← Power Hour Optometry
Power Hour Optometry
Private Equity, AI & Recruiting: The Conversations Quietly Shaping Optometry Inside ODwire
01:00:48
Loading summary
Transcript64 lines
- [00:00]
A
Foreign. Welcome to the Power Hour, Optometry's biggest and longest running show. I'm your host, Eugene Shotsman. And today's episode is about something that has quietly shaped optometry for more than two decades. The conversations that doctors have with each other when nobody else is in the room. My guest today is Dr. Adam Farkas. He is the founder and chief technologist of OD Wire and CE Wire. And his story starts in a pretty unexpected place. His father, who a retired optometrist, and a group of doctors mailing cassette tapes all over the country with the simple idea, what if optometrists had a private place to ask questions, debate ideas, share concerns, and learn from each other? That idea eventually became OD Wire, which is now one of the largest private online communities in optometry. And in this conversation, Adam gives us a really, really interesting look behind the curtain of what happens. With 1.5 million site views per month, we talk about how the big conversations in optomet have changed over time from practice management board certification, private equity, AI, Medical optometry associate recruiting, ce, and the future of online communities in a world that is increasingly filled with bots, with hype and with noise. And what I really enjoyed about this conversation is that Adam has a really unique vantage point. He's not just watching the industry from the outside. He has been seeing what doctors are actually talking about, worrying about, arguing about, and trying to figure out together for the last 20 plus years. So before we jump in, quick reminder, Please subscribe on YouTube, Spotify, Apple Podcasts or wherever you listen so that you're alerted every time a new episode drops. And as always, reach out to me@eugene shotsman.com or through the Power Hour website with questions, feedback or episode ideas, or if you'd like to work together and need some help. And now here's my conversation with Dr. Adam Farkas. All right, Dr. Adam Farkas, welcome to the Power Hour. Excited to have you on the show.
- [01:57]
B
Hey, thanks so much for having me, Eugene.
- [01:59]
A
And you know, I think for context sake, it would be very helpful to the audience to hear a little bit about your background and your journey and how you went from studying medicine to running a really well recognized technology company in our space. So let's start there.
- [02:16]
B
Sure. And this is an adventure that actually I never thought I would take. So, you know, back in the late 90s, early 2000s, I was at the University of Michigan. I was going through their medical program and additionally got a full time MBA after I graduated from the medical school and did an Internship and all that fun stuff. But simultaneously as I was working on all of this and then working in the technology field, doing medical technology, sort of fusing both the MD and the mba. My father, who was an optometrist in New York City for gosh, he actually started, I want to say, 1958. So he'd been at this a long time and he actually developed one of the, the largest private practices in Manhattan over his time. And he was sort of one of the pioneers of contact lenses back when contact lenses were a little bit more challenging than they are now, right? You had to stick hard plastic in people's eyes back in the 50s and 60s and it was very much sort of cutting edge stuff. So, so he started doing that way back when, as the 90s rolled around though, he retired from clinical practice. And so, you know, as we like to say, you can only play so much golf, right? You know, you do the typical thing of moving from New York to Florida and you're retired and you're playing golf. And eventually, you know, he started to get a little bit restless and a little bit bored and he wanted to continue to connect with his peers, you know, as part of his career. When he had his practice, he was also out lecturing. This was one of the things he loved to do was actually go to all the trade shows, the continuing education and lecture and see his peers and try to trade tips with them. And he found that he was just getting a little bit bored and he had more to contribute because he actually retired relatively Young in the 90s. So he wanted to get back into doing stuff. And part of what he actually did in clinical practice, and this was actually very innovative back in the 60s and early 70s was he had a group of doctors called the Round Robin group. So this was a group of, I think it was six or seven guys in different cities around the country. So they were in non competing areas where they would trade practice management tips by taking cassette tapes. So talking into the cassettes for a good two hours, right? Just going on and on, right? Blah, blah, blah, talking into these things, taking the cassette, bundling it up, mailing it and sending it on to the next guy who would then listen, think about it, then start to record his own stuff, throw it back into an envelope, take it on to the next guy. So this, these tapes would loop around the country and that's how they did their little practice management groups.
- [05:03]
A
So, so interesting and such comparison to today's information sharing groups. And the audience knows I'm a big fan of those but that is, that is a wild way to start. One is I just imagine like opening the mailbox and there's six cassette tapes that I have to listen to.
- [05:20]
B
Yep. And in fact, I, I have memories of, as a child in the 70s of him holding himself up in his, in his home office recording these things and kind of wondering, like, what the heck's going on here? But this is how things were back then. Right. That was the only real way you could communicate with your peers who were far afield. And of course, he was a contact lens specialist back in a time where that really wasn't a thing. So he had to communicate with all the contact lens guys he knew around the country. That was his sort of, you know, his resource. This core expertise was sort of bound up in these guys around the country. So that went on for a good long time, well into the 80s, actually, if you can imagine it. And as Paul, my father, liked to say, over time the topics drifted from clinical stuff to, oh, my back hurts and you know, did you guys get a prostate exam? And like, and on and on. Right. So, you know, it sort of drifted to more personal and, and stuff of the aging clinician. Right. Which I find really funny. They moved from sort of this cutting edge clinical stuff to, you know, things
- [06:22]
A
that matter most at the particular moment in time.
