Why Diagnostic Tools Go Unused — and How to Make Them An Asset to your Practice with Dr. Mile Brujic

Summary

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Podcast Summary: Power Hour Optometry

Episode Title

Why Diagnostic Tools Go Unused — and How to Make Them An Asset to Your Practice
Guest: Dr. Mile Brujic
Host: Eugene Shatsman
Date: December 19, 2025

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Episode Overview

This episode dives deep into a persistent challenge in optometry: Many diagnostic and therapeutic technologies, despite their promise, often remain underutilized—or even unused—after being purchased by practices. Host Eugene Shatsman welcomes Dr. Mile Brujic, a leading clinician and educator, to discuss the smart, patient-centered framework for incorporating new technologies to improve both patient care and practice profitability. Dr. Brujic provides practical strategies, communication tips, and actionable insights drawn from over two decades of real-world experience.

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Key Discussion Points & Insights

1. The Right Approach to Adopting New Technology

• Start from Patient Needs, Not Shiny Objects
  • Dr. Brujic emphasizes the critical mistake many make: buying technology first, and only then figuring out how to use it. Instead, identify true gaps in patient care and seek technology to fill them.
  • Quote:
    "What technologies actually do is they fill gaps. So as we care for patients, constantly I'm looking...for those technologies that'll fill gaps." — Dr. Brujic (04:03)
• Beware of Sales Hype
  • Sales teams often pitch technology as a path to 'center of excellence' status—but unless it fits a clinical need, it risks becoming a costly "dust collector."
  • Quote:
    "We oftentimes look at it in the exact opposite direction. We're looking at it and saying, all right, here's the piece of technology. Now bring this in. Now let's start using it. When that's the exact opposite way that we should be looking at this." — Dr. Brujic (04:27)

2. Real-World Technology Integration — Case Study: IPL for Dry Eye

• Identifying the Care Gap
  • Dr. Brujic shares his decade-long journey exploring dry eye and the role of facial rosacea, leading him to question traditional pharmaceutical management and eventually adopt IPL (Intense Pulsed Light) therapy.
  • Critical insight: Observing patient populations, especially masked signs like makeup concealing rosacea, can reveal unmet needs.
• Stepwise Adoption: Risk Mitigation
  • He started with low-level light therapy for experience, then brought in IPL when patient demand and clinical evidence justified it.
• Effective Communication Drives Utilization and Acceptance
  • Patients respond when you explain technology as a solution to their specific problem, not just as an 'offered service'.
  • Quote:
    "I'm filling a true gap with patients. And patients feel that, patients know that." — Dr. Brujic (11:56)
• Persistence and Documentation
  • Every recommendation is documented, and treatments are discussed at each follow-up.
  • Quote:
    "It's always documented. And every single time I see that patient for a follow up, guess what the discussion is. Remember last time we talked about this procedure?" — Dr. Brujic (12:17)
• High Treatment Acceptance Rates
  • IPL recommendations see 60–70% initial acceptance, with many more patients opting in at follow-up.
  • Quote:
    "It's high. So it's 60 to 70% of patients say, yep, I'll do it." — Dr. Brujic (16:15)

3. Patient-Focused Communication (Cost and Clinical)

• Transparency Builds Trust
  • Clinicians should not shy away from discussing cost—they should initiate the conversation to avoid patient distrust and increase acceptance.
  • Quote:
    "We in the exam room need to give our patients some level of perspective on what they're going into...we always talk about cost." — Dr. Brujic (17:06)
  • Memorable Moment: Eugene shares a negative example where clinician avoidance of cost discussion eroded patient trust and lost a sale. (19:10)
• Provide Options & Be Binary
  • Clearly present options, pros/cons, and pricing to empower patient choice and simplify acceptance tracking.

4. Underutilized Technologies: Scleral Lenses & Imaging

• OCT in Scleral Lens Fitting
  • Despite availability, many don't use anterior segment OCT for every scleral lens patient at every encounter—a missed opportunity for both clinical outcomes and revenue.
  • Quote:
    "The OCT for scleral lenses is probably one of the most underutilized technologies that I've seen...when it comes to what can we do to make outcomes better for these patients." — Dr. Brujic (26:42)
• Diagnosis Drives Opportunity
  • Take a proactive approach with conditions like keratoconus and EBMD—don't wait for 'end-stage' before using fitting and imaging technologies.
  • Practical Tip: Use fluorescein and imaging on all appropriate candidates and leverage easy, repeatable workflows for staff.

5. Billing and Practice Management Pearls

• Know Your Payers
  • Vision and medical plans have different rules—know them, communicate clearly, document everything.
• Prompt Pay Discount
  • Offer a transparent, policy-wide 20% prompt-pay discount for cash patients (without ever framing it as an 'insurance discount').

6. Top Mistakes in Technology Purchases (Rapid Fire)

[37:36 – 43:38]

• Mistake 1: Restricting Use to Only Advanced Cases
  • E.g., Only running diagnostics on severe cases, not building it into routine flow.
  • Fix: Integrate into pre-test protocols; review schedules with technicians each morning.
• Mistake 2: Inadequate Communication Planning
  • Fumbling through explanations when tech is new; overexplaining or spending too long.
  • Fix: Pre-plan & rehearse your "script" for patient conversations.
  • Quote:
    "Make sure you're coordinating your conversation around the technology. Before you get the technology, figure out what you're actually going to be...Otherwise you're going to learn it on the spot and you're going to stumble." — Dr. Brujic (39:57)
• Mistake 3: Overestimating Usage and ROI
  • Don’t get swept up by shiny new tech at expos or from peer pressure.
  • Fix: Underestimate early usage to set realistic expectations and avoid disappointment or wasted expenditure.

7. Team Buy-In & Change Management

• Limit Big Initiatives
  • Focus on one practice-wide initiative per quarter to avoid staff burnout and boost successful adoption.
  • Quote:
    "You can only put so many things on that plate in a day...with new mental effort, they become habit. And when they become habit, they take up less of that plate." — Dr. Brujic (47:12)

8. Leadership & Prioritization Wisdom

• Prioritize, Don’t Just Say 'No Time'
  • A key lesson from Dr. Brujic’s mentor: Saying "I don’t have time" is dishonest—say it's a lower priority and know your top priorities.
  • Quote:
    "Tell me that whatever I'm presenting to you is lower on your priority list and let me know where it is...otherwise not having time is the worst excuse you could give somebody." — Dr. Brujic (49:36)

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Notable Quotes & Memorable Moments

• On Integrating New Tech:
  "I didn't take it from here's capital investment that's going to turn me into a dry eye expert... I've actually created this advanced dry eye practice where we're helping a lot of these patients." — Dr. Brujic (12:51)

• On Scleral Lenses as a Growth Area:
  "Don’t wait till the end to consider scleral lenses. Start moving it closer to the beginning." — Dr. Brujic (32:05)

