Low Vision Myths Busted: How One Practice Earns $600K Seeing a Few Patients Each Week

Summary

Podcast Summary: Power Hour Optometry Episode Title: Low Vision Myths Busted: How One Practice Earns $600K Seeing a Few Patients Each Week
Host: Eugene Shotsman
Guest: Dr. Richard Schuldiner
Release Date: October 11, 2024

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Introduction to the Episode

In this enlightening episode of Power Hour Optometry, host Eugene Shotsman delves deep into the specialized field of low vision care with renowned expert Dr. Richard Schuldiner. The episode, titled "Low Vision Myths Busted: How One Practice Earns $600K Seeing a Few Patients Each Week," explores the intricacies of running a successful low vision practice, debunking common misconceptions and shedding light on effective strategies for both patient care and practice management.

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Guest Introduction

[00:07] Eugene Shotsman:
Eugene warmly welcomes Dr. Richard Schuldiner, highlighting Dr. Schuldiner's unique practice model that achieves $600,000 in revenue with minimal overhead by focusing exclusively on low vision care.

[02:04] Dr. Richard Schuldiner:
Expresses gratitude for the opportunity to share his expertise.

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Practice Model and Financials

Dr. Schuldiner shares the foundational aspects of his practice, emphasizing efficiency and specialization.

[02:30] Dr. Schuldiner:
"Low vision is a specialty and therefore patients are already coming, having had the medical and getting diagnosis and all that. So I just have to make sure that they can actually see and function."

Key Highlights:

• Patient Volume: Sees 3-4 patients per day, twice a week.
• Revenue: Grosses approximately $600,000 annually with a net profit margin of over 50%.
• Overhead: Minimal, as he rents space from other doctors, has no staff, and operates without an office of his own.
• Payment Model: Accepts only direct payments (cash, check, credit card) since Medicare doesn't cover low vision devices and glasses.

[03:36] Eugene Shotsman:
Confirms the patient volume and revenue model, underscoring the high profitability with low overhead.

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Debunking Low Vision Myths

A significant portion of the episode focuses on dispelling prevalent myths that deter optometrists from pursuing low vision care.

Myth #1: There's No Money in Low Vision [41:13] Dr. Schuldiner:
"If you know how to get the right patient in the chair and you deal with prescription low vision devices in the former classes, number one, you're going to help a lot of people. Number two, you're going to make a lot of money."

Myth #2: Patients Are Too Hard to Work With [09:43] Dr. Schuldiner:
"Can you read the headlines on the newspaper? No, well, okay, we got a lot, a lot of vision loss. What do you want to be able to do? ... I make sure that I know who's going to be in the chair."

Myth #3: It Takes Too Long [03:56] Dr. Schuldiner:
Each patient visit is efficiently managed, typically involving two appointments totaling around two hours, ensuring high profitability and patient satisfaction.

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Patient Selection and Experience

Dr. Schuldiner emphasizes the importance of meticulous patient selection to ensure both effective treatment and financial viability.

[08:54] Eugene Shotsman:
Asks about patient disqualifiers to understand the selection process.

[09:00] Dr. Schuldiner:
"Unreasonable goals. ... I’m just not going to be able to help you tell how far we."

Patient Screening Process:

• Pre-screening Calls: Conducts a four-minute phone call to assess vision level and patient goals.
• Functional Questions: Determines patients' daily activities and realistic expectations.
• Expectation Management: Clearly communicates the nature of the visit and potential outcomes to avoid disappointments.

[13:06] Dr. Schuldiner:
Describes the welcoming and non-intimidating approach during the in-person visit, including personal introductions and minimizing paperwork.

[20:25] Eugene Shotsman:
Commends the approach for reducing patient anxiety and fostering a positive experience.

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Treatment Modalities and Technology

The episode delves into the tools and technologies utilized in low vision care, highlighting the balance between optics and electronics.

Optical Solutions:

• Bioptic Telescopes: Custom-made for near tasks.
• Prisms and Filters: Tailored to specific patient needs.
• Handheld Magnifiers: Recently upgraded to electronic models for variable magnification.

[22:10] Dr. Schuldiner:
"We have better optics now, so we're using a lot of bioptic telescopes... electronics really is more for very low vision patients where they need a lot of magnification."

[24:15] Dr. Schuldiner:
Demonstrates a custom telescope, emphasizing the uniqueness and necessity of specialized equipment for effective low vision care.

Patient Interaction with Devices:

• Trial and Fitting: Uses demonstrators to ensure patient comfort and functionality before ordering custom devices.
• Customization: Ensures that devices are tailored to individual tasks and environments, enhancing usability and satisfaction.

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Marketing Strategies and Referrals

A critical aspect of Dr. Schuldiner's success lies in strategic marketing and building robust referral networks.

Marketing Techniques:

• Interruption Marketing: Utilizes print ads, billboards, and television to increase awareness.
• Intent-Based Marketing: Leverages Google AdWords and SEO to attract patients actively seeking low vision solutions.
• Personal Referral Networks: Builds relationships with retina doctors through patient feedback and co-management strategies.

[29:14] Dr. Schuldiner:
"Every geographic location seems to be a little bit different... you have to be willing to try things."

Referral System:

• Feedback Loop: Sends detailed reports and videos to referring doctors, showcasing successful treatments to encourage referrals.
• Co-Management: Collaborates with retina doctors by offering services that complement their practice, ensuring mutual benefits.

[35:14] Dr. Schuldiner:
"Another patient comes in, oh, I’m also seeing that doctor gets another report... sooner or later I’m going to get him on the phone."

Evolving Marketing Focus:

• Reduced Print Advertising: Shifted towards digital marketing and referrals as these channels proved more effective over time.
• Personal Relationships: Prioritizes building trust with referring physicians through consistent and transparent communication.

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The Low Vision Market Opportunity

Dr. Schuldiner provides compelling statistics underscoring the vast demand for low vision services.

[37:29] Dr. Schuldiner:
"There are at least 27 million people in the United States that are visually impaired... California has about 5 million people visually impaired."

Key Insights:

• Underserved Market: Despite the sizable population in need, low vision services remain grossly underutilized.
• High Demand: Significant potential for growth and service expansion within the optometric community.