- [06:25]
B
Right, right. So it was pretty hilarious. But anyway, so he, he really enjoyed it. And that's the way he kept in touch with his peers when he wasn't going to the, the big trade shows. Right. The Optifairs, which became Vision Expo or whatever. So roll around to the late 90s, and I'm working in technology at this point, and I'm in, actually. I graduated from the MBA program. I was working in Cambridge at a technology company, at a software company. And so, you know, this was at the height of the dot com boom, for better or worse. So, you know, I got to live through many bubbles so far, which is really interesting. But anyway, so he knew, you know, obviously I was sort of on the leading edge. The company I was working with actually did a lot of social stuff. This was before social media was a real thing. Right. Because this was the late 90s, so there wasn't really that much out there. Right. You had your AOL groups, you had some, you know, small online listservs and so forth, but we didn't have sort of the. Any sort of really concentrated place where people met online. So dad said to me, hey, you know, I think I want to set something like this up where I could Have a spot just for my buddies, where we could come online and talk, you know, can you do that for me? And I rolled my eyes, as, you know, young people do with their parents, and I'm like, dad, let's not do this. It's like, it's going to be a disaster. No one's going to use this. You're not going to be able to do it. He's like, no, no, no, this is going to be great. Let's do it. So, you know, he had a. A lot of will, and so he was already in his 60s. He taught himself to type, which, of course, back then, you know, people didn't know how to type, right? Especially people of his generation taught himself because he wanted to sort of stay as cutting edge as he could. And he kept gnawing at me to do it. Let's do it. Let's do it. And I'm like. And then finally, my mother, you know, God rest her soul, she came on and she's like, please do this for me, because your father is at home driving me crazy. There's. There's, you know, retired men around the house, right? And she's like, please, just do this. You know, give him. Like, just do it. And I know it's going to be a disaster, but just please, Adam, do it for me. All right, Mom, I'll do it for you. So that's how this adventure started. And this was in 1999, where he started to put together the theory for how it would work. Handed me these requirements. I'm like, all right. So on my weekends, I started building this thing for him that was eventually called Senior Doc, which would become OD Wire. And again, the idea was that he would just contact his buddies, these old men. And so the first 30 people that joined, he actually hand wrote. He took a pen and he hand wrote them physical letters and put them in the mail and said, hey, come to this website and it'll be great. We'll have a private space where we could talk online. And I'm like, dad, that's crazy. They're never going to respond to this. And of course they did. So from this initial little thing where he had just a few of his old friends, the site started to grow via word of mouth. Now it's private, right? We don't let. It's like the opposite of Facebook, if you can imagine. This is as private as it gets. When somebody comes to the site, they're just not allowed in, right? When they register, they have to be manually verified before we'll even allow them in, which in the beginning was easy because it was just me and him and his buddies. But then over time, people started inviting their friends because it was fun and they were getting, you know, good advice from it. So we started getting a flood of people, and, you know, we had to manually verify everyone that came in. It started taking more and more time, but you can sort of see that, I guess they call it the J curve, I guess they call it, right, where things just sort of spike. And that's what happened. So within a matter of three years, maybe, it went from just me and him to about 12,000 users.
- [10:21]
A
Wow.
- [10:22]
B
As Senior Doc. And by that point, you know, it was no longer Senior Doc, Right. Because the people that started to register were getting younger and younger to the point where I'm like, dad, we got to do something about this. Like, first of all, this is taking up way too much of my time. But secondly, because again, there's no business model here. This was just a hobby. I was paying for these servers myself. Again, my mom, I wanted to keep her happy. So I'm like, all right, I'll do this. Not a problem. And so we were running it that way, but eventually it just started getting so big and taking up so much of my time that I'm like, we gotta do something. So in 2004, we rebranded as OD Wire, right? To stress that this is for everyone, for all optometrists, right? Because that's really who the site's for, not just older folks. So we rebranded in 2004 as OD Wire. And once we did that, that's where things really started to go through the roof, right? Because people saw that it wasn't just, you know, for old fogies like Paul, this was for everybody. And we started getting a huge influx of users. And it was a spot where the older clinicians could interact with the younger folks and sort of they could take advice from each other and learn. And, you know, it just sort of took off from there. You know, a place where people could feel very safe and private, particularly in the era of social media that came afterwards, right? Because we were. Again, we were around long before that. But once you started getting other social networks come on, you know, obviously they're popular, but some people realize, like, hey, I don't want to be on Facebook where my patients are. Like, that's no bueno, right? Because eventually people are going to see this, and I don't want to be part of a group where office administrators are allowed in or anyone from industry can Just waltz on in. This is not what we want, Right. We want to have a spot that's truly private, where it's just clinicians or if you're going to let in anybody else, we need to know who these people are. And so it's a very tightly knit, you know, tightly controlled group. And that's just sort of been our philosophy from the beginning. And with that, you know, doing no marketing whatsoever other than word of mouth, it just grew because people sort of, I think, wanted that. They wanted that space where they know that it's just not a million people looking in, that it's just their peers. And that's kind of how it happened.
- [12:45]
A
And you know what's interesting, and, you know, everything I know about OD Wire is that there's a lot of passion that happens in your community, Right. Like, there's people who are combative, but passionately so. There's people who are, you know, that. That have differing opinions. And over the years, you've probably had to learn, like, how do you balance that? How do you create. Yeah. How do you moderate that conversation in a way that ultimately doesn't necessarily, I don't know, piss people off or get them to leave the site?
- [13:20]
B
So some people will get pissed off and some people will leave. I think my overwhelming philosophy, actually, you can see it on my laptop sitting right here. It says, be kind. And I tell people when they're coming on the site. The most important thing you can do is just have a level of kindness to one another and just remember that everyone here is a professional. Right. Everyone here has got a doctorate. Nobody here is special. Right. That's why it's funny. It's very informal. Say we all refer to each other by our first names. Because, of course, why wouldn't we? Right. You know, we're all kind of on the same level, and we're all just trying to help each other so, you know, people can get combative. My one rule is I don't like personal attacks. Like, if you're making it personal, no good. And that's. That's where things stop. But if you have a substantive complaint about a product or service, and you're not just, like, ranting and raving, but you can actually say this went wrong because of X, Y, Z, I'm totally here for it. And people can complain as much as they want about whatever product or service they want as long as what they're saying is factual. Where I draw the line is if they're saying stuff that's just a rant or they're making things up, or they have no actual evidence that to me, it doesn't sit well with me. And that's where we'll start actually moderating.