• On Practice Philosophy:
  "Do what's in the best interest of the patient. It's in the best interest of the practice." — Dr. Brujic (33:01)

• On Staff Engagement:
  "If you’re trying to do six of those in a quarter...the staff are just hoping this is another shower thought that the doctor had." — Eugene Shatsman (47:01)

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Timestamps for Key Segments

• 04:03 – Dr. Brujic on filling care gaps with technology
• 08:30 – 12:29 – Case study: IPL for dry eye (clinical insight, workflow, and communication)
• 16:15 – High treatment acceptance rates for IPL
• 17:06 – 19:10 – On cost transparency & avoiding trust erosion
• 25:22 – 26:59 – Underutilized diagnostic workflow for ocular surface disease & specialty lenses
• 37:36 – 43:38 – Rapid fire: Top mistakes with practice technology adoption
• 47:01 – 47:57 – Quarterly "one major initiative" advice
• 49:36 – Prioritization wisdom from practice mentor

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Practical Takeaways

• Systematize Diagnostic Use: Integrate advanced imaging and diagnostics into pre-tests, not just advanced cases.
• Rehearse Patient Communication: Prepare concise, confident patient explanations for any new tool or service—record yourself if needed.
• Prioritize Patient-Centric Investment: Match every technology purchase to an existing, repeat clinical need.
• Be Upfront About Cost: Clinicians should initiate cost discussions and present clear options.
• Cultivate a Deliberate Change Culture: Implement only one major initiative per quarter and involve the whole team in the rollout.

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Resources and Additional Learning

• Close – Collaborative Learning of the Ocular Surface Education:
  Year-long clinical education program for developing dry eye practices (in partnership with Woo U and Optometric Insights).
• Scleral Consultative Institute:
  Weekend, hands-on training in Nashville, focusing on scleral lens fitting, billing, and practice integration.

Contact information and links provided in the episode description.

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Host's Note:
This episode is packed with practical, no-hype guidance for clinicians who want to turn technology into a true asset—improving care, boosting revenue, and avoiding common traps. Dr. Brujic’s “Melee nuggets” of communication and workflow wisdom are worth revisiting and sharing with your entire team.

Transcript

[Dr. Mile Brujek]

This next statement that I'm going to tell you changed everything. She looked at me and she said, did my new glasses cause dry eye? And when she said that, I realized I had to change everything in terms.

Of the way I was doing it.

She thought that I did something wrong with the glasses. And now she's thinking that her glasses.

Caused the dry eye that I'm not finding at the second visit.

So in an attempt to identify these.

Patients before they got glasses just started staining everybody. And what we saw was tremendous.

[Eugene Shotsman]

I'm your host, Eugene Shotsman, and today we're talking about something that a lot of practices get wrong, bringing new technology into the office. My guest is Dr. Mile Brujek, a name that many of you know from podium and from journals. And what I love about Mile is that he doesn't really chase shiny objects. He has a very intentional way of deciding, deciding what technologies and treatments actually belong in this practice, when to bring them in, and how to make sure they don't end up as very expensive dust collectors. So in this episode, we unpack Melee's framework for turning technology into real patient care upgrades and also real profit centers. And then we get into some really practical, I guess I'll call them Melee nuggets. These little things that he does and says that lead to consistently high treatment acceptance rates, like in his treatment of dry eye and scleral lens acceptance rates. And then we zoom out to some of the biggest mistakes that practices make when they buy equipment and also how you can avoid them. So this episode's got no hype, no gadget talk, no sponsored content. Just as a much smarter way to think about technology, patient care, and growth. What I really loved about this conversation is that Milei brings more than just 20 years of experience, but he also has a ton of real world, here's what I learned the hard way type of insight. So if you listen closely and it pick up a lot. And before we jump in, quick reminder, if you have an episode idea, a question, you want to work with us, or if you want to share what's working in your practice, you can always reach out to me@eugene shotsman.com or at the Power Hour website. I do read every single message and respond. And I want to make sure that you're subscribed on YouTube, Spotify and Apple podcasts. So whenever, wherever you listen, you'll know when a new episode drops. All right, let's get into it. Here's my conversation with Dr. Mile Brugic Mile. Welcome to the Power Hour. Excited to have you on the show.

[Dr. Mile Brujek]

Thank you for having me, Eugene.

[Eugene Shotsman]

All right, so I want to jump right into it because I think you and I decided we're going to focus the show on incorporating new technology. Now, many of our listeners are going to know you from lectures they've heard you give, and I think you have a command of a variety of, of topics that are related to, you know, incorporating all kinds of things into your practice. But I think today I wanted to generalize it as much as possible, at the beginning at least, and say, how do we not waste money on new technology that we're bringing into our practice? So why don't we start there? Mila, what do you think?

[Dr. Mile Brujek]

Oh, Eugene, you told me we have.

About 45 to 50 minutes. This may be a longer topic than this.

[Eugene Shotsman]

Well, we could have a two part episode, maybe.

[Dr. Mile Brujek]

So I have the good fortune of.

Having 23 and a half years of clinical experience at this point.

And with that said, I've seen a.

Lot of technologies come and go and I've seen those that have actually stuck. And.

It'S almost concerning and frustrating to me when I hear either industry or clinicians thinking that because they buy a piece of technology, they become a practice.

Of excellence in whatever setting that might be or whatever specialty and eye care that might be.

Because. Because what technologies actually do is they fill gaps. So as we care for patients, constantly.

I'm looking, Eugene, for those technologies that'll fill gaps.

So when I'm saying patients, I always.

Wonder and wish, man, I wish there.

Was something that could take care of X. And as you start seeing that more.

Frequently, you start seeking out the technologies.

That are available or are not available there. And when they are or when they do become available, then you're ready to.

Pounce on those and incorporate those into your practice. And.

But the reality is we oftentimes look at it in the exact opposite direction. We're looking at it and saying, all right, here's the piece of technology. Now bring this in. Now let's start using it.

When that's the exact opposite way that we should be looking at this.

[Eugene Shotsman]

Well, and I think that the sales, the sales teams of those technology providers are doing a good job if they get you to think about it that way. But that may not be the best way for your practice to think about it. But I totally agree with you. I have so many clients that have reached out and said, hey, I bought this piece of technology. Now let's think about what my marketing plan is, because I can now offer X. Whether X is Dry eye or scleral lenses or something else. Right. But, like, I bought this thing because it was a good deal. And obviously, I would imagine you would advocate that that's probably the wrong way to approach is.

[Dr. Mile Brujek]

And the reality is, is when you're providing advanced technologies, you're treating more advanced patients, and those patients command a level of explanation that's deeper than the superficial.

Or the more mild patients in those categories.

So because of that, if you incorporate.

Something and you're not bound with the information or the knowledge technically and also.

Clinically to back everything that you're doing up, it becomes an awkward conversation between.

You and the patient.

And that actually is part of the.

