A Candid Conversation: Navigating Race and Equity in Optometry

Adam Ramsey: It’s like, why do I need to even discuss this? I treat everybody the same. And what people of color would rather is, I want you to see color. I want you to see the beautifulness and the differences that color brings.

Bethany Fishbein: Hi, I am Bethany Fishbein. I am the CEO of The Power Practice, host of The Power Hour Optometry Podcast. And here with a guest today, this is Dr. Adam Ramsey. He’s medical director at Socialite Vision in Palm Beach, Florida. He’s a co-founder of Black Eyecare Perspectives and a speaker on diversity, equity, and inclusion. And I’m happy and excited that you agreed to have this conversation, Adam. Thank you so much for being here.

Adam Ramsey: Thank you, Bethany, for having me. I appreciate it.

Bethany Fishbein: It’s a little bit of a tricky topic, but I’m really hoping that we can talk today about race and racism as it comes up in optometry and with practice owners specifically. It’s something that I feel offices are starting to talk about more openly, sometimes in a positive way, sometimes in a negative way, because an incident has happened. And I’m hoping that questioning the status quo or questioning why things happen is really the only thing that leads to change. And so I’m hoping to be able to ask you or maybe have us ask each other some of these questions today that will get people to think a little bit differently about how they’re interacting with people of different backgrounds, different abilities, just people who are different than they are in their own practices.

Adam Ramsey: All right, thank you for that. At first, I want to commend you for even having a conversation. This could be not easy for some people to want to talk about, but one thing I want to say is it’s a safe space. You can talk about race without being a racist, right? It has to do what the conversation is. That’s like talking about sex and not being sexist. I can talk about gender without being sexist. I just can’t make sexist remarks. But just talking about women or talking about men isn’t sexist. Talking about black people and talking about white people and talking about Asian people isn’t racist. It’s what you say within the walls of that conversation.

So you can talk, have a discussion about it. It doesn’t make you a bad person, right? And you have to talk about it with people that are different than you because if everybody around you has the same thoughts as you, you learn nothing, right? You have to talk about it with people that think differently from you for you to get a different opinion. A lot of us grow up in towns and cities where everybody’s pretty similar. So you may think what you’re saying is okay. It’s okay for those people. It’s okay for the people that are within those towns and cities because y’all talk to each other. Y’all talk the same way. Somebody else may view it differently. Somebody else may have a difference of opinion about that same statement. And at the end of the day, what matters is how it makes the other people feel, not your intent, right? Because I cannot intend to hurt my wife’s feelings. Does it matter if I didn’t intend on it and she’s crying? No, I could be like, babe, I didn’t intend on hurting your feelings, but you did.

So do I have to apologize even though I didn’t intend on it? Yeah, because it’s how it made her feel, not what my intention was. And I think that’s where we get hung up is we make it, I didn’t mean it. I didn’t say it that way. Doesn’t matter what you meant. Doesn’t matter how you were saying it. It matters how it is received by the other person and putting yourself in the other person’s shoes and saying, well, will you say it like that? Yes, that’s how I’m receiving it. And that’s where the issue is, is putting yourself in the other person’s shoes. So we can have a conversation, relax. We’re gonna have a good conversation. This is fine. It’s better to have these conversations. I usually have these conversations with a glass of wine or a scotch, maybe a cigar. We’re not doing that today. Maybe for the subsequent conversation.

Bethany Fishbein: That sounds good. And Adam, thank you really for just establishing that right out front, that this is a safe space. I was actually talking to somebody yesterday, not related to this at all, just friends. And they were talking about the best way to be supportive. And at that point we were talking about gender and sexuality, and it just had come up. And they were talking about the importance of having those safe spaces and safe people. And it’s really, I think that feeling of not having that safety that prevents some of these conversations. I was talking to a practice owner recently who was interested in hiring a staff member who is transgender and had some concerns about it and went to ask questions and felt a little bit attacked for even asking the questions. And that was hard. She said, should I not have asked that? So I appreciate you setting that up right from the beginning.

Adam Ramsey: Yeah, I think you have to know what you can and cannot say. And you have to leave the door open to the conversation because sometimes you can have a conversation and it’s either you’re trying to educate somebody else or you’re trying to come and learn. Most times you can’t do it both ways. So your line of questioning has to also be, I’m coming to learn, not coming to direct, not coming to tell you what I think. It’s more, nobody would be mad if he says, hey, I am not sure how to do this right, but I would like your help in learning how to say the right thing and do the right thing. So can you help me in that process?