- [14:34]
A
So how much time is spent kind of managing this community and moderating it now?
- [14:41]
B
That's a really good question. So for me, it's become so much of my daily routine over the past 20 years that the actual moderation of the OD wire side is minimal. The technology, we've rebuilt the platform actually four times over the site's history, to give you a sense, because we want to always keep up with the latest trends. But every time we'd rebuild the technology, I would always make sure that there was a degree of automation to it so that I don't have to babysit it. Right? So that's probably the biggest thing. And in terms of the moderation, it takes me, maybe, I want to say, a half hour each day perhaps, to really moderate it. And I think that's because it's gotten easier, because I think people understand the expectations, right? They understand what the site's about. And again, you'll occasionally get people calling me a censor, right? They'll call me Stalin or whatever else. Like, how dare you? You know, you're censoring me. You're doing this, that or the other. I'm like, look, again. You know the motto, like it says here, be kind. That's all I'm asking you to do is like, be kind. You can be as passionate as you want, you can be as factual as you want, but don't tear other users to shreds. Like, that's not the kind of site that I want to run.
- [15:56]
A
So do you find people coming on and, you know, overly commercializing or, you know, selling stuff that. And how do you feel about that?
- [16:06]
B
So we don't allow that, actually. So if somebody comes on, the one other thing besides not tearing each other to ribbons is if you have a conflict of interest, you have to state it out right? If you work for a company, you have to let people know. You just can't come on and say, blah, blah, this is my product. And we sort of walk the walk in that regard too, because we've also had other projects that we worked on, commercialized products that I haven't even advertised myself on the site. Right. Just because I didn't want to be seen as sort of hypocritical. Right. We had a contact lens ordering system a lot like Marlowe, which we actually built, like 15 years before there was a Marlowe. But we would never really market it too much on OD Wire itself, because I never wanted to have that conflict of interest. I never wanted this to be a place where people felt like they were just being marketed to. So, yeah, we're really careful about that.
- [17:06]
A
Yeah. So, you know, naturally, we eventually might get to your business model. But I'm much. You know, I'm really curious, as you've been so close to the platform for the last 20 years, I'm curious, like, how have the conversations evolved and what are some of the biggest trends? What are some of the. And first of all, I guess maybe you can tell me, like, how active is the community? How many. What are your metrics that you use to measure that ultimately. That ultimately help you decide? Like, is the community more engaged than they were a month ago, less than engaged than they were a month ago?
- [17:42]
B
Sure. Yeah. So OD Wire itself has about 30,000 optometrist members at this point. So that makes it, as far as I know, the largest, you know, purely optometric community. We do have small spots for ophthalmologists and opticians as well, but they're partitioned out. They're not actually part of the main community. They're much less active. But we'll get to why we actually have that. Maybe later we'll talk a little bit about CE Wire. But in terms of the. Of OD Wire itself, it does about, I want to say last month, about 1.5 million page views of the conversations, to give you a sense. So that's how we kind of gauge. We look at those sort of gross metrics. The other big part of OD Wire that I didn't mention before is our webinars that we do, which is kind of a funny thing. We've been doing these for over 15 years now, right. Every Wednesday or whatever it is, we do a live event where I'll come on and emcee this thing. Typically, companies come to me and they want to show off a product or whatever. Those things are commercial, 100%, no denying it. And we talk about it right up front, like, here's your infomercial. But surprisingly, those are also popular as well. I thought in the beginning, when we started doing that, those would be, like, nothing, that they'd peter out to nothing because no one would be interested. But surprisingly, on a Wednesday night, we could easily get 3, 300 people showing up live to hear about a product. And that always blows my mind, and, you know, about a thousand or two thousand more will watch a recording of that webinar Right. On the site, you know, within the six months of it being posted. So that's kind of how we just kind of keep a pulse of what's. What's happening. We just look at what people are looking at and try to adjust accordingly. Although I don't intervene too much in the conversations, you know, people are going to talk about what they want to talk about. Um, I'll seed some conversations as well. If I see interesting stuff out there, I, I absolutely will post it because, you know, if I find it fascinating, hopefully people will too. But for the most part, you know, people will let the conversation go where it just will go naturally.
- [19:36]
A
Interesting. So let's talk about how those conversations have evolved over the years. So last. Let's just go with last year. So what are some of the. If you kind of look at the last 12 months or maybe 2025, what are some of the top topics that, that seem to get the most amount of interest in the, in the community?
- [19:59]
B
Sure. So going into. I can even, you know, take it back maybe even a little bit further. 2023. Ish and on. Right. Like talking about the post pandemic era, obviously, when the pandemic was, you know, really happening. 2020, 2021 or whatever, dominated the conversations right throughout. And you'd expect it to. One thing that's happened in the post pandemic era, the biggest ones, private equity, no question about it, it became massive conversations. Right. You know, both, how does it work? The impact of private equity on eye care, what's what people's experiences are. Right. For people who decided to take the plunge, you know, people would frankly ask straight up, should I do this or not? Right. I may have someone's making me an offer, do I take it? Right. So these conversations were going on for a very long time up until the point, I guess, where private equity consumed as many of the large practices as they could. Right. They ran out of practices to sort of pick. So maybe going into 2025, that conversations died down a bit, replaced more by. And I guess along that line, some of the other big conversations have to do with sort of more overarching optometry itself and where it's going. Talking about schools that have continued to open. Right. So supply and demand is a huge issue. You know, is there an oversupply? Why are more schools opening? How is that working? We're also seeing more discussions of I have to go take a job now. Right. You have a new grad or someone who's young, they're getting job offers. Where should they go? Should I take offer A or offer B? And so that's been a really interesting thing too, watching how the older docs navigate that and try to help the younger docs to sort of guide them and figure out where they should go.
