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Owner Burnout and Frustration? How to Reset, Rebuild & Prevent It from Happening Again | The Power Practice
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- [00:00]
Brian Spittle
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 one that is very timely because there's a weird thing that happens every year. It seems like you grind through November and December. You survive the insurance reset in January, and then things slow down just enough for you to finally notice everything that's been slipping through the cracks or everything that bothers you or frustrates you. And this is when fatigue kicks in, the frustration, the why am I doing this? Feeling. So today I brought on Brian Spittle and Alison Kramer from the Power Practice, and we go straight at the real version of burnout, the kind that doesn't just affect you. Your staff feels that, your patients feel it. And quietly, this is eating away at your performance and profitability as well. And Brian shares a lot of his own story too, including a moment where he seriously considered selling the practice. But really, we get into the practical a lot as to like, what if you're feeling this way, what can you do this week? If you're feeling it right now, what are some of the things that you can do tomorrow? But also what systems can you put in place so that you don't end up here again next year or in three months or in six months? So we talk about issues, list, delegation, communication, cadence, but really, like a lot of issues, business systems that, whether you're feeling this way or not right now, will help make the business better and more manageable long term. So before we get into the show, as always, make sure that you subscribe so that you never miss an episode of the Power Hour, whether you're on YouTube, Spotify or Apple podcasts. And if the conversation sparks an idea, you got a topic you'd like us to tackle or you just want to reach out for help, or one on one, please reach out to me at the Power Practice website or@eugene shotsman.com I always enjoy hearing from listeners. And now let's get into today's show. All right, Brian Spittle, Ali Kramer, welcome to the Power Hour.
- [02:04]
Alison Kramer
Happy to be here.
- [02:06]
Eugene Shotsman
Okay, so I think I'm going to just jump into the conversation today because you both, Brian, you run a pretty busy practice and you both advise other practices and were having this conversation and you both mentioned to me that something interesting happens this time of year. And Ali, I'll let you describe it, but it seems like people get through the holidays, the stress of the holidays, people have all these great ambitions for the, for the beginning of the year and Then what?
- [02:38]
Alison Kramer
Well, yeah, so what happens is they've been busy. They've running full speed ahead all through November, December, even January, when the insurance is. Vision insurance is reset. And as it starts to slow down, it's sort of like a reality check. All the things that may have been slipping through the cracks are a little bit more obvious, and they're just frustrated and also tired. And, you know, it's just a general sense of, why am I doing what I'm doing?
- [03:08]
Eugene Shotsman
Yeah. And would you, Brian, you kind of, when we were talking before, you kind of called this something like burnout. Is it burnout? What is burnout? And what. What is this feeling?
- [03:20]
Brian Spittle
There's definitely some seasonality to our business, and it's not just seasonality of, like, patient demand. It's the seasonality of our team.
- [03:28]
Eugene Shotsman
Right.
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Brian Spittle
So you'll go through a season where everyone's clicking and it's all going the way you want, and then there's like, the full moon shows up and the crazy patients come in the office, and then, you know, an employee will get some chronic illness and quit. And, you know, and then somebody has a car wreck, and then you don't see them for three weeks. And. And so there's these just seasons of just. They're almost micro stressors to you as a manager where you have empathy for your team, you have empathy for these patients, you know, and. And it's hard or, heck, the end of the year happened and people quit paying their bills because they bought everybody Christmas presents, and now you're chasing people for money. Right. And so these micro stressors show up, and if you're in the right mindset, if you're on the front side of. Of your business and of your, you know, your life and life, everything's fine, you. You might be able to brush it off and move forward, but if it catches you on the backside and it's a long enough drag through the mud, you start to get miserable. And at some point, burnout's a real thing. Right. And I think there's probably. I'm not a mental health professional, but I think there's probably different stages of burnout, you know, mild, moderate, severe, whatever it is, classifications. And sometimes you just. You just want to throw things, right? It just becomes really stressful.
- [04:38]
Eugene Shotsman
Well, and it's true. And I don't know specifically now, now that I'm thinking about a couple of the client conversations I've just recently had, and Matt, maybe Ali, you can reflect on a couple that you've had. But, you know, I It is weird because at some point early this week I was talking to somebody and they, and this is a larger practice. And this guy, I said, how are things going? And he kind of put us head in his, in his hand. And he said, yeah, just like there's a lot going on. And I said, oh, what in particular? And he mentioned, he's like, you know, one of my associates has to take a month off because, you know, some, something unexpected happened medically and, you know, we just lost one of our office managers. And on top of that, we had this, you know, this grand opening construction thing that was, that was happening for, you know, reopening one of our locations. And that's way behind schedule. And it kind of seemed like, you know, like, kind of like what you were just saying. Brian, like he was absorbing the stress onto himself. I had no great, like, therapy advice. Maybe we'll get there somewhere in the, in the show. But, you know, it does sound hard. It's true. It's like it is a. It, it sounds like there's a lot going on. I, I agree. Ally, what do you, what, what are some of the examples of some of the things you're hearing from clients?
- [06:03]
Alison Kramer
Yeah, I want to just say first, this year in particular, I think has been harder for those that are in areas where there's a lot of weather events, a lot of snowstorms. I mean, almost every office I'm talking to in the Northeast has been having to close for some period of time, which is stressful because your staff members are upset because they're not coming in and they're not getting paid. They're obviously not seeing as many patients. They have to redo the whole schedule. So I think this year it's coming out more so than it. Than it normally does. But Brian and I are very lucky to share a couple of clients together. And I just love working with Brian so much with practices. We're a very good balance. And we had a couple of calls where, you know, two in a row that were, they guys were really down. One was having a situation where there was a legal something going on and then another one who just was, you know, I don't think I want to do this anymore. Like, I didn't think it was going to be this hard. So we, Brian did a really good job of talking about the burnout and what happens and, you know, what to do about it. And he was so thankful after that call that we were, that he had a friend to talk to, so we weren't really talking about his Numbers. We weren't giving advice about the practice. We were just making him know that we were there for him.