What transgender person is going to be mad at an employer saying, hey, I don’t know what to say and do, but I’m willing to learn. How should I address this? What should we do? What would make you feel more included? What would make you feel safer? What would make you feel more involved or invited into the workspace? What do I need to do? I have not told them my opinion. I have not gave up anything. I have left the door open. That person will say, wow, I have a great boss. They want to know what’s coming, but it’s a totally different way. I don’t know, do I need to have these kinds of bathrooms and we’re not going to be doing these kinds of things and I’m going to say what I’ve been able to say because I’ve been saying this my whole life. And it’s just the way I say it. You have to just receive it the way I was. That’s two different ways about having a conversation. So with that, I’m not saying I’m the best at that either, but I am open and willing to learn. I’m open and willing to understand for somebody else’s viewpoint.

Bethany Fishbein: Yeah, and that’s what counts. And that’s how I’m coming to this conversation. I’m interested to learn because so much of the conversation that’s out there is happening because somebody said something and it wasn’t received in the way that they expected. And so something that might not have felt like anything to the person who’s saying it, and it felt like a big something to the person who is hearing it. And so help me understand from your perspective kinds of things that are just sometimes said casually that maybe you know, okay, that probably wasn’t intended, but it doesn’t change that you feel that its impact is hitting different than the intent from things that you hear from people.

Adam Ramsey: So I am one of two Black optometrists in my county, right? When I got to Palm Beach County, there wasn’t another one, right? When I went to SCO in Memphis, I was the only Black male in the school. So I show up and a security guard tells me, hey, you know, you’re the only Black guy here? No, I didn’t know that. I was coming from Florida, coming to Memphis, Tennessee. There’s a lot of Black people in Memphis. And you’re in a world that’s different, right? And classmates would make comments and jokes about our patient population that are coming there and not realizing what you’re saying is making generalizations about people and not realizing some of those people in those positions, not at their own fault. Some things because of systems don’t allow them to get out of it.

And when people use comments like you people, who is you people? You know, like, what do you mean? I think whenever we make generalizations, that’s when you can get into trouble. Now, all of us have generalizations. We all work through life with general thoughts about people, about cultures, about places. I make a thought about what a biker bar is. I have an opinion about what a piano bar is. I have an opinion about what the difference between Target and Walmart is, right? There is a difference to those things. There’s nothing wrong with that, right? But there is a line in which something you can say, you can laugh at somebody or with somebody. And if all your jokes are at them instead of with them, that’s different, right?

When you’re talking about something that they have no control over changing and not understanding that, you know, I have staffers and they started off at one wage and they were doing so well that I said, hey, I want to give you a raise. And she came back to me and says, Doc, can you please not give me a raise? And I was like, what, why? Well, if you give me a $2 raise, I’m going to lose section eight food stamps and my voucher for daycare. So your $2 raise would cost me about $500 a month. So that’s a way in which a system is set up that doesn’t allow a person to advance to a certain point because you would, I would have to double her salary for me to be able to make up for the services that she would lose if I gave her a raise.

Now that same person, somebody may look at them and say, why are they on welfare? And why are they doing this? And not realizing that there is a huge drop-off that happens when people that are in certain situations have to actually move up. And when they do move up, the services that they lose and they have to make a choice between saying I want to advance myself or I want to stick within a system and stay where it is. So sometimes we can make comments and things without being educated.

Last week, I went to the Racial Equity Institute. They did a two-day summit here in Palm Beach. It was sponsored by the United Way. They do them all around the country. And we spent two days talking about race and how it affected this country and where we come from. And even as a Black person, that doesn’t mean I’m qualified to talk about racism, right? Just being Black doesn’t mean you have to do the work to put into educating yourself in a way in which you can understand how race affects people and how it is affecting systems in this world.

So it’s hard to make generalizations when I say, hey, these comments are bad. There’s a lot of bad comments. I don’t really think I should go into each and every comment that could be bad. I think the better use of time of the conversation is saying, hey, understand that we’re different. Understand that people are going to view the way you do something a little bit differently than you, right? Think of like there are doctors that may work in a predominantly minority city, but you’re a white doctor working in a minority city. Those patients are happy that you’re there because without you, there’s nobody to be seen. You’re coming into the inner city and you’re doing good work. You’re providing good care. You’re taking care of glaucoma. You’re doing the things that they actually need in those cities. But you have to also look at it that you then take those dollars and go back out to the suburbs and you sponsor the baseball team in the suburbs, not the baseball team in the inner city. You take those dollars and resources that you make off of those kids in the community and all those people in the community that you take and you go somewhere else with it. So somebody else views it differently.