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Advice for Other Optometrists

Dr. Schuldiner offers practical guidance for practitioners interested in incorporating low vision care into their practices.

Steps to Integrate Low Vision Care:

1. Determine Patient Criteria: Clearly define the types of patients you are willing to serve.
2. Enhance Educational Background: Seek additional training through lectures, online resources, or residencies focused on low vision.
3. Invest in Equipment: Assemble a comprehensive kit of low vision devices, including telescopes, magnifiers, and prisms.
4. Understand Patient Goals: Focus on what patients want to achieve to tailor treatments effectively.
5. Build Relationships: Establish strong referral networks with retina and other specialty doctors.

[44:50] Dr. Schuldiner:
"Sit down and determine the kind of patient that you are willing to see in your office."

Additional Resources:

• Training Programs: Encourages participating in training programs and residencies to gain specialized skills.
• Community Engagement: Suggests connecting with existing low vision specialists to learn best practices.

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Conclusion and Final Thoughts

Eugene and Dr. Schuldiner wrap up the discussion by reiterating the potential and profitability of low vision care. Dr. Schuldiner reiterates his commitment to educating and training other optometrists to expand the availability of low vision services, ultimately improving patient outcomes and practice success.

[48:38] Dr. Schuldiner:
"You didn't miss anything. Really?"

[49:11] Eugene Shotsman:
Thanks Dr. Schuldiner for sharing invaluable insights and resources, emphasizing the episode's value to listeners aiming to enhance their optometric practices.

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Notable Quotes with Timestamps

• Dr. Schuldiner on Practice Satisfaction:
  [04:14] "That's exactly. And of course... I'm very happy with what I do and I love what I do."

• On Managing Patient Expectations:
  [10:07] "I'm managing the expectations. So I tell them you’re going to be with me for about an hour."

• On Patient Psychology:
  [21:22] Dr. Schuldiner: "They have been told so many times there's nothing that can be done... I didn't even know low vision existed somewhere."

• On the Importance of Marketing:
  [29:14] Dr. Schuldiner: "You have to get the phone ringing. That's number one."

• On the Market Size:
  [37:29] Dr. Schuldiner: "There are at least 27 million people in the United States that are visually impaired."

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Key Takeaways

• Specialization Pays: Focusing on low vision care can be highly profitable with the right patient selection and efficient practice management.
• Debunking Myths: Contrary to common beliefs, low vision care is financially viable, manageable, and can greatly improve patients' quality of life.
• Patient-Centric Approach: Building strong relationships, managing expectations, and creating a positive patient experience are crucial for success.
• Effective Marketing: Utilizing a mix of traditional and digital marketing strategies, along with building strong referral networks, is essential to sustain patient flow.
• Vast Market Potential: With millions of visually impaired individuals in the U.S., there is a significant and underserved demand for low vision services.

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For practitioners interested in enhancing their services with low vision care, this episode provides a comprehensive blueprint for integrating this profitable and impactful specialty into their practices.

Transcript

[Dr. Richard Schuldiner]

Foreign.

[Eugene Shotsman]

Welcome to the Power Hour, Optometry's biggest and longest running show. I'm your host, Eugene Shotsman, and we've got a great show for you today. Today I'm interviewing Dr. Richard Schuldiner, and he's got a very interesting model of practice. Richard sees something like six to eight patients per week, and he has a $600,000 revenue line with about. About a 60% profit margin. How does he do it? Well, he's really leaned into the subspecialty of low vision care, and we got some serious details in today's show of exactly how he does it. So during our conversation, Richard briefly mentions the three myths of low vision. Number one, there's no money in it. Number two, the patients are too hard to work with. And number three, that it takes too long. And he spends most of the episode debunking those myths and talking about how he actually runs this, a successful subspecialty practice. Today we also talk about the vastly underserved demand for low vision, at least from his perspective, the psychology of the patient, and certainly what it takes to be able to execute this. Well. Richard shares his decades of experience and really talks about patient selection, what the exam is like, what the treatment modalities are that he uses, and he really doesn't hold back anything in this conversation. So this, this episode is really an open book on how to run a successful low vision subspecialty practice. I really enjoyed the conversation. And as we jump in, quick reminder to subscribe on YouTube, Spotify, Apple, or wherever you get your podcasts. I love that we get to make these episodes relevant to our industry. And that's all based on your insights and your feedback. So please reach out to me, Eugene shotsman.com or the power Hour website. Give me your feedback, give me your insights. I'm always looking for ways to get the best possible content to you and be the best possible resource for you. So Again, that's Eugene Shotsman.com or the Power Practice website. Okay. And now let's go to Today's show with Dr. Richard Schuldiner. All right, Dr. Richard Schuldiner, welcome to the Power Hour. Excited to have you here with us today.

[Dr. Richard Schuldiner]

Thank you very much. I very much appreciate the opportunity.

[Eugene Shotsman]

Well, so I am excited to talk about your practice because you have a very, very, very unique practice. And I think maybe the best way to start the episode is for you to just talk a little bit about some of the numbers from the outside, so to speak. How many patients do you see? What is the revenue of the practice and how, how does it all work?

[Dr. Richard Schuldiner]

Well, low vision is a, a specialty and therefore patients are already coming, having had the medical and getting diagnosis and all that. So I just have to make sure that they can actually see and function. So I don't need all the optometric equipment that most practices need. So I actually have no office. I rent space from other doctors. I have no staff, no clues. I accept no third party payments because Medicare doesn't pay for low vision devices and glasses. I see usually about three or four patients twice a week, Seeing patients twice a week, grossing somewhere in the neighborhood of about 600,000. Basically, it net is a little over 50%. So I'm very happy with what I do and I love what I do. It's great, great specialty.

[Eugene Shotsman]

All right, so just make sure I got that right. You see three to four patients a day, Correct. Twice a week?

[Dr. Richard Schuldiner]

Yes.

[Eugene Shotsman]

Are those full days or is that like a half day?

[Dr. Richard Schuldiner]

I'll usually go to two different offices each day. So I might go and drive a half an hour to one office and see two patients and then maybe dispensing, and then drive maybe an hour to another office and do the same thing.

[Eugene Shotsman]

Right. And so I don't think that. And so just again those numbers, four patients a day, twice a week, and you're grossing $600,000 in that practice with next to no overhead, basically.