- [07:23]
Eugene Shotsman
And I think that's so true is that I think once, I think all practices know that they have options or most practices know that they have options. Right. Like if at some point I want to stop, I can sell. Right. Because there's probably, if, if my revenue is above a million dollars, there's plenty of private equity groups that would like to make me an offer. And the truth is that sometimes that makes make sense and sometimes that doesn't. But I, I always think about it and then like making decisions under a state of stress or duress or whatever is usually not the, not the best way to do it. Because if you really do want to sell, you kind of, there's some strategic things you can do to prepare to get the most out of that transaction. But Brian, I think you've been there before, right? Like to, to talk a little bit about your experience.
- [08:14]
Brian Spittle
Yeah, I was, it's been 10 years now since I would call it major burnout for, for myself. And, and I, you know, I practice in the suburb of Richmond, Virginia with, with my wife who's an OD and, and two other associate ODs who in part exist because of my burnout journey. Right. So, so, you know, we started out as a very small practice. We helped an older doctor retire and it was a part time practice. It was, it was, we saw patients maybe three days a week in that practice. When we took it over one doctor, three days a week. And you know, one lane as you go through that, there's no one in school. I actually like to use plumbers and heating and air and electricians as the analogy. Right. Like they have a trade and now they either go work for some company or they start their own company. And it's really not that dissimilar from us. We go to school for optometry and you know, now you can go to optometry school and get an MBA also. But those of us from the Stone Ages, that wasn't a choice. And, and so you, you just had to wing it. You had to ask your friends if you had any. You know, before the Internet was a big thing and so, so much of what I know is trial by fire and screwing things up. And, and so over time the micro, the micro stresses, as I know them now, as I can recognize them now, they start to add up. I don't know how to train an optician or, or a receptionist or a technician. Right. I just know what I know in school, which is how to diagnose clock home. And so you don't necessarily have an outlet, right? You feel alone, even though we all know there's systems in place outside of us. You know, somebody can call me, anyone can call me, and I'm happy to walk you through my life experience in that moment where I can relate to you. But even working with my wife, you know, we didn't have that outlet. We just got to where we didn't like coming to work, where we didn't know what the next steps were. And we literally picked up the phone and said, there's no private equity in our city. We called one of them and said, can we meet? And we went to New York and met. And as a part of that conversation, we developed a contract. And I got to experience the private equity journey a little bit. And so now I have this, you know, 10 pieces of paper, and it tells me what everyone else already knows about private equity, that there's dollars involved and there's a phase out. And on the other side of that is, I guess, a life in the Virgin Islands, sitting, you know, being a Diet Coke in my room and. And trying to find some joy that's not seeing patients.
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Eugene Shotsman
It's interesting because you. You didn't ultimately end up going down that path, right?
- [10:50]
Brian Spittle
I'm still sitting in the building that I tried to get rid of 10 years ago, you know, as a part of. Of going to get that contract, you start to take your baby and crack it apart, and you start to say, I'm going to wean away from that. I. I'm going to give it up for adoption, right? And this isn't as sincere as honestly giving up your baby for adoption. I want to be clear, that's a terrible analogy. But at some point, like, I, the. I chose the paint colors and the equipment and the paperwork and, you know, I had influence over all of those things. And now I'm going to let somebody else. In exchange for money, I'm going to let somebody else do all of that differently. Sell different product, higher grade, lower grade, whatever it is, get rid of dry eye, add dry eye. I don't know. But they get to do whatever they want because they're now owners, and you're only as good as your advisors. So I take it to the lawyer, right? And a lawyer goes, hey, it's a good contract. It's all solid. You'll be fine. Just follow the rules. And I take it to the accountant, and he goes, it's a couple million dollars this sounds great. Or whatever the number was. And he goes, but you're 35, and you're going to have to work for them for, I don't know, three to five years, whatever the term was. And they're going to change it all up, and they're going to repaint it, and. And they're going to get rid of your equipment, and they're going to schedule twice as many patients. He goes, does that. Fix your burnout. Oh, and you're going to burn through that cash because of the lifestyle that you said you wanted when you came on board as a client. Go home and think about it. I already thought about it. It's how I got here. And he goes, no, you have to go back and actually think about it.
- [12:14]
Eugene Shotsman
Talk a little bit more about what led you there. Like, what. How did you end up 10 years ago? What are some of the things that happened that ultimately you were like, all right, I'm done. I'm done. And I'm. This is too much. And I'm. I'm giving it to somebody else.
- [12:28]
Brian Spittle
It's all the small things that hit you in the face every day, right? You poke the bruise and it starts to hurt, and then you start to cry, and you don't know how to make it stop poking you, right? It's the frustrated patient that's belligerent over something dumb. I don't want to pay my co. Pay. That's not fair, right? Like, that makes no sense. Why do I have to deal with it? That. Or that employee who's not doing what you trained them to do, or that employee who's on maternity leave, and now you have to go find their, you know, their temporary replacement. These are good people doing okay things, but they're all inconvenient, and they're not what you signed up for. I just wanted, like, go diagnose glaucoma or get somebody some great contact lenses. I don't want to deal with the hr. It's not. And it's not all staff, right? It's. And it's not all, you know, embezzlement. It doesn't have to be criminal things. It snowed just. Just a couple weeks ago. It was so dang cold in Virginia, right? It's like 5 degrees. For two weeks, we couldn't get our front door to open because of frost heave, right? I don't even know what frost heave is, but our sidewalk's lifted up an inch and a half, and I can't open our front doors, and I. I'M at a point in my career where I don't know, this is happening. And all of a sudden, at the back door, back here by the janitor's closet and in the employees bathroom, I have patients coming in the back door. And. And so it's as simple as you can't get your front doors open because it's so damn cold. And now what do you do? I gotta, I. I can't keep having people come in by the bathroom. And they certainly can't see my desk. What a disaster. Don't judge me. And so we had, we had to hire some guy to come shave off the sidewalk. So we get the doors open and so it's those things that are not part of, like, who wants to deal with that? And it sounds flippant and it sounds so not serious, but when you stack all these pennies up, it becomes heavy. And so, yeah, you forget why you come to work, because you're just there to put out fires. That's all you do. You're just a firefighter with the doctor title.
- [14:23]
Eugene Shotsman
So, Ali, you know, as you're talking to clients and you're probably hearing more and more of the same type of stuff, like, you know, you, you hear people complaining about the fact that they, they signed up to do one thing, but they're doing a million other things that weren't necessarily part of that job description. What are the categories of things that stress people out the most? Because when I'm listening to Brian talk about it, he is saying, you know, it's all these, like, unexpected things or people behaving in ways that people would normally behave, but just sort of like all too much at the same time. And, uh, and it's. But maybe we can break these down to, like, types of problems.