Reason why sometimes these technologies don't get utilized the way they do, if we think about it the exact opposite way.

And, Eugene, you'll hear everything that I say is, what's in the patient's best interest ultimately will lead to what's in.

The practice's best interest as well, too.

So that's always what I'm doing, is looking for those gaps in care and then helping find those technologies that'll fill.

Those gaps to make what I'm doing for that patient better. Yeah.

[Eugene Shotsman]

And let's maybe even go a little bit deeper in terms of the technologies that you're seeing today that are innovative enough. And let's take them through the pro. Let's take our listeners through the process of. This is the gap you saw in care. This is the technology you brought in. This is how you selected that technology. And the process being, okay, we're doing it the right way, as opposed to the sales guy showed up and said, you got to have this thing because I want you to be a center of excellence and xyz, and you need the latest gadget to do that. And maybe we'll talk about what happens if you do it that way.

[Dr. Mile Brujek]

Well, let's. Let's do that. And Eugene, just as a joke, you know, with the internal kind of joke, is the. The best way to get rid of a capital sales rep. You know, if you're.

They're selling a diagnostic or a therapeutic piece of equipment, you know, the best way to get rid of them or stop them showing up to your office is by the equipment.

So I'll give you the perfect example. And this was this. I'll give you my journey with ipl, or Intense pulse, like therapy, because, you know, over the last decade, you can't go into an education session without hearing about ipl. But I remember thinking initially like, this makes no sense to me. Why if we're treating somebody tragus to tragus, will it actually provide a benefit to somebody's eyes? And then somebody started talking about rosacea and the fact that rosacea is actually.

Linked to dry eye.

And I thought, okay, we've learned about.

Ocular rosacea, but that's not a term we even hear about a lot.

We hear about meibomi gland dysfunction, but we don't hear about ocular rosacea, even though ocular conjunctivitis, or excuse me, rosacea conjunctivitis has an ICD10 code. We don't usually talk about it, but it started getting me interested in this whole topic. But I thought, you know, 10 years ago, I still had adequate solutions for.

For this.

You know, we can use oral doxycycline.

Dermatology is managing this with topical lotions and things like that and creams and gels.

So as I started progressing through my dry eye journey, this started again. I started treating dry eye in a.

Formalized way about 20 years ago.

About 10 years ago, I started looking.

At this whole rosacea thing.

And then about five years ago, I had one of the probably most brilliant conversations. And, Eugene, this set off a light bulb for me, and it started me on a more direct path, because you start seeing these patients that are responding to traditional therapies, or they're not responding as well as others are responding to.

Certain therapies, whether it be procedures, whether it be pharmaceutical agents.

And I sat down with a clinician, and she said, you know, you're probably not understanding how much rosacea there is out there.

And I said, what do you mean?

Said, well, you don't know this, but most females that walk into your practice will have something that covers up the natural tone of their skin. Said, really?

Yep.

It's either some type of makeup that they're using, some type of powder that.

They'Re using, some type of lotion, some.

Type of cream, some type of UV protection that they're using that has some type of pigment in it that's not giving you a realistic perspective. The next day, it changed how I started asking questions. So every time I had a female patient in the chair, I asked them, are you wearing any makeup on your face? You know what the first response I got was?

Nope.

I didn't wear any eye makeup today.

Said, great.

Are you wearing any makeup on your face? And I remember the first woman, she looked and said, yeah. I said, okay, what does your skin look like when you don't have makeup? And she described this telangiectatic appearance. She said, oh, yeah, I can see little blood vessels.

That's kind of why I do it. I cover it up.

And I realized at that point that I was missing something that I was. Was sitting in my exam chair that I was just unaware of. So I did this exploratory phase. And as I started seeing these dry eye patients back, I realized how many of these individuals had this underlying rosacea or facial hyperemia. And I started thinking, am I going to commit this person to doxycycline because there's baggage with this, or am I going to start thinking about offering other options? And that's where I saw the gap. I said, okay, I can help these patients. And that's where the whole discussion for me and IPL in my practice came about. I saw this gap. I didn't understand where the gap was initially, and I figured out where the gap was. And as soon as we brought it in, we were immediately busy with it. We had to develop our protocols.

We had to do everything. We needed to figure out the way that we were going to be doing it. Was I going to be doing the procedure? Was somebody else going to be doing the procedure?

But hesitancy was an interesting thing too.

That's an inertia that we have to work against.

Before we brought in the ipl, we brought in low level light therapy because we knew that was beneficial as well, too. It was a full facial, like full face is exposed. But I wanted a lower level of risk. I didn't want to worry about Fitzpatrick score because there's other concerns with IPL.

That we need to be cognizant of.

After six months with the low light.

Level therapy and seeing what it could.

Do, that's what sparked it. I said, we have to bring this in, period. Because there's a gap in patient care. People are wanting to less frequently take medications.

They're looking for more naturopathic or natural ways to improve what they're doing.

And this gives us the ability to.

Harness mother nature's true energy, light, and just literally correct these patients.

And Eugene, when, when we got it, the way that we communicated about the.

Exam room is different.

It's different than I bought it because I thought I could do this instead of other stuff. I'm filling a true gap with patients. And patients feel that patients know that. Now, Eugene, I don't want to present a scenario where every single person I.

Talk to wants and signs up for ipl, but it's always documented.

And every single time I see that patient for a Follow up, guess what the discussion is. Remember last time we talked about this procedure?

I do think this is something that could help you.

I do think that this is something.

That could make things better for you.

It is something that we should consider. And what's also interesting is now with pharmaceutical agents being less, I would say, predictable in terms of their cost, this is making procedures a much more approachable.

Discussion with patients as well, too.

So that was kind of my journey. But you saw, I didn't take it from here's, here's capital investment that's going.

To turn me into a dry eye expert.

I don't consider myself a dry expert. I consider myself a passionate clinician that is constantly seeking out what's in the patient's best interest. But in that journey, we've actually created.

This advanced dry eye practice where we're helping a lot of these patients.

[Eugene Shotsman]

And I bet patients feel your like they understand that commitment, that passion. I bet they actually feel it when you're talking to them, when you're, when you're describing the opportunity they have to get care that they previously didn't have access to.

[Dr. Mile Brujek]

They do, because I'm very forthright with.

Them as well too.

Even if there's something that they have ocular surface wise that there's no FDA approved treatment for, we're very forthcoming with that.

There's nothing that's FDA approved for this. This is our best shot at managing this. And this is why.

So we get into detailed discussions, but those detailed discussions couldn't happen with a.

Rudimentary view on ocular surface disease.

We go deep with these patients because oftentimes they're seeking out something more in.

Terms of their treatment as well too.

But Eugene, the good news with all this is because we've incorporated this, it actually factors back the practice is benefiting. Don't get me wrong, we're not giving away services. We're still at the end of the.

Day for profit business. I love the United States of America. It's the best country on earth.

And with that said, we've set up systems in place so that when we.