[Dr. Richard Schuldiner]

Correct? That's exactly.

[Eugene Shotsman]

And of course. And so here's the, I think the hook for the show, and this is why I wanted to start with it, is that I don't think we're suggesting to doctors that this is exactly the practice model that they follow. But imagine if you were to potentially look at low vision as a specialty in your practice, that this is what it could potentially add to your practice. Because chances are you don't necessarily have to add overhead, you don't necessarily have to add staff, you just have to potentially add the specialty. So this is why we're going to zoom in on the specialty of low vision today.

[Dr. Richard Schuldiner]

Yeah, you're correct. Because someone who has a full scale practice, really, if they just took one day off just to do low vision, maybe in their office or a remote office, it's easy enough to do. You don't have to give up anything else.

[Eugene Shotsman]

Well, so how did you get into low vision?

[Dr. Richard Schuldiner]

Well, it's interesting, you know, that there are times in life that you just do something that you think is going to be, you know, no big deal and it turns out to be remarkable. So I went to A Lions Club meeting. When I first opened my practice, because the dentist next door said you should come, there happened to be a guest speaker from the Commission for the Blind. He mentioned to the Lions members that the commission pays optometrists to do low vision care. And so that triggered me finding all about how to get into it and loved it ever since.

[Eugene Shotsman]

So. And that was how long ago?

[Dr. Richard Schuldiner]

That was 50 years ago.

[Eugene Shotsman]

And so over time, you've probably seen, we'll talk about technology, but you've talked, you've probably seen the problems with low vision progress in our society, but also you've seen other optometrists try, succeed, fail in treating low vision. Let's just start at the beginning. You know, let's talk about the types of patients that you're seeing in your, you know, we'll call it your, your practice or your practices or your locations that you're practicing and what are you doing for them and how does it work?

[Dr. Richard Schuldiner]

Very good question. One of the things that we can't get away from is that in optometry schools there's not really a lot of education in terms of low vision. And what there is is really what I call nonprofit agency based low vision, where I practiced at the New York lighthouse for 12 years when I was in New York. And in that model, you have to see any type of low vision patient, no matter how good or bad they are. And in those models, you need a lot of specialties. You need orientation mobility instructors for people who can't see to get around. You need occupational therapists, you need a whole bunch of, of team members. When I moved to California, I wasn't going to have that, so I had to come up with a new model that would work in a private practice. So what do you have to, what do you have to have in a private practice? Number one, you have to be able to help the patient. There's no question about that. You have to do a great job taking care of the patient. Second thing is you have to make a living. So it has to be both. So in my practice here in California, there's only certain type of low vision patients I can see. So I need to know ahead of time that I'm going to be able to help them. So because I'm only doing low vision, I speak to every patient on the phone, every person that likes to come in, and I have to find out about how much vision they have. And I've developed kinds of questions, functional questions. Can you read a newspaper? If not, can you read it with a Magnifying glass that'll tell me whether or not there's amount of vision that I can work with. The second thing is what are their goals? Is it reasonable given the level of vision? So I filter out the kind of patient that I am willing to see. The last thing I ever want is a patient in my chair for an hour and then I have to tell them I'm sorry, there's nothing I can do. Oh, and by the way, now you owe me a teeth or services. So for me, I make sure that I know who's going to be in the chair. Now other doctors that I've worked with who have full scale practices, they don't have to do that because if the patient comes in and, and they have that issue, they still can do medical exams and see whether there's anything medical that can be done. But the way I do it, I just talk to the patient. That takes, I've developed about a four minute phone call and I know right away, yes, I can help them, no, I can't.

[Eugene Shotsman]

What are the biggest disqualifiers for a patient?

[Dr. Richard Schuldiner]

Unreasonable goals. Can you read a newspaper? No. Can you read it with a magnifying glass? No. Can you read the headlines on the newspaper? No. Well, okay, we got a lot, a lot of vision loss. What do you want to be able to do? I want to read my, my family bible with print. Very, very small. Not going to happen. Or I want to get back to driving. When's the last time you were behind the wheel? 12 years ago. Not going to happen. It's just not going to happen. Can you see cars? Can you see how far away you are from the car in front of you? No, no, driving's not going to happen. And I'll explain that. Look, I could probably get you to see the television better, but I'm not going to be able to help you tell how far we.

[Eugene Shotsman]

Got it. So those are the disqualifiers. Now you've got qualifiers which sounds like it's a mix of, it's a mix of reasonable expectations and then also the progression of their, of their condition right now.

[Dr. Richard Schuldiner]

Right.

[Eugene Shotsman]

Okay, so then what do you do? So they, they want to come in, you schedule them what happens next?

[Dr. Richard Schuldiner]

Well, I give them all the information on the phone so that there are no surprises. So I'm managing the expectations. So I tell them you're going to be with me for about an hour. We're going to figure out exactly how much vision you have. And I say that because it's different when they go to the primary care eye doctor with 2200 and 2100 letter on the chart. So I'm going to figure out exactly how much vision you have, then we're going to put different kind of glasses on you. And by the way, some of them will be the ugliest glasses you've ever seen. So I'm managing the expectation because if I'm going to fit them with a, with a reading telescope, for example, you know, ahead of time, and they actually come in wanting to see what these ugly glasses look like, you know, so you're going to know exactly what they look like. We're going to make sure that they work before we actually order them. So you're going to bring in materials that you're having trouble with, but we're going to make sure you can read them. So we want to make sure they're working with their materials. And then I tell them the fees, what the exam fee is going to be, what the possibilities are on the glasses so they understand the cost involved since insurance is not going to cover make the appointment.

[Eugene Shotsman]

Then they come in and you just give me a range. But how much is a typical patient going to spend with you in that first visit?

[Dr. Richard Schuldiner]

The average patient that I see is somewhere between 2,500 and $3,000.

[Eugene Shotsman]

And how much pushback do you get on that when you share those fees?

[Dr. Richard Schuldiner]

A little bit, but I've already programmed them or kind of got them used to the fact that that's what it's going to be. And these people are very anxious to get back to being independent and function. And so when I tell them on the phone what the costs are going to be if they cannot afford it, then I'll refer them to a clinic of some sorts where they can get care, but they just can't get care in a private practice.