- [15:12]
Alison Kramer
I think typically a staff is what most people would say. I like to kind of ask questions and figure out, is it really the staff or is it you and the lack of involvement and training that you've put into the staff. So they want to be easily frustrated with the staff members, but they haven't been willing to take the time to make sure that the staff members have all the tools that they need to succeed. So I think that that's probably the biggest one and that's kind of an easy one for me to help fix, because I can point it out to them that, hey, maybe we can do things a little bit differently and put some systems in place to make sure that the things get done and also delegate because there's this huge mental load that comes with being a practice owner and most practice owners are not willing to release the reins a little bit and let their team help them. They're surrounded by good people and then not allowing them to do anything. So I think that is probably the biggest one.
- [16:11]
Eugene Shotsman
It's interesting because hiring the wrong guy to shave off the, to shave the sidewalk or maybe paying an extra $300 over because, you know, you didn't, you didn't talk to three different people. I can totally see a world where, you know, business, a business owner would want to get involved in that and be like, I need to see the quote. Okay? Like how many guys you call it, like, let me see, you know, and then. And at the same time it's like, yeah, like that, that over management, in some cases it costs more than you're saving, right. Ryan, what do you think?
- [16:45]
Brian Spittle
I heard recently that your return on investment in your business equals your rate of involvement, right? To Ali was just saying. I actually think that's true, but I think it's true in an unhealthy way because if, if I under delegate, if I am overly involved, right. I start to take empowerment away from my team. And the whole point of hiring them was to do the work I don't want to do or to do the work I can't do or the work I'm not good at doing. And so if I am the loudest voice in the room, I'm contributing to my own, my own woes, right? My own fires. Why don't they know what they're doing? Well, they always ask me for the answer and I give it to them rather than teach them to go fish.
- [17:27]
Eugene Shotsman
And in, in that particular case, you know, as you're, you then go back to Ali's point, which is that, well, maybe you showed them once and now you're expecting them to go catch fish perfectly every single time. And when they come, come back empty handed, you're pissed. What do you do then you run
- [17:45]
Brian Spittle
into the wall over and over again and get burned out or you take a different approach to the conversation. And you know, somewhere along the line I, I have a lot of, I have a lot of mindset changes for myself. And telling. There's a book actually telling Ink Training is the name of that book. And, and so, you know, there's quite a few authors out there who, who basically take a different approach to the same topic, which is you need to parrot this, you need to come at things a different way, be consistent, right? Hold people accountable. There's all of that stuff that matters but as long as people are doing it mostly right, you should be mostly happy with what they're doing and go focus on growing your business in some other way. Like, you know, if you, if you don't need to return the cases with the frames. Right. When you send frames back to the manufacturer. If I spent four extra dollars on the UPS label and I didn't need to send the cases back, I'm not going to remember it two years from now. So I shouldn't get worried about it. I shouldn't, you know, my, my reaction to that shouldn't be more than it's worth. And, and so great, let's do better next time. Let's find a better system for that. Let's hang it on the wall and say for this brand you need to return cases and for this brand you don't. But it's a UPS label and you wouldn't miss the $4 that it cost us in the cases back versus not having it in there. Right. So stepping away, stepping back, taking some time to understand how the business is responding. If it's growing, like it's okay as long as you're paying the bills. Don't live by rules that don't have to exist.
- [19:17]
Eugene Shotsman
Yeah. So we're going to come back to some of the solutions in a, in a moment and we'll probably do that after the break. Ask one more kind of burnout related question. If you, if the practice owner is burned out, what does that mean for the staff? If they're, if the practice owner is in this like, I don't know, like, cycle of frustration, disarray constantly, like not super, not, not super friendly, not very happy with anything that's going on. Allie, you first tell them. Talk about how that reflects in the staff.
- [19:55]
Alison Kramer
The staff absolutely notices the energy change in the room. They know you very well if you are the practice owner and they can feel it. But it's funny, a lot of practice owners say, well, the staff keeps bringing their personal stuff into the office. Well, guess what? So are you. And your staff knows it.
- [20:10]
Eugene Shotsman
Yeah. And it's interesting because you, you start going down that path and you say, okay, well if you do this for a day, they'll be like, oh, okay, you know, he's just having a bad day or she's just having a bad day. And like we, we can deal with it. We know, and we can deal with it and we can accommodate. But what happens if you do it for a month?
- [20:26]
Brian Spittle
Brian, I love this question because some of us don't have a Lot of social, you know, awareness and, and you know, eq. And, and so my, I, I, I went to my administrator, my manager and said, you know, you seem to be really upset today or really down. Can you tell me what's going on? And she goes, you've been like this for a month. And I'm like, right? And, and then she expounds on how I've nitpicked and called out and micromanaged and you know, and I'm, and she's right, she has all the examples. She can tell me what I said. She has that gift of, of replay. And, and sure enough, I, I am the burden. I'm the problem. I'm not the only problem. Her team's not doing what she expects and you know, family life issues and all, you know, all sorts of things. And that was the beginning where I started to have a conversation to say, call me up, right? Help me to be better. Because I didn't know. I don't have that empathy, that little like, antenna that, that zooms up to this guy to say, hey, Brian, don't say that, or take a different approach. It wasn't just that one time, right? I didn't learn the first time, just like my staff and I, I kept pounding that, that button wrong. You know, three months later I'd do it again, and three months later I'd do it again. And finally I think she, she got to a point where she can verbalize that, where she has psychological safety to, to say something. And now we have days where we're, we just start with, I am not having a good day today. Just, just ignore me or, or what have you, right? So I've created the awareness, she's created the awareness for me and given me permission to verbalize it ahead of the screw up. It's not the only screw up, but
- [22:04]
Eugene Shotsman
that's part of it. Yeah. So I think the, the, the reality is that how, how you're feeling as the leader in practice is going to impact the staff. And of course it's also going to impact the patients. And I doubt that there have been that many studies that have been done that are like, what's the, what's the return reactivation and recall rate on patients who, so a happy doctor versus a doctor who is trying to put on a happy face in the midst of like wanting to kill everybody around them and you, I mean, whether the patient is likely to verbalize it or not, I imagine that there's a significant impact on the patient experience too. Have you seen anything concrete, Ali
- [22:51]
Alison Kramer
not from the patient side necessarily, because I'm not in the exam room. I sit here at my desk and talk to doctors about it. But I have worked with a practice where when I went in for a visit, the entire staff was telling me how the doctor was cranky for a good six months to a year and all they wanted was to be appreciated. And when I approached him on it, he was a little hesitant at first, but open and has made a big shift since then. It's simple as telling, catching your staff doing something well. And it's, it's, it is a mind shift change because it is human nature to know, to focus on what's going wrong. But if you actually step back and look at what's going right just a couple times a day, it makes such a big impact on your team and I would imagine on your patients too. And that trust factor that they have with you.