You may view it like, look at the good work I’m doing. You’re right. You are doing good work. But what do you do with the resources from that good work? Are you hiring the people in the city? Do all your staff come from the suburbs? What do you do with the resources? Which baseball team do you support? The one your kids go to in the suburbs or the inner city one where all the patients are giving you the resources to support that baseball team, right? So there’s ways you look at it, but somebody else may not see that unless you look at it from an outside view. You’re like, what? I’m supporting the community. I love everybody. It’s not about race. Nobody said it was. It’s just somebody may view it differently. Somebody may see it differently and says, hey, you’re not realizing what you’re doing and how you’re doing and how it affects me, how it makes me feel. And I think understanding that people are different means you have to also be aware and cognizant of the things that you do and say, how it may affect somebody differently.

And you know, my analogy about my wife in the beginning, I use that to this day. Sometimes she’s mad at me. I have to sit down and be like, what did I do? I do not even understand why you’re mad at me right now. Then when she tells me, I’m like, okay, I didn’t mean it that way. You received it that way, but I didn’t mean it that way. This is what I meant. I was talking about this. Oh, I didn’t hear you. The shower was on. So she missed part of the conversation and got mad at me, but it doesn’t matter. I understand why you’re mad. I apologize. I’m sorry for that. And we have to start off with, I apologize. I’m sorry for that. I can figure out a way to do better. I can figure out a way to give some more context when I’m saying something. But you have to start from that, from understanding that we’re different, but it’s okay that we’re different. Celebrate the differences. Celebrate what makes us special. Celebrate what makes us unique.

Bethany Fishbein: Go back to what you were talking about, about when you started school, learning from a security guard at the front door, that you were the only black man in the class. It’s a situation that I don’t know that I’ve ever been in. So what’s the feeling sitting in a classroom at the beginning of a career, not having somebody else sitting there who looks like you?

Adam Ramsey: It is, well, I went to University of Florida. So it was a predominantly white institution. So I was kind of used to it to a certain degree. I’m an only child. So I’m used to being by myself and figuring it all out. It didn’t always have a negative effect until I really went to SCO. I remember one class in particular, I would study, I was there in all the classes. I wasn’t a student that didn’t need to study. I put in the work. I graduated honors from undergrad, but I had to do the work. I’m not the person that could just skip class and just get an 85 on a test. That wasn’t me. And I remember this one class I studied, but it wasn’t my strong suit. I was studying, I’m not going to say the classes. I don’t want to, the teacher still teaches there. So I’m gonna leave that out. And I studied and I tried and I bombed the tests. And I remember coming out of the test. Everybody was like, wow, that was so easy. It was just like the practice test. And I’m like, what practice test? Come to find out the previous year, students had, I guess, a copy of the test and everybody else got a copy except me.

So nobody thought to come and give it to me. They were studying in groups. I was not invited to the groups. I wasn’t invited to their house to study. I studied in the library by myself. And the class was based on a curve. So the test, if the best person got an 80, then that 80 became 100. That’s how the class went. So the teacher pulled me aside and says, Adam, why did you do so bad on this? Everybody else did good. And I just kept it to myself. I didn’t tell on them that they had the previous test. I didn’t do it. I just took that bad grade and had to figure it out on my own and everybody else, they didn’t know the material any better than me. They just knew the 30 questions and A, B, C, D and put it on there. And it was just one of those feelings of being by yourself.

It’s there and that is the question. I would say it’s the same feeling when there used to be no women in classes and there was a first woman that came into the class. They had to struggle. They had to figure their way out. Now we got 70% of women. So it’s not the same experience. But I would say it would be pretty similar to when there was one woman and 99 men in the class. There were some differences. There were some good old boys clubs that they would hang out and play golf together and maybe didn’t give her the test and figure that out. It’s a similar experience.