- [21:52]
A
So that's really the topic conversation. And I don't know if I'm allowed to get into the content because obviously it's for private consumption. So without going like super specifics, why don't we like pick one of those? So for example, if a young doc is getting on OD Wire and is trying to ask if that's one of the big frequencies of conversation, like, okay, like how, where should I go? What are the, what are the kind of decision points that ultimately, because I think there's people who are listening to the show and like, I have a recruiting problem, I need ODs. So based off of the content that you're seeing, what are, you know, and I guess there are pretty clear standing corporate offers that exist in the industry and I'm sure that there are some people who that's a good fit for them. But if I'm listening and I'm an OD and I have a practice or I'm a practice owner and maybe I'm not an OD and I have a practice and I want to be able to work, learn from the conversations that are happening on OD Wire about how to better recruit or what I should potentially offer that matters the most to people. What would that look like, Adam?
- [23:06]
B
Yeah, so we actually had a really interesting one last week that was really illustrative of it. In fact, if people, I don't know when this is going to go out, but when you come back to the site, you might even still see it running. Because it was a really interesting conversation. We had a young person who had an offer between a typical commercial practice and an ophthalmologist's office doing post refractive care. And so the offers were very different financially, they were very different clinically. Right. In terms of what you'd be seeing. Whereas in a commercial practice you would see the gamut, right. Of whatever walked through the door. In an ophthalmology practice that focuses on refractive surgery, you're basically seeing one kind of patient over and over again doing pre op and post op work. And so the conversation was fascinating because it hit every aspect of this job, right. Financially, right. Which one's better to take, who knows, right. Experience wise, if you think you're going to open a private practice in a few years, do you Want to take the commercial job just because you'll get a much wider scope of what's going on, or do you want to take the job with the ophthalmologist because you're going to get a huge volume of patients who are going for refractive care? Is that a better experience? Will the ophthalmologist actually show you more? Right. Because now you're not in a commercial environment. You're actually working with an omd, Right. Is this the kind of doctor who's just going to stuff you away in your lane and say, whatever, you handle it, or are they going to be collaborative with you and teach you? Right. Which is really what you'd like to see optimally. So really fascinating conversation, and it's fun to see everybody's point of view on what this person should do. And they haven't made a decision yet, so who knows what they actually will do?
- [24:46]
A
Which one paid more?
- [24:48]
B
So that's the interesting thing, right? So it's definitely the commercial job could pay more, Right. Because there's commission that goes on.
- [24:56]
A
There's a production. Yeah, the production dollars.
- [24:59]
B
Exactly. So what do you take? I don't know.
- [25:03]
A
Well, and that's actually a really important point. I actually, I don't want to go too far into left field here, but I always talk about this with people when they say, well, you know, my, my doctors could make up to, you know, $200,000 if they, you know, if they just meet their production numbers. And we always think about this and say, okay, but somebody who's never done this before, who's never worked in that type of model, isn't going to value uncertainty. They're going to value certainty way more than they're going to value the opportunity. Unless they're just a really clear, I'll call them, like outlier to that, to the typical model. But that outlier is probably thinking about how they're going to start their own practice because they're enterprising and they're really excited about the opportunity. And so they're like, well, why the heck would I keep 20% of that? Right. I'd want to keep 60 as an owner.
- [26:02]
B
Exactly. And so these are all factors that have to weigh in. And it's tough. It's tough. You see these things. The one thing that turned me away in this particular case from the OMD practice is because the ophthalmologist was talking about your job would be to upsell premium IOLs. And so I try not to weigh in too much on the conversations on the site. But to me, this was like red flag going off. Like, you know, the alarms going off. Like if someone tells you they're going to push premium IOLs, like Time out, you, you need more information there. Right? You know, what is it that you're going to be doing? Because obviously clinically they can have a benefit. But if someone tells me, oh, yeah, try to sell these, then, you know, I don't know.
- [26:43]
A
So, yeah, I mean, it's, it's, it's interesting, but I don't know how different that is really from, hey, in optometry, you're going to be pushing premium, premium lens technology in someone's glasses.
- [26:56]
B
True. Except the only difference is this is permanently attached.
- [27:00]
A
That's fair. That's, that's true.
- [27:03]
B
So, yeah, so that's, it's, you know, so these are the kinds of conversations and they're fun, right. At the same time, they're deadly serious for the person who has to make this decision. Um, so those are the kinds of things where I really.
- [27:16]
A
AI. Has AI been a. I mean, I imagine I can't go anywhere without. Without talking about AI. Can't go to the show without hearing about AI at least a couple times a quarter. So what role is AI playing in some of the conversations on od?
- [27:35]
B
Sure. So, I mean, it's a big discussion, sort of for better or worse, you know, I am the resident AI skeptic. So I, you know, people know my opinions about this. I make them clear when we're talking about it. Obviously, machine learning has its uses and some of the best discussions about it are around very specific technologies. Right. So for instance, you have an OCT that might help you clinically. Right. Where it's using machine learning. And I'm sure you've seen all the press releases about different instruments where they've had AI added to them, which is great. And I say AI. I'm going to use the term loosely, right, because this is machine learning. This has been around since before you or I were born. Right. This concept. So those are good conversations where people can try to actually very specifically talk about the tech and what they're going to be able to use in their practice with the instruments that they have or frankly with the software that they're also implementing. You know, that's clinically useful. Obviously there's the discussions about the sort of more nebulous AI as well, sort of the LLMs and all the hype and everything else. And my feeling, you know, when we get into those discussions, it sort of shifts. Right. Because you're talking about two totally separate things. You know, I, I think a lot of it is, you know, 90% nonsense. And again, having lived through the dot com bubble, you know, I. History doesn't repeat, but it rhymes. And a lot of what I'm seeing is rhyming. I was right there at the epicenter of it and I can see what's, what's happening again. So again, these are the kinds of conversations that we're having where you have people on the pro side, you have people on, you know, the negative side and we just go back and forth about it and I, you know, we try to get technically a little bit deeper. I in fact went in and set up and a locally running LLM, I set up a Linux server just to show people, walk them through it. Like if you wanted to run one of these things on your own without relying on the big commercial LLMs that are spying on you, you actually can run it on your own standalone, off the Internet device if you really wanted to. So I just went through a little 20 minute demo showing people how that actually works so that they can see it in a little bit different light. So these are just the kinds of fun things we've been doing with AI over the last year.