- [23:41]
Eugene Shotsman
Yeah, that's good. I think we'll get into more strategies in a second as to like, how do we fix this? How do we change our own mindset, how do we help people? But I just wanted to kind of put the bow on this before the break that I believe that this concept of burnout, which you're telling me is seasonally highly relevant right now, it impacts you and maybe like your level. But you might say, okay, like, I can suffer through this, I can deal with this. But truly, if it's impacting you, it's probably impacting your staff, it's impacting your patients, and it's probably impacting your bottom line because unhappy patients don't transact in the office nearly as much the revenue per patient. But then also they're like less likely to come back. Even if they did buy from you this year, there might be less likely to come back because nobody really wants to go. We're talking about a positive patient experience. No one wants to go see a cranky doctor. Brian, any comments on that?
- [24:33]
Brian Spittle
There's a saying, if you take care of your people, they'll take care of the people. And, and so I think that's, I think that's true. It definitely trickles down from the top. And, and that should also impact maybe even who you hire. Right? So, so if I'm around, if I hire toxic employees, right, And I can't be around that negativity, then it's going to bubble up into me and then it permeates the whole organization. So being very picky about the mindset of the people that hire is really important because we've had whole Teams defect, Ophthalmology's poached, our entire tech team, and they all leave at the same time. So five techs leave on the standing day is quite a pickle. And, and so why does that happen? I, I didn't, I wasn't a sticky boss and they were toxic and, and amped. Right. And so it definitely mindset matters and, and having some awareness is really, really important.
- [25:34]
Eugene Shotsman
All right, so when we come back after, after the break, we'll talk a little bit about some concrete strategies that help deal with burnout and help you, you reset and make positive impact along the way. Be right back on the Power Hour. All right, quick pause for Power Hour listeners. I'm here with my good friend Jamie Rosen, and if your practice is doing okay, but it still feels way harder than it should, this is for you, right, Eugene?
- [26:00]
Brian Spittle
So if you're busy and you're growing, but somehow everything still runs through you,
- [26:04]
Eugene Shotsman
and if you're in the day to day minutia and every time you think about growth, it feels like more stress, more problems, not more freedom.
- [26:12]
Brian Spittle
And a lot of owners just assume
- [26:13]
Eugene Shotsman
it's normal and it doesn't have to be. Which is why we're super excited to announce something that we're officially unveiling this march at Vision Expo. It's the ICARE BOSS System. B O S S. So the ICARE
- [26:26]
Brian Spittle
BOSS stands for Business Optimization and Scalability System. So it's a system that helps you optimize and scale your practice whether you're one location or whether you're 20 or more locations.
- [26:36]
Eugene Shotsman
And we developed it after working with thousands of practices coast to coast and seeing the same gaps and the same patterns over and over again. And Jamie and I used what we saw from some of the most successful practices out there, and we also used some other business literature, but we adapted this to specifically serve the unique needs of eye care today, which is really important.
- [26:58]
Brian Spittle
So what we see is that many successful practices, practices have made a ton of mistakes and kind of tripped their way to success. But this is obviously slow, super iterative, and takes a ton of work and literally years. And the system we've created helps you learn from your mistakes and really the mistakes of others, eliminating those mistakes and fast tracking your own success.
- [27:20]
Eugene Shotsman
So most practices do not have a clear system for how to optimize their practice and also how to scale without the owner becoming the bottleneck, or if you keep people in your practice becoming the bottlenecks. And again, that's why we created icareboss because it focuses on five important parts. People, accountability, revenue data and patient experience. Yeah.
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Brian Spittle
And all those five parts working together as a system is really critical and that's what leads to the actual optimization or constant improvement of your practice. But also we include the tools that you'll need to support the growth, which is all part of the ICARE BOSS system.
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Eugene Shotsman
And scalability is really growth that doesn't have to break stuff as it happens. Right. So growth where practices run on structure and not just talent of a few key people is what scalability is.
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Brian Spittle
We'll be walking through the system on the vision stage at Vision Expo, offering CE and sharing tools and resources you can actually take back back to your practice and use. This is not just theoretical information, it's super practical and very usable.
- [28:24]
Eugene Shotsman
So if you're doing fine, but you know you're capable of much, much more. And if you want growth and also some sanity, I think.
- [28:32]
Brian Spittle
Join us at Vision Expo March 11th through the 14th in Orlando.
- [28:36]
Eugene Shotsman
And by the way, for Power Hour listeners, use a special coupon code VE26POD to register. Register and get free entry into vision Expo. That's V E26P O D. So go
- [28:48]
Brian Spittle
to visionexpo.com, click the register now button and use the code VE26POD and we'll see you there.
- [28:57]
Eugene Shotsman
All right, we're back on the Power Hour. Brian Spittle, Alison Kramer and I think before the break we made a really compelling case that burnout's real. It's impacting people and they. That's beyond just the practice owner. It's impacting your patients, it's impacting your staff and it's costing you probably money and most importantly your, your health, like your, your the reason you come to work, it's wasting your time. So let's get into how we actually fix this. How do we solve this problem? Brian, what did you do? You talked about your personal story here.