That isn’t the experience now for women, but there was a time in which 20 years ago that was the experience. So it’s just, there are differences. It’s not good or bad, but you make your way through it. It makes you stronger. And then now I have a nonprofit in which they’re trying to diversify eyecare and get more minorities into the profession so other students don’t have to have the experience I had. Now we have a club that meets with them on the 13th of the month, Black Eye Care Perspective. And we have a pre-optometry club that meets with the students on the 13th of every month. Even if they don’t go to school with another person of color, they can meet on a Zoom and you can have one person from every school but they get to meet together and be able to communicate, talk, help each other through different situations so they don’t feel alone. They don’t feel lonely. They have a support system there, which I didn’t have which is why I co-founded it and helped start that organization.

Bethany Fishbein: I know you gave the analogy of the first women in the class and we were actually talking about this a couple of months ago. My husband’s mom just turned 90 and she’s a physician. So at the time she was in medical school, there were two or three women in her entire class. And one of the other women was at her birthday party which was kind of cool. They’re friends all these years later. But I know that one of the things that they fought against was a perception that women couldn’t do this. They weren’t smart enough. They weren’t strong enough. Do you feel that that’s still out there with regard to race?

Adam Ramsey: Of course. You know, media shows you a person in a certain light and that’s how we are going to view that light. If I see somebody with tattoos on their face and they have a leather jacket on and they’re wearing a motorcycle, me and you both just thought and made an assumption about that person, good, bad, or indifferent.

Now I can sit and talk to them and they can be an art professor after I’ve had the conversation with them. But before you have the conversation with them, if their face has tattoos and their bald head and they have a leather jacket on and they’re on a motorcycle, I have a perception about that person. Now after I talk to them, I may feel differently. This person might be a lawyer, could be anything. I’ve seen that could be a lot of different ways. But before that, I might make an assumption about that person. And I think right now for race, that is the truth because a lot of people are in silos. A lot of people are where you don’t maybe interact with people that are different than you very often. Not everybody has a diverse friend group, a diverse set of people they hang out with. So your perception of people may be what you see on TV.

Now minorities don’t control what’s on TV. So the shows that are being shown and how you are being viewed are not controlled by people of color. So there are things on TV that make perceptions about people and that may be the only perception you get of people, right? The social media, that is a filtered view. Your social media, my social media, what I see on my timeline and what you see on your timeline is totally different. But that’s your world. That’s your perception of what’s going on today in the world. But what you see and what I see is different, right? So people’s perception of how it feels and what it’s like isn’t always reality, isn’t always what it is. So yeah, there’s a variety of how people feel about one another.

If you have three African-Americans in a class and one of them failed boards or two of them failed boards, to some people, that’s 66% of them are failing boards. But if you have 50 white people in the class and two failed boards, oh, it’s only a few of them failed boards. But in the world of it, you say, oh, black people can’t pass boards. There’s two people. It was still two people. It’s just a matter of the amount of people that were in the class. So there’s a perception that may be out there of people, but that’s not fair to the number of people. You have so many other people. It’s just a matter of who’s coming into the profession. So yeah, there’s a lot of preconceived notions about people. Some are right, some are wrong, but I think having conversations is where the starting point is.

Bethany Fishbein: So, I mean, do you feel like when you’re in that small number, so if you’re one of three African-American people in your class and you’re getting ready to take boards, like, do you feel that pressure that something that you’re doing is representing not just you as an individual, but is affecting how people are feeling maybe about Black people or Black optometry students in general?

Adam Ramsey: Of course, there’s pressure, everything. Now, you guys also need to know my backstory. I wasn’t born here. I was born in Trinidad in the Caribbean, right? I’m an immigrant. I came to the United States when I was eight, right? I look different. I talk different than how other people spoke. I was used to different things. I’m used to that. You know, when I get to the school and all the security guards are like, I’m cheering you on, all the custodians are like, all right, do it for us. Go, go, go, go. We want to see more of you guys out there. Yeah, that’s pressure. I’m used to the pressure. It’s there, but it’s there. Yeah, of course. You know, even the Black faculty that was there, don’t let me down, Adam. I’m counting on you. Yeah, that’s pressure. Some of that’s good. Some of that’s not so good, but at the end of the day, I would say it’s good. But there is pressure, but there’s nothing wrong with pressure. Pressure make diamonds. It can make something good or bad, you know, just a matter of what you’re putting pressure on. So that pressure was there definitely when you’re there trying to support.

You gotta also look, a lot of minorities are not just having to think about the next generation. They gotta think about the previous generation. You know, a lot of minorities are having to support mom and uncle and brother and sister and maybe support their kids. So they don’t have to only look in one direction. They have to make that money stretch two ways. So yeah, there’s pressure, definitely. But I don’t think there’s anything wrong with that.