Provide the best patient treatments, we're rewarded financially as well, too.

[Eugene Shotsman]

Well, of course. And by the way, kind of a brief philosophical aside, at what point did you decide that rosacea was kind of in the scope of care that you wanted to address? Right. Kind of in the same way that that patient responded to you and said, well, I'm not wearing any eye makeup. Right. They think that that scope of care, how do you communicate that extension of Scope of care also to the patients.

[Dr. Mile Brujek]

I love this whole discussion and I used to show them a diagram.

I don't show them this diagram anymore.

And this is the exact description. So if you're a patient and I.

Feel like the ocular rosacea that you're experiencing is from a more diffuse facial rosacea, this is my exact discussion with the patient.

So you know the redness that you're seeing on your skin, this is actually.

Related to what we're seeing on the eyes as well too, and how your oils aren't producing oils the way that they're supposed to. Here's the good news. We actually have treatments for this. These blood vessels, they're actually dilated and they produce inflammation.

And the blood vessels on your face.

Are actually connected to the blood vessels in your eyelid.

So we know that as we treat this area around your eyes, that's actually going to reduce that inflammation and it's also going to reduce the inflammation in.

Your eyelids as well too. The good news for you is that's actually going to reduce some of this periorbital redness or this redness around the.

Eyes, but it's also going to help.

Your eyes produce those oils better as well. And then we go into what exactly to expect with the actual treatments. Usually four sessions separated by two weeks.

[Eugene Shotsman]

That's awesome. That, that's. I mean, if, if somebody is just listening to this episode for just that one set of guidelines of how to explain this to patients, it's already, it's already worth your time for sure. Uh, let me ask, what's your treatment acceptance rate? Mile when you, when you present it?

[Dr. Mile Brujek]

Uh, it's high. So it's 60 to 70% of patients.

Say, yep, I'll do it.

And if they say no that first day on a repeat visits, they'll say.

Yeah, I really need to do this.

Because usually what they'll say is because the good news is that through HSAs.

FSAs, this is a covered medical procedure. So the good news with all, all.

Of this is that even if they say no, it's usually for a reason. I'm going to plan for 2025.

So we're 2026, so we're going to make sure that we do this.

And they'll even ask like, does this have to be repeated? And I say, yeah, you should plan for every six months to have just a touch up on this. If you don't need it, no problem, you just saved dollars for that. But if you're planning ahead, you should.

Be planning for, for that.

[Eugene Shotsman]

Who talks about cost in your practice?

[Dr. Mile Brujek]

Everybody. So I'm a strong advocate, Eugene, that we in the exam room need to give our patients some level of perspective.

On what they're going into.

The last thing, if it comes to anything daily disposable contact lenses. If they don't know what they're getting.

Into, cost wise and they love it.

Then they get outside or I transition.

To an optician or a technician where.

They'Re now talking about the price and the patient surprised. My concern is that that's a horrible experience. Why do you put me in this lens?

That's this cost.

So we always talk about cost. I, I actually enjoy it because that gives me perspective on what the patient.

Finds most important for them.

So I'll usually say the cost initially.

Then what we do is we have a form that shows essentially we have a package that we've created.

So we have each session costs X and, and then if you go with all four sessions, it's essentially get three.

Get the fourth one for free. So it's a package price that they'll actually obtain.

But it's me.

And then it's solidified by the technicians. That's awesome scheduling.

[Eugene Shotsman]

And I've heard the similar feedback from practice from clinicians who aren't afraid to talk about cost. I know it feels icky to some people, but I will tell you the most awkward experience and I'll try not to. I'll make sure I de. Identify the practice. But the most awkward experience I've ever had in shadowing patients and consulting for a practice was one where I observed a really qualified clinician make a really strong recommendation to the patient. And the patient really wanted the procedure. And the patient asked the clinician and said, how much is this? How much is this going to cost? A clinician, because she was really uncomfortable selling, said something like, well, you know, my team will go over that. I don't really handle any of the pricing or anything like that. And I, you know, so you'll have to talk about that with my coordinator. So then the patient transitions to the next person who is the coordinator. And the woman, the first thing out of her mouth says, the doctor gave you a great deal on this procedure. It's going to be XYZ number of dollars. So what you've immediately done is like it's become completely clear to the patient that the whole thing's a sham. You've eroded the trust in the patient. And you've also created this horrible, this unnecessary distance where the clinician is uncomfortable with Cost. So now the patient's uncomfortable with the cost and the patient walked out of the door. I watched the patient walk out without accepting the treatment. And of course, the coordinator wasn't really all that well trained either to handle that conversation because of the way she started it. It was kind of pretty obvious. But it's also one of those things where I think a lot of doctors are afraid to sell or they don't want to. So they got into this because of patient care and they don't really feel, and I've heard the objection that, oh, I don't want to feel like a used car salesman and talk about how this is going to cost thousands of dollars and, you know, haggle with the patients. But I also think that there's probably an alternative perspective. And that alternative perspective makes a lot of people, including yourself, very successful with treatment acceptance rates. Right.

[Dr. Mile Brujek]

Well, Eugene, I'll tell you, you bring up such a huge point. And I, I, maybe it's my years of experience, maybe it's my age. I'm going to be 50 in another month. I become increasingly binary with patients and I give them the options so that they can kind of choose their own pathway. And they also know what the pros.

And cons about each one of those things are.

Because I think it's partially our duty.

As well to, to help patients understand what this cost is.

I'll give you another perfect example. Medically necessary lenses. When you're utilizing vision plans, I think it's incumbent upon us clinically to help patients understand cost wise what they're getting.

Into and whether or not it will or won't be covered through their vision plans or their medical plans.

Because I think the clearer that we paint the path, the clearer we know.

What the next steps are for that treatment option.

Again, it requires assistance. Like you said, I can't do everything, but I at least have to share.

With the patient what the cost is.

And I have to be comfortable with that. And if a patient declines it because of the cost, they'll share that with you. And we know exactly what to record.

In our notes as well, too, so that the next time we talk to that individual, we know exactly what the issues are. We can build on that conversation as well.

[Eugene Shotsman]

Well, and back to your earlier point, if a patient declines a treatment because of the cost, it seems to me that you then have, you are armed with two pieces of information. Piece of information. Number one is the case presentation wasn't enough for the patient or that the issue wasn't enough for the patient to Take action. Or alternatively, this treatment might, or this solution might have been too aggressive for this particular patient. Maybe there's a gap. Back to your earlier point. Maybe there's a gap and I need to fill that gap with some sort of mid level or middle point that could potentially solve part of the patient's problem, at least right now.

[Dr. Mile Brujek]

That second piece was so brilliant, and that is 100% true for the exact same reason that the presbyo, they don't.

Necessarily go into the most advanced treatment initially.

If you're picking up a pair of.

Reading glass once or twice a week, you don't need something that's very advanced.