- [29:34]
Brian Spittle
So. So I was really young, right? I was 35 when this really, really hit and it happened again at another point in time, but I had a better skill set and I was more mature. So again, I've experienced this more than once, right? So, so it's not fixed and out of my life, it's managed in my life and it's a challenge and I'm blessed to have just a big busy business and you know, by, by most standards, just extraordinarily successful and thankful. The other part of this is we happen to, to, for the power practice, we happen to sort of interview or we, we survey folks from time to time and and so it was really great to see what other people were doing as well through this. But for me, I learned that, that if. If a pile of money from selling my business was not going to be the end result that was successful, that I could do some version of that over time. And so the conversation with our accountant was just see less patience. And I learned about myself, as I said earlier, that I don't necessarily have awareness that I'm beating up my administrator emotionally at work. Well, it turns out I wasn't providing a great social experience in the room because people were exhausted, right? I was. I was giving them everything. And I needed time to personally recover. And so the answer for me was to start seeing patients every other day. And so I dropped from five days a week in patient care, three days a week, and the day in between. I chose to be administrative, but other folks might. Would choose to, I don't know, mow the grass or, you know, be away from the office and recharge in some way. And so patient demand was there. And the reality was, is we ended up hiring an associate doctor to come see those other patients with us in the business. And it was wonderful. It wasn't enough, but that was really important thing to me was to be able to say, well, if I'm going to sell the business, I could just see patients three days a week and keep the business and from there make everything else work out. And so that was really the most important and impactful strategy that we came up with.
- [31:44]
Eugene Shotsman
Yeah, that's interesting. So, and this kind of hits at the point of you were trying to play by an invisible set of rules, and I've heard you say this a couple times, is that, you know, maybe those. Maybe you realize that the rules you're trying to follow don't really exist. Right.
- [32:01]
Brian Spittle
And fast forward to Covid. Right? And. And we are closed for. Many of us are closed for, you know, a month or even two months. And. And looking back at that time, it was. It was terrifying, right? Covid's terrifying. My mom was in excess death from COVID I don't have any joy of COVID but that time away allowed me. I took a week off, right? I took a week, sat at home like everyone else, freaked out and slept and just got caught up sort of personally. But then I came back and just worked in the business and identified all the things that were stealing my joy. We made a whiteboard list, and I still have that picture today, of the things we needed to work on to make business less hurtful, less emotionally Burdensome. And, and we still work on that five years later or six years later or however long it's been, you know, that list. Some of those things repeat. Right. Staff training. Right. Those kinds of things, they continue to repeat. Delegate. Are you done delegating all. There's. So there's a lot of stuff that just is a continuous work in progress, but as you get better at it, the burdens get smaller.
- [33:10]
Eugene Shotsman
Yeah, it's interesting. So you start listing. We're going to come back to this in a moment where you start listing the things that bother you. Ali, what do you think? What, what are some strategies to deal if you're feeling overwhelmed, if you're feeling burned out, if you're feeling like you're not at your best, what are some strategies to deal with that?
- [33:28]
Alison Kramer
I think you need to really give yourself permission to take a step back and look at the big picture. It doesn't have to be. You're seeing patients five days a week every single, you know, every single week of the year, not taking vacations. Like, don't let your business own you. There's a reason that you're a private practice owner and that gives you the, the permission to take some time off and really discover what it is you want, not fit into that invisible set of rules. And I think that's in life too, not just in. Being a practice owner is just to, you know, you don't have to be what everybody thinks you're supposed to be.
- [34:00]
Brian Spittle
Yeah.
- [34:00]
Eugene Shotsman
And it's, it's interesting. It seems to me like there's kind of two, two tracks here. Track number one is understanding. Okay, if I'm feeling this way right now, what can I do? Literally right now, today, tomorrow, like next week, what, what can I do now to help myself? You know, shift this mindset and to get into this, like kind of reevaluate, like, what rules am I playing by that I really, you know, kind of have self imposed a little bit or whatever. So that seems like one category. And then the second category is prevention. Like, there are probably people who feel this way less and less every year and they, and it's because they've done some things in their business. And we'll talk about what some of those things are, but let's speak to the first one as well. Is it just like, are there any other strategies that either of you can think about or can, can come up with or you'd advise a practice of like, okay, I'm, I'm overwhelmed. Yes, I heard you. Like, I need to zoom out And I need to see what rules are, are kind of guiding my decision making that don't necessarily have to guide my decision making. That's one. What else, what else can you suggest that could help get me and my team and my patients out of this funk? Brian,
- [35:19]
Brian Spittle
in, in talking with others, right? And in my own experience, I, I think the question is, is, you know, what, what helps you stay centered or re, you know, gets you rebalanced and, you know, refreshed. And for some of us, that, that, that could be an unhealthy thing. Right? And so I would say avoid unhealthy things like, like alcohol. Right. And, and, and, and ant. Right. Like there's a whole list of those things where we have not a great set go address our emotional mental health challenges. And then there's other things that I think people universally probably agree with, you know, like exercise, like going to the gym, hanging out with friends in some sort of social way. And that, that could be probably not at the bar, but it, you know, a backyard cookout, you know, guys night, ladies night. Spending time with your family and your kids would, would, would, would rise up on that. But non, non doctor things, right? Getting away from work, stepping away, church, you know, practicing faith meditation, mindfulness is, you know, a list of those music for a lot of people. And so just doing more of whatever it is that brings you joy. Because that to me is the opposite of burnout, right? Burnout is me going, I dread work. Can we burn it down and get the insurance money? You know what? You know, at some point you're just so, so challenged. You say crazy things like that. Okay, well, the opposite of that is what do I want to do more? I love to snow ski. Maybe it's, maybe it's. I, you know, take time away in the winter and go snow ski, you know, whatever it might be, let's do
- [36:52]
Eugene Shotsman
that naturally, building in some of those breaks. Although the counter to that, as much as I agree with that, the counter to that is like, if you take a week away from the business, sometimes you come back and those same problems are just there and amplified and you know, like, and then you gotta, you gotta deal with that, but maybe you have more energy to deal with that at a different level. Allie, what do you think?
- [37:17]
Alison Kramer
I kind of think if you do take that time away, you have to, when you're reentering, is kind of get into that space where you remind yourself why you did this in the first place. So you're not just taking a vacation to forget to work and Then it's all gonna be there. But I think looking, you know, what your vision and why you started and why you became an eye doctor in the first place is help helping people see clearly. It's a pretty amazing job. Like, I just think it's the coolest thing. So, you know, I, I. You went into the business for a reason, and you've let it, like, capture you and take over all the good things about it. So really just going back to your why.