[Eugene Shotsman]

Got it. Understood. So then the patient comes in so that they're, they know they're going to spend the 2,500 to $3,000. And by the way, that's typically a one and done visit with you. Right?

[Dr. Richard Schuldiner]

Well, they'll come back for a 30 minute visit for dispensing so that I make sure it works and it's fitting properly.

[Eugene Shotsman]

Got it. But that's. And that's it. So you're going to see each patient twice.

[Dr. Richard Schuldiner]

Correct.

[Eugene Shotsman]

And that's it.

[Dr. Richard Schuldiner]

Unless their vision changes or they're having difficulty with the device? Pretty much that's it. Yes.

[Eugene Shotsman]

Okay, so that's a 2,500 to $3,000 for 90 minutes essentially of your Time.

[Dr. Richard Schuldiner]

Correct. Okay.

[Eugene Shotsman]

So then when they first come in, talk to me about what happens and how it, how it, how the exam plays out. And then also, you know, what are you doing in that, in that first night, a 60 minute visit?

[Dr. Richard Schuldiner]

Well, first I visit them. I actually go into the waiting room and introduce myself because I want to interrupt their history that they have, that they bring with them of doctor's offices. So what happens when you go to a doctor's office? You meet somebody at the desk, they hand you paperwork that you got to fill out. You got to fill out a million pieces of paper, the history. I want to interrupt all of that. I want this to be a positive experience. I don't want them to think this is same old, same old. So I go out into the waiting room, I introduce myself. I'm. I happen to like to play with people. So, you know, yesterday there was a patient, Ed, and his wife Carrie. So I'll go out into a waiting room, I'll look at both of them and I'll say, I think one of you is Ed. You know, they laugh at that. It's just silly, but, but it relaxes them. The second thing is there is no paperwork. I don't want a visually impaired person to have to sit down and do paperwork.

[Eugene Shotsman]

First. Yeah, so I was just thinking about that. Yep, they can't.

[Dr. Richard Schuldiner]

Second of all, someone has to do it for them. Well, that means they're not independent. So I want to minimize that. So I will. First I'll ask them for their glasses and their magnifiers and they usually bring a big bag of all sorts of things with them, three or four hand magnifiers that all look different, yet it's the same power. So they're all not going to be good if they're not good. And I want to, you know, check the refraction, check the prescription of the glasses, neutralize it. So I do all of that. I'll just get that bag from them, go inside and check all of that. And again, I'll play with them. I'll look inside the bag and I'll say, I don't see any snacks in here, nothing for the doctor. They'll laugh again. I've. There's a purpose for that. Relaxed, let them see this is going to be fun. And then I bring them in. I tell them on the phone ahead of time, there's going to be no dilation, no drops, no medical doing nothing medical. And that's another one sigh of relief because they've had this eyes dilated 10 million times. They hate it. Everybody hates it. So I'll sit down and talk to them for a few minutes. I want to know if what they're. If they know their diagnosis. Generally, I know their diagnosis ahead of time, but I want to know if they know their diagnosis. I'm checking to see cognitively, how. Where they are, any medical history I should know about, whether it's diabetes or glaucoma or whatever it is they have. And then I want to know what they're hoping to achieve. So what's on your wish list? What do you want to be able to do? Now? I'm listening to specific things. When I ask that question, I'm listening to three things. What do you want to be able to do? Far distance. What do you want to be able to do? Intermediate distance. What do you want to do? Near distance? Because all the low vision devices we're working with are distance specific, task specific. So once they tell me the tasks, I need to consider, how much magnification are they going to need? Once I know their acuity, how much field of view are they going to need? How much illumination are they going to need? What are. What are the needs for this particular task? There are some tasks that people come in with that I've never heard of, so that I have actually described.

[Eugene Shotsman]

Like what?

[Dr. Richard Schuldiner]

For example, I want to play hand and foot. What is hand and foot? It's a card game. Okay, well, where do you hold the cards? So I've learned over the years, you know, bridge, you have to see the cards on the table. It's about 26 inches. You got to see the cards in your hand. It depends. A number of years ago, I was sitting at a poker table in a casino here in California Indian Casino. And there was a lady sitting next to me, and she was taking her time on betting, and somebody called her out on it, and she said, I'm sorry, I have macular degeneration. It takes me a minute. So when the game was over, I said, excuse me, ma'am, and I introduced myself. And she came in, and I had to figure out for her how do I get her to see the cards in the middle of the table. Now, if you know a poker table, there's a lot of different seats and a lot of different distances.

[Eugene Shotsman]

Yep.

[Dr. Richard Schuldiner]

Plus the cards in her hand.

[Eugene Shotsman]

Yep.

[Dr. Richard Schuldiner]

And they. And they don't. Casino doesn't really like you to pick up the cards and bring. They want the cards down here.

[Eugene Shotsman]

Right.

[Dr. Richard Schuldiner]

So I had to figure out how. How I could do that. And we figured out A way for her to do it. And I actually dispensed the glasses at the casino. I called them. They had to get approval from the casino commission, California, whatever. To actually sit at a table with a real dealer. And I moved her from seat to seat. Make sure you. It was a fun thing.

[Eugene Shotsman]

Wow.

[Dr. Richard Schuldiner]

So. So the next thing I do is ask them what's on their wish list, and I'll probe. You want to drive? Yes. Well, what's the problem in driving? Well, I can't see street signs or road signs or traffic lights. Perfect. I can handle that. I want to read. What do you want to read? I had one farmer say to me, I want to read. I said, well, I never really knew that farmers had the time to read. Oh, no, I don't want to read read. I want to be able to see the numbers and the gauges, and I'm working on my engine. Well, that's not reading. I need specifics. So, you know, I get the whole deal. What do you want to be able to do then? We have to take visual acuity. Can't take visual acuity on a projected chart unless their acuity is somewhat better than 20 over 100. So I start with a handheld chart, and I can stand 2ft away, 5ft away, 10ft away. I can stand wherever I want. Usually, I stand five feet away. Why? Because I want this to be a positive experience for the patient. So many say, oh, I can't see anything. Yes, you can. I have a number that's this big. Oh, I can see that. That's a four. And then we progress down when they can't see it anymore, then I start probing peripheral. Well, keep looking at my face. I'm going to move the chart. Oh, I can see that now. That's wonderful for the patient. And it's even better for the person who's sitting there with them. The spouse. Wow. Oh, my God. So then we used to move the Carter. It's off. Probe where their vision is. And once I have that, I will use my retinoscope. I know a lot of people don't use a retinoscope anymore, but I'll take my retop and scope them just to confirm that their refraction. The glasses they have are accurate these days, 99% of the time, it's accurate. Back in the 70s and 80s, when there were no auto refractors and most optometrists were working privately, they weren't in ophthalmology offices. Rx's were off all the time. Now they're not so I know that's correct. So now I have to start figuring out how much magnification do you need to be able to see it? And I start with various magnification devices.