And you probably won't pay for something that's very advanced. If you need to pick up reading glasses 10 to 20 times a day, you're going to start thinking about, all.

Right, let's, let's get functionality back into this whole picture.

[Eugene Shotsman]

Yeah, exactly. So I guess you know that we've, I've heard your philosophy on technology, starting from finding this treatment gap loud and clear. So now my next question is, what are some of the widely adopted underutilized technology that you, you've seen in your experience or in your work with other practices?

[Dr. Mile Brujek]

Well, so Eugene, one of the things that we do is in addition to.

A lot of advanced ocular surface disease.

And I, I have a passion for.

This because I see these people.

And just to in full disclosure, this happened 20 years ago. The reason why I'm so passionate about.

Ocular surface disease was in 2005 I became a part owner of the practice that I'm in.

And as an owner, as you're well aware, you not only look at the top line numbers, but you look at.

The expense side of things. 42 year old female, who I used to describe as an older 42 year old female. Now I describe her as this young, hip, 42 year old female. She came into the practice, she was.

Getting her first pair of progressives. She was a minus one with a plus one ad.

And we all know what the challenges with that are.

People that are equal in magnitude but.

Opposite in prescription of their level of presbyopia are going to always tell you, well, I can see better with my.

Glasses off than I can through the.

Progressives because of the wider field of view that they experience.

So I go through the whole kit.

And caboodle in the exam room. I explain everything.

She comes back one month later, she.

Says, I can't see out of my new glasses.

And when I check her visual acuity, this is 2005 it's fluctuating on every blink. And she's asking me, am I supposed.

To be seeing like this?

Well, Eugene, at the time, all we had was fluorescein.

So I put fluorescein on the eye. Her tearful breakup time was almost immediate. She had a band of corneal staining inferiorly. So pull the slit lamp back, start.

Her on a prescription drop, which was.

The only one that we had at.

The time, and go through this whole dry eye spiel. And it was an inexperienced dry eye.

Spiel, needless to say, it was again 20 years ago.

But this, this next statement that I'm going to tell you changed everything. She looked at me and she said, did my new glasses cause dry eye? And when she said that, I realized I had to change everything in terms.

Of the way I was doing it.

She thought that I did something wrong with the glasses. And now she's thinking that her glasses caused the dry.

That I'm not founding at the second visit.

So in an attempt to identify these.

Patients before they got glasses, we just started staining everybody.

And what we saw was tremendous, not only with that, but also ocular surface disease, ebmd. So we started looking at these individuals and we realized there's a need here. So one of the spaces that we started in addition to advanced dry eye.

Or ocular surface disease was specialty lenses.

Now, specialty lenses have advanced a lot.

Over the last 20 years, but the.

Biggest kind of thing was scleral lenses. We have a process in place, Eugene, that I'm kind of surprised sometimes when.

I talk to other people who are fitting scleral lenses.

But every time we put a scleral lens on, we're taking six measurements, two.

Through the center with our OCT and four in the periphery so that we can see the limbal clearance in the.

Landing zone every single time. We do this because these patients, first and foremost, they need us most because without the scleral lenses, they can't see. So we are ultimately doing everything we possibly can to make it as precision based as possible. But the second thing is, they're arguably the most profitable people in our practice because again, they are the ones that.

Have the highest level of specialty services that we can provide.

So with that said, we do those OCT scans on every patient at every single encounter. But the OCT for scleral lenses is probably one of the most underutilized technologies that I've seen in, in this space when it comes to what can we.

Do to make outcomes better for these patients.

[Eugene Shotsman]

So that's six point oct you said every patient every single time, right?

[Dr. Mile Brujek]

Correct.

[Eugene Shotsman]

Do you charge for it?

[Dr. Mile Brujek]

Depends on the patient's insurance. What I mean by that is when you're talking about vision benefits, vision benefits.

Have a different bucket of rules.

So they give us a 90 day global fee that's supposed to encompass every.

Single thing that we do.

And in those circumstances, every single thing that we do and every test that.

We do is incorporated in that 90 day global fitting fee.

When we're talking about medical insurance, they're a little bit different. They're fee for service.

So what a medical insurer wants is.

They want everything that we do with.

That patient listed out and submitted to them. So that's what we do with the medical insurers.

So for medical insurers. Yep. Because it's one of the line items that we do for vision plans, it's.

A little bit different because it's that 90 day global period. So we do not. With vision plans.

[Eugene Shotsman]

Yeah, I know that some practices charge imaging fees and then advanced imaging fees and that kind of thing that are cash pay for patients. So I don't know what your opinion.

[Dr. Mile Brujek]

That's the third bucket of patients that are.

I don't have insurance and I don't.

I don't have medical or vision insurance.

We actually.

Eugene. So myself and a colleague doctor since you know, we started something called the Scleral Consultative Institute where we do a weekend of scleral lenses from start to finish.

Nuances on fitting, but also we go.

Through the billing and coding to help actually figure this whole thing out for.

Clinicians so that they can put strategies in place to really systemize everything that.

They do in their office when it comes to doing this. So that there's consistent billing patterns as well too. Because that's one of the most important things too. You can't willy nilly this stuff. There's rules that we have to abide by when it comes to vision providers and medical providers as well too.

[Eugene Shotsman]

When, when and when you teach that weekend, I'm just curious, what are the biggest mistakes that practices are making? Maybe you know, aside from this imaging thing that when they're trying to bring sclerals into their practice. Because I, I do talk to a lot of practice owners who are like, yeah, I'd love to grow that part of our business. And yet it very rarely grows. So what are some ways that practices could grow that side of their business and what are the biggest mistakes they're making?

[Dr. Mile Brujek]

Becoming more proactive with the patients that they're selecting?

I'll give You a perfect example.

You ask a clinician, when would you think about scleral lenses for a patient with keratoconus? Most of the time we're thinking about.

It as a more advanced cone that we're thinking about putting into a scleral lens.

When you think about the clinical benefits and you think about the fact that if you're putting a scleral lens on the eye, you're actually mitigating access to the cone. And we know that access to the cone and rubbing the eye are one of the key clinical instigators of cone progression. If you actually put a scleral lens on the eye, you're inadvertently protecting that cornea. And because of that, we've pushed it up in our treatment algorithm significantly because we know that under a scleral lens and we have hundreds of patients where anecdotally we're seeing their cones aren't changing. They haven't necessarily had corneal cross linking, but their cones aren't changing under these scleral lenses. So again, the first thing is, is taking it from a last ditch effort to something that's pushed a little bit.

Sooner in the treatment algorithm.

The second thing is think about conditions.

That you don't normally think about with scleral lenses.

For example, epithelial based membrane dystrophy is.

One of these gems that I love fitting these patients in scleral lenses.

Oftentimes it's sometimes difficult to identify these people with just a standard white light assessment. But when you put fluorescein on the.

Eye, look at the eye with a cobalt blue light and a rat number.