- [37:53]
Eugene Shotsman
Yeah, that is a really interesting point. So let's talk about prevention. And one suggestion, Brian, I heard you talk about, like, put out on the whiteboard, put all the stuff that pisses you off or all the stuff that's not working or all the stuff that you want to do less of. I have a slightly different suggestion, and I want to hear you all, you both talk about some of the systems that need to be in place in order to kind of prevent some of this says some of the struggle that we're describing. But the suggestion I have is an issues list. And in my opinion, what an issues list does is it frees you up from the daily distractions, right? And my team, for example, and the. And when I talk to practices, one of the things I always say is, like, the first thing you got to do is just build an issues list. Because on my team, hey, it's like, nobody bothers me throughout the day unless it's a real emergency, because they know that, you know, we have a meeting every week, and that week we look at the issues list and we prioritize the things on that issues list. And every issue, eventually, based off of its level of importance, every issue gets an audience. And so you don't need to be distracted with, hey, Brian, got a minute? Hey, Brian, got a minute? Hey, Brian, got a minute? And then, like, you're. By the end of the day, you got no hair left because you pulled it all out. Because we really, like, each one of those minutes was a. A distraction from something else that was going on. And sometimes when somebody has to articulate an issue more completely, it's actually a really, really powerful thing, because, number one, you could identify, as you're looking at that issue, you could identify somebody's knowledge gaps. And by the sheer, sheer effort of having to document an issue, they may be documenting their own knowledge gap. And then they actually realize it and take the issue off and go solve it themselves. Or alternatively, as you document an issue, you identify a much deeper issue that exists in the business. And so to me, one of the first Things from a systems perspective in a business is you gotta have an issues list so that you don't have to feel like you have to own every single thing that's wrong in the business and then you have to have a process for looking at that issues list. Brian, what do you think?
- [40:10]
Brian Spittle
I, I, that is our long term strategy which is traction. Right. So for us it was grabbing this book called Traction and trying to figure out what it meant and rereading it because I was like this is, this is Right. But it's so difficult to execute and, and it turns out once you get the core principles of it, it's not difficult to execute. But as, as, as I look back at the things that micro stressed me out of business almost they were things that other people in the business could have managed and shielded me from. And, and, and as we talk about our issues, I can go, I'm not a great guy to handle that. That's not in my wheelhouse. But this tech thing I could handle or whatever. Right. Because it is in my wheelhouse. I'll take that. I like fixing problems. As a dude, fixing things is important. It's part of our psyche. Right. Stereotypically and so. Good. I'll go check these off the list for everyone else. Some of my team don't like the IT stuff. I don't mind connecting the wires. And so it allows us to have a conversation about where our boundaries are and it created a framework for ongoing execution of that. So just today we had our weekly issues meeting. Right. If you will. And so we walked through some of those challenges and we were able to celebrate some really significant successes as a part of that. And as we rewrite a training process for our, our complete training, we revamped that today or our first meeting about that for our entire optical and our retail process. So, so massive project, right. Tons and tons of hours of work into that and, and, and chunks of that have been delegated. Very excited to see the work done. I'm excited to see the progress. We're getting a new competitor across the street in the fall and so I can't wait to try to, you know, compete with Warby Parker that's going to show up down the street. So what's that strategy? What's that look like? They didn't know but here this is showing up just in time for that. So with that issues list, things don't get dropped. We can circle back to it and say hey, you know Bill, where are we with this? And I don't know. Okay, well that Tells me a lot in this moment that it wasn't important or Bill's not the right person for this kind of thing. So, yeah, systems.
- [42:27]
Eugene Shotsman
And I think that the issues list in itself is. And I actually once worked with the team and they, they said, I asked them what was on their issues list and they said, well, our issue, we're great. We have no issues. And I was like, I think that's a miss. Let's, let's reframe that a little bit. Finding issues is like finding opportunities. So if nobody is looking for opportunities throughout the day to get better, we have a real problem. And which is why again, kind of reframe issues as like, these are not necessarily problems that are, you know, somebody's going to get chastised for or somebody's going to get fired over or whatever. Like, these are issues. And if we can get to the core foundational reason of that issue, like a patient wanted a refund because we screwed up an order. Because this thing, like, let's not chastise Linda for screwing that order up. Let's identify what system, what process, what training issue kind of exists in place so that this doesn't have to happen again. And thank you, Linda, for putting that issue on the list because it's true. Like, you, yes, you screwed up, but you want to fix the core issue, the core problem that exists in the business, which is an opportunity. So I always recommend people kind of when they think about issues like teams are not great if they have no issues. Teams are great if they have a really long issues list that they can, that they prioritize every single week and solve cohesively as they go through it. So I think that's one system. Ali, if you had to name a few other systems or what's like, what are some of the more important habits of super successful practices where you can kind of prevent the concept of burnout?
- [44:05]
Alison Kramer
Well, I think when you're looking at your issues, you have to figure out why, where they're coming from. Right. And so where's the priority? So is it your staff and the lack of training? Is it the fact that you don't have written processes in place that you don't, you know, you haven't spent the right amount of time communicating. So figure out what has stressed you out the most that brought you to that burnout place and start with that.
- [44:28]
Eugene Shotsman
Yeah. And when you start solving it, I think there's probably like a few different ways that you can solve an issue. Right. One of it is like, what's our what's our short term band aid? How do we kind of like, what action can we take tomorrow that kind of makes this thing hurt less? But then what's the, what's the real long term thing that we can do that can be somebody's like, I don't know, some, something somebody could work on for a few months, and then ultimately somebody's project that ultimately makes the whole practice better off. And then we can be proud of that. We can be proud of the fact that we move forward, we move past this thing that stressed us out. And maybe, you know, maybe it's not necessarily the fact that, you know, the sidewalk wouldn't let our front door open. We, but it could be, but it could be something about like a major patient experience issue that patients aren't having. The, maybe patients are having to wait a long time and like, yes, tomorrow we can do something that prevents that in the short term, but long term, maybe we can identify the root cause and we can make it somebody's project to solve for it.