Bethany Fishbein: Talk about when you got to clinic. Like, I’m remembering in our class, a lot of our clinical rotations were at VA hospitals. And that was really maybe the first time that I started to become aware of how people were being treated differently. And it was specifically some of the young female Asian doctors that were treated differently by the veteran population, which at that point was typically an older white man. That’s changed also. But what was your patient reaction when you were a student doctor?

Adam Ramsey: You gotta think, I never saw a Black optometrist until I got to Memphis. So I chose this profession without ever seeing somebody that looks like me. I never saw anything on the website, online, anything like that. So I didn’t choose this because I had a role model. I had somebody to look up to. There wasn’t enough.

There wasn’t anybody around me. There weren’t any in my county, Broward. When I was there, there was nobody. So I didn’t have any of those role models or people of color to look at. So when I get to clinic, most of the patients that come there, even if they’ve been coming there for years, you gotta think that there’s only one Black male out of the hundred that you could be seeing. It’s a 1% chance.

So you could come to that clinic 100 times and still never see a Black person, right? So for the patients, when they come in, when they would see me and we had a mainly Black population being in Memphis. So it was mainly Black patients with mainly white doctors. That’s what the patient population was in Memphis. And that’s probably a lot of the population in a lot of these schools.

Because a lot of these schools are in inner cities. A lot of these schools are in low-income neighborhoods. So it’s a lot of minority patients being seen by white doctors, which is most of eyecare. They would be shocked. They’d be like, you’re the student doctor? I get to see you today? Oh man. Yes. They were happy to see somebody. They would cheer me on. They’d be, you know, good job. Keep it up. I liked it. And at the end of the day, one thing I would say to anybody, it’s building that connection and rapport before you get started matters a lot. When you work with a patient, they have to know that you care before they care what you know.

I think a lot of times doctors skip that part. They skip the personalization of it. They skip the connection part of it, especially with minorities. Minorities are big on family. They’re big on connection. They want a doctor to be their friend. They want the doctor to have a connection. You know, I have a picture of my family in the office. So, you know, the staff get to see the patients. They come in and they ask about it. When my daughter was born, I emailed out a picture of her to all the patients and stuff like that. So now they come in every year.

Do you have an updated picture? I send out Christmas cards with my family on it so that they can see to the staff. So when they come in, but then when they come in, I ask about the patients. When we find out that patients pass away and their spouse is still a patient, we send flowers. When they come in before they even get started, I say, I understand. I know it’s been rough. It’s okay. You haven’t been here. I know. I get it. Let me know if you need something, right? Before I start talking about minus two, your new contacts, we got these new neural lenses in, blah, blah. That doesn’t matter in the beginning. It’s making sure that rapport and connection. And when that patient realizes that I remember her husband passed away, I had care and concern. And I’m like, did you get the flowers we sent? Yeah, I got the flowers. Thank you so much. I appreciate it. Blah, blah, blah.

Now, all of a sudden, when I start talking about neural lenses and I start talking about these new contacts that came in, she can get that out of the way because I have built that connection, that rapport. And it’s very important in minority communities. It may be important for everybody. I’m not saying non-minorities don’t care about that. But I would tell you when they realize that you care for them as a person, they come back for their follow-ups. They are much more compliant. They respect your time better. They’re on time for their appointments. Different things like that because, oh, I got to be there, Dr. Ramsey. You know, he’s counting on me. He doesn’t like when I’m late. Oh, I got that text message. I got to be there. Yeah, I do have to go. Oh, he’s going to get on me. I know he’s going to get on me. Oh, man. And then they come in and they say, Dr. Ramsey, I know this is why. And it’s because I built a rapport with those people.

So, I write little notes. I don’t remember every single patient. So, I write little notes at the bottom. Ask about this. Do this. We have little alerts that pop up. And we do that. They got married. We put a little alert because they tell us, oh, I want contacts for my wedding. Next time they come in, you should ask about the wedding. It’s a little thing. So, we put a little alert. I’m not going to remember the wedding. I’m not going to remember. But I have a little alert that pops up that reminds me. Ask the patient about the wedding. That’s, oh, you remembered. Oh, my gosh. Oh, yeah, I got to tell you. And I’m just typing away. It’s a little thing. And I’m not saying that non-minorities don’t care about it. I’m just saying that’s what sometimes is missing. That connection part that they feel and that understanding.