12 filter, you see these subtleties where these patients are 20, 25, 20, 30.

Can'T get them down to 2020.

And we attribute it to something like.

That'S probably the cataracts.

Macula is clear cornea. Cornea looks okay with white light.

It's probably the cataract.

When you put cobalt blue light in.

A RAT number 12 filter and forcing on the eye, it shines it like crazy.

Eugene. Just as a process perspective, we actually have rat filters on every single slip lamp and we also have a mouse.

On every single slip.

You may be wondering what's the mouse for? The mouse controls the anterior segment imaging. So the night before we see patients.

The technicians will actually populate it with.

All the patients names. They just click.

So whenever I walk into an exam.

Room, that anterior segment imaging, at any of the doctors in the office, it's ready to go. They're assuming that we're going to be Acquiring some type of imaging for those patients.

So we don't have to think about it, we don't have to bring up the patient's name, anything like that.

Just click on the gas pedal, it.

Immediately starts recording it.

But when you catch these patients by.

Just literally putting fluorescein on every patient.

Every encounter, you see how many people.

Can be helped by all of this.

So, again, biggest takeaway, don't wait till the end to consider scleral lenses. Start moving it closer to the beginning.

Of that pathway of correction for patients.

And consider those conditions that you may.

Not have considered for this EBMD, any type of corneal irregularity, post LASIK irregularities, post RK irregularities, injuries.

We've taken patients from 2100 down to 2020 people in our chairs that have just been kind of around saying, yep, this is my weak eye. We fix them and.

And. And now they're part of the specialty lens family, so to speak. And they're benefiting, and we're benefiting.

[Eugene Shotsman]

That's awesome. Yeah.

[Dr. Mile Brujek]

And.

[Eugene Shotsman]

And, you know, you. I think you alluded to this, but these patients being profitable in your practice, or some of the most profitable patients in your practice, talk a little bit more about that.

[Dr. Mile Brujek]

Yep.

So again, Eugene, I go back to my basic philosophy. Do what's in the best interest of the patient.

It's in the best interest of the practice.

So I always, every single time I see these patients as a new patient, whether they be referred in or whether.

They be a patient that I'm seeing in a regular exam, I identify this.

I always tell them what the cost is. This is what it'll cost you to fit.

This is the lens.

This is the fitting cost. And we always, on every single patient, and I didn't know how uncommon this was, but we always have the benefits.

If they have vision insurance, we always have those benefits printed out.

So let's take vision plan patient, let's take medic medical patient, and then let's third take, like, just cash.

Patient comes in.

So with the vision plan patient, know.

The rules and understand the rules so that you can communicate it immediately. So I say, this is what it costs.

This is what it would cost under your vision benefits, because your vision benefit.

Has recognized this as a medical condition that they're covering with this copay.

And the patient always says, the first time they see us, they say, oh, well, can I check with my insurance? I said, no problem.

But we do this all the time, so we know that this is the case.

And they immediately get a level of confidence or Comfortability. So then I say some people will actually schedule it back. We, we treat it like standard soft lens. So Eugene, if you're in my chair and I said, we identified you with.

Something that would benefit from a specialty lens. So do you want to start the process today?

I said, I'll be able to show.

You by the end of the fit process how you'll be able to see.

They think about it, they say, yeah, let's do it. So we just start immediately and it's.

A process that we've streamlined.

I put lenses on, technician gets called.

Into the room through our ehr, send them to the oct, get the measurements, get the autorefraction, come back into the room. I do the final touch ups, and the rest is history.

Medical insurance is a little bit different.

Because with medical insurance we don't necessarily know whether or not those individuals will actually have coverage or not.

So I always tell patients, I say, this is what the cost is.

And what we're going to do is.

I can go through the fitting process with you today.

I'll take that risk. I'm not sure if they're going to cover this or not.

We can't order the contact lenses until.

We figure out what's actually happening with your medical insurance.

And when they hear that there's an immediate, okay, the doctor's on my side, they're going to go through this, they're.

Going to show me what my vision is.

And that way we wait to hear.

Back from the insurance plan before we order any lenses and we don't get caught in this vicious cycle of lenses are dispensed, everything's good. Now we hear back from the insurance plan. They've denied anything and now we're going after the patient.

We always want to make it so.

That we're on the same side as the patient.

And then the third option is patient has no coverage. And when we do that, it is.

Literally, Eugene, we just talk about what the price is. Is this something that you'd like to proceed with today?

Sometimes they do, sometimes they don't. It's their choice, but they know exactly.

What the options are for them.

[Eugene Shotsman]

Them when it's complete cash pay. Do you, do you position it as for patients without insurance coverage, we offer some sort of discount or I never.

[Dr. Mile Brujek]

Say without insurance you have a discount.

But what we do offer is a prompt pay discount. And we offer that same prompt pay discount to every single person that's going.

To be paying the bill, whether it be the patient or whether it be the insurer.

If you want to pay us today, you get access to our prompt pay discount and that way the policy is.

Consistent across the whole practice.

[Eugene Shotsman]

How much is the prompt pay discount?

[Dr. Mile Brujek]

20%.

[Eugene Shotsman]

Oh, fantastic. I love that prompt pay discount. That's great language. That's great. So when we come back from the break, Neelie, what I'd like to do, I'd like you to rapid fire some more mistakes people make when purchasing equipment. And we'll do that right after the break.

[Dr. Mile Brujek]

Awesome.

[Eugene Shotsman]

All right, we're back on the Power Hour. And Melee, I. I think what I'd like to do for the rest of the show is zoom back out and say, okay, we've talked about some really interesting treatment philosophy. I think that's great. We also talked about some philosophy with how to approach a capital equipment purchase. But I think what I'd like to go back to is the first thing where we started the episode, which is, what are the biggest mistakes people make that cause them to make those boxes just sit there, collect data, dust, and burn money for their office as opposed to be solid, patient focused profit centers. So top three mistakes, let's go.

[Dr. Mile Brujek]

So there's two buckets. First bucket is diagnostics.

Second bucket is therapeutics.

So I'm going to give you one for each and then I'm going to.

Give you one combination.

So diagnostics, the biggest thing we always.

Want to know is what's the cost.

What'S it measuring, and what's it going.

To do to our clinical utility with that patient?

Mistake number one with diagnostics. This is the biggest thing that I.

See is we always save it for.

Our most severe conditions. For example, somebody has macular degeneration. Oh, they have intermediate macular degeneration with.

No signs or no risk of leaking. I'm not going to run an OCT on that patient. It's not what a retina specialist does. That's not what standard of care is at this point.

If you have an OCT in your.

Office, you're supposed to run it. The, the caveat is, though, why would.

Somebody not run it? Usually it boils down to flow. What I'm going to share with you right now is probably the best tip.

That I could give this whole audience.

And that is in the morning before you start your day, make sure that.

You go over your schedule with your key technician so that they know what they're doing with that patient prior you walking in the office.

