Power Hour Optometry — The Framework to Scale Optometry Across 4 States: Cold Starts, Acquisitions & the Medical Model

Host: Eugene Shatsman
Guest: Dr. Solomon Gould
Date: February 6, 2026

Episode Overview

In this episode, host Eugene Shatsman dives deep with Dr. Solomon Gould, an accomplished optometrist, serial private practice owner, and consultant. The discussion centers on Dr. Gould's remarkable experience scaling independent optometric practices across four states—including two acquisitions and six cold start “de novos”—and the pivotal role the medical model played in his success. Dr. Gould shares candid insights on transitioning practices from retail-focused to medically oriented, the operational and cultural challenges of scaling, and the strategic pillars that supported growth. Listeners will gain concrete advice on leadership, team building, technology investments, and practical business metrics for anyone considering expansion.

Dr. Gould’s Career Journey and Early Lessons

[02:46–04:10]

• Solomon has owned eight independent private practices and consulted for hundreds more.
• Involvement spans private, corporate, and private equity sides of the industry, offering a broad perspective.
• Early inspiration: Entrepreneurial drive since optometry school graduation in 2012.

“I've had the genuine pleasure of owning eight private practices that are fully independent ... and been involved in both private equity and corporate ventures.”
— Dr. Solomon Gould [03:08]

Early Ownership Experience:

• First practice purchased was established (42 years in operation, same doctor and optician).
• Biggest lesson: Challenge status quo, make informed decisions before taking action (e.g., business entity, payer credentialing, patient care model).
• Major early mistake: Not being strategic about payer mix, accepting whatever plans were available.

“I would say the biggest things that I learned is... not being afraid to really ask a lot of questions and challenge status quo.”
— Dr. Solomon Gould [04:28]

Implementing Change & Building Buy-In

[07:04–11:47]

• Immediate resistance from legacy staff and even vendors when shifting to a medical model in a historically retail-based practice.
• Dr. Gould prioritized creating employee buy-in by involving them in off-site planning and visioning sessions.

“We mapped out everything that, you know, I had in my vision and then I had the team, you know, contribute to building the roadmap... What ended up happening is that some of the employees who maybe previously weren't as vocal ... started to really synergize with the vision.”
— Dr. Solomon Gould [09:38]

• This participatory approach helped identify strong team members and highlighted those less fit for the new direction.
• Key leadership lesson: Bring people along the journey versus imposing top-down change.

Scaling from One to Multiple Locations

[12:21–17:41]

First Practice:

• EBITDA before medical model: ~$380,000
• Strategic focus: Increase exam reimbursement through better payer contracts.
• Leveraged external help to access preferred insurance panels.

Results After Shifting to Medical Model:

• EBITDA grew to ~$570,000 (70%+ increase).
• Revenue increased by 35%, new patient ratio up by 15%.
• Strategic cost control—consolidated tech stack and vendor alliances—improved operating margins.

“Within two years was able to increase revenue by 35%, new patient outpatient volume by 15%, but profit by 70%.”
— Eugene Shatsman [18:22]

• Dr. Gould validated his “rinse and repeat” approach by replicating the process with the second acquisition.

The Medical Model Impact—Revenue, CAPEX, and Patient Experience

[19:48–28:14]

• Medical exams drive revenue per patient, improve margins (lower or no cost of goods compared to retail).
• Capital expenditure (CAPEX) was introduced sequentially, not all at once—strategically prioritizing equipment that both improved care and differentiated patient experience.
• Initial tech: Diopsys ERG (~$60K in 2012), followed by VR-based dark adaptation screens, later “mainstream” tools like OCT when cash flow allowed.

“It’s easy to go after the shiny objects ... I was really focused on a combination of the key technologies that I knew were good for the patients, good for the clinical care of the patients.”
— Dr. Solomon Gould [19:48]

• Use of VR-based visual fields and screening: started as a patient experience tool, with billing reserved for follow-up diagnostic exams when needed.

Cold Starts (“De Novos”) and New Market Expansion

[29:19–39:00]

• Moved from acquisitions to cold starts, first in Boston’s North End in partnership with a local optician.
• Success in de novo setting required: sharpening marketing and outreach, authentic and creative social media engagement (“Huey” for the printer, “Buzz” the Keurig).