- [45:33]
Brian Spittle
Brian and it's, and it's as simple as just having a little list, like a blank list at different touch points in the business. Because every once in a while you walk into a room and you're like, this machine doesn't work. Oh, it's been like that. And those are those things where you're just, oh, you just cringe inside. Like, I would have fixed this, like last night if I'd have known the camera didn't turn on yesterday if you'd have just said something. So, so sometimes there's no psychological safety. They don't feel like they can say anything or they're gonna get yelled at or what have you. Even though you've never yelled in your life at these folks, they just don't have that safety or they don't have a communication tool. Like, they're, you're too busy, you know, you're, you're talking to Eugene on the power hour, and you, you know, they can't come in the door. And so they don't want to bother you because they don't know what's happening when your office is closed and when the door is closed. And so, so in our exam rooms, we have, we actually called an opportunities list, and we have that in the rooms. And I, not just for equipment breakdown, but if a patient has a complaint, like, hang on, can I write this down? And the process is really simple. On Fridays, our manager picks up all the sheets and puts down empty sheets, and then she goes through them and no balls get dropped in that way. And it's just really simple. And the person who needs to hear the negative, which is not me, is collecting those and sorting through.
- [46:53]
Eugene Shotsman
Yeah, that's great. I love that, having an opportunities list in every single room. Um, so I think we talked about this one system, right? This, this issue issue tracking and getting your time back because you're not being pulled into a million different directions. We talked about that system as possible strategy of prevention of burnout. You talked about identifying the use of your time, Brian, when you talked about like how much time do you want to spend seeing patients, what stresses you out and kind of how much, what, what's the right amount of time? I think we ally you covered some of the rules that people don't necessarily have to abide by or that they self impose, that they don't necessarily need to self impose. What else? If we had to think of one or two more things that we could give to the audience to think about as far as systems they could put in place that would help prevent burnout in the future, what would that look like? Ryan, you want to go first?
- [47:56]
Brian Spittle
The first one is to, is to, I would say hire your happiness. And, and that is, that is not necessarily hire someone, but reallocate someone. Figure out the thing that's really bothering you. And, and if it's, I don't have, you know, busy schedule, get one of your employees to work on busy schedule, right? Like if it's the most burdensome can get you, get somebody else to work on it or stop doing the things that are, that are driving you crazy and go work on that thing that's important, right. If you don't make it a priority, no one else will either. And so recently we hired a virtual assistant to just make appointments not for tomorrow, but for next month.
- [48:38]
Eugene Shotsman
Right.
- [48:39]
Brian Spittle
They're just working on next month because one of our team members gets really upset if they look at the schedule in the future and it's not slammed. And that's just a mindset issue. But that's fine. We'll make it look slammed. We'll get people into the calendar for you. And it turns out we don't have to work as hard filling last minute appointments because we have this person already working on. So I would just say the first thing is, is to hire out whatever the problem is. And so for me it was seeing patients five days a week, not a ton of patients. I was seeing, you know, 15 or 20 a day, just a normal schedule. But I didn't have any downtime to go work on my business. I didn't have any downtime to go to the gym. I didn't have any downtime to mow the grass. In fact, I don't like mowing the grass. So I paid some guy to mow the grass and. Right. So it's just being truthful to yourself, being sincere to yourself to go be unchained, unburdened from those things.
- [49:37]
Eugene Shotsman
Yeah, now that makes perfect sense. Allie, what do you think, systems wise?
- [49:41]
Alison Kramer
I think the most important thing is a communication structure. And with that I don't mean just, you know, having a conversation when you walk in the door, but a real performance evaluation system, for lack of a better term, and having one on ones with your people and knowing that they, where they want to be and what their goals are. Maybe you have a somebody sitting at your front desk who's really pining away secretly about being an optician. It's going to be fantastic at it. You don't know that unless you're having those continuous conversations with them. So really identifying your in your internal talent and appropriately helping them grow into the position that best suits them.
- [50:20]
Eugene Shotsman
That's a really good point. And we haven't talked enough about that. I don't think is. So how often would you recommend having those kind of performance or talent conversations? And what if you had to do those performance conversations? How, how would you start them? And what's the, if you're not doing them regularly, what, what do you recommend to practices that want to get into that?
- [50:42]
Alison Kramer
So I would keep it casual if you haven't been doing anything because it can be be pretty scary when your boss says, can you come sit at my office and have a conversation? At some point it gets to be a normal cadence and it's an enjoyable conversation. But that first one may be a little difficult. I would have a, a structured kind of just a sheet of paper that says, you know, what makes you happy working here? What are some of the challenges that you've had? If you've got to choose your position in the office, are you happy in this one or is there something else you're interested in learning about? Really just getting to know them, even maybe asking what their favorite chocolate bar is. So if they're doing a good job, you put a Snickers on their desk. I don't know, you know, asking their favorite things, but just really opening up a line of communication that doesn't feel scary so that you're building trust with each other. In my ideal world, it would be one on Once a month. I know that that's not totally realistic, but at the very least quarterly. And then there's one where there's going to probably they're going to expect a raise. So you have to come up with a system on how you're going to do performance evaluations and how does that interact with. Do they get an increase in their salary?
- [51:49]
Eugene Shotsman
Yeah, that's a really good point. Is that the second you have structured conversations, they want to know what they're working towards. Which is why I think a lot of owners avoid some of these conversations. Because, you know, Susan hasn't gotten a raise and in two years and we'd like to keep it that way. Or maybe her last raise was like, she knows that her last raise was less than she deserved, but that's kind of what we could afford at the time. And so, you know, the second you start having those structured conversations, something happens. So Brian, how do you deal with that?
- [52:24]
Brian Spittle
The momentum of just having them is the hard part. You know, you have a one on one, they bring you all their problems in addition to wanting the raise.
- [52:32]
Eugene Shotsman
Right.
- [52:33]
Brian Spittle
Having that sometimes silent expectation, sometimes verbal expectation. If you aren't having regular communication with your people, you have no idea what's going on in your practice. You're showing up to work and doing lots of work and it may not be for the benefit that you think it is. And so one on ones are important. In fact, we've built in to our bonus system. We've built in one on ones. If they don't have a monthly one on one, their bonus isn't what it would otherwise be. And so that's to incentivize the employee to go to the manager and have that conversation. And that conversation is pre planned. They can't have it until they fill out a little three question survey. You know, what's going well, what's not going well, and you know, what have you learned kind of thing, right? So it's just real simple. But they've got to do that and turn it in 24 hours ahead of, of of their one on one or they can't have it and it gets pushed off.
- [53:31]
Eugene Shotsman
So that's every month.