[Eugene Shotsman]

So one of the things that impresses me so much about this, about the whole patient experience that you're describing is that you're absolutely right, the patient is anxious. And your focus on making the patient feel good during this whole interaction, we're not talking so much about what you can't do, we're talking about what you can do. And we're making them making a little bit more fun and we're making a little bit more playful. And so it feels less like a medical transaction and more like a high value, you know, both advisory and positive interaction.

[Dr. Richard Schuldiner]

I try and make fun, play with them as much as I possibly can.

[Unknown]

Yeah.

[Eugene Shotsman]

And it, and it also, you know, I guess it not, not only does it disarm them, but it truly, you know, I love the focus on helping show them what they can do early on so that, so that you can make them feel like they're not, they're not there to give up, they're there to regain what they can do.

[Dr. Richard Schuldiner]

They have been told so many times there's nothing that can be done, that sometimes they come in angry. Why a patient yesterday, she's 40 something years old, why didn't they tell me about this? Why did I have to go on Google and find a low vision doctor? I didn't even know low vision existed somewhere I heard that term and I went to Google and found you interesting.

[Eugene Shotsman]

Yeah, we're going to get into the, the marketing side of this in a little bit. Obviously that's a big passion of mine. But let's just as you're thinking through all of the different tools and back and what's in the bag of tricks, talk a little bit about how technology has evolved over the years and what treatment modalities you have for patients.

[Dr. Richard Schuldiner]

We have better optics now, so we're using a lot of bioptic telescopes, what we'll call full diameter telescopes, large telescopes. So in optics there have been some advances, electronics, there have been a lot of advances, but I find that electronics really is more for very low vision patients where they need a lot of magnification, where they need contrast enhancement, that's where we use electronics. And just to be frank, there's not a lot of profit in those and they're difficult patients to deal with. So I'm referring those patients to clinics where they can, where they have the time and the ability to do that and work with that patient. And that patient usually needs more services, need an occupational therapist to come into the home and help them be safe in the home. I can't do that in a private practice, unfortunately. So I'm using mostly optics and the benefit of optics and really what patients want is they want to see better. They want glasses. They want glasses. Do they want electronics? Not really. They, they'll, they'll accept it if they have to. So handheld electronics hand magnifier has one power, that's it. And hand magnifier, whatever they mark on the hand magnifier for the level of power doesn't mean anything because they just pick enough. So now I'm recommending to people that they have handheld electronic magnifiers. Because electronic magnifiers, you can vary the magnification. So if you're looking at a medicine bottle and the print is ridiculously small, you use a little more magnification. If you're in the grocery store and you need to see if it's a can of corn or a can of peas, you can use less magnification. So I use that for electronics. And they're really, really good. But for the most part, where's person going to get something like this?

[Eugene Shotsman]

For all of our audience, Richard is holding up some, some spectacles on, on. So if you're watching, if you're watching on YouTube, you're going to see it. If you're not watching on YouTube, you should go watch on YouTube.

[Dr. Richard Schuldiner]

Okay, so it's a telescope that's focused for near this particular one and it, with the prescription of the patient's Rx is already in there. It's a custom made device. They're not going to be able to go to their local optometrist or optician to get it. So it makes for a very good marketing issue and it helps the patient. Because what can be better than having specifically custom made exactly for what their purpose is for them in a pair of glasses, that's what they want.

[Eugene Shotsman]

And what you're doing when you're fitting them in, the first visit you have, I guess will be the equivalent of some trial lenses for this.

[Dr. Richard Schuldiner]

So the kit, as I'll call it, of devices cost me probably around 7, $8,000. So we're talking a very little investment in terms of getting into low vision. And I have demonstrators of everything. And I tell the patient on the phone I have demonstrators of everything. Why? Well, first of all, you want to make sure it works. Second of all, you want the Patient to see what it looks like. And you want it on their face so they can feel it because some of them are a little heavy. So you want the patient to know that ahead of time. Like I said, I want no surprises. They have to know all these things before we order. So, yes, I have a kit of bioptic telescopes and reading telescopes and microscopes and prisms and filters and anything I might need to the kind of patient that I need to see in my office.

[Eugene Shotsman]

And, you know, now shifting the conversation, you know, tell me how these patients react at the dispense. You know, that second appointment you dispense. I imagine this has got to be in some ways equivalent to, you know, the feeling that I hear from so many optometrists when they're able to have. Have a kid, see for the first time or see really well for the first time. What's it like? What, what kind of feedback are you getting from patients?

[Dr. Richard Schuldiner]

It. It varies. And, and I've. I've learned over the years to kind of listen for the level of excitement that they have. And frankly, the more excited they are when they come in, the more worried I am and the more concerned they are, the happier I am.

[Eugene Shotsman]

Okay?

[Dr. Richard Schuldiner]

Because let's face it, you know, it's not. They're not going to be normal. They're just not going to be normal. You know, if you lose a leg and you get a prosthetic leg, it doesn't matter how phenomenal that prosthetic leg is. Are you happy with the prosthetic leg? Well, it's better than nothing, but really, you'd like to have your own leg, wouldn't you? So. So the people that come in, they're a little worried. I know I'm going to make them happy because they're going to put these glasses on. It's going to be like, oh, my God, they really do work. Well. I could see. See, I can see. I can see your face. And it's fun to watch. And it's fun to really watch the people who are sitting on the side. You know, it brings to mind so many different experiences I've had. I had one. One woman sitting in the chair. She was about 82 years old, and her husband is sitting on the side. This is just doing the exam. I said to her, what are you hoping I can help you with? And he starts crying like, okay, sir, what's going on? Well, she can't play bridge anymore. We lost all our friends. That's all we used to do. So once I got her seeing those Cards. I mean, he was as happy as can be. It's really, really funny. So, yeah, some people are just thrilled and sit there and laugh and I'll grab my cell phone and I'll video them for a number of reasons. One is it's fun to have, and two is in terms of marketing, if they've been referred by their retina doctor, I'm sending the video to the retina doctor.

