate, Julia?
- [43:32]
Dr. Julia Zaden
2015.
- [43:33]
Dr. David Moore
Okay, so we're probably just that enough of that. Different. Probably old. I'm. I'm more in line with the old school versus the new school. We're just generally a little Bit different. And so I started. What's that?
- [43:48]
Dr. Julia Zaden
I started late.
- [43:49]
Dr. David Moore
Okay.
- [43:49]
Dr. Julia Zaden
So, okay, optometry. I was already, I think 20, 26 or 27.
- [43:55]
Dr. David Moore
Okay. Yeah, I graduated. I think I graduated when I was 27. And but my. So my. I kind of grew up in it. My dad was an optometrist, and so I had a lot of his old friends that were mentors. And so I kind of saw how they did it. And that was, hey, you're the producer. You know, you're the. You grow it until you need somebody else. Then you add somebody and you kind of grow that way. And so that's what I did. I worked for seven years and kind of grinded that out, Grew it and was fortunate to be in a great location, good community that needed a. Needed care. And so we grew pretty fast. I heard my first. It was my wife and I first. And then I think we hired our first employee at three months and then our second at six months. And then I think I paid myself first at six months, which is great. Um, and talking about just efficiencies, obviously Julia is like really efficient. Low, lower overhead. I think we have. I don't know, we may have like 22 staff members. 22 to 25 staff members across locations. And so obviously you're. I always have this idea of like, hey, there's gotta be. There's gotta be patients in the chair and we need to be seeing patients. Somebody does all the time. And so when you have. And I do think, you know, so we could. We can talk about technology. And I do think as artificial intelligence starts taking over some of the pre testing and some of the appointments and insurance type, like, we will get more efficient in. In our front and back office sides and it'll make the optometrist. I, I feel like for a while we'll continue to do what we're doing, but it'll. It'll help with our margins. And so. So yeah, I think it's really interesting to contrast. Like, I've got a huge staff and Julia does equal care and kind of is a little more nimble. So, yeah, so we're. So I took the other approach. We. We grew, hired more staff. As soon as you hire a doctor, you feel like you gotta get busier. Cause they're very expensive and. And being in a smaller rural community, we're about an hour outside the city. There's not a lot of opportunity to hire a doctor for one, two, three days a week. And they may be like working somewhere else. So it's Like a huge commitment. You're like all in four or five days a week. And of course they're not going to be completely busy at first, but so in longevity in a smaller community matters. So when I talk to our new associates and say, hey, look, this isn't like, hey, you're going to come out and get some experience for a year or two and then go away like that. That's like worst case scenario for. For the practice. We really need you to commit, want to be here and stay. And. And so I do have a great doctor here that. That is. Is been with me for eight years and she has her own patients. And so that allowed me just having a really good foundation for a second doctor, allowed me to go start the other. The. The other office. And I covered that one for a while. Um, and that was a more expensive. I think when I first started my. My first practice for the. The entire note was 250, 000 for all the equipment, the building remodel. My rent was 2,000 bucks a month. So it was fantastic. You know, now we're. I think my build out for my second location was 700,000. I mean, just nuts.
- [47:22]
Eugene Shotsman
That's just the buildup then equipment and all that other stuff. So now you got a big note
- [47:27]
Dr. David Moore
to carry you maybe for the second practice. And then you, you know, you start up and try to cash flow all that stuff, and you're just kind of waiting on the turn. And unfortunately, our turn was at Covid. So, you know, we're. We're. That practice is growing, getting there. I've got a good associate that patients alike, and so that's been good. But I. I did kind of go through the school of hard knocks, just more in line with COVID kind of issues, which I'm sure a lot of listeners can relate to, especially if they've gotten out or tried to start an office in the last three or four years. So that was interesting. I learned a lot of things. I wish I had always had more cash. But then on the third practice I had, interestingly enough, this is kind of a sidebar. We had a mobile clinic. And so we saw like a lot of demand. And we started that unfortunately in 2019. And then all the everything, assisted living, independent living, we didn't do nursing home. But all of that shut down. So we kind of sidelined it and I had to find space for. I was looking for space for my staff because I didn't want to have to lay a bunch of people off. And so anyway, we. We started that Back up and then, and so that's kind of the impetus of why I needed a third practice. Because we just ultimately decided, okay, we're gonna kind of shut that down. And then. But I wanted to keep the staff and so I bought another practice and that one was a rehab. It had had, it had been a practice for 40, 50 years. Two doctors that whole time. And, and so that was interesting. I ended up having, buying that, thinking the doctor would be around for probably a year. He ended up having some health issues and never, never stayed with us. So it was like, that was another catch in the, in like a lesson learned. When you buy a practice, you gotta try to keep the, keep the doctor for a while. Otherwise it just turns into kind of a semi startup. And so we're, we're working through that. I've got a great associate now. We just moved locations so changed the name, gone through all those things. So it's been, it's been. So I've kind of learned three different lessons like an initial low cost startup, a second kind of more high end expensive startup and then, and then a rehab.