- [29:49]
A
And Adam, what are you most skeptical of when it comes to AI?
- [29:55]
B
Oh, how much time do we have? I mean, obviously the claims are outlandish. They're backing off from a lot of them now. Like what? Generalized intel, like AGI. The idea that there's some generalized intelligence that's going to come out of this, that's absolute nonsense. And of course you're now seeing that, you'll notice over the last few months you haven't heard much about it at all because it was nonsense to begin with. It was very much science fiction. Nothing that these LLMs generate will ever approach generalized intelligence. The technology is not there. I think the other problems that I have with it, at least in a medical context, is the fact that it's a very stochastic system, it's random and you know, you will get the wrong answer a certain percentage of the time. And the problem is if you're not checking closely, it's going to lead you astray sooner or later. And that's one of the biggest hurdles I see with a lot of people using LLMs is that people will say, oh yeah, I'm checking its result. But the reality is when you study it, most people aren't, they're trusting the machine. Because what we've been taught always before is that you can trust the output of the computer, right? It's going to be identical each time you do it. That's not the case anymore. Right. You can ask an LLM a question, the same question twice, you'll get two different answers and that's a real problem. So these are all sort of the challenges that people are going to have. Not that it, you know, it'll definitely have its uses, but I think the use cases have been dramatically overblown. And I think the other problem that I try to make people aware of is that right now if people are building technologies on top of these commercial LLMs like Anthropic or OpenAI, the price is going to go way up. So even if you are using it and you feel like, okay, it's reliable enough for me, you can expect in the future you're going to be paying an order of magnitude more for the same functionality because right now it's all been subsidized. Right? The VC dollars are what's allowing you to actually use something like OpenAI for free or cheap. And finally we're starting to actually see all that come to a head as people are moving to more usage based models because the sort of all you can eat stuff is going away. So interesting times.
- [32:11]
A
I so, and I agree, I think the, that particularly, I'm in agreement. So first of all, I thought we were really going to disagree because I'm a huge proponent of leveraging technology to make your practice more efficient, deliver a better patient experience and ultimately be able to help differentiate a practice to allow it to actually be more human with AI doing a bunch of the, we'll call it, mundane tasks. Right. So I've been a proponent of that for the last year and I thought we were really going to disagree when I asked you this question, but turns out that we actually kind of agree. Especially because it's the mindset that's required to leverage AI appropriately. And oftentimes people go in saying this is a cure all. We're, we're gonna, you know, just, it's, we're gonna be able to trust everything that it does. And the reality is that you can compare it to the machines that we're used to, right? Like if I hit Control P on my computer and the document comes out of the printer that's over there in the corner, that's very predictable. It happens exactly the same way every time. And if it doesn't happen the same way every time, there's a predictable number of reasons that I know, like the ink, the printer is out of toner. The, you know, that the connection isn't set up correctly between the printer and the computer. But like that's the, you know, and then the troubleshooting kind of makes sense to me that I can follow. The reality is, I think the models have that because we're getting different results sometimes from the same questions. From an AI standpoint, when you, when you even ask the model and say, well, why did you give me that answer? Oftentimes it has no idea. Like the troubleshooting doesn't exist, which then. Or the troubleshooting is unreliable inherently, which then creates the complexity of if you have a thing that has to do something reliably with every single patient, every single time, you better be sure that there's enough steps before it and after it. And sometimes those are technology steps, in my opinion, that are double checking the work. And it's like, well, if I hit control P and the thing didn't come out over there, or if a completely different thing came out of there, like somebody. We now have to add a step. I didn't even know I had to add a step that somebody has to read that document and compare letter by letter that the original document that I had on my screen matches the thing that came out of the printer and that magically didn't hallucinate because I didn't even know I had that problem before. And so trying to use a, you know, I guess kind of a basic example to demonstrate that, like it. And if you do have technology in place that then says, okay, I am going to now error check the fact that the thing came out of the printer was the same thing that was on your screen. You're now spending money for that technology and there's a tax from, for accuracy. And I think that a lot of the solutions that exist right now, at least the ones that I've been exposed to, are really on the right track. But they're missing this one key point that you made, which is that there's an accuracy and a predictability problem and we have to pay for that problem. And we either have to pay for that with additional technology or humans on the front end on the back end, which may be cheaper than paying a human to do the job in the first place, but you still have to be able to check it and you still have to invest resources into that. It cannot just be a blatant cure.
- [35:33]
B
All right? And in fact, in 1979, IBM wrote in one of their user manuals for their mainframes a very famous sort of line in the user manual it said a machine cannot make management decisions because the machine has no accountability. Right. And so this came straight from IBM, right? They understood this problem in the beginning, that ultimately we are the ones who are accountable. Right. And if we just blindly accept what the machine is giving us, eventually we are going to have a problem and perhaps a large problem. So being able to check and be really critical of this output, especially now, is incredibly important. Just one little anecdote. My wife, one of her books that she wrote in her field, she's fairly well known, um, she decided to like, you know, look herself up and in ChatGPT or Anthropic or one of those, whatever it was, Claude, it started giving, you know, basically looking up, you know, what she wrote about in her field and just to check it, just to see what it knew. And it started making up quotes that she apparently said that she never actually said and then came up with citations that never actually existed. Right. These things that sounded plausible and sounded like they were in her voice, but they weren't real.
- [37:00]
A
Was this recent, Adam, like within the last three months?