[Eugene Shotsman]

Of course. That's smart. That's really smart. So, and again, like you, like we said earlier on, you're really only seeing them twice unless they have a problem with the device or they, you know, something changes in the future. And. But this is a little bit like a one and done elective procedure type of, you know, similar to Lasik and that kind of thing. And Lasik practices are always marketing. Right. You think about it, because you're always looking for the next patient, the new patient, that kind of thing.

[Dr. Richard Schuldiner]

Exactly.

[Eugene Shotsman]

So I want to transition a little bit into one of my favorite topics, which is, okay, well, you know, you've got this super successful practice by almost every account possibly. Imagine you've got a lot of time, you've got a good revenue number, you've got super high margin, and at the same time, you, you got to have some patient flow. So what brings in the patient flow? Richard?

[Dr. Richard Schuldiner]

Yes. You have to get the phone ringing. That's number one.

[Eugene Shotsman]

Yeah.

[Dr. Richard Schuldiner]

And so, yes, it's, it's a constant. But I'm only seeing patients two days a week, so I've got one or two other days to be marketing.

[Eugene Shotsman]

Okay.

[Dr. Richard Schuldiner]

So every geographic location seems to be a little bit different. So I've trained a lot of doctors in how to do low vision. We've got doctors all over the country, and it's a little different in each area. So print advertising does still work now? Yes. Twenty years ago, it was phenomenal. You put an ad, literally an ad in the newspaper and the phones rang off. The why? Because nobody ever heard of low vision. So that's one mode, and I'll, I'll use that from time to time. I've had some of the doctors I've trained use television, and yet in some markets, it's phenomenal. The phone l rings like crazy and it's. There's nothing happens. You have to be willing to try things. One of the doctors I worked with realized that his office was across the street from a huge retinal practice. And he noticed when he came out of his building, there's a huge billboard. And he said to himself, well, why not put a huge billboard? You got to be willing to market. Now I've had critics in my profession say, well, if you have to market, if you have to advertise, then you, you can't be that good. Now the problem in, in low vision is the problem in the entire eye care profession. And that is the culture. Culture doesn't support taking care of visually impaired people. It just doesn't. So people don't know. So how are they going to know? You have to go directly to the public.

[Eugene Shotsman]

You have to tell.

[Dr. Richard Schuldiner]

So yeah, so there's this print advertising. I use Google AdWords. I get a ton of patients calling just because they did a search. So for a new practitioner, yes, you.

[Eugene Shotsman]

Have to advertise or a practitioner who just added it to their, to their practice. And it sounds to me like there's maybe three different mechanisms, right. One of them is interrupting the patient or, or interrupting the flow and just kind of getting in front of them and letting them know, just making them solution aware. You know, you have a problem with your vision, we're going to make you solution aware, whatever you're doing. Right. So whatever those interruption marketing things are, you mentioned the billboard, you mentioned tv, all of those are. I'd call, I'd put in the category of interruption marketing. Then it sounds like there's intent based marketing, which, you know, if you're saying you're using Google Ads successfully or doctors that you've trained. I have used Google Ads successfully. That means that there's some demand, there's some patients who are looking for like low vision services. And if you add them to whatever Google tools you're using, whether it's search engine optimization, whether it's Google Ads, whatever it might be performance max. But you could potentially get patients to understand that, you know, yes, I'm solution aware and that's the provider for me who can offer that solution. And the third, it sounds to me like you've got a little bit of a referral network. So tell me who your best referrals are and who the worst referrers have been that you thought might be good.

[Dr. Richard Schuldiner]

We've always had up until the last five years or so difficulty in getting referrals from retina doctors. And that's where most of the patients are.

[Eugene Shotsman]

Okay.

[Dr. Richard Schuldiner]

What we've kind of figured out is how to use the patients that are coming in from the other two modes to reach that retina doctor and get the pump flowing. So over the past five years, my level of print advertising has gone down to almost zero. And My level of Google AdWords and referrals have skyrocketed and now I'm getting referrals like crazy. A number of things. One is the patients I've seen are going back to their doctors because I'm educated. Look, you got to go back to your retina doctor, show them these glasses. So that promotes. So yes, there are retina doctors that will say, yes, yes, yes. You know, if you go to their office and give them brochures and all of that doesn't really work, or sell yes, you to death and say, of course I'm going to send you patients. And they don't. So you have to really develop a personal relationship. And I can do that through the patients that have come in through, let's say, advertising. Like this patient yesterday who never knew and was really upset with her doctors. Well, I'm now educating her. I'm getting the name of her doctors. I'm now going to. I had her sign a release. I'm going to send a report to those doctors. Then I'm going to call the doctor and say, by the way, I saw your patient, whatever her name is, and I've been able to help her. By the way, what's your cell phone number? I'm going to send you a couple of pictures to see what we did. That motivates them and gets it going. So my referral base now is pretty, pretty nice. I'm getting optometric referrals, which is ridiculously rare and ophthalmological. Yeah.

[Eugene Shotsman]

And you know, I think that mechanism of getting closing the feedback loop, it's not always something we think about. Right. We're done with the patient, we move on to the next patient type of thing. But closing the feedback loop, number one, kind of closes the cycle of complete care. But number two is it really is a marketing component because then you're top of mind for that doctor all the time. And you're absolutely right. I think that it's both a marketing activity and an activity to help more patients.

[Dr. Richard Schuldiner]

Yes. And. And when you're obviously in one area, like I'm Laguna Hills, you're only certain number of retinal practices. And I'm getting a lot of patients, even if it's not from them who are seeing them. So, yes, I send them a report and give them as much information as I can. Another patient comes in, oh, I'm also seeing that doctor gets another report, gets another report, gets another report.