- [49:49]
Eugene Shotsman
Is there a unifying, kind of an, an overarching unifying set of lessons across those three different scenarios?
- [49:58]
Dr. David Moore
Yeah, have, unless you're like independently wealthy, have, have a lot of cash or a good banker, you know, those. And then I think, you know, realistically like we have, I think if you walked in, like I have patients that go in between all of them and our staff is, is the most key. Right. Like so having that customer friendly relational staff where when they, they, the offices may look a little bit different, but when they can go in and get the same feeling. So like my, my first office is in what would be considered the cowboy capital of the world. It's what we, the town calls itself. And so a lot of western lifestyle, you can imagine a lot of ranchers and you know, cattlemen, oil people, that kind of stuff. And so those, you know, those patients are, they're just, they have a different lifestyle than my city patients, but yet my rural patients, when they go, they can't see me in there. They'll sometimes go to my other location and they're like this place is great. So I feel like when those patients any of my pay and then I've actually had city patients travel to my rural location that's an hour away. And so when, when people do that and they're like, yeah, this is great. I feel like we're doing a good job. If the symmetry is. And the customer service and that relational Aspect is, is the same between the offices because obviously I'm the same, the equipment's the same. So it's really just the staff and that kind of relational side.
- [51:36]
Eugene Shotsman
Yeah, it's interesting because I think both of you talked a lot about equipment and obviously opening a new location or adding team members, adding lanes requires equipment purchases. So talk a little bit about some of your decisions of who you choose to partner with and why. Like why do you decide to buy equipment from the people that you choose? How do you keep equipment from becoming, I'll call it, you know, just the expensive coat racks or you know, dust collectors in a closet. What are some of your lessons, Julia?
- [52:10]
Dr. Julia Zaden
Yeah, great question. So I think with the first location, I think I went on one of those exhibits. I think I asked around, I think I asked around and see what other people were getting and someone introduced me, maybe there was a Vision Expo, one of those exhibitions and I was introduced to Scott and drew from Marco Co. And they, I just love their personalities, honestly. They were just so laid back and at the same time very professional and at the same time just not pushy. I think they guided me through, they showed me the equipment, showed me how everything worked. And I also like the aesthetics of it. And because I was building this new practice and everything was new and I wanted to have that a little bit of that luxury feel to it. So I really love the aesthetics. And then I mean as far as the magnification and a little tools on the equipment, they pretty much very similar throughout and I just loved working with them because they answered all the questions and it felt in that moment that would be there for me whenever I needed them. And it actually how it's how it's been. If I ever have like a small malfunction of something or the cord came out or something that I can't, you know, figure it out. Like I can just text them. Like I text them and they text me back within very short period of time. So I think the biggest thing is probably a support after the purchase. That's the, the biggest game changer. But technology is, it's the, they're all pretty good technologists throughout but the way they're going to treat you after you purchase, that's, that's the biggest, I think the differentiator. So I enjoyed working with, with their company so much. Then when we opened second location it was kind of like a no brainer to do to replicate. And plus I haven't had, honestly I haven't had any single issue. Hopefully I don't jinx myself, but I haven't had any issues with the equipment and I honestly haven't had any issues. And they have good covers for the equipment that are very waterproof. Because what happened a year ago on the third floor, there was a water heater that broke and it flooded. It's flooded this beautiful space. Like everything was like, flooded. And it was during Christmas break and that was the way. And also speaking of having an amazing team, so one of our team members, Amy, was here and she handled it so, so well while I was away. But that little cover is saved. None of my. None of my equipment was damaged. Not the optimap, not the order, not the lensometer, not the slit limb. Because they had the covers on.
- [55:29]
Eugene Shotsman
Wow. So the reminder for everybody who has covers, put. Put them on the office.