Bethany Fishbein: I’ve talked to doctors who are deciding where to open a new practice. And sometimes people will express concern about being in a community that is too much like them or too similar to them. Because they’re worried that having those kind of connections and showing that much care for patients that patients are going to turn around and be offended by charges or expect discounts or special treatment. Does that ever come up? Is there that side of it?

Adam Ramsey: People ask for hookups and discounts all the time. That’s normal. I don’t think that’s anything special or different. I had a patient this week and he had enough money to have a personal assistant with him day and night. She comes to all his appointments.

She drives him around in a big fancy car. And he still tries to barter and tries to do stuff in the optical. That don’t matter. And that person don’t look nothing like me. It’s going to be there. It’s okay. They can do that. But everybody knows come to my office. I have people that come to my house and you’ve been to my house and I still not give you a discount in the optical. Because it’s two separate things. Because when I go to your business, I pay full price. Now, if you’re going to give me free dental work, you can come get some free glasses. But if I’m going to pay for my Invisalign at your office, you’re going to pay for these glasses over here. I think that’s all personal. You can draw a line in the sand for whatever you want. I don’t think any patient population is any different for that. Just choose to put the office in the best place for you. Open and get going.

Bethany Fishbein: Do you ever get negative reactions? Like you said, most of the patients when you were a student doctor were happy to see you. And they kind of joined this crowd cheering you on. Did you ever see a patient who didn’t want to see you because you’re Black?

Adam Ramsey: Oh, yeah. White patient? Oh, yeah. I’ve had that. But what I try to do for that is like when you book your appointment, we send you a link and my picture is on the link. I used to have my logo from our office or a picture of the office on there, but I changed it to my face so that you know who you’re booking to see.

The city that I’m in is 3% Black, but my patient population is probably 65% Black. So, I pull from a large area of people, but the people in my city is only 3% Black. So, a lot of the people that are coming, if you’re coming to the closest office to you, that’s me. It’s most likely not going to be a person of color. So, I’ve had that happen, but the difference is I kill them with kindness and they come out and says, you know what? I’ve never had somebody of color be my eye doctor, but you did a great job. I’m going to tell all my friends about you, right? And at first, it may be different because it’s just not normal for them. You can make a random appointment.

Most likely, you’re going to see somebody that looks like you. You know, I had a patient, not a patient, a friend of mine, and I was like talking to her and she was a white woman and she was like, well, how come people of color say they want to find a black provider? Like, I don’t do that. I just look for whoever’s on my insurance and whoever has good reviews. And what I had to tell her was, well, you don’t have to try and find a white provider because 9 out of 10 chances the person you’re going to see without even trying is going to be white.

So, then you get to pick somebody with insurance that has good reviews and a 90% chance you’re going to see somebody that looks like you. It doesn’t have to be a thought process for you because most likely you’re going to do that. Now, go live in Chinatown and do the same thing. Are you just going to look at the best reviews and look at who’s on your insurance? Because it might be a 90% chance you’ll see an Asian person. Oh, yeah, maybe I would think of it differently. Yeah, because your normal environment is I am the majority.

Most of the services that I go to, most of the places are going to be welcoming to me or going to look like me or going to be conducive to something that I’m used to. And when you’re not in the majority, you feel differently about it. You see it differently from that review around me.

Serena and Venus Williams are tennis players, right? And there was a big story article written up about her and that when she was conceiving and having a child, she almost bled to death in the hospital. Now, this is a person of color that is very wealthy. They named the whole wing after her because she donated a lot of money before she had a child. And this person of color almost bled to death because the doctor felt like she could take the pain, right? That was what was in her story. The doctor didn’t feel like she needed the treatment. She didn’t need the treatment that they may have given to somebody else. And that’s where somebody of color feels like I need somebody that’s going to treat me like a person and see me differently and they may feel differently about things that affect them. And it’s disheartening, but it isn’t everybody. And this is where the tough thing comes in.

The person like you that is brave enough to have a conversation with it like me, most likely is thinking I don’t see color. It’s not a problem to me. I treat everybody the same, right? And it’s like, why do I need to even discuss this? I treat everybody the same. And what people of color would rather is I want you to see color. I want you to see the beautifulness and the differences that color brings. Instead of thinking about it like I don’t see color. I treat everybody the same. Everybody does the same for me. I don’t treat anybody differently. And people of color say I don’t want you to see everybody the same. I want you to understand that I’m black. Understand there’s differences. I understand you’re white. I see color. I know that.