- [37:04]
B
Yeah, so this was recent. So that's the problem is that, you know, if you're going to check, great. Most people don't check and they just assume that this is correct. And I saw actually that one of the larger online scientific research paper sites is now going to issue one year bans to anyone who gives a fake citation. Right. They're going to literally ban scientists. If they submit a paper that has a fake citation in it, you're gone. Which it's about time because this has become a problem. So, yeah, it's just very interesting like that we've reached a point where someone can actually feel comfortable submitting a paper with a fake citation. I mean, you know, 10 years ago if you actually did that, you'd be gone, you'd be kicked out, you'd lose your faculty position. Right. You'd be disgraced. And now it's okay. So these are my big concerns and I think other people share them as well.
- [38:02]
A
And it's really interesting in the world of education, just so happened that my daughter is moving to middle school next year. And so I went to go meet her middle school teachers and I asked a question of how much technology do they use in the classroom? And two of the teachers said, the science and social studies teacher said, well, what we're doing is we're actually starting next year, we're asking the students to handwrite all of their reports and we're asking the students to handwrite all of their answers to all their questions. And while the school issues Chromebooks for every single kid. Right. The school has an issued computer. Every single kid, they're saying, no, we're not going to, we're not going to do that or we're not going to use those tools for this particular application because we see that it's not really the right approach. And they're also obviously concerned about the kids use of AI rather than developing critical thinking skills.
- [39:03]
B
Yep, that's definitely the trend. I have a son in high school and they very much go back to the Socratic method. Right. Of a lot of interaction in class. In fact, they've limited homework now, which is interesting. I'm of an era, as you may imagine, where homework was a thing and he spent hours doing it. But they don't do that anymore. He's got hardly any homework at all in many of his classes because they want that interaction in class. And you're right. The blue book, which I thought had died with my generation, has made a huge comeback.
- [39:32]
A
That's funny. Yeah. So many exams written in the blue book. Yeah. Listen, we got to take a break, but when we come back, I want to talk a little bit about the evolution into CE Wire and also some of the most important topic or some of the most recent topics there. And if we have time, I want to come back and I want to know what the trend was, what was 10 years ago, what were some of the od Wire highlights 10 years ago. Because I want us to recognize how, where we've come from. So we'll be right back on the Power Hour. Hey there, it's Eugene and I want to let you in on something. So you've been to conferences before. You come home fired up and then Monday morning hits and it's back to the grind. The ideas don't stick, the plan never gets made, and six months later your practice is in the same place. So I know that pain. I've been to those conferences with you and that is not happening. At this new event called I Care Boss Live. You've heard the story of I Care Boss and now there's an event, I Care Boss Live. It's September 16th through 18th in Cleveland. Two and a half days. We're bringing together 200 of the best practice owners in Icare for a one of a kind event that combines speakers, peer learning, mastermind groups and industry innovation. All designed around one goal. You leave with a 90 day plan and you can actually execute it and get stuff done. And we're going to tackle some real stuff. Exam only. Rates, revenue preparation, people problems, leadership, AI and technology specialty growth, the things that keep people up at night. We're going after it, and we're doing it in a room full of practice owners that are just as serious about growth as you are. This is not a conference, it's not a seminar. It's something different. There are only 200 spots. So if you want to be in on this, this is not publicly announced, just on this podcast. Go to the powerpractice.com click events. Click apply. Now. This is invite only. It's not for everybody. So you have to apply. We'll ask you a few questions, and if it's a fit, we'll invite you to register this event. I care. Boss Live is going to sell out. Do not sit on it. I invite you to apply. Right now, we're back on the Power Hour with Dr. Adam Farkas. And I think as we're talking about this journey with OD Wire, at some point you mentioned these webinars that you were having that were commercial webinars, and at some point that evolved into something more. Is that how CE Wire came to be? Talk a little bit about that initiative.
- [42:04]
B
Yeah. So the webinars, you know, were very successful for us for, for many years. And again, they are very commercial, right? So a company will come up with a new instrument, let's say, and they'll want to show it off in a more interactive way. So they'll have me MC an event on a Wednesday night where we'll just talk for an hour about it. And what started happening after we did the webinars for a while is I get emails from the docs and they'd be like, hey, how come I can't get CE credit for this? And I'm like, well, because it's not ce. This is an infomercial, right? This is a commercial, right? It's a space where we don't have to restrict what we're saying because it is just, it's an infomercial, essentially, right? So we're talking back and forth with folks, and that's fine. And people love it, right, because they get to see the latest and greatest. But they wanted education. And over time, people kept on me and they're like, please, can we get real education? And I'm like, I'm not an educator. Like, I'm not, you know, I don't know how to do this. Like, I, I, we're not set up for this. It's a totally different thing. But by 2015, after we'd been doing, you know, these webinars for many years, I finally caved in. And Ody member Dr. Steve Silberberg was like, look, you really should do this. I can help you with it if you want to try to, to get some of it set up. My father was like, yeah, we should definitely do this. And my father was always really funny because he always had great ideas and I'd always implement them as best I could for him. But obviously he wasn't a tech guy. So whenever he would have an idea, what that would mean is that I would end up doing a lot of work. So it's one of those things, right, where he'd come up with a crazy idea and I'd have to implement it. But finally he's like, yes, we should do this education stuff. Let's go for it. And he said he'd help as best he could. Of course, he couldn't do that much, but he was definitely helpful in the process, too. So in 2015, we decided to do actual real cope CE. So I went through the process of becoming a COPE administrator and learning how it all works and what you have to do and how to actually produce real CE. And so 2015, we had our first live online event, CE Wire 2015. And it was successful. It was stressful. It only had, I want to say it was like 15 hours over a weekend. It wasn't a lot of classes. Know, for us it was small and we had a fairly good turnout. We had over a thousand people, I think, register for it. And so it sort of grew from there, this idea that we could offer online CE. And of course, in 2015, not many people were doing it or not doing it well back then. So we thought, you know, the whole idea and the whole reason I wanted to do it is because I thought we could do it better. And so that's how CE Wire was born and the idea behind it. And to this day, it's very different from other continuing education online, right? In that it's strictly by clinicians for clinicians, meaning the people who take CE Wire pay for it. Right? The doctors who sign up for it pay for what we call Season pass. And by so doing, they're paying directly for their education. We don't rely on advertisers to make CE Wire run. So it is strictly a doctor to doctor conversation. Right. We don't allow outside influences. We're not constantly scrambling for grants. We're not going to allow sponsors to come in and tell us what to Do. So it's the only conference that I'm aware of, at least online, where that's the case, where it's not sponsor driven in any way. The curriculum is totally determined by what the people who sign up for CUI or want to see. And that is the one key critical difference with CUIRE from everything else. And it's really driven sort of what we do and how we put together each event.