- [55:34]
Dr. Julia Zaden
Yeah, yeah. Not sick. And who would have thought I'm like a water heater on the third floor. It was just. You can't even think about this.
- [55:43]
Eugene Shotsman
I am interesting. David, what about you? What, what are your. How, what. What kind of things guide your choices in who you choose to do business with when you're buying equipment and then also when you were expanding, what are some of the choices that you made?
- [55:59]
Dr. David Moore
Yeah, I. So I've done this both ways. So I had a couple. So initially when I started up right out of school, I was trying to save money. I bought a few pieces of equipment that. And they weren't like. So one was a field and the other was a camera, retinal camera. And that company was not, um, they just hadn't been around long. And I've never seen the company since. I don't use those instruments anymore. And so I think buying from that lesson. And then I've bought a couple other pieces of equipment that were new and kind of innovative, but the company longevity wasn't there. It was kind of a startup and I've. I've been bitten a few times with that. So initially when I started, I bought. I bought a two one lane. One Marco lane with manual for optor. An ark. Because one of my mentors was like, hey, you got to buy the Marco Nidec ark. It's dead on. You just won't have trouble with it. It works forever. And so I bought that. I bought. I think I bought three or four cents. And. And then I've just kind of added over time. We have 12 lanes with automated for opters across the. The clinics with Marco lensometers, arks. Now Myopia. Al Myopia. So all. All of our stuff is Marco because of just they're there kind of like Julia had said. We they. If I text or call, they're here. You know, like I, I have a new rep now, but when Dave was my rep in Florida, across my locations and he'd be somewhere else and he'd be like, oh, I'm in, I don't know, Oklahoma. And then he'd just like show up later that day to like fix my problem. Like, you know, it's kind of like the butler on Mr. Deeds. If you. That maybe, you know, just appears so that that's been great. And just through that relationship, I'm the, the equipment works. Right. And there are other competitors to Marco, but that's who I started with. It's who my mentor said to start with. That's who my, my dad's equipment was in the 80s and 90s. And so the, so it's been great. They have a great partnership with vision soarers who I'm a part of. And, and so as we. As, as new innovations have come along, if they have that op option or opportunity to purchase through them, I just go ahead and buy it through them because I know the pricing's good, they're very fair. They help me with financing a lot of times with those. If you're bringing in something like the Ale, the Ale Myopia, you're, you know, it's still going to take at least for us. We. I've kind of realized over the years, hey, it's going to take me three to six months to get this going when the payments start. And they're always judicious and helpful about, hey, this will start in three to six months and gives us time to get going. So I think that you talked about
- [59:02]
Eugene Shotsman
that earlier is a big component is
- [59:04]
Dr. David Moore
work, you know, having an equipment. One is the service good. Two is your. How's the relationship if you do have a problem? And do they, you know, are they. Are they good with helping you get financing and all that kind of stuff?
- [59:16]
Eugene Shotsman
Yeah. And giving yourself the opportunity to build up when you, when you buy it. Right. Is part of the equation. I is kind of my last question. I wanted each of you to reflect on the difference in the way because there are some unifying factors here, right? You're, you're both high technology practices. You both, you know, you, you both use the technology in as. As a tool to drive better patient experience. But you both have very different ways that you approach growing a practice and also, and also just kind of your, your practice model. So I want to Take a moment and just ask each of you to kind of reflect and see. You know, one of the, One of the things that's fascinating, of course, is like anytime you talk to a colleague, you're like, oh, I can learn that from this person. I can learn this from that person. And I wanted to ask each of you to reflect a little bit on what are some of the differences that you noticed and what are some of the decisions that. Or maybe some of the things you want to look into a little bit more. Julia,
- [60:25]
Dr. Julia Zaden
as you were asking this question, I had so many thoughts and then they just. Yes. So let me, let me collect myself. Speaking of equipment, I just wanted to circle back. At that time I was also a vision source partner. So I think that pricing also made sense. So it's not just, you know, the relationship and that, but also the pricing was like 30% off or something. Like that was great. With as far as the. Yeah. Reflect back, I think like the biggest thing, right. If you, if we are. I remember, I remember I was listening to someone who was a private practice, and then this doctor sold his practice to private equity and he was much more. And he stayed on board for some time and he was just much, much happier that he didn't have to deal with like day to day and then managing people and patients complaining about $10 copay and things like that. And I was just thinking to myself that I think I actually enjoy being a business owner in a way that I am curious about figuring out, like how, like about the problem solving