[Eugene Shotsman]

Yep.

[Dr. Richard Schuldiner]

Sooner or later I'm going to get him on the phone. I may not get him on the phone on the first patient or the second, but by the 10th patient, he's going to be on the phone and you start to get the sense that, yes, maybe I ought to start referring.

[Eugene Shotsman]

Yep.

[Dr. Richard Schuldiner]

And lately I've started something new, which is co management.

[Eugene Shotsman]

Okay.

[Dr. Richard Schuldiner]

And you know, I went through the legal process of lawyers to make sure that this was completely, completely legal because you can't pay for referrals, you have to pay for services. So I figured out if they refer me a patient and I fit them with a low vision device, again like this one that I demonstrated before, I'm now teaching their staff what to do in a follow up. So I send the patient back to that office and there's a checklist of things that want them to do to make sure that the device is working for the patient and I can pay them for that service. So we're now starting co management and believe it or not, they like it.

[Eugene Shotsman]

Okay. And that you're, you're saying the ophthalmology practices or the optometry practices, like retina practices. Interesting.

[Dr. Richard Schuldiner]

RETINA Doctors see 50, 60 patients a day, of which 5 or 10% of new patients, I mean, they have a constant, constant flow.

[Eugene Shotsman]

Yeah.

[Dr. Richard Schuldiner]

Call management, they're getting a constant fee, which is very nice for them.

[Eugene Shotsman]

Yeah, that makes perfect sense. Okay, so we've covered some marketing, but marketing obviously requires there to be a demand. Do you think that the low vision patients, are there enough low vision patients and are there enough low vision doctors that, that there really is a market opportunity here?

[Dr. Richard Schuldiner]

Richard, it is humongous. There are at least 27 million people in the United States that are visually impaired. And I have a slide deck that I will use when I do lectures that says exactly how many visually impaired people are in each state. So California has about 5 million people visually impaired. North Carolina has about 200,000 people that are visually impaired. South Carolina has about 80,000. You. The, the, the market out there is ridiculous. The demand is ridiculous. Just nobody's happy.

[Eugene Shotsman]

Well then, so these patients, what's their typical journey before they get to you? Who else have they talked to? Obviously you mentioned the retina doctor, but you know, where have they bounced around and who has tried to help them and what are they frustrated with?

[Dr. Richard Schuldiner]

Well, the reason for the upset and the, and the anxiety and depression is that year after year or every few years, you go to your optometrist or your ophthalmologist and you need a pair of glasses, you need them updated, and you need an ad and have a stronger ad. And stronger reading glasses. And it's always great because they let the getting new glasses, they're going to see better and they're going to feel better and have nice cosmetics. And then one day they go in for new glasses because they think it's the same thing. And they're told, I'm sorry, if it's their optometrist, you know, he looks in and sees some bleeding back there. You have a serious condition. We're going to send you to the retina doctor. Well, the retina doctor, they're seeing 50, 60 patients a day. How much time do they have per doctor? Per patient? You know, very little. So that's been a complaint for a lot patients. It's just no time to get answers. So now all of a sudden they need injections or, or I'm sorry, it's dry macular degeneration, there's nothing more we can do. And they walked out dazed. How am I going to manage? I can't read, I can't be able to drive, how am I going to get to the grocery store? And so obviously then you want another opinion. So now you call a major hospital or a major medical center to go to somebody else. They go from one doctor to the next to the next. And in the medical model in terms of vision, there's nothing more we can do. They're not being helped. That's the problem. Doctors seem today seem optometrists seem to think that +3 is the highest ad they can possibly have. They don't think in terms of a plus four, plus five or plus six. A couple of months ago, this 92 year old man brought in material that was so ridiculously small. I fit him with a 56 diopter lens to read. Yes, he was right here, right up on his nose. He was as thrilled as could be thrilled. He was reading, he was happy. So that's been a major problem. People don't know and they're not getting the care. It's as simple as that.

[Eugene Shotsman]

So Richard, I'll play devil's advocate here for a second because I've talked to a number of clients and they said, well, you know, there's just, it's not really profitable to do low vision in our office. It's not, these are not patients that are that, that we necessarily want to, want to be able to serve because it just doesn't really work. So what's the biggest objection you've heard from, from the optometric community as to why they don't offer more low vision services inside Their offices.

[Dr. Richard Schuldiner]

The myths of low vision.

[Eugene Shotsman]

Okay, yes, please.

[Dr. Richard Schuldiner]

There's no money in it.

[Eugene Shotsman]

Yep.

[Dr. Richard Schuldiner]

Patients are too difficult to work with. It takes too much time. Those are the myths. I've completely dispelled those myths. If you know how to get the right patient in the chair and you deal with prescription low vision devices in the former classes, number one, you're going to help a lot of people. Number two, you're going to make a lot of money. Okay, so 500 to $3,000 per patient and I'm getting about a 60% net for an hour and a half. And it's cash. There's cash. There's no third party payments. I don't have any accounts receivable at all. Everybody pays me cash, checker, credit card. That's it.

[Eugene Shotsman]

Is there. And I mean, obviously your practice is not set up to bill insurance and you're not dealing with any, you're not on any panels or vision plans or anything like that. Is that different? Is this, is the, are the economics different for a practice that is seeing, you know, Medicare patients and is, and is on the panels?

[Dr. Richard Schuldiner]

Yes, it is a bit different with panels. I really don't know whether some of the panels will pay for low vision or not. So I know of one particular panel that does pay up to $1,000 for low vision. So the patient can get reimbursed or the doctor can get reimbursed. There are ways to build Medicare for time or for confirming the diagnosis. So, but they're not going to pay for the refraction. And most of low vision is optics and they don't pay for optics. But yes, some of the doctors that I've worked with do build Medicare for some of their time, but not for the glasses. So that is a possibility.

[Eugene Shotsman]

Okay, so you're saying the economics could work either way. Doesn't. But you have to be careful on patient selection. So let me ask you, of the next 10 phone calls, or call it 100 phone calls you're going to receive, which of those, how many of those patients are you going to want to see or you're going to select? Because you talked about a careful selection process initially about two out of three. Two out of three.

[Dr. Richard Schuldiner]

Okay, two out of three.