- [45:54]
A
And do you recruit the education from the expertise within the community? So like, you see somebody who's constantly contributing a lot on Dry Eye, for example, and you say, okay, we got to do a CE on Dry eye. I'm going to ask that guy.
- [46:07]
B
So in the beginning, that's, that's actually how it worked. You know, optometry is a small field. Of course, I kind of know everybody. So if we know somebody who's good, what I'll do is reach out to them and ask if they want to participate. Essentially, you know, 10 years on or whatever it is, 11 years on, everybody knows who we are and what we do. So it's not hard for us to recruit. And in fact, we have the opposite problem these days where CE Wire. We have 75 hours of education at CE Wire, so we have a lot of education. But even so, we can't include everyone anymore because we have a roster of so many speakers. We have to constantly rotate people in and out each year because so many people want to participate. But what we've relied on is in CUIRE itself, we have surveys at the end where people tell us what it is that they want to see and who it is that they want to see. And if they really love someone, we make sure that they're back the next year. If they don't like a topic, we downplay it. So here's a really good example. Contact lenses. In the beginning, contact lenses were a huge topic. If you actually look at the number of topics that were contact lens related, C wire was large. Over the years, people have told us, hey, we want you to de emphasize contact lenses. There's just too much of it. We don't really care. There's other stuff that's more interesting. Stop doing so much contact lens stuff. Fine. So we did we adjust the curriculum based on what people actually want to see, not what companies tell us they want people to see. And that is a huge difference.
- [47:39]
A
Interesting. And how have those conversations, or I guess how is that? You mentioned it a little bit with contact lens, but what are some of the most popular CE topics in let's say, 2026 versus what they were a couple years ago versus than I guess when you first started.
- [47:57]
B
Yeah. So there's definitely a bigger shift to medical over the years. So again, in the beginning we had more contact lenses, more optical, definitely move more medical. A lot of surgical, which is very interesting to me as well, especially as surgical privileges are now expanding across the country. People are very interested in laser, which is something that wasn't the case 10 years ago, for sure. Glaucoma has a huge interest. You know, we have a huge glaucoma track each year just because there are many states that require it. So one of the things that we try to do for our users as best we can is if a state requires something, we try to actually include that as well so they don't have to go outside to get their other requirements. So for instance, we have an entire track of 8 or 10 credits. I forgot how many for narcotics because the DEA requires a certain number of narcotics credits every cycle. So we're like, okay, well if you're here, you may as well get all your narcotics credits. So that's something we started doing too. So again, very much of a shift to medical over the years. That's probably the biggest trend that I've seen.
- [49:04]
A
Got it. And then in 2026, I imagine, like GLP1s is a big one. What else?
- [49:12]
B
Yep. So we do have GLP1 lectures. So of course that's a huge deal these days. You know, I'm trying to think about the biggest ones this year. So surprisingly, you know, Dry Eye carries on as a real topic that people want to hear about. You know, that that sort of crescendoed, I would have thought, you know, post pandemic, it went up for a while. I thought it would go down by now, but people are still very interested in it. So that's been very popular this year as well. The glaucoma, again topics are huge, especially because surgical intervention in glaucoma, which really wasn't a thing 10 years ago or even 5 years ago as much. Huge. Right. SLT has become a huge topic and in fact, some people use it as first line therapy now. Right. So these lectures are popular as well. When to recommend slt? When do I refer out things like that?
- [50:05]
A
Yeah, interesting. And if you had to go pre pandemic, you know, let's just kind of go the late teens or the mid, the middle of the 10s. What were some of the most exciting topics when you first started it?
- [50:24]
B
I mean, the biggest ones that people cared about back then Again, dry eye. And I'm not sure if that is because before the pandemic, there was an onslaught of new products to treat dry eye. Right. So that's again, I guess, I don't know, I don't want to call it fad, but it's like things come and go probably just based on the amount of noise a topic has. And back then you remember like Xijer and all these other drugs that crashed onto the market, Right. All of a sudden you had all these new agents that you never had at your disposal before. And I think that was a huge deal for people and that's why they were so interested in it. Now we're starting to see agents for presbyopia, right near and dear to my heart. So we're starting to see that, right, where you have some sort of pharmaceutical interventions for it where that never existed before. And that is, again, becoming a hot topic. You know, are these drugs ready for prime time? Should I be using them in my practice? Right. Because that's one of the things that can be rather disruptive. You know, the. A sort of new class of drug that you've never seen before. Those kinds of things are very interesting to people when they finally do hit the market.
- [51:34]
A
Yeah, interesting. So I guess if I'm. If it seems like dry eye has staying power, I'm curious, do you have stuff on myopia that. That, like, how much interest is there from providers in myopia management and has it grown over the years?
- [51:54]
B
Yep, still a surprising amount. You know, you would have thought again, that would have peaked. Is there not that much, you know, going on, but people still are interested in it. Some of the biggest topics we have around it are sort of the. The overview. Right. The different things you can do, whether it's using a lens or using a pharmaceutical agent. I think, at least for the CE Wire audience, which is basically a general C wire, I should have backtracked. So CE Wire is mostly attended by general optometrists. We get about 5000 ODs a year taking it, give or take. And the bulk of those folks are just generalists all around the country and in Canada. And so for them, these sort of survey classes, these overview classes are very important, especially on things like myopia. Right. Because even if you're going to refer these things out to another organization that might handle myopia management, you at least want to know what the options are. Right. Or if you do want to start handling it yourself, you want to know what's out there to do. So those sort of survey courses are actually very popular.