This is what the flow used to.

Be in our office.

We used to literally see patient order oct, see patient back again.

So we're engaging, disengaging, reengaging. That's bad for flow. That's bad for a lot of reasons. We started this a decade ago going over the chart. When that patient's in for their exam.

Do the pre test, but in addition to the pre test, do a macular scan. So they're doing that as part of the pretest.

So when I walk into the exam room, I'm engaging once and disengaging once because I have all the information I need.

That one little change just simply made us more efficient, period.

I was gathering more information on that patient.

So again, Tip one, make sure you're putting it into your flow so that you have time to incorporate it. Again, for me it was making it part of the pre test so the.

Technician knows to run those tests so that we're making sure that we're doing.

Those tests and not getting into a.

Bottleneck where we're saying, oh God, we don't have time now we're gonna to have the patient back or something crazy like that.

Tip two is for therapeutic devices. The biggest questions we're always asking ourselves.

About therapeutic devices is what does it.

Treat, how much does it cost, and.

What'S the clinical utility that we'll have?

One of the biggest challenges and the biggest things that I could give to clinicians as a piece of advice is make sure that you're coordinating your conversation around the technology. Before you get the technology, figure out what you're actually going to be and how that communication is going to happen to patients when you think they would benefit from it. Otherwise you're going to learn it on.

The spot and you're going to stumble.

So think about it and put real mental thought and effort into it and even consider practicing it in, in your head, even though you're not going to say it out loud, which you could.

That's the best practice.

But we clinically, we're not used to practicing that way. So think about it, write it down, do something so that you have an organized group of thoughts that you can describe it, because otherwise it's going to.

Take too much time in the exam.

Room and it's just going to get.

Sloughed off to other responsibilities.

[Eugene Shotsman]

Yeah, and if I can maybe add to that one before you go to your third one, is that I think, at least what I found is that oftentimes when people get a new piece of technology or a new therapeutic or something like that, they over explain it and so they spend a lot of time explaining it. So I would say I would Add to your point, which is that end time yourself when you do it. I actually, I'm a huge fan of self role play. Like, you know, you talk to yourself. You can record yourself. You got a cell phone. Just record yourself and say if a patient saw that, would they be compelled?

[Dr. Mile Brujek]

Yes.

[Eugene Shotsman]

And you know, I come from, you know, my, my, my natural inclination is towards split testing, and split testing requires measurement, and measurement requires, you know, kind of precision recording type of stuff. So in my mind, it's like just record yourself saying it once, right? Like or twice. And then listen to that recording. It might make you cringe a little bit, but if it does, then at least you didn't waste the patient opportunity and the shoot.

[Dr. Mile Brujek]

So, right.

[Eugene Shotsman]

That like, if, if you're not going to spend the time to practice, then you're going to waste somebody else's time and you're also going to waste your own money and the patients and the patient's trust.

[Dr. Mile Brujek]

So, Eugene, we're not trained like that. Sales. Sales consultants that come into our office every day, they're trained, they do that. We're not trained like that. So the first time you ever do that, if you never heard your voice recorded and played back to you, you're going to look and you're going to cringe and you'll say, oh, God, I sounded so crazy and so horrible. Second time, it's not as bad. Third time, you're like, got it.

That's my voice.

All right, let's continue. This is what everybody's here on a.

Daily basis, but the first time, it's going to be so weird. You're going to feel like, I never want to do this again.

Break through that and do it a.

Second and a third time, and you'll find, Eugene, it's probably one of the best tools that somebody could do.

So the third, the third thing is don't get entranced by the shiny new tech. There's a reason why we visit things that exhibit halls.

There's a shininess and an aspiration towards.

Something, and we can be dishonest with.

Ourselves in showroom floors.

And the reality is we need to.

Be objective about these decisions.

And what I mean by that is.

Don'T overestimate the amount of people that you're going to treat or going to utilize this technology with. Underestimate it.

Because if you underestimate it, you'll likely hit those goals and exceed them. You're setting yourself up for success. So measure everything against what you think is going to be the lowest level of treatments.

Or diagnostic procedures that you'll be doing.

And then you'll start to understand what.

The greater role of that technology is in your practice.

And you won't be concerned or frustrated.

Or feel committed to utilize it to make a payment.

And under that set of circumstances, you'll.

Bring in the right technologies at the right time in your practice. One of the best sales consultants I.

His name will go unnamed, but he was with a device company. He'd interviewed clinicians, and he talked to.

Them about the condition that he was selling on.

And he would literally tell them, you're.

Not ready for this technology.

And he had 100% success with the.

People he sold to.

And they used to go through the applicators like crazy. But he picked his people that. That were ready, and he did a.

Fantastic job at it just by interviewing.

[Eugene Shotsman]

Them, which makes perfect sense, is that, you know, I agree with you on the showroom floor in a. At an exciting expo, especially if other people are buying or it seems like, well, I don't want to be left behind. I don't want to not have the thing that, you know, some guy across the street has. And oftentimes I teach practices the idea of differentiation. And oftentimes differentiation does come through technology. But you're absolutely right. If you're not ready for it, it's just going to sit there, collect dust, and probably frustrate your staff. And the worst thing I think you can do in bringing in technology is bring it in when your staff aren't ready. Because if they're not bought in, if there's no process by which your whole practice organizes behind a piece of technology, then all of a sudden you're in a position where you're trying to kind of placate the staff and kind of play peacekeeper between staff who are like, I'm already burned out. I'm too busy. I don't have time for this other thing. And, you know, I'm. He wants me to talk about this and he wants me to learn that, but, like, I don't have time for that. Like, I'm barely keeping up with the.

[Dr. Mile Brujek]

Schedule as it is, Eugene, to that point. So there's a software that I think.

Is absolutely brilliant right now.

And we had to make the decision, are we going to bring this in right now? Well, there are so many other initiatives that we have right now that we.

Didn'T want that to happen.

So I told the individual, reach back out to me in June of 2026. We want this. This just isn't the right time. Right now we have other initiatives. We have our fourth remote employee and.

There are other technologies that we're working.

To kind of smooth out in the practice right now. So we want to talk in six months again. And it's for that exact same reason. We want to make sure we're bringing.

It in at the correct time where everybody can be engaged.

[Eugene Shotsman]

And one of the things I try to teach is that you want to have your practice organized around one major initiative every quarter, right? So if there is a initiative like, I don't know, reducing exam only, which requires no technology, but that's the one thing that you're going to focus on this quarter. You know, you're going to meet about it all the time, you're going to identify issues with it all the time. You're going to identify how are we adopting this new initiative, what tools do we need, what systems do we need? And that could just be about improving your capture rate in your optical or reducing your exam always. Or it could be about, hey, we have this new cool IPL device. To go back to the start of the conversation, how many treatment plans have we as an organization, as a team, how many treatment plans do we have commitments from patients on? And then we identify issues, we meet about it, we talk about it, where do we get the training, we do all the stuff we need as a team. But if you're trying to do six of those in a quarter because somebody went to the show and we haven't, we haven't even cleaned up the four of them from last quarter and now we got two other ones and now it's just, you know, the staff are just hoping this is another shower thought that the doctor had. Right.