I see somebody that’s Asian. I see somebody that’s Indian. I see somebody that’s Native American. I see that. And I learn about their cultures and I fully submit to their cultures. I fully love to be submerged and be involved and engaged with them for those things. It’s okay to see color. It’s okay to see the differences. There’s some beautifulness in those differences. There’s some funny stuff in those differences. There’s some cool, unique things in those differences. There’s nothing wrong with that. And that’s the tough part because a lot of times people don’t want to have tough conversations about how they feel and how they view the world. And it’s difficult. It’s not easy.

Every day I don’t want to talk about this. Like I have a lecture on this. I talk about this kind of stuff. But this isn’t what I wake up wanting to talk about. I don’t walk around the world saying, you know, I want to talk about racism today.

Bethany Fishbein: Even when I asked you to do the podcast, you said I talk about this stuff because somebody has to and not enough other people are doing it.

Adam Ramsey: People ask me why do I post it on social media? Why do I talk about it? And I said I talk about it because you don’t. If you talked about it, I wouldn’t have to talk about it. And I don’t want to talk about it. I started my non-profit because the students needed it. The non-profit is supporting the students. I’m not in school. My daughter’s two. She might not even choose to be an optometrist. I didn’t do it for me. I’m not doing it for me. There’s no benefit to me. I like business actually better. I don’t want to talk about it. I didn’t write a book on racism. I wrote a book on private practice because that’s what I would like to talk about. I like the creativity. I have some ideas and stuff that I’m doing in my office as unique and outside of the box and it makes my work-life balance where I can have a day off today and sit and talk to you and I’m still making money today.

That’s what I like to talk about but I’ll have the discussion because you need to talk to somebody that’s different than you for you to understand somebody else’s perspective. My roommate in optometry school was a white guy, Andrew. He was in my wedding and I was in his wedding and it was a beautiful thing. I was the only black guy in his wedding. He was the only white guy in my wedding but he’s one of my closest friends. We talk all the time. He’s about to open a private practice so I’m going to tell him to come talk to you. He’s buying somebody’s practice and it’s a beautifulness to it but we’re different and it’s okay to be different.

Me and him would sit down. I remember I got into optometry school in 2008 right when Barack Obama got into office in November so we started school in August. I remember sitting on the couch me and Andrew and they saying President Barack Obama is now president and me and him would go back and forth until like three in the morning four in the morning on different topics. He’s Republican, I’m a Democrat. He’s more to the center and I’m more to the center so we’re both on the centers on two sides of the aisle. He wasn’t far right and I wasn’t far left. We were kind of like right here but we would sit there and I would say Andrew I got to go to sleep. I actually got to go to class tomorrow. You’re going to skip class and it’s okay.

You’re going to sleep till noon but I have to actually go but we would sit there and have heated debates and heated discussions but there was some beautifulness in there and our friendship came out of that. That we’re still friends and I talked to him a couple days ago but we’re very different. It’s okay to be different. It’s okay. It’s not anything wrong and I say what I said in the beginning you can talk about race without being a racist. It’s what you’re saying in the conversation. It’s not the fact that you have the conversation. It is the what you’re saying and how you’re saying it and realizing that racism is when you use your power and authority over people of a different race. It is not just saying something. It is when you’re using that against them just because they are of a different color. That’s what people have a problem with.

That’s what people see is that you’re pandering to them. It’s different. It’s not the same thing. You can laugh with me or laugh at me. The joke is different. When you’re the butt of the joke it’s different. Oh, we’re just joking. No, we’re not joking. You’re joking. You’re joking about me. Not with me. That’s different. And I think it’s the way you say something, the way you color it, the way you view it that makes people be offended, that makes people not feel welcome.

When I come into an office and I ask you, do you have any frames for people of color? And you say, all my frames fit everybody. That’s not true because we have global fit frames for Asian people because we knew that Asian people were different and they needed a different thing because of their bridge on their nose. There are different facial features African Americans having wider and bigger noses a built-up bridge and need different things to fit them. So when somebody says, do you have something for me? It doesn’t work.