just like to my specialty. And I do a lot of. I do a lot of binocular vision. I do a lot of prism like stuff that not everyone likes. Right. And then they. I get like, I think the most challenging glasses prescriptions and, and yeah, when people can't figure out the prescription, they send those, those patients to me and I'm able to figure it out. So I just, I. I enjoy to, to. I love being curious and think outside of the box and figure out the problems. Right. And the more challenging, the better. And I think with owning a practice, it's almost like I didn't start as a business owner, I started as a doctor only. But having that trait of loving solving the problems helped me to grow my business. Because whenever there is a challenge, like if there's gotta be, there's gotta be a solution to that or it's gotta be a route to that problem, if the patients complain about $10 copay right. In the office, then maybe we need to address that and figure Out. Where is this coming from? Maybe we're not communicating. The co pays ahead of the exam, so no surprises. And also being transparent and giving patients to make their own decisions. So if they don't want to pay this amount in your office, they don't have to come in, then they can make that decision. So then you don't have to deal with it. So. So I guess the takeaway. My point here is that if you truly in owning your. Want to own your practice, want to open this, be ready, be, get prepared to fall in love with the process and follow, not fall in love with, with solving, Solving the problems. And then the second thing that comes to my mind is just like on my, from my experience, right on my example, you don't have to wait very long time before you bring an associate in. And I think it's even maybe harder sometimes to bring an associate later on because everyone is just so used to you and you being the only doctor there. So it's actually when you bring someone earlier on, it can, it can work out even better. So people are not. Yeah, they're not used to just seeing you and then there's another doctor. And then that also gives you an opportunity, step out of the practice a little bit and have that time. Like what I do, right, what I've done, I stepped out. And that gave me an opportunity to look at the practice as a business and improve the systems and improve the processes because it's really, really hard to zoom out when you inpatient care. And I separate the days when I'm only work on my business from the days when I see the patients. Because when I'm with the patients, that's all I can think about, the patients. Even if it's four patients a day, my whole day will be thinking about them. Like, it's really hard to switch that focus. Okay, I'm going to see the patients for this hour and then the next hour I'm going to be focusing on my, you know, on my business. So.
- [65:15]
Eugene Shotsman
So, yeah, that's great. Thank you. And interesting, interesting nuggets of advice. Thank you, Julia. David, your thoughts?
- [65:25]
Dr. David Moore
Yeah, I think so. I've had an opportunity to kind of go through different phases. I was at Julia's phase and then realized that I don't enjoy being a middle manager. Like, I don't want to, I don't want to manage staff. I don't enjoy. I want to see patients and I kind of want to have the. I want to be the CEO. And, and so that impetus, once I kind of realized That I wish I would have known that like starting out, but once I got into that position and just didn't enjoy that kind of pull between patient care and, and then the, the day to day management of it, I, I realized like, okay, I gotta grow. And, and I think, I think two is a really. And the way Julia's doing it, it's probably, I, I think she's kind of pacing it well enough. But 2 is hard, 3 is a little easier, 4 is probably 4 and 5 are probably even easier than that because you have more systems and more people to help. But I really enjoy, I'm to a point where I really enjoy the way that we're practicing. I would have done lots of things different, but I think all of those things I've learned valuable lessons. But me being able to show up. I just interviewed or talked to a young OD that we're looking at bringing on and talking to. And I always disclaim to ODs like, hey, I'm, I'm not the, I'm not the manager. So you know, there we have people that take care of those problems. I don't want, I think ODs do like a really good job with patient care, but we don't make, oftentimes don't make great managers because instead of having those relationships with our staff and with patients on that business side, we just kind of go in and try to put out fires all the time. And that's just not the best way to run a business. And so I've, I've been able to kind of separate that. So I think, I think from where I am at this standpoint, I'm really enjoying patient care and I can do it for a long time. And then it's just trying to backfill as I slow down. It's trying to backfill with great ODs. So did I answer the question? Yeah.
- [67:39]
Eugene Shotsman
And just interesting, just again, interesting phases of practice and there's some really unique similarities and then there's also some just very different ways that each of you approach your, both patient care and the strategy with which you run the practice. Fascinating conversation. Thank you both for being on the Power hour. I think we're out of time for today, but I think it's been really insightful and I appreciate you both being as guests.
- [68:05]
Dr. David Moore
Yeah, thanks so much. I enjoyed it.
- [68:07]
Dr. Julia Zaden
Thank you for having us.