[Dr. Mile Brujek]

You are so right. We all have a certain level of. We have a mental plate, which is.

What I refer it to.

And you can only put so many things on that plate in a day. Here's the good news with what you're talking.

I love your initiatives in a quarter.

Because even if you're trying to increase capture rate, that requires mental effort. But what happens is over time, with new mental effort, they become habit. And when they come become habit, they take up less of that plate because they just become more automatic. And when they become less portion of that plate, you can put something new on that plate. So I absolutely love it and I concur 100% with your philosophy because I think that's the only way that this can happen. One step at a time. I love. There's no way that you can transition up. You can't Make a practice totally different tomorrow. But what you can do over a year time period is you can change.

Three or four things that are going.

To make massive impacts. I love your philosophy on that, and I am wholeheartedly 100% behind that.

Yeah.

[Eugene Shotsman]

And I think, you know, it's, it's one of those things. Anything that requires focus cannot be, you can't focus. You can't have five priorities that are all number one priorities. Right. You just, you got to, if it's going to require the practices focus, you set a goal and you say, that's the thing we're going to do for this 13 weeks and we're going to measure and we're going to change the behavior, we're going to do all that stuff. But if you just went to the show once a year and you brought back four pieces of equipment, you just can't have four priorities that are number one.

[Dr. Mile Brujek]

Eugene, I don't want to beat a, a dead horse here, but I, I, I have to share this with you, my senior partner. This is back 23 and a half years ago when I first started with him. He asked me about something and if.

I wanted to do something. And I said, I don't think I have time to do that.

And he shared with me his comeback. His response to this was so brilliant. And I thought, man, this was such a harsh response. But it's ended up being the best nugget for me, my practice life. He said, he looked at me and he said, don't ever tell me that.

You don't have time to do something.

But let me know that it's low.

On your priority list right now.

And I looked at him and I.

Said.

He'S exactly right. Because if he gave me tickets to Chris Stapleton, guess what? I probably would figure out how to get there that evening. But because of what he presented to me was lower my priority list at that point in time. I said, I don't have time. I always tell people that not having or saying you don't have time is a dishonest answer for me. Tell me that whatever I'm presenting to.

You is lower on your priority list and let me know where it is.

On your priority list and if you.

Ever want me to follow up with.

It again, otherwise not having time is.

The worst excuse you could give somebody.

And again, early on in my career.

He gave me that, Eugene. And it just feeds to the point that you were talking about earlier.

[Eugene Shotsman]

And it makes a perfect, I think it makes perfect sense too, because when somebody tells you that Something is low on their priority list, it doesn't close the conversation actually opens another conversation. Well, what's high on your priority list? And how can I help that? Right? Same way as you're going back to the treatment gap. It's the, you know, for, for having a professional conversation with somebody. And it was an interesting conversation I had last week with a, with a practice owner who said, you know, I wish I could use some demand generation services because I hear you guys have some new technology in that capacity, but I just don't have the capacity to do that right now. Um, and I asked a similar question. I said, okay, well what's high on your priority list? And he said, well, hiring doctors. And I said, oh, okay, well, that seems difficult. And this practice was particularly rural and I had asked about some of the things that that person had done to hire doctors. And then we somehow the, the, the conversation transitioned into practice efficiency and by the end of that conversation, that individual had realized that they could see more patients with the doctors they already have and they could maximize the patient opportunities in the practice without hiring additional doctors. And it was like, aha, you know, they, they could. Something clicked because we found rather than saying, hey, we're going to go down a linear path of what's your, let's, let's figure out that one particular priority, let's figure out what bigger problem we're trying to solve. And similar to your treatment gap conversation, Melee I found that it's like, it's, it's real easy to find what, when something is somebody's top priority and, and you may have some solution to help with that, it's really easy to have that conversation.

[Dr. Mile Brujek]

Couldn't agree with you more, Eugene. That's great.

[Eugene Shotsman]

So I know you do a ton of things in addition to practicing clinic. What are, I guess if somebody were to try to learn a little bit more from you or was able to try to find out more about the types of things that you're doing or where you're speaking. Where do they get that information?

[Dr. Mile Brujek]

Mele so there's two big initiatives, Eugene.

That I've been involved with over the last several years. The first one we started this year.

It'S actually called close collaborative learning of.

The ocular surface education.

And essentially what this is, is a.

Year long process split into five phases.

Where clinicians, we take them from individuals.

Who are passionate about wanting to start.

A formalized dry eye process in their.

Practice, going through the diagnostic side in phase one, the therapeutic side, and specifically pharmaceuticals in phase two, billing and Coding in phase three, Phase four is meeting.

The unmet need through procedures.

And then phase five is a year end wrap up where we talk about a lot of the nuances that create successful versus unsuccessful dry eye practices because again, it has to follow some form of systemic flow within the offices that's.

Actually we're presenting that in collaboration with Woo you. The company that we have with Dave.

Kading is Optometric Insights. And it's been a collaborative effort and.

We'Ve had such success with 2025's efforts.

That we're going to be doing it back in 2026.

So if you weren't a part of.

It in 2025, no worries. We're going to do the exact same thing in 2026 as well too.

And you get assets and you get.

Take homes and everything like that. So it's a real energetic and engaged and immersive process where again the goal.

Is, is spread out over a year.

So that you can build habits and incorporate those in your practice. Second big initiative and we've been doing this for eight years. Dr. Cincinno and I have something called the Scleral Consultative Institute.

It's literally a weekend immersion process in Nashville at his office where we take anywhere from nine to 11 clinicians per weekend and we take them start to finish where Saturday is an all day.

Event where we're in the office fitting.

Patients, fitting each other, working through nuances on how to make long term success.

With scleral Lens wearers. Go through the billing and coding and then Sunday morning we actually fit three live patients on a timescale or timeline. The cool part about it is all of these initiatives are no cost to the clinician.

Close is supported through industry and SCI.

Or Scleral Consultative Industry. Scleral Consultative Institute is supported by the sponsoring laboratories as well.

So again, it's great options for clinicians.

If they want to know more about those opportunities as well.

[Eugene Shotsman]

Cool, that's great. And we'll post some links in the, in the episode description for some of that. So Mila, such a pleasure to have you on the show. I do think that if I asked you two more questions they would probably lead to another two hour conversation. So we'll have to do a part two and possibly part three at some.

[Dr. Mile Brujek]

Point in the future.

[Eugene Shotsman]

But this has been an absolute pleasure. I think you've given people a ton of value and some of those nuggets as you call them throughout the episode, just been fantastic. So thank you so much.

[Dr. Mile Brujek]

Thank you, Eugene.