When I opened my office, I asked the frame reps, do you have any marketing materials with people of color in them? And they all said no. Every single one of the big manufacturers said no. Why? Because black people are going to buy it regardless. So why should I have to make career marketing materials for them? I don’t have to make it for a particular group and make it for the majority. Then what I did? I did a whole photo shoot myself. I hired a photographer. I hired models. I hired a makeup artist. I partnered with a local clothing store to get the clothes and we did our own photo shoot. And I created marketing materials for my office because people went to my website and the stock photos didn’t look like people of color. And they say, Dr. Ramsey, you have a majority minority patient base. Yet your website is all white men and women. All the flyers and all the stuff on the wall is white men and women.

How do I know that frame is for me if I never see a person of color looking like it? So you know what happened? I did the photo shoot. I posted the pics on social media. I posted it on my website and then I got white people messaging me saying, am I allowed to come to your office? Because all I see now on your social media is people of color. And I said, oh, I can’t win. I can’t win. There’s nothing I can do. I get beat up from the left. I get beat up from the right. And I had to let them know. I said, no, scroll a little further. I have it for everybody. I did a photo shoot and I’m using the pictures and I’m marketing materials. But then I had to go and find people of color. So you know what I had to do? I had to create my own frame line. And I partnered with a partner from Seyo Eyewear.

It’s called Ethnicity Eyewear. And they’re made in Japan because I had to make frames to the people of color because they were coming in saying, the temples are too short. It doesn’t fit on my bridge. The frames hit my cheeks. I need something that’s going to work for me. So I had to go out there and do it. Did I really want to? No. Did I make a million dollars doing it? No. Did it take up a lot of my time? Yes. But I had to create it for the people so they feel welcomed. They feel seen. They feel heard. They understand that I support a community and I’m there. And I try to make sure that I support people and organizations that are in the community supporting the community.

Bethany Fishbein: You were joking when you said it, but that feeling of I can’t win, right? I’m trying to do it one way and then I’m getting it from the other side. I think that’s something that prevents a lot of these conversations from happening or starting to prevent them. That somebody wants to ask a question and becomes afraid to ask it or they ask something once and somebody is offended. And it might be something that offends one individual. It doesn’t mean that everybody is offended by that. But it then becomes, okay, I better not say anything. And I feel like that’s really counterproductive to gaining understanding.

So where do you find that line between okay to ask, not okay to ask? I’ve seen on social media, there’s a TikTok creator whose name I can’t remember at the moment, but she does a role reversal thing. She does like if Eastern Europeans were the minority and she plays the role sometimes of a teacher. And she’s like, Jennifer, that name is so interesting. Where’s that from? And sometimes someone’s name is interesting and I’m curious about the background or a staff member comes in and yesterday they had short hair and today they have long, beautiful hair down their back. Like help me understand where that line is.

Adam Ramsey: It’s not as complicated as you may think. It depends on the way you ask the question. It depends on why you want to know.

Bethany Fishbein: Can you give me a good way, bad way?

Adam Ramsey: I got you. It depends on how you’re asking the question. Why are you asking the question? Is that your hair? Certain things are just inappropriate to ask in a certain way. Do you actually care about my community or are you just being nosy? Do you actually want to understand cultural norms and differences or are you just like, I need to know everything about everybody around me, right? It’s the way you ask the question. It’s the way you say it that’s different. You’d be like, oh, your hair is so unique. I love that you can just switch up your styles all the time. Like my hair is always the same. I don’t get to switch it up. I wish I could do what you get to do with your hair. It’s so unique that you get to try so many different styles.

Oh, all right, Bethany. Yeah, yeah. You know, I have a friend that does this. Well, you know, she can braid your hair too. Oh, I’m going on a cruise. I would love to get my hair braided. You think she’ll braid my hair? Yeah, yeah. She comes to your house and everything. She’ll braid it for you. That’s totally different than, what’s that? Is that a weave? How do you do that? The way you’re saying it, it’s what is the way you come across, right?

I think having the conversation is not wrong. Why do you want to have the conversation? What about that is something you would like to learn about? And I think having genuine friendships and genuine people that you can talk with, people that you are genuinely friends with are not going to have a problem with you asking a question about them. Asking a random stranger a very personal question might not get received very well. It depends, right?

So if I have a question and I want to ask Andrew about something, his family was farmers, and I call them and ask them something about farming, it’s going to be received pretty good because he knows I’m coming from a genuine place. I’ve been in his house. You know, he’s come down to see me. Our kids know each other. That’s going to come from a genuine place. Would I talk to a random person on the street and ask them that question? Probably not. It depends on why you’re asking the question. And I think what most minorities want is somebody to be genuinely curious