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Power Hour Optometry
The 4 Pillars of a Highly Profitable Practice: How to Build a Scalable, Patient-Centered Business
01:03:06
Building a thriving optometry practice isn’t about luck — It’s about strategy, efficiency, and data-driven decisions. Dr. David Cockrell has spent over 40 years refining the formula for success, turning his practice into a 12,000 sq. ft....
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- [00:00]
David Cockrell
Foreign.
- [00:07]
Eugene Schottzman
Welcome to the Power Hour, Optometry's biggest and longest running show. I'm your host, Eugene Schottzman, and we've got a great conversation for you today. My guest today is Dr. David Cockrell. And David has been practicing and running a successful practice since 1981. So if you've listened for a while, you probably know my fascination with data and, and also with successful practices. So when I first met David and I heard him talk about some of his numbers and his practice, I was excited to share some of his experiences with our audience. So picture this. David has a 12,000 square foot practice in rural Oklahoma with 5 ODs, seeing 40 patients a day each. He has almost every specialty you can imagine, including aesthetics. And in reflecting on what makes a practice successful, it actually turned into a pretty structured conversation with what we kind of turn into four pillars of running a successful practice. Now, you're going to have to listen to the episode to figure out what these four pillars are. But I'll tell you, there's the pillars and then there's also the hidden gems behind the pillars. You're going to hear David talk about how he does time studies in his practice, which actually turned out to be a little bit easier than it sounds. How he makes the staff present research pieces at staff meetings to build culture. We talk about efficient team time use and how you work with local schools and local hospitals. So many interesting angles in this conversation. Now we also talk about David's longtime advocacy work. And in the last few minutes of the show, you have to hear David's pitch for OD advocacy, which I think is a very important topic. And also we hear a little bit more about his role as the chairman of the Health Care alliance for Patient Safety. Now, one reminder that I enjoyed during the show is that you always have to find the next constraint in your business, whether it's something that's slowing down efficiency in the office or the inability to deliver the care that you want. This is a mindset that David adopted. And if you measure, you can find the constraint and you can do something about it. So on that note, I guess don't get constrained by having to remember when the next episode drops. Go ahead and subscribe on your favorite podcast platform and then also please reach out Eugene Shotsman.com or the Power Hour website. Again, that's Eugene Shotsman.com and you can send me questions, you can send me feedback. If you want to tell me what you thought of this episode, or if you just like to connect, I'm here as A resource, and I absolutely love what I do. Now let's go ahead and go to the Conversation with David. David Cockrell, welcome to the Power Hour. Excited to have you on the show.
- [02:31]
David Cockrell
Thank you very much. Very nice to be here.
- [02:33]
Eugene Schottzman
All right, so I think you have such a deep understanding of our industry. I think you have a deep understanding of where the industry is headed. But I also think that you have a unique perspective on what it takes to grow a successful practice. So I usually don't start with a lot of introductions, but I do want people, for context sake, to hear a little bit about your practice, because there's some things that I've learned about your practice that truly fascinate me. Like, for example, that your Doctors see, what, 40 patients a day or something like that. So tell the audience a little bit about what your practice is, what your practice does, and kind of how you've generally continued to expand the service offerings that you have for the community that you serve.
- [03:16]
David Cockrell
Yeah, I think our practice is. Is where it is from a patient base, because I've always tried to look many years down the road to see where I think the profession of optometry was going and in general, the profession of healthcare itself. And, you know, I had the great fortune of when my wife Cherry is an OD as well. We started a practice in 1981. We had the great fortune of being in a very small practice, absolutely landlocked and couldn't expand. That might sound like an odd thing to say, but I learned a lot from that. And one of the things that it made me think about is we really started to try to figure out how to practice optometry and do. The business of optometry is there's multiple constraints when you come to growing a business. And a practice is another form of business. For me, optometry has always been what happens when I'm with the patient inside the exam room. The business of optometry is when I step out into the hall and I'm thinking about what it takes to make payroll and to keep the entire operation going. And I think in general there's. I realize there are four constraints that are really critical when it comes to developing the type of practice that you want. And if you don't remember, remove all four constraints, you're still going to have a very good practice. But any one or more of those can really limit what you do and identify those constraints is first of all, the physical space. Remember my comment about having the good fortune of being in a tiny building? We couldn't Expand. Right. If you don't have enough room to grow in that particular place, then you're either going to be fixed in what you can do with that particular size, or you're going to be constantly moving to get to another location that's larger and then maybe another location that's larger with the inherent problems that occur with that. So physical space is number one.
- [04:54]
Eugene Schottzman
Well, hold on. So let me. Let me pause for a second because we're going to get to all four of them. But I'm curious, because I did hear you say you were fortunate to be in a small, landlocked space, and then I'm assuming you moved since 1981. Maybe not once, but multiple times. So talk about that. And as you moved, what. What lessons did you learn? And what kind of. And what mistakes did you make that might be interesting for the audience to hear about?
- [05:23]
David Cockrell
Now, let's start with a mistake. The mistake I made was staying in that small location for too long. What I learned from that was a. I couldn't get the land on either side of it, and I was having to pay for parking for my patients. So as we got busier, I had to pay for more and more parking per year. Very expensive at that time, or at least I thought it was. So when I decided it was time to move, I looked for a piece of land that was large enough that I wouldn't have to move again. And that was at least the thought that I had when I went into it. So ultimately, we wound up buying a block. Like a city block. We wound up buying a block, a city block. And with the thought that I wouldn't take up the whole block, but I wanted to make sure I secured enough land that I could build what I wanted to. And when I did that and realized, you know, knew at the time I wanted to build a building, I went to an architect and I. And I. I had literally visited very large practices on the east and west coast of America, went to the largest practice I could find, walked in and introduced myself, introduced myself before I came, and I walked in. And every time I walked in one of the doors, the first thing that every single doc did was say, well, let me tell you what I don't like. It was. It was like they had a recording. And so that's what I heard. But it was always physical constraint. There was always something about the physical constraint of the building they were in. So ultimately, when I went to the architect that we actually chose, I told him that I wanted to build a building. That was what I needed then and what I thought I wanted. And I had a briefcase that literally was this full. I couldn't even really close it. He listened to me very politely for about 30 minutes and said, why don't you close that? David, let me tell you something. If I do what you want me to do, I'm going to build you a building twice as big as you need. You're going to have to have twice as many staff as you need to, and it's going to take you forever to grow into it. Let's talk about where you think you're going to be in five years and 10 years. And I can build a building for that. So what we ultimately did is we built the building that we needed. But because I wanted to plan for future growth, I literally bought the bricks for future growth. And because, because you know, when you add on a building, you can't get the same bricks. It looks different, it looks like it's added on. So we built a building in 1988. We added onto that building in about 19, almost, almost 2,000. And then we added on again in 2007, we added on again in 2016. And now we're in a 12,000 square foot building. And when people have never been in here before, they look like it's one building built. Because I had the plans for all three. For all three. At one point I thought I'd have the world's largest barbecue if I didn't build out. But I wanted all the bricks to look the same. I really learned that planning ahead and having the right architect to do that. And if you're fortunate enough to go out with a mindset that I'm going to buy a piece of property that allows me to grow, you don't have to move again. So that was my physical plan.