[Eugene Shotsman]

So you believe. So I mean, if I, if I'm doing my math correctly, you know, you got 27 million people with, you know, low vision issues or, you know, issues that can be helped by, by what you're describing, and 18 million or so. So two out of three would be good candidates.

[Dr. Richard Schuldiner]

Right.

[Eugene Shotsman]

And you're and I think you're. Are I, I what, what I'm hearing you say is that there's not much in the optometric community that's there. There are not that many people in the optometric community that are serving that demand and, or at least serving that demand to its fullest extent.

[Dr. Richard Schuldiner]

That is correct.

[Eugene Shotsman]

So, and again, you, you've listed some of the objections. Now let's shift to the maybe if you're giving advice to doctors who want to get into low vision, or you're giving advice to doctors who maybe, you know, dabbled a little bit in it but haven't really had much success. What. Let's talk about what that advice would look like.

[Dr. Richard Schuldiner]

Sit down and determine the kind of patient that you are willing to see in your office. That's number one.

[Eugene Shotsman]

Yep.

[Dr. Richard Schuldiner]

Remember when you're in optometry school and going in your low vision rotation, you're seeing the worst of the worst. And so you get a very bad taste about that. But if you start to look at your own patient base and you look at the people that are 2030-2040-2050-2080, start giving him higher plus ads, explain to them that they got to bring it a little bit closer. Start there. Bring in a set of prismatic. Most of the labs you can get medium plus power prismatic glasses plus 4, 5, 6, 8, 10 with prism for the convergence. Start there. So if the three add the patient's still complaining, give them a 4ed. See what happens. Once you can get comfortable doing that and you get comfortable with the kind of patient, then you can start looking into more advanced low vision glasses like telescopes and microscopes. Go to lectures, go online on YouTube and a lot of, a lot like power hour like this, you can, come on. You know, there's a lot of YouTube videos that'll explain a lot of the telescope glasses and how they work.

[Eugene Shotsman]

Yeah. And I mean, obviously you have a program that teaches that as well. But my, in my, in my experience, you know, again, people are hesitant, but it's also because I don't know that they necessarily think to differentiate their low vision practice from their, you know, primary practice. And what you just described, it's, I can see that there's probably a gray line and I don't know when, when I cross to the other side of it where I'm like, okay, I'm just, you know, I'm just trying a higher. Whatever. I'm, I'm, I'm just trying a different pair of frames that can fit a thicker lens versus okay, Now I'm going to like a device with a telescope.

[Dr. Richard Schuldiner]

Yes. It's scary to people, to doctors who just don't know anything about it. Yeah. But the companies that actually manufacture telescope glasses, microscope glasses, they have people that are willing to work with you. I mean, yes, I train doctors and that's one possibility. There are also residencies. Most of the optometric colleges have residencies. So literally you can go on Google and say optometric residencies and low vision in a whole list of places where you can go and do residency if you really want to.

[Eugene Shotsman]

So you believe that adding a low vision subspecialty, if I'm summarizing some of your observations during the episode, you believe that adding low vision subspecialty, the success is in, number one, charging appropriately, having good patient selection, having a good, we'll call it kit. You called it, you know, your kit. I call it the bag of tricks. Having a good, having a good set of tools that can help solve the patient's problems, understanding the patient's goals. As you, as you would talked about, you know, me knowing what it is that they're actually trying to accomplish and then really working hard on accomplishing those goals. And you know, I don't want to under, under. I think I want to really point out the patient psychology because oftentimes these patients are in a state where they've been told, no, you can't help you lots and lots of times, which then leads you to be able to help these patients and drive market. I get that summary.

[Dr. Richard Schuldiner]

Right.

[Eugene Shotsman]

What'd I miss?

[Dr. Richard Schuldiner]

You didn't miss anything. Really? You didn't miss anything.

[Eugene Shotsman]

Well, so final thoughts. If anybody's considering low vision specialty, final bit of advice for them, call me.

[Dr. Richard Schuldiner]

I'm happy to advise you, give you any advice I can on the phone, point you in the right direction. Yes, I train doctors. You can talk about that if they're interested, but there are other ways as well. So I would say or find a low vision doctor in your area that is doing low vision, talk to him. Yeah.

[Eugene Shotsman]

So, you know, thank you so much, Richard, for being a resource on the Power Hour, for being a resource to the optometric community. Obviously you've got a lot of experience and the type of practice that you run is very unique. But I think that leveraging that particular experience for our listeners today has been super valuable. So thank you for being here on the Power Hour with me.

[Dr. Richard Schuldiner]

Thank you for having me. My job is to, to get more people taken care of and doctors having a great life doing.

[Eugene Shotsman]

Thanks, Richard.

[Unknown]

Hey, There, it's Eugene. And I've got a question for you. Do you do medical billing in your practice? What if we took 10 charts and looked at them pretty closely? Would they be good enough to pass an audit? Or would you owe the insurance company some money? Or would there be some found revenue that you could put back in your pocket? So looking at 10 charts is a new service that's now available from the Power Practice and it's called the Power Audit. What happens during the Power Audit is that some of the most knowledgeable billing experts in the country are going to do a friendly audit on your charts and see if they can find opportunities. By the way, in auditing hundreds of charts, nine out of ten charts, they look at, they find something. And typically that something fits into two categories. One, something that better protects your practice, or two, something that can make you more money. In fact, almost every single audit they do uncovers under billing areas where you can get paid more for what you already did. So let's just play it out. You send them your medical charge and a few weeks later they provide you with a detailed report and analysis or write up a coaching guide that helps you prevent any issues in the future and again, helps you get paid more for what you're already doing while protecting your practice. So if you're doing any amount of medical billing in your practice, this is a service that's well worth the $2,500 it costs. And as a limited time opportunity, 10 listeners from this episode can get a $700 savings certificate for the Power Audit. So the price is only 1799. But the opportunities that the Power Audit uncovers are worth many, many, many multiples of that. So go to the Power Practice website. Up near the top you can click.

[Eugene Shotsman]

Request a Power Audit.

[Unknown]

Now, you're not committing to pay anyone at that point. You're just locking in your $700 savings. But you will get a chance to schedule a 10 minute phone call to get your questions answered and to see.

[Eugene Shotsman]

If the Power audience.