“Boots on the ground, grassroots efforts, and really leveraging the marketing aspect ... organic social media presence, being authentic and being real.”
— Dr. Solomon Gould [32:24]

Boston Location:

• First-year revenue exceeded $1 million; eventually grew to $1.7 million.
• Medical model comprised 25–30% at launch, scaling to 40%; margin at this site reached 35%.
• Maintained personal patient interaction—one day a week per site, even flying back monthly to see Iowa patients for continuity.

Expansion into Vermont:

• Chose Middlebury, a rural market, to test model adaptability.
• Increased medical side to 60% due to patient demand and low competition; significant patient draw radius.

“We were servicing patients from two or three hour radius ... only had one other eye care practice in the local community.”
— Dr. Solomon Gould [37:20]

Site Selection and Community Integration

[39:00–43:14]

• Location strategy: “worst house on the best block”—maximize efficiency, modest space, best neighborhood.
• Patient acquisition: repeated local outreach, community and physician networking, and honed paid digital marketing mix.
• Emergency room relationships: valuable referral source, especially in rural markets lacking ophthalmologists.

“My consultations are free of charge... then it became, wow, this guy has all that is needed for eye emergencies. Let’s send our patients in that come with eye emergency.”
— Dr. Solomon Gould [41:36]

Managing Across States: Challenges and Systems

[46:50–49:01]

• Four-state operations—and differences in payer mix and credentialing challenges (e.g., Minnesota).
• Two biggest keys to multi-site management:
  • Strong cloud-based tech stack and real-time dashboard for daily metric monitoring.
  • Local partners with equity/"skin in the game" for on-site accountability.
• Major challenge: labor costs escalated with scale, requiring change to performance-driven compensation models for all roles.

“The biggest challenge ultimately came down to the labor aspect ... so I pivoted how I was paying the teams in all different positions.”
— Dr. Solomon Gould [47:09]

The Three Pillars: People, Technology, and Strategy

[49:59–52:30]

1. People:
   • Proactively address generational workplace differences.
   • Involve employees in visioning and strategic planning to ensure commitment and retention.
2. Technology:
   • Invest incrementally in tech that’s both clinically impactful and enhances patient experience.
   • Use tech as a predictive, not just diagnostic, tool for proactive patient care.
3. Strategy:
   • Approach every practice shift methodically; collaborative planning with your whole team, leveraging their insights.

“The best thing I ever did, Eugene, was sitting that first team down and mapping out the vision of how we get to where we wanted to go ... I learned a lot from my teams along the journeys and I had insights from them that I wouldn't have thought of myself.”
— Dr. Solomon Gould [49:59]

Vigilance & Accountability: The Metrics That Matter

[53:20–54:14]

• Dr. Gould’s daily/weekly metric checklist:
  • Collections per full time equivalent (FTE), especially by provider.
  • Trends in individual provider performance relative to personal goals.
  • Retail metrics: multiple sales, upsells, and staff productivity ratios.
  • Efficient labor allocation to provider ratio.

“When I asked you about the numbers, you didn't just say the numbers, you said ... how the person who I assigned the number to, what their goal is and how they're trending towards their goal.”
— Eugene Shatsman [54:14]

Notable Quotes & Memorable Moments

• On patient loyalty:
  “Once consumers know that you are doing everything all at the same place... that actually really created what I like to call the sticky factor for patient loyalty.”
  — Dr. Solomon Gould [45:26]

• People over process:
  “Without your people, you don’t have your team and you don’t have your businesses.”
  — Dr. Solomon Gould [50:00]

Key Takeaways for Practice Owners

• Scaling is rooted in tested systems, but must be adapted market by market.
• The medical model is more than a revenue lever; it drives differentiation, improves margins, and creates opportunities to delight patients.
• Success hinges on authentic staff engagement, sequenced technology investments, and daily metric accountability.
• Community involvement, especially with emergency care and local physicians, can build lasting patient pipelines.
• Compensation models and performance culture are essential to attract and keep top talent as you grow.

For Further Exploration

Explore more ideas from Dr. Solomon Gould or get in touch with the Power Practice team at www.PowerPractice.com.

Summary by Power Hour Optometry Podcast Summarizer, 2026