- [08:06]
Eugene Schottzman
So, so one, that physical side. What you know, are there any tips that you could give to people listening in terms of what to avoid? I understand the too small, too few lanes, but what are some of the lessons that you've had as you've toured practices and as you mentioned, you, you've gone to some large practices. I'm sure that in your advocacy work you've seen all kinds of practices. So what are things that, what are common mistakes that people make when it comes to the physical space?
- [08:34]
David Cockrell
You know, as you think, and I'll get to that, as you think about healthcare, one of our major constraints is our fees from our payers are essentially fixed. Right. You know, if you think about VSP or IMID, they've not raised our fees in over 20 years. And so in order to continue to grow, you have to be able to go faster and you have to be able to be efficient with your time. So when we work with the architect, he literally had taken a stopwatch, he knew to. He literally knew more about how long it took to open a vial of contact lenses in 1988 than I did how long it took and how long it took to walk from one spot to the next. So we really, when you start to think about your physical plant, you want to make it as fish. As efficient as you can for yourself, but you want to make it really efficient for your staff. Otherwise they're never where they're supposed to be because they're walking from point A to point B. So each time we've done this, we, we built essentially a pod format. So you work within an individual pod that you're in and you're not wandering all over a large building or even a small building. You're not wandering back and forth, keeping in mind that where that your expenses to operate your business grow and your overhead, your, your payment modality is fixed. Unless you can generate non insurance revenue, then you've really got to be efficient. So I think efficiency is number one.
- [09:51]
Eugene Schottzman
Well, it's interesting and I was sitting in a, I was sitting in a waiting room waiting for an appointment a few weeks ago and I actually observed that exact point. There was a woman at the front desk and there was always seemed to be a line at the front desk and there was a woman at the front desk that would service each particular patient and she would talk to whoever. And then obviously part of the practice flow was that she would print out some sort of paperwork. And every time that she did, she would hit print. She would get up from her desk and she'd be gone for about a minute, minute and a half, and then she would come back and she would hand the paperwork and the conversation would be over. And she'd do that. And she does that, you know, I don't know how many hundreds of times in a week, but you think about that and you're like, okay, well you know, Even if it's 50 times a day, 250 times a week, each times a minute and a half, all of a sudden you killed like 400 minutes or what, like five, six hours of actual, of actual productivity that could have happened. And also you impacted the patient experience because every one of those patients stood in a line waiting, waiting to be service. And every single one of them is grumbling, checking Their phone is not as engaged. And if there was a sale component to the, to that piece, I'm sure that sale would be out the door, or at least it wouldn't be. It wouldn't feel as good, it wouldn't feel as high value, and it wouldn't provide for that patient.
- [11:18]
David Cockrell
You know, it's exactly right. Every, every single quarter. And we've done it for decades now. We do a time study in our office and that's from the time the patient interaction starts at our front desk. How long does it take there? How long does it take with their technician? How long does it take with the doc? How long does it take with the optician? Because patients are adding those minutes up just like you talked about, Eugene, whether they recognize it or not, they're adding them up. And when a patient is unattended, those minutes stretch out to what seems like hours. Right. And so we want to make sure we've always got a patient constantly attended, whether it's at our reception area or whether it's with our technicians or certainly the last thing we want is them sitting in exam room wondering where the doc is. Right. And so we try to make sure that where nobody's walking very far at any point in time and we don't leave a patient unattended.
- [12:03]
Eugene Schottzman
What's a time study? How does it work? I mean, I understand in concept, but are you literally like your office manager sitting there with a stopwatch, like following a patient around?
- [12:12]
David Cockrell
Actually, we have a can't use my hands. We have a small document that's prepared. It's a small 4 by 6 piece of paper and it's got check in and somebody's going to put their initials and their time on it. Now there's a little bit of honesty counted on. We count on the person at the front desk to do it properly. But from time to time, our practice manager will go through and make sure that people are recording the time accurately. So they record it when they walk in, they just put their initials and they record it when they're done with that and the charts ready for a technician. Technician records when they pick it up, they record it when they finish with it and put in there for the dock. And you know, I'll use myself as an example. The recording it when David Cocker walks in the room, whether or not he remembers to record his own time or not, and recording when I walk out. So they keep me honest. Right. And so at the end of the day, we take every one of those for every doc, for every patient seen that day. And we go through it on our staff meeting. We have weekly staff meetings. So we go through and we try to find out where the constraint is. If we get behind in pre test, is it got because we got behind because some piece of equipment wouldn't work or because somebody was not trained as well as they need to be and it took them too long to do xyz and we. You know, I always think about, I use this term constraint a lot. I try to find the constraints in the system and figure out how to lessen that constraint, remove it if possible.
- [13:24]
Eugene Schottzman
Mm. So the. So, so as you're looking for the constraint and just to clarify, so are you doing this on every patient or you do this once every quarter? Once every decade? What's the.
- [13:35]
David Cockrell
We do it on every patient that day. We do it for a quarter. And you think about five docs in 40 patients a day, you've got a pretty good time study to show you where your problem is. Right. And if there's a consistent problem, it's going to appear with that. But we only do it once a quarter. We do it for a couple reasons. Hey, we want to stay on time for patients. B, we know the longer patients in the building, the likelihood of their spend, as you said, or revenue can drop. C, we want to really take care of our patients and we want to remind everybody in the building, wait a minute, we're slipping here, we're slowing down here. And by doing it once a quarter, everybody knows it's coming. And you can stay on time within about a three minute time span. One time I tried to do it once a year. By then you've lost any effectiveness of it. Right. So that's why we do it once a quarter. It kind of sounds like a burden, but it's really not. You're putting your initials in a timestamp down. Right.
- [14:24]
Eugene Schottzman
I mean, that makes perfect sense and it's really interesting that it actually does not seem to be super operationally disruptive. You don't have to take anybody out of the operation to follow patients around or to sit at stations or whatever. So that makes good sense. Have you found, by the way, like an actual data driven correlation between patient spend and time in the office?
- [14:47]
David Cockrell
When a patient goes to our optical, if they've been in our building, if they've been in our building more than 45 minutes before they get to the optical, they're ready to leave that optical within 10 to 15 minutes. They're not going to spend as much time. And granted, we don't want them in there for multiple hours. But we certainly think about 30 minutes to 40 minutes is time for us to be able to explain all the things we need to about whatever the technical aspects of their lenses are, the technical aspects of their eyewear frames might be. So if we're late getting the optical, we know it's going to be a shorter time because they're busy. Therefore they're likely to say this is all I want, I'll do this and this. Or they're likely to say I'll come back again later. So we have a complete loss revenue.
- [15:26]
Eugene Schottzman
I've heard the term time to doctor done. So is that something you measure and what is your, what what's your target?
- [15:33]
David Cockrell
Generally from, from the time they finish at the front desk, we want it to be no longer than 15 minutes for the doc walks in the room.
- [15:40]
Eugene Schottzman
Okay.
- [15:40]
David Cockrell
So that's in our pretest. Our pretest consists of blood pressure, visual acuity, auto k, auto refraction, wide field imaging. Something in there I'm leaving out. So it's, it's pretty thorough. We want a lot of stuff done, but we want all that done in 15 minutes.
- [15:55]
Eugene Schottzman
Okay, and then how long are your doctor visits?
- [15:59]
David Cockrell
15 minutes. You know, I realized a long time ago that back when I started, I took forever in there and I equated time spent with a patient for quality of exams. Patients don't really do that. And I realized one time when I was again timing myself how long I really spent looking in the eye. But I'm in that with a patient. Right. Most of what I need to know I'm going to get from their subjective history and that's going to have been gathered by our staff. I'm going to reconfirm or reaffirm that history. Then I'm going to spend some time looking in their eyes and that's, that's minutes. It's not tens of minutes, that's minutes. The rest of the time is me talking to the patient, educating the patient. And 15 minutes is an ample time amount to do that amount of time.
- [16:38]
Eugene Schottzman
So you have, you're potentially seeing up to 200 patients a day in your practice. 40 patients per doctor, five doctors. And you guys are able to drive all of that volume efficiently and carefully and make sure that each patient has a really good experience and get them through into the optical within what sounds like something in the 30s for the number of minutes.
- [17:04]
David Cockrell
Yeah. Our goal is from check in desk to finish with the doc. 30 minutes. So we're getting to the optical in 30 minutes. Got it, and we're pretty close to that because you know what, there's another patient coming, so you're gonna, you're gonna stay with it.
- [17:18]
Eugene Schottzman
So this is, you know, and that's why it's so important, I think, to go back to your earlier point, why it's so important to design your space so that everybody can be efficient and the doctor is not running across, you know, a 12,000 square foot building as I imagine to go see their next patient because that might be a three minute walk anyway. In four minutes they're slowing the process.
- [17:39]
David Cockrell
Down and you're going to get caught by somebody on the staff with a question or you're going to say hello to a patient. Our docs from the exam rooms walk no farther than four feet from one exam room to the next. Each of our docs have three exam lanes.
- [17:51]
Eugene Schottzman
I see.
- [17:51]
David Cockrell
So there's just back and forth in a small area.
- [17:54]
Eugene Schottzman
Makes sense. And we're going to talk about the patient flow in a moment. But. Okay. So the physical space, you said, number one is efficiency. Is there anything else that you need to consider or mistakes that people make when they think about their physical space?
- [18:09]
David Cockrell
It's thinking about where you're going to put your ancillary testing. You know, when I started in optometry, I think there was such a thing as an auto refractor, but that was about all the ancillary testing. There was now. Right. And when you come in our office before you see me, not only are you going to have autocadore fracture, but you're going to have wide field imaging, you're going to get an OCT as a screening. So you want to have, wherever your examination rooms are, you wouldn't have room for those ancillary testing equipment. Again, where you're. The, the technician who's doing that isn't walking all over the building because that means the patient's walking all over the building. Some patients are very mobile, you know, some are very young and difficult to move from spot spot. Some are not nearly as mobile. They're maybe they've got some type of handicap or they're just a senior patient that's a little bit slower. So again, we put our ancillary testing area within those pods or quads that we've got. So no one's moving around very far, I think. And then, then just the layout of the examination room and just a way to, to move that around. You know, all of our rooms are handicap accessible. All of our, all of our, some offices don't have as Easily handicap accessible situation for the exam chair. We just resolved all that and said everything's going to be ADA handicap accessible. That helped us. So it doesn't matter what patient goes in what room.
- [19:22]
Eugene Schottzman
Makes perfect sense. Okay, so that was your pillar number one or I guess kind of consideration number one of what it takes to run a successful practice. So that was the physical space. All right. I think I'm ready for number two.
- [19:37]
David Cockrell
Number two is staffing. You know, you have to decide. I'm going to use a lot of staffing. You know, our docs, remember I said VSP hasn't raised our price since the year 2000. It's 25 years later. Right. So we're still getting paid the same thing. And so we use a scribe. When that doc walks in the exam room, I want them talking to a patient, looking at a patient. I want them do an examination and talking to the scribe so that I'm not spending my time looking at the computer, turning my back to the patient, spending extra time keying it in, extra time coding it. I literally just want to have a conversation with the patient, explain what's going on, diagnose it, explain what's going on, and then be able to turn around and look at either the iPad or look at the monitor and go over the chart, make sure the chart's filled out like as I indicated, what was in there. Then I also want to be able to look at the coding to make sure we did the coding appropriately. And by utilizing staff to do that, we can do that 15 minute exam. I've had so many people say, well, how could you possibly provide good care? Well, if you really, any doc really thinks about how many minutes they really look inside the eye. And by the way, we dilate all of our patients. So you normally don't spend that many minutes of an exam looking inside the eye. It's all the rest of things we do. Or you can have someone else who doesn't have an OD degree do that for you. So, so we use a lot of staff. We have multiple staff at our front desk. We have six check in checkout locations. Right back to your seeing that line. I don't want a patient waiting at the front desk. We've got 14 or 15 technicians. So we've always got somebody who's doing pre test workups, somebody's doing other ancillary testing, and somebody who's in the room with the doc. Our docs don't leave an exam room and walk a patient back to the optical. Remember I said we're going to walk about four or five feet, right? That, that scribe who's with us. We're going to do the handoff to the scribe. The scribe is going to do the handoff to the optician and I'm going to be in the next room seeing another patient. So you really have to have a lot of people to do that. But if you really think about the, the actual monetary cost of one technician slash scribe, it's about one exam a day.
- [21:46]
Eugene Schottzman
Well, this is an interesting point because I, I actually ended up having almost a debate with somebody a couple weeks ago. I gotten off stage and you know, a guy came up to me and said, you know, I really wish I need Mark, I needed marketing, but I honestly don't think I do because I'm booked out a couple months out. But you know, some of the stuff you said was really interesting. He asked me a question and I said I wanted to go back to something you said. You said you're a couple of months booked out. I said, well, how does your practice run? How many patients are you seeing per hour? He said, well, I typically see a couple two patients an hour. And I said, oh, and why is that the case? And he said, well, you know, because I spend 11 minutes per patient. And he knew the number, said, I spend 11 minutes per patient entering things into the computer. I'm good at documentation and that kind of thing. And I said, and what do you think the patient is thinking while you're typing at the computer? And he said, oh, I don't know, I hadn't really thought about that. And I said, well, you know, the patient experience is certainly one, the other part of it is I said, what do you, what do you think it would cost you? Because I said exactly what you said is that, you know, there's lots of different solutions, right? There's the in person scribe, there's the virtual scribe, the person who just hangs out in the exam room. Now it sounds like you're using the in person scribe to hand off the patient, which is interesting. I might come back to that in a second. But there's the in person scribe, there's the ambient, there's the virtual scribe, the person who's sitting there on a, you know, whatever, zoom call and just listening to the conversation. And there's the ambient scribe, which is the, you know, the AI assisted scribes that are now available. But in all cases I suggest use a scribe because if you can cut that time from 11 minutes to zero, that's. And so I was asking the guy. And he said, well, you know, I just. I don't think I can afford it. And my argument was, well, what do you think that person would cost? He said, well, in my area, you know, kind of expensive. $22 an hour or something like that. I said, okay, and what do you think your time is worth? Is it worth more than $22 an hour? And he kind of looked at me, and I said, well, or just let's put it this way. If you could see three exams instead of two, what would that do to your revenue? Would that take your practice from an $800,000 practice to a $1.2 million practice simply by seeing, you know, no more rent? No, not any more rent. Not any more spent on office manager? Not any more spent on anything other than you can now see three patients instead of two per hour. And yes, you have to staff for that success. You may have to put an extra person as a scribe. You may have to put an extra person on the optical to be able to accommodate that. But what would that cost you? What would that $400,000 in addition to your practice cost you? $22 an hour? That's a $40,000 investment to get an extra $400,000. Are you kidding me?
- [24:42]
David Cockrell
The incremental cost is nothing.
- [24:44]
Eugene Schottzman
Right? And I said. So I kind of told him this, and he said, I guess you're right. It's not that I can't afford it. It's that I can't afford not to do it. I said, oh, well, that's great. We're on the same page. But. So I totally agree with your point. I completely agree with it. Now, tell me this one piece, because I know that capture rate is such a critical thing that our audience has heard me talk about over and over again. When I think about capture rate and exam only patients walking out without buying anything. So what is. What impact does it have on your capture rate when you hand off the patient to the scribe and then describe walks the patient hands them off to the. To. To the. To the optician. And is the scribe also the tech that's seeing them the whole time?
- [25:28]
David Cockrell
Yes. So if we can, it's the tech who did that person's pretest. They also happen to be that scribe. So they've heard that person's original symptoms. Right. They did the case history. Then they sit in there to hear the clothes from the doc. Right. So they're intimately familiar with whatever it is we've told the patient they need, whether it's an optical needs or whatever the need is. So back to directly answer your question. You know, we're pretty certain it affects us. We're pretty certain that it probably cost us 2 or 3% on terms of our capture rate. But I guess we're, we're willing to do that because it would cost us a lot more for the doc to be walking to the exam room. First of all, we couldn't see the number of patients that we see. And then because there's a lot more to go out there and back and forth. So the actual dollar cost of doing that is greater than the potential cost of loss of revenue. We can tell you that once we get a patient to our optical, we measured, you might imagine we measure everything in our office. Every single week we get a report we're between 95 and 100% of the patients that go to the optical are purchasing an optical good. Now our office is different than many offices because we're a pretty significantly medical office. So a lot of our conference exams aren't back for refractive exam. You know, if you're, if you're really effective at pre appointing, you know, if you think about the average patient purchases a new eyewear every, depending on who you want to believe, 22 to 28 months. Right. Well if I'm bringing you back every year, I'm not counting on you purchasing eyewear every year, right. You're coming back in for your annual health check. I'm building, you're building a faith base that you're going to come back in knowing I'm going to take care of whatever your needs are, not that I'm here just to sell you a new pair of eyewear. So that, that's our goal. So we're pretty, we're very, very aggressive and I think very effective with our pre appointing system which is why we've grown to the size we have. So we're going to have a lower cost. I've got friends that, that have a 70% capture rate. You got to have a whole bunch of new patients or a bunch of patients that haven't been in for two years, right. To do that. And so there's a different philosophy.
- [27:32]
Eugene Schottzman
It is interesting because, you know, I, I always wonder if, especially if you're seeing VSP patients and I challenge you a little bit on this, David, is that if they have a, what they perceive to be a benefit and if we look at glasses as a fashion accessory and not necessarily medical device, so even if their prescription hasn't changed, why not take an allowance towards a, towards another fashion device? Or towards another functional device that may be, you know, now a pair of computer glasses or a pair of golfing glasses or something like that.
- [28:04]
David Cockrell
If our average, if our average family has two or three children in the family, which they do, and if it so happens that two of those three happen to wear eyewear, what we've not seen is that the majority of our families want to purchase new eyewear regardless of the fact. Unless they just want to get what VSP covers. If they just want to get VSP covers and I actually pay for my staff time in that, then it's not much of a return on revenue really. And it's not much of a return on the time that you spend. So, you know, when I said we see 40 patients a day or schedule 40 patients a day, two of those visits are just medical visits. Now those three comprehensive exams may be medical as well, but two of the others are just pure medical visits. I have zero cost of goods in those medical visits.
- [28:54]
Eugene Schottzman
Yep.
- [28:55]
David Cockrell
I have zero cost and light bill, zero cost in phone bills, zero cost in staff, zero cost in anything. So yeah, that makes sense.
- [29:03]
Eugene Schottzman
Makes perfect sense. So you were talking about the staffing model. Is there a benchmark or kind of numbers or KPIs that you found, you know, X number of staff per OD or X number of staff per patient? What's the, what's. Or maybe X number of staff per doctor hour, maybe.
- [29:22]
David Cockrell
I look at, if it's eight hours a day, I look at five staff. Five staff spread out across whatever that you've got in the building. Right. Five staff is your minimum. Six staff. You're probably going to be slightly overstaffed. So in our particular case, we've got 27 and a half. 27 full time staff, one halftime staff. So we're slightly more than that five number. And we want to make sure we're generating a minimum of a minimum of collected revenue. $275,000 per staff person, collected revenue. If I start to get above that number, I know I'm making the staff run pretty darn hard. Right. If I'm below that number, I probably got staff that are standing around or I'm not being very effective with what I'm doing.
- [30:02]
Eugene Schottzman
And how often do you check on those numbers?
- [30:05]
David Cockrell
We look and see what we're doing every year. Remember I talked about the fact that we're getting paid the same. Right. By the third party payers. And so I have to increase revenue. So what am I doing to make that number go up? It's either going to be either an increased eyewear sales, perhaps increased medical care, maybe aesthetics that we now do in our office, where we're generating dollars from that. So, and that number is strictly my number. I'm sure there's numbers published out there in the industry. I haven't seen a great number in a long time. Not a great number. I haven't seen a different number in a long time.
- [30:35]
Eugene Schottzman
Okay, so as you're talking about staff, so you said 5ish staff per od though, Right. Just to make sure I got that. So if I got two ODs, I should have somewhere between 10 and 12.
- [30:48]
David Cockrell
Yeah, right.
- [30:49]
Eugene Schottzman
Got it. All right, that makes sense. And I think you're absolutely right. What that does is that allows you to get paid well for the time that you actually spend and it feeds into the highest and best use time theory, right?
- [31:05]
David Cockrell
Yep.
- [31:06]
Eugene Schottzman
All right, so let's go to number three.
- [31:09]
David Cockrell
Number three are demographics. Right. When I got out of school, I was told that at that time you needed 7,700 patients to keep an optometrist busy and have a throat driving practice. Again, that was October, May of 1981. I don't think you need nearly that many now. But if you want to develop a specialty practice, and I'll use an absurd example, you're probably not going to develop a big pediatric practice if you're surrounded by geriatrics. Right. If you want to develop a giant, thriving narrow angle glaucoma practice, you probably shouldn't be someplace where everybody's blue eyed and doesn't have as much narrow angle glaucoma. So I think it depends upon, as you determine, do I want to have a specialty practice defined. Defined by XYZ or do I want to have a general practice of optometry? I would describe our office as a general practice of optometry. I mean, we're in Stillwater, Oklahoma. The next big city is 70 miles away is Oklahoma City. 70 miles away is Tulsa. We have lots of farming communities around us. We happen to have a university here in town. So we have a pretty diverse patient base. And once a year we look at our patient demographics and by that, our age demographics. I want to see what that bell curve is. How many people do I have below age 10? How many people die from 10 to 20? 20 to 30, all the way down to 80 to 90. Right. And we look at that. Do we. Are we still on the short side of that curve? In other words, I don't want my average patient to be 50 years of age. I want them to be about 40. Right. And just ran it recently. And that's where we're at. You know, we're always looking for what, a minimum of 20% new patients a year. Right. Because people leave, people move, people aren't happy with your care. So you've got to have new patients coming in and you don't just want to have a senior based patient base because over time those folks move on. Right. One way or the other. So I look at the demographics as a general practice, I've got to have that broad range of patients. If I'm a pediatric practice, I have to be someplace else.
- [32:57]
Eugene Schottzman
So if you're looking at the general demographics and things are shifting one way or another, what do you do with that information? How do you act on it?
- [33:08]
David Cockrell
That's a great, great comment. Let's say that for some reason we saw that the number of patients that we're seeing in our patient base was not what it was. And we haven't had a whole bunch of people move out of town. You know, I think we'd want to do certainly an outreach to the school system. Whether it's marketing, whether it's direct contact, we'd want to figure out why we're no longer seeing that number of children that we used to see. So it's analyzing what am I missing in terms of age group and then why am I missing that? And then respond to it. And it's just not that hard to do. You know, we don't do quote unquote marketing in our office. Other than the fact that I learned a long time ago the best way to grow your practice is from within your practice. So we're, I would say, pretty aggressively talking to our patients all the time, doing some type of internal marketing. We don't do external marketing. So that gives us a pretty good feel for what's going on in our patient, in our practice. Based on the, the type of patients that we see, are they young, are they older, are they mobile, are they not mobile, are they fluent, Are they not fluent? So we look at all those things a lot.
- [34:14]
Eugene Schottzman
Yeah. So it sounds to me like understanding that gives you a chance to say, okay, where am I going to do the outreach? Now, you mentioned something about reaching out to the schools. What would you say if you reached out to the schools? Like, how would you do that? Because that's, that's an interesting tip. I had not really thought of that before.
- [34:31]
David Cockrell
You know, we, we, we've done it. We, we reach out to schools with either one of our doc or multiple of our doc. We contact the school system, we write letters to the, to the principal. We have six elementary schools in town. We'll write letters to them offering our services for in service, in service education for their teachers, whether it's on reading issues for children, whether it's on some other learning issue. And we make sure we're beef up and understand that. We do presentations to the local hospital, to the diabetes groups. Every year that we've done it for so long now, the hospital schedules us to come in and do it. They don't bring the ophthalmologists in. We come in and we're talking to the patients just like we would talk to them in our office. We want to make sure that we keep those medical patients with us. We do it to the lupus group. So we have an outreach to wherever patients are. And that's really going to be your hospital, your schools, your local senior citizen centers. We're very active in those areas.
- [35:31]
Eugene Schottzman
So it's interesting because I think I heard you say you do an in service for the teachers about reading issues and those types of things. And it's like, I think that's brilliant. I love that. I think, I think that's fantastic. And you know, as a marketer, I'm taking notes. I also think it's fascinating, you know, identifying. I always talk about this a lot with, with our team and with our clients is that, you know, you, you figure out who has access to the patients that you want and then you figure out a way to, you figure out a way to reach those particular people or reach those patients. But the in service for the teachers on reading issues. I like that, David. I like that a lot. And when you do that, I imagine what happens is you do it as a kind of a goodwill gesture. There's, you know, you come in on a, you know, teachers have in service days all the time. So you come in on an in service day, you do an hour thing and then, and, and then the teachers start handing out cards to patients or, or like, how does it work?
- [36:32]
David Cockrell
Public school systems can't do that. Right. So they can't really market for you.
- [36:37]
Eugene Schottzman
Right, right.
- [36:37]
David Cockrell
But, but you're the name they remember. You're the one who was there. Right. And if they tell a parent child X is having X problem and the parent doesn't already have established care, they'll say, well, who do you go for your eye doctor? Who do you go see? We want to make sure that we're the eye care provider for the school system. And by that I mean we Want the superintendent, principal, and all the teachers coming to us for the eye care because they can't. They legally can't. They're prohibited from saying, go see David Cockrell. Right. But if somebody says, who's your eye doctor? That's what I go see. Right.
- [37:08]
Eugene Schottzman
Got it.
- [37:08]
David Cockrell
So we work really hard on that group.
- [37:10]
Eugene Schottzman
Okay. When we come back from the break, David's going to tell us his fourth secret to building a successful practice. And we'll also talk a little bit about what we forecast to be the future for the optometric space.
- [37:24]
Allie
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- [38:18]
Eugene Schottzman
And we're back on the Power Hour with David Cockrell. And, David, I am truly enjoying your kind of laundry list of things, of factors of a successful practice. We've been through three the physical plant, staffing, demographics, and now I think we're ready for the last pillar. And what is it?
- [38:41]
David Cockrell
The drive of the doc, the internal drive of the doc. How busy do you want to be? You know, I've talked to so many docs who said, well, I don't want to see 40 patients a day. Well, how many hours do you want to work? Eight. Well, I'm going to work eight hours, too. Our docs, by the way, we don't work 15 hours a day. Our docs work eight hours a day. They have an hour off for lunch. So that's what we're seeing within those hours. And it depends upon how busy do you want to be. You know, I Use this term with my children. Where in America, most of us are born on a pyramid. Some people are born below that base, some people are born up here. But all of us move up and all of us plateau. Every once in a while we work pretty hard, we get here and then we kind of plateau and become satisfied. And then we, if something comes up, we work a little bit harder. Right. And that's what I term the drive of the dog. So if you want to develop some expertise in your practice, you're going to have to be somewhat single minded about that. With all the other responsibilities in life we have, you still have to be pretty single minded to move it up there. And I think that every OD can do that. They were all successful. I use that because they all got in uptime school, they all got out, they all have done something other people can't do. So then it's a matter of really defining what's my short term goal and what's my longer term goal, not what's my longest term goal, but what's my short and long term goal. What are the things I have to do to get there? Again, what are those constraints I have to move? When Sharon and I got out of school and started our practice in 1981, we paid 20 and a half percent interest to the bank.
- [40:08]
Eugene Schottzman
Wow.
- [40:09]
David Cockrell
That was 1981. That's when interest was real. And that type of interest will make you want to work pretty hard to be able to pay your bill. Right. And so again, I look at that and think how fortunate it was because I learned the value of time and money right off the bat that I was going to have to do something pretty remarkable to be able to pay 20% interest. Again, I look at how fortunate I've been in seeing those changes come and go, seeing the constraint that is, and recognizing it's not a constraint. I just need to get. It's not, it's a constraint, but it doesn't prevent me from doing it. I need to figure out how to get beyond that constraint, how to move it out of the way. That's why I use the term the drive of the doc.
- [40:45]
Eugene Schottzman
And it's interesting because today we hear a lot about the OD shortage, right? We also hear a lot about students kind of getting their pick of the litter of, you know, who they're going to go work for. And I'm curious how you would, you know, in the, in an environment like today where it seems like a practice owner is going to take what they can get and at the same time A newer optometrist or an associate optometrist kind of has a choice of, you know, do I want to work hard? Do I not really want to work hard? And, you know, maybe sometimes it's the. I don't really understand what hard work really is because maybe hard work is not actually working more hours and burning yourself out. Maybe it's. Maybe it's something else. So comment on that for me, please. Given, you know, how do you. How do you reconcile this concept of the drive of the doctor with the fact that we have an OD shortage?
- [41:44]
David Cockrell
We all set our own limitations, whether we realize that or not. I grew up hauling hay and was paid a penny a bale, and I'd haul 30,000 bales of hay in the summertime for one penny a bale. They weighed about 100 pounds. That's pretty hard work. I work indoors now. It doesn't matter if it's hot or cold, doesn't matter what it is. But I know what my goal, whatever it was, whether it was a financial income, whether it was something I wanted to accomplish, some new level of patient care, I wanted. I knew that I was gonna have to put the time and effort into it to do it. I didn't want to just coast and not quote, unquote, be productive. It doesn't mean somebody who's not doing what I'm doing is not. I don't mean that at all. But for me, I knew I always wanted to be growing. You know, I still read multiple clinical journals a month because I still want to continue to get better and not practice five years ago as healthcare, right? It's easy to become complacent because we're so doggone successful, right? There is a doctor shortage, there's an OD shortage. So you can get a job almost any place. That doesn't mean you're really going to have a great job. It just means you're going to get a paycheck, right? And, you know, I think that the future is so bright for us. If you really want to do whatever it is you want to, whatever your goal is, you can achieve that if you'll decide. I'm going to put in the effort and time and thinking to get there.
- [42:58]
Eugene Schottzman
Let me ask you this. You guys do specialty. I know you talked a little bit about aesthetics. I want to come back to that. But do you do things like dry eye and myopia management or scleral lenses, anything like that?
- [43:11]
David Cockrell
We do. At one time, I wanted to be able to say, our office does everything that could be done in eye care. We don't do low vision or subnormal vision. We're just. We don't have the patient base and I'm terrible at it. But yeah, we have an active myopia management program. We're also very fortunate. We put an excimer in our office in the year 2000 on Oklahoma docs can actually do PRK. We seldom do it because Lasik is better for most people, but we bring a surgeon into our office to do Lasik on a monthly basis. Obviously we do the other things you can do Oklahoma, the SLTs and yags and stuff like that. I truly believe patients want access to the best, newest technology they can be. So one of my other, I call it ego or goals was I wanted to be the most technologically advanced office in our particular community. If somebody heard about something, I wanted to be able to say, cockerel eye care has got it there. And so we've always been one of those innovators to uptake new technology. I bought some stuff that didn't work, by the way. But we want to be the 1 innovator of new technology. So our patients, when they walked in the door, we want to be able to say, man, that's something new. You didn't have that last year. Now maybe you did, maybe we didn't, but it was new to them. Right? And so then we roll aesthetics out into our office. Several years ago, we. You can get neurotoxin or Botox in our office. We do IPls in our office. We do pretty much again, by the way, we still do vision therapy in our office. I spent the first two years of my career doing that. So again, we try to do everything we can. We're just a larger general practice with the exception of subnormal vision.
- [44:40]
Eugene Schottzman
So how do you get your associate docs? I imagine that when you see a patient, you have a pretty good. If a patient's a dry eye candidate, for example, you have a pretty good referral rate to go into, whether it's into treatment or dry eye eval or something like that. And thinking about all the specialties, how do you manage the docs who work with you in your practice? How do you get them to have the same drive and also to refer patients into treatment at the same. At the same rate?
- [45:15]
David Cockrell
You know, you don't. They either have it or they do not. We have docs who don't work for us anymore. And they were here, they were nice people, but they just didn't want to be innovators they didn't want to study, they didn't want to deliver that career. And so, I don't know, we're very fortunate with the docs they have. They're all somewhat like me, which I guess you're either going to be like me or I'm going to drive you crazy. But I haven't had to do anything to say, let's study, let's learn, let's do this. You know, I might be the one to suggest something. My partner, Jeff Miller, he's 10 times better at evaluating a retina and OCT than I am. He might be the one that suggested. Or Lauren G. The, the young lady who's really in charge of our aesthetics program. They're bringing ideas in. I, I think you constantly have to bring new ideas to the table. And I think again, a practice has a culture of its own. Once everybody, it might be some of our staff who bring the culture. You know, once a week on our staff meeting, every single week, one of our staff makes a presentation on something in icare, they make it to the whole staff. I do that for a variety of reasons. I want everybody in the building to recognize how important the receptionist is, the technician is, or the optician is. And they can make that on anything in the. Anything in eye care. They can make it anything they want to. They get 10 minutes of our staffing to make a presentation.
- [46:32]
Eugene Schottzman
This is fascinating. What's an example of like the last three presentations?
- [46:37]
David Cockrell
One of the last ones was on the genetics of eye color. That was done by one of our technicians. You know, she fascinated by the fact that people had green eyes. So she did some work on genetics. A recent one was on macular degeneration from one of our. Another one of our technicians, a recent one from our optical, was on a new type of spectacle lens that they had read about, not available yet in the United States. It's the one from Myopia Management Spectacle Lens. But, but they're reading too. And you know, it's, it's a little bit, I'm sure frightening when they come to work, when we say, by the way, everybody on staff makes a presentation. Now with, with as many staff as we have, they're only going to have to do two of those a year. All of our docs say, we'll help you with the presentation, we'll help you put it together, we'll help you do it, we'll help you walk through it. Because most of us are reticent about making a presentation in front of other people. But I want Everybody to recognize they're important.
- [47:25]
Eugene Schottzman
That's fantastic. And I love that. I think it breeds a certain type of culture and it also forces people to think about how they're going to stay on top of their game. I love that idea. I think that's. I think it's fantastic. And you're right, it's a 10 minute presentation, but it's also your time to be in the spotlight and it's also your time and everybody has to do it. Right. Like, I think that's fantastic.
- [47:47]
David Cockrell
Docs, everybody, everybody's. Everybody gets to take a shot at it.
- [47:50]
Eugene Schottzman
So what was your last one on? What did you talk about?
- [47:54]
David Cockrell
Words matter. I talked about words matter. That's it. And interesting. It's very easy for our younger patients to use the terminology that they're used to using. Right. It's very easy for someone who's older to get confused by what they mean or just not hear them or how you say the word matters. Right. It's back to patient relationships. You know, from the time a patient interacts with your. With a phone call or your website or something, that relationship is. Is being stressed. Right. It's being put to the test. How's that experience all the way through? We talk about, in every one of our staff meetings, patient experience. What was the patient's experience like? You know, routinely we'll have some technician who picks up a patient at the front desk to take them back to get something started. I have to look down the hall and they're 15 foot ahead of the person that I know has poor eyesight. Right. Or they're 23 years old and they can walk pretty fast. And that person's 82 and they can't walk very fast. Right. It's constantly thinking about that patient experience. Did we walk off and leave them or did we're right there with them having a conversation with them?
- [48:53]
Eugene Schottzman
I love that you point that out to people and it sounds like that's a. It's such an important part of the way that your practice functions. Kind of the intangible. When you talk about marketing, it's really the intangible internal perspective that somebody has because then that ultimately drives a lot of word of mouth. Talk to me for a moment about aesthetics. So what made you bring it in and what are you doing from an aesthetic standpoint and how does it look?
- [49:18]
David Cockrell
You know, partly ego, partly go. We're very fortunate. Optometry. In my career, our scope of practice has expanded wildly across the United States. It has. Ours might be a little more broad. Than some other states. But I continue to see the local dentists in town doing botox around the eye. I'm thinking, what on earth? Okay, what's wrong with this? The ophthalmologists don't have an aesthetician in their offices. They're not doing it. But I've got four dental practices saying come see us, we'll, we'll take care of your, whatever we need to from your, from your jawline up. And I thought, really, we're eye care providers, we need to step up and do that. And I had the great fortune of having a guy. Lauren's been with us for five or six years now and really, really interested in it. Our other docs do it as well. But she was the one willing to take on and say, okay, I'll take control of this, I'll help build the program, I'll do it. The other thing that made it happen though is remember I said we haven't had our fees raised since the year two. The only discount vision plans we accept are VSP and Eye Med. They haven't raised their fees. But all of our, all of our traditional third party medical payers, they're not raising fees either. Right. Medicare is flatlined. Right. And I know it's going to cost me more to pay the staff a year from now. I need to find some revenue source that's not married to a third party payer with a constraint on my fees. So aesthetics is a cash based business.
- [50:37]
Eugene Schottzman
Right, Right. Which makes perfect sense. So what did you roll out in your practice? Do you do the full scope of, you know, injectables and fillers and all the lasers and micro needling and everything?
- [50:52]
David Cockrell
We do, yes, all those, all those together. And we, we took, again, we have a facility that allows us to do this. We built a aesthetic suite inside of our office. So when a patient walks in there, they're not just in an exam room. And it doesn't look any different than anything else we've done. It's an aesthetic suite set up to do it. We train technicians specifically to help facilitate that. Again, because I don't really want our docs doing the ipl.
- [51:17]
Eugene Schottzman
Right.
- [51:17]
David Cockrell
We want to train our technicians to do it. Our docs are overseeing it. They're using their mind to do that. They're going to go in and say, here's the program we need. They're going to write it up, they're going to deliver it to the patient. The technician is going to then take, go forth and do it.
- [51:29]
Eugene Schottzman
So one comment I've Heard, and I think some people struggle with this a little bit in practice is getting the patient to understand that they're at the eye doctor's office, but the eye doctor is also, also able to do these other things. How do you start the conversation with the patient is like, hey, you know, you like those wrinkles up there or what?
- [51:52]
David Cockrell
It's actually pretty simple. You know, when we, we actually ask them, are they on our entry form, Are you interested in any aesthetic procedures? Today our office does the following things, right. And then whether they fill that out or not, our technicians are going to ask them, are you interested in aesthetic procedures? Here's what we do. And our technicians may talk about, you know, the, the wrinkles around their eye or whatever it happens to be. They're going to talk about it. So then it's on a. It's in our exam. So the doc is going to follow that up. Right. So we try to do that like we do everything else. The questionnaire starts at the beginning before it ever gets to the doc. So the patient's already thinking about it. You don't want to surprise the patient just before you walk out of the door with it. Oh, by the way, you're interested in contact lenses or, oh, by the way, you're interested in whatever.
- [52:35]
Eugene Schottzman
Right.
- [52:35]
David Cockrell
Have that conversation all the way through.
- [52:37]
Eugene Schottzman
Now, you said you have a pretty high medical practice, so I'm going to take that into consideration. When you know, of think thinking about your answer this one. But, you know, so what percentage of your patients that you're seeing actually take you up on the aesthetic procedures?
- [52:55]
David Cockrell
Well, let's define the demographics who need them. Right. Because, you know, we're not gonna have children take us up on that. We're not going to offer it to them. Right, right. But if the aesthetics. Right now, we've been doing it for several years, I would say it's probably 5%. Maybe it's. Maybe it's 5 or 6%, something like that. And that's grown every year as we started to do it.
- [53:14]
Eugene Schottzman
Okay, yeah, interesting. So we probably could have a whole separate episode on that. But one of the questions I really wanted to ask you was really, you know, you've had your, You've been practicing, as you said, since 1981. You've been own. You've owned your practice since 1981, and the industry has changed tremendously. In all the diff, you can probably cite a number of different milestones across the. Across that time period. What does the future look like and what are some of those milestones that you think we're defining milestones for optometry?
- [53:48]
David Cockrell
I think there's some very clear ones. You know, I was so naive about optometry and eye care. When I started optometry school, I didn't know that there were a lot of things that we just couldn't do. And so I didn't know we couldn't prescribe eye drops. I didn't know we couldn't put an eye drop in the eye. When I started optometry school, when I got out of optometry school, by the time I get out four years later in 1981, I realized that there were a lot of things I couldn't do that I was being trained to do, which got me interested in advocates for optometry. If we're going to do something, we have to change the doggone law to do it. We come in with constraints again, that word, constraints. Constraints on what we can do. And the only way we can change those is to, by going and legislatively change those things. So it got me interested in how do you do legislation and what's, what's it takes to successfully pass it and then each time you enable yourself to provide more levels of care. I've wanted to move forward and do more of those things. And again, I'll say fortunate because I didn't view the fact that I couldn't do something or get out of school is something I could never do. I said, how do I get past that? How do I do it? Leading me to a more direct answer to your question. I think the future is really bright for optometry. You know, first of all, people are always going to need eye care. We have a growing population, we have an older population, we have a decreasing number of ophthalmologists that's projected to continue to decrease at least for the next 10 to 15 years. An increasing older age patient. I think it was 2015 when the largest age demographic in America became that age over 65. Who needs medical eye care. That group. It's not a bunch of five year olds, it's that group. So you've got a decreasing number of providers that could provide primary and secondary care and you've got an increasing patient base who needs that. Optometry should fill that role. We can certainly refractive care is always going to be necessary. We're always going to do that in our office. But I want to fill those other roles if I can, which makes me believe the future is very bright. You know, there's again challenges in optometry. We've talked about constraint on fees. Right. Figure out a way around that. Right. Figure out how to provide more care that your patients need, and you'll have all the patients that you want.
- [55:49]
Eugene Schottzman
Yeah. And, you know, I've heard you talk about this concept of constraints, and I love that you keep, you know, you keep bringing it up, and whether it's looking for the constraint that's the constraint to the optimal patient flow in the office or the optimal patient experience, or looking for the constraint that, you know, prevents you from. From being able to perform a particular procedure. So what are the kinds of constraints? And I know you're doing some advocacy work, so I actually would like you to talk a little bit about that and what kind of constraints you're up against.
- [56:20]
David Cockrell
Current constraints for today. If you think about the fact that in optometry Today, we have 12 states that can utilize laser procedures, not even all states can utilize IPLs. So I still look at legislative constraints on scope of practice. Again, that's fixable in every single state. From 1984 forward, Oklahoma could treat glaucoma. It took until two years ago for Massachusetts to be able to treat glaucoma. We now know a whole lot more nationwide about what it actually takes to affect legislation to change it. That's a constraint that we need to overcome. Federal constraints. We have to deal with some of these problems with Discount vision plans. The AOA has a current legislation called the Doc Access act that they're doing with its Dental and Optometric Care Act. So it's a combined piece of federal legislation that they're using to remove some of the federal constraints on how we interact with Discount vision plans. So I think there's legislative, state, federal, and there's also regulatory constraints. And so I think every single optometrist could have done what I've done. I guess I'm a guy who hates to be told no. I really hate to be told no. And so that's what got me involved in advocacy. And I think if we had every OD in the United States doing just the things I've done, you could pass any law that you want to pass. And so it's getting more of our young people involved in that, our young ODs. And many, many, many of our young ODs are very, very active. The American Optometric Student association is really, over the last 15 to 20 years, the students coming out, they're all looking at, what can I do? I want to be able to do whatever's done in optometry. So we have some very active Groups that are going to help us to expand the scope of care in each state. It gets really, really important.
- [58:01]
Eugene Schottzman
And I agree with you. I think, and you know, from what I know about generational, you know, generational behavioral dynamics, the generation of people who are graduating today are very much into cause driven action. So as long as you give people a good cause that they can believe in, I think that you just have to make sure you get the word out to say, hey, these are, these are important issues. And these are important issues that don't just impact you, the optometrist and your earning potential, but they also impact the well being of your patients. Because some patients aren't going to get access to care that they need.
- [58:41]
David Cockrell
Think about the fact that, you know, 75, 80% of primary care in America is delivered by optometry. Oklahoma is one of those states where we've got optometrists in 77 counties. We have ophthalmology in 10. And you can multiply that in most states. We're where the patients, we are where the patient lives. It's accompanied incumbent upon us to be able to provide that care that they need.
- [59:04]
Eugene Schottzman
Yeah, that's fantastic. And you know, I also, I read that you were part of the alliance on Patient Safety. Right. This is a big deal. And you're. And talk a little bit about that.
- [59:17]
David Cockrell
You know, if I wear my advocacy hat, you know, I've been obviously a legislative advocate inside of Oklahoma. I was fortunate enough to be in the AOA and active with state government and advocating there. But really when you're doing that, that you're advocating for David Cockrell. I'm advocating for an optometrist to be able to remove barriers or constraints the patient. The Healthcare alliance for Patient Safety is advocating for patients. We're advocating for restrictions from eye care that might restrict the patient from eye care. But we're advocating above and beyond just eye care. There's multiple different things that, you know, it's the first time in my career that we've had the industry involved in helping us do that. We've got the major contact lens players, Johnson and Johnson and CooperVision and Esther Luxottica is participating in it with us. We've got patient advocacy groups across the country that are all involved in it. So if David Cockrell is at Capitol Hill talking to a legislator, I'm not talking about David Cockrell the optometrist. I'm talking about here's a problem that's a patient safety issue that we need to remove. So it was started by the AOA in conjunction with Johnson Johnson in 2018, I think, is when it was started. So we're seven years in. It's continued to grow every year. We've got thousands of people across the country that are involved in it now as members. So I'm pretty excited about that as a way to advocate above and beyond for optometry.
- [60:37]
Eugene Schottzman
And what's one example of something that that group is working on?
- [60:43]
David Cockrell
A direct example right now, there's multiple. But it started as an offshoot of some of the constraints for contact lens prescriptions, is far beyond that now. So an example would be we're literally always trying to remove an access, an impediment for a patient to go get access. Right. So we view patient safety as if a patient can't go get care. That's a safety issue. So we're working with Federal Hill on a couple of different pieces of legislation that will make it easier for a patient to actually be able to access care through a payer, able to. Easier to get insurance, more likely for the insurance payer to cover that particular procedure that they've got. Interesting. There's a list of them. I kind of garbled that, but there's a list of things we do well.
- [61:24]
Eugene Schottzman
No, it's. It's fantastic. And I'll, I'll throw a link in the, in the show notes for anybody who wants to check it out. David, this has been, and I'm sure we could probably talk for hours about both the industry and also what it takes to run a successful practice, but this has been a fascinating conversation. I'm super grateful to you for sharing some of your insights over the course of the last, you know, over the time that you've been practicing, I think there's been a lot that you've learned, and I think summing up those learnings and those four pillars have been super interesting. And then I agree with you. I think the future for optometry is bright. And we'll share some of your contact information in the show notes for anybody who wants to get in touch with you specifically. I know you're very passionate about the advocacy side. Thank you so much for your time today and thank you for joining me on the Powerhouse.
- [62:14]
David Cockrell
Thank you very much, Eugene. It's a real pleasure. You have a great day.
- [62:17]
Eugene Schottzman
Thanks for listening to today's Power Hour episode. The Power Hour is actually owned by the Power Practice. Power Practice is a premier consulting group who helps practices achieve freedom of time, confidently solve practice issues, and grow their practices. They do this by having coaches and OD consultants, people who have actually done it, been there, and they're ready to help. If you want to learn more, go to Power Practice. There's a bunch of free tools there. You can also get a whole bunch of information and decide whether it's right for your practice. Again, if you're looking for more time, you're looking to solve complex practice issues or grow the Power Practice might be right for you. Go to powerpractice.com to find out more.