- [53:06]
A
Interesting. Got it. And I guess, you know, to kind of bring it back or circle back to the topics that. And the evolution of topics on OD Wire. Let's talk about those trends. So when you first started, I'm sure that, you know, that's not a. When you first got to that 12,000 user mark that you had mentioned, you know, what were people most excited to talk about? Why were they joining the community? What were they most interested in? And. And then over the years, how has that evolved?
- [53:36]
B
So in the beginning, practice management, I would have to say, was people's obsession. And again, totally understandable. Right. Because of where it came from. The crowd initially was older, they had established practices and they were just looking to maximize revenue. And that's what they did. Right. They would trade tips with each other. We had one doctor who said he left a quote somewhere that OD wire saved him $400,000. Right. And like, that is what was important and meaningful to them back then. That's kind of shifted over time. Right. The topics that have become more important are clinical topics, by and large. Where should I practice? That kind of practice management question. What kind of scenario should I get myself into? Should I go commercial? Should I go private? What should I do? That's important too. The political topics have also become hugely important. So I guess it was maybe whatever it was 10 or 15 years ago that board certification became a huge thing. That was just an explosive topic and one that was actually difficult for me personally to deal with with all of these sort of the rancor and the back and forth and the mud slinging and. And so, you know, those kinds of topics were. Were important as well. We're getting much less of that these days. I don't know if, if people are just calmer online now or they're not as willing to just start flinging mud at each other or what, But. Yeah.
- [55:07]
A
Yeah. And I kind of wonder if, you know, since this is an OD to OD community, what is being said behind the scenes or what's being talked about behind the scenes that you wouldn't necessarily see on, you know, like. And as you said earlier, you know, there. There's Facebook groups where there's practice managers that are part of those Facebook groups or that there's industry that's part of those Facebook groups. So I'm curious what topics you. What. What effect you think that has on the community and what topics people can really talk about.
- [55:40]
B
Sure. So not having sort of office manager staff around is a huge Thing we also have the facility on the site to submit anonymous questions. So this is an unusual feature, right? So, and these are truly anonymous. So people always ask, well, how do you do that? How do you make things truly anonymous? Right? Because in the beginning the issue was, you know, people could always say, well, Adam, you can obviously see everything. Right? Right. Since we run the technology. So I set up this sort of byzantine system where the system will send me an email anonymously, there's a form on the site, it'll strip all the information from it and then shoot me an email stripping out all the person's information. So even I don't know who this anonymous person is because I wanted to be blinded to this too. And between having that capability and only having ODs, they can start really going at it about really sensitive stuff. You know, talking about audits. Right. Which is always a topic of conversation. Talking frankly about VSP and, you know, what's happening with them and how can they avoid being audited and what can they do to, you know, to stay clean with vsp, you know, what's the proper technique, things like that. Right. Really sensitive stuff that they might not otherwise want to get involved with in any more private space. So yeah, mostly a lot of that, that stuff has to do with billing, the most sort of private stuff. The other thing is employment situations where someone is in a bad situation and they want to get out, but they don't want to use their name and they don't want people to know where they are.
- [57:26]
A
Well, even the big topic you mentioned of private equity offers, you know, people probably don't want to, if they're revealing certain details about their offer, you know, they probably, probably don't want their staff to know or they don't want their patients to know how much money they're making or whatever that's happened.
- [57:43]
B
Yep. And the private equity discussion is a challenging one too because people who actually do work with private equity end up under non disclosure acts a lot of the time. Right. And so you get this really weird dynamic where you'll get a lot of people talking before, before, before and then after it just falls away and you're like, what happened to that person? Why aren't they talking about this anymore? And the reason they're not talking about it anymore is because they can't. So that's a little challenge that we have. Right. You always know what the before looks like. The much tougher part is what happens after. And that's where having a little additional privacy might not be a bad thing. Either.
- [58:22]
A
So where do you think the community. Last question, Adam. Where do you think the community is going and how is it going to be positioned? What's its role in. Given the recent evolution of technology, social media, etc.
- [58:36]
B
So I think for a while there OD wire in its format itself, people are like, oh, this is obsolete. Why are you doing it this way? It looks so old school and blah. They're giving me the business and I'm like, well, yeah, it does look a certain way and it is private. It's very different. It doesn't try to be what it's not. And I think for a lot of people, they're like, well, that's old fashioned. But now, of course, you know, you've obviously heard of Dead Internet theory, right, which is rapidly becoming a reality. This idea that because of all the bots that are out there that can mimic humans now, and they're getting better at mimicking humans, most of the content that you're seeing online now is fake in some capacity or another. We are one of the very few remaining spots online where when you go to our site, when what you are seeing is real, right, because we kick out anybody that's not. And in fact, I warn people, do not ever post AI stuff here. If you think you're just going to cut and paste the output of Claude or whatever, you're sadly mistaken. Like, this is not what we want here, it's just human. And I think that's a trend that hopefully will allow the site to thrive going forward. I think there's a hunger for it. I think people are sick of just dealing with all the nonsense sort of on the public Internet, which is a shame, right, because this is one of the greatest technological marvels humanity's ever built and it's just collapsing in on itself with no real way out. So at least we're providing this little buffer, this little locked away space for professionals that they can use and at least feel like it's almost like cheers. Right? Norm walks in, the door closes behind him and this is where you are now. You're safe in here, at least in our little underground, whereas you might not be outside.
- [60:24]
A
Yeah. Well, Adam, thank you so much for all the work that you do and thank you so much for keeping this community thriving. I appreciate having you as a guest on the Power Hour. I think it's been an interesting conversation and I appreciate contributions.
- [60:37]
B
Great. Well, thank you so much, Eugene.