- [53:33]
Brian Spittle
That's every month. And it's about engagement, right. They chase the manager, the manager's not chasing them and it's worth 50 bucks to them. Like it's, it's, you know, it's a tank of gas or half a tank of gas depending on what's going on. But it's, we've had plenty of people Ghost us or leave. And then we find out later, you know, through Facebook posts or something that they were upset about some slight that we didn't even know happened. And, and if we had just asked like good people and good humans, we would have had a good response from another good person and we probably wouldn't have had that turnover. And then that turnover comes with all the things that burned me out.
- [54:14]
Eugene Shotsman
Yeah, it's interesting. So Brian, I like your structure of you got to do it on a one, you got to do it on a monthly basis, you got to fill out a three question survey ahead of time and it's on the employee to schedule it with the manager so that the manager isn't chasing it and the employee is kind of forcing the conversation. I like that because it kind of shifts the shifts the nature of the conversation. How do those conversations go in your office? Is there more structure to them?
- [54:42]
Brian Spittle
So we, this is really, we created this in response to, to the managers avoiding the one on ones because they were unstructured. And then they become this dump of negativity and problems for the manager to go fix. And, and, and right. And, and hearing those things isn't all that bad because you still need to address them. But, but it became disincentivized conversation for the manager to have them. And, and so as we just kind of kept digging into why is this not working for us, we said let's, let's number one, put them in a scenario where we hear them more often so when they dump, it's less to dump on us and let's give them structure so that we can kind of control the narrative a little bit or guide that narrative and I don't know, let's put some money behind it so that they have some motivation to go do it. Like they're not unhappy when they're getting paid. That's a good problem. So, so far, so good. Everything, every system's imperfect, but the managers are happy with how that's going and the employees are pretty perky and that helps me be less burned out. Right. It helps me come in the, in the room and not be the terrorist that I am when I'm in my fields in the wrong ways.
- [56:03]
Eugene Shotsman
Yeah. And I think one of the things I would ask is if, you know, sometimes when, and I've suggested this to some managers, when they tell me, oh yeah, the employees are just dumping all their problems on us, I would maybe push back on the employee and say, hey, what is the problem? But then also can you bring three solutions to the meeting. So if you identify an issue, I'd love you to proactively try to come up with two or three solutions that we could potentially discuss. Because chances are, you know, this isn't just a problem for you, it's a problem for others. But you have an opportunity to take action on the problem and I'd love to get your involvement in it.
- [56:46]
Brian Spittle
And if you have data, right, so if you have data like, you know, I'm not good at selling transitions. Well, Mary's great at selling transitions. Let's go understand why Mary's doing that and buddy them up. Because the person who's not good at transitions is probably good at something else and is an asset in a different way. I'm imperfect. I, you know, there's lots of things I'm good at and there's plenty of things that I'm not good at. And.
- [57:10]
Eugene Shotsman
Yeah, and then like, actually that would be a, that's a perfect example, Brian, because I would say, well, so Mary's good at selling transitions, but you're not. So your task this month between this check in and the check in next month is to observe Mary 12 times and to report back, what are the kinds of things that Mary is saying that make her good at selling transitions? Because nobody was born good at selling transitions. She's probably just saying certain things. And it would be great to write a one page manual that we can distribute amongst all of the opticians to make them great at selling opticians like Mary is. So your job is to be Mary's shadow for at least 12 patients so you can write, so you can document, document all of the great things that Mary does that help her sell transitions. And maybe you can even try some of them and let me know how it goes.
- [57:57]
Brian Spittle
It's, it's that hard, right? And the hard part is the time investment and the hard part is the follow through. Right. On the other side of that, how did it go with Mary?
- [58:07]
Eugene Shotsman
Yeah, that's it. But if we've got a structured check in every month, I already added one of the agenda items just by, just by simply talking to you this month. Because if it's unstructured, you're end up, you end up kind of falling off the wagon and you got to wait till the, you know, more problems pile up and then we're having another, you know, whatever, dump. But in your structure, which I really like, is that the employee is chasing me next month to have this conversation and I already know one of the items on that thing is to follow up and they already know is to follow up on what happened with Mary.
- [58:40]
Alison Kramer
And also having that open line of communication makes it less scary to tell them corrections, you know, like, so you're already talking to them, you have this open conversation. It doesn't have to be scary if you have to give somebody some advice about how they could do something better.
- [58:54]
Eugene Shotsman
Yeah, I love that. So here's the deal. I think we've really covered the topic in a couple different ways and I'll try to summarize. I'll ask for some final thoughts if you've got them. But. So we talked about the concept of burnout in general and how it kind of surfaces in different ways. And people hear the term all the time, but you know, it's a relatively recent term and whatever it means, and some people are sick of hearing it. But the reality is that you might, if you want to practice, you might feel a certain way in this particular month or next month after, after kind of the craziness of the holidays and the beginning of the year. All of that is now sort of. And now you've got day to day stress that's weighing on you and maybe the year is going a little bit differently than you expected. So now you're here and you got to recognize that you're here and then you can do some things and you know that you're here and it might be impacting patients, it might be impacting staff, and chances are it's having an effect on more than just you in your practice and it might be having a financial effect. So then there are some things you can do. There's some things you can do short term, there's some things you can do to set up the business in the long term, but the reality is that you cannot ignore it. And that was really the message of the show. Let's do final thoughts. Ally, what would you like to add?
- [60:10]
Alison Kramer
So when you're having that moment where you call me and say that you're going to sell your practice today, just wait, take a step back, think about why your, why you started. And I promise you that next week you will be better.
- [60:24]
Eugene Shotsman
Yeah. Brian, final thoughts.
- [60:28]
Brian Spittle
Number one, eat. Because when you're hangry, you make bad decisions. Number, number two, lean on your people, right? Lean on them. And number three, find a work buddy, right? Find somebody that you can talk to who's not at work, the office across the street, a small group, somebody in the power practice, me, whatever, and just bounce ideas like, hey, I'm not, this isn't working for me. What do I do. And it doesn't have to be burnout, but you need to talk, and it's a dude. You gotta talk about your feelings. That's important, too. You're not alone.
- [61:02]
Eugene Shotsman
Yeah. All right, well, thank you so much. Great, great insights from both of you. I appreciate you both being on the show. Hank, we've got. We cover the topic well, and I'm excited for our next conversation.