Power Hour Optometry
Episode: The Eyecare BOSS System—Build a Practice That Runs, Optimizes & Scales Without You
Host: Eugene Shotsman | Guest: Jamie Rosen
Date: February 19, 2026
Episode Overview
This episode unveils the ICARE BOSS System—Icare Business Optimization and Scalability System—a comprehensive operating framework created by Eugene Shotsman and Jamie Rosen, designed exclusively for eye care practices. The episode explores the frustrations many optometric practice owners face, the essential need for a scalable system, and the five core pillars that underpin ICARE BOSS. The aim is to empower practices to grow, optimize, and thrive independently of their owners, turning bottlenecks into architecture, and decision dependence into empowered teams.
Key Themes and Discussion Points
The Challenge: From Bottleneck to Architect
- Practice owners are often the bottleneck, not the architect.
- “In a self optimizing and scalable practice, you are not the bottleneck, you become the architect... your team has a super clear framework for making good decisions independently.” —Eugene, [00:00]
- Owners often feel they must approve every decision, are overwhelmed by daily issues, and find it hard to execute on new ideas.
- The desire is for a business that can run, optimize, and scale itself—giving back time and peace of mind.
Why the ICARE BOSS System Was Needed
- Hard to scale without a systematic approach:
- “Left to our own devices… it’s really hard to create a systematic approach to running your business that also scales.” —Jamie, [05:41]
- Owner and staff face common frustrations: constant interruptions, staff disengagement, executing new ideas before the previous one is in place, and high turnover.
- Traditional business/leadership books are not directly applicable or easy to adapt to eye care.
The ICARE BOSS System: The Five Pillars
"The five pillars: Accountability, Revenue, People, Experience, and Data." —Eugene, [13:32]
1. Accountability System [21:29]
Core: Create the discipline and cadence to resolve issues, clarify vision, and execute priorities ("rocks").
Key Components:
- Issues List:
- “If the issues list is small, that means your team is not engaged... you are not thinking in a self-improving type of thing.” —Eugene, [21:29]
- Issues should be surfaced daily and tackled through the PASTE framework:
- Prioritize
- Analyze
- Collaborate
- Execute
- Document
- Vision: Staff needs a clear, present-tense, vivid vision—paired with a long-term BHAG (Big Hairy Audacious Goal). [24:58]
- Cadence: Structured daily, weekly, quarterly, and yearly meetings—with specific agendas and issue resolution. [24:58]
- Rocks: Borrowed from Stephen Covey—set big, quarterly goals broken into actionable assignments per team member. [29:50]
"If you never aim for the moon, you always end up eating dirt..." —Eugene, [24:58]
2. Revenue System [30:56]
Core: Systematic growth through proven levers, not just shiny objects.
Key Components:
- Three Ways to Grow:
- Get more patients
- Increase patient spend
- Increase visit frequency
- Lifetime Value, Allowable Acquisition Cost, Blank Check Marketing: Rethink marketing as an investment, not a cost.
- Hundreds of Growth Levers: From phone capture rates, exam-only patient conversions, to formalized referrals and strategic reactivation. [32:54]
- Incremental improvements compound.
- “If you just get 3-5% better in a few key areas, it’s staggering how that accelerates growth.” —Jamie, [32:54]
- Prioritization: Disciplined focus on what moves the needle the most, not everything at once.
“If I could take revenue per patient and improve that by 20%, get 20% more patients, and get them to come back 20% more often, I’ve made my $2M practice a $3.5M practice.” —Eugene, [37:49]
3. People System [40:18]
Core: Build leadership, engagement, clear expectations, and accountability into your culture.
Key Components:
- Core Mindsets: 3–5 non-negotiable behaviors, forming the ‘rules of engagement’ for the team. [41:56]
- Assessment Tools: Quick evaluations and force-ranking to identify top and bottom performers; decisions on coaching, promotion, or termination become clearer.
- Leadership Development: Identify ‘visionaries’ vs ‘operators’, avoid the promotion trap, and only develop leaders who want to lead. [44:24]
- Always Recruit: Proactive staff planning, not reactive hiring. [47:36]
- Change Management: Behavioral feedback loops rooted in Daniel Kahneman’s research; manage behaviors, not just metrics. [49:15]
“‘You do not manage the metric; you manage the behavior behind the metric.’” —Jamie, via Eugene, [49:15]
- Behavior Observation: Systematic observation and feedback, so teams learn from each other, not just from ‘the oracle.’ [54:41]
4. Experience System [57:29]
Core: Design and deliver a patient experience that differentiates your practice, is mapped and measured.
Key Components:
- ‘Power of Wow’: Borrowed from Disney, Starbucks, Ritz-Carlton—consistent service culture and intentional patient journey.
- Journey Mapping: Analyze every ‘moment of truth’ in the patient’s visit—27 steps identified, but focus on the five that impact satisfaction most. [57:29]
- Hints at findings: the actual exam isn’t one of the five most impactful moments.
- Counterfeit to commoditization: As telemedicine/AI grows, a well-executed experience is the differentiator.
5. Data System [60:12]
Core: Data-driven culture, track meaningful lead and lag indicators for actionable decisions.
Key Components:
- Metrics Classification: Operational, Financial, and Marketing metrics—track daily, weekly, monthly.
- Lead vs. Lag Indicators: Lag (what’s already happened); Lead (what predicts your future performance). [62:30]
- “Lead indicator tells you if you have enough ‘at bats’ for Monday’s appointment book.” —Jamie, [62:30]
- Focusing on What Matters: Avoid vanity metrics (e.g., Facebook impressions); focus on those that genuinely drive practice growth.
“Do you want your paycheck to be in engagement? Or in dollars?” —Jamie, [65:28]
Notable Quotes & Memorable Moments
- On shifting from owner bottleneck to architect:
- “You are not the bottleneck, you become the architect. Not every decision has to flow through you.” —Eugene, [00:00]
- On prioritization and focus:
- “We’re not racing to implement things one after the other... we’re taking a systematic approach and tackling the biggest revenue driver.” —Jamie, [15:34]
- On managing people:
- “My people are a problem” is the most common survey answer—address this from the ground up, not with a band-aid approach. —Eugene, [40:18]
- On hiring and succession:
- “You cannot wait for the resignation letter before you start recruiting.” —Jamie, [47:36]
- On data-driven decision making:
- “If you wanted to get paid in impressions, I’d pay you in impressions. But most people like to get paid in dollars.” —Jamie, [65:28]
Segment Timestamps
| Segment | Timestamps | |------------------------------------------|---------------| | Introduction & ICARE BOSS Overview | 00:00–05:41 | | Why Systemization Matters | 05:41–13:32 | | The Five Pillars Overview | 13:32–19:20 | | Pillar 1: Accountability | 21:29–30:56 | | Pillar 2: Revenue | 30:56–40:18 | | Pillar 3: People | 40:18–57:29 | | Pillar 4: Experience | 57:29–60:12 | | Pillar 5: Data | 60:12–69:11 | | Closing Remarks & Next Steps | 69:11–71:38 |
Actionable Takeaways
- Implement a system: A practice operating system, not isolated strategies, is the shortcut to scale and optimization.
- Focus on the five pillars: Accountability, Revenue, People, Experience, Data—for ongoing growth and operational excellence.
- Prioritize and document issues: Let staff surface, analyze, and resolve problems systematically.
- Don’t manage by gut—measure what matters: Cultivate a data-driven culture with actionable, not vanity, metrics.
- Develop people and leaders: Define core mindsets, always be recruiting, and promote intentionally.
For More Information
- Attend the Vision Expo East 2026 (main stage presentations)
- Visit icareboss.com for resources, tools, and implementation guides
- Connect with Eugene at eugeneshotsman.com
“The system is not an easy button, it takes discipline, but it compresses the time it takes your practice to go from wherever you are now to wherever you want it to go.” —Jamie, [69:11]
The ICARE BOSS System isn’t infotainment—it’s actionable methodology so optometric practices can win, owners can reclaim time, and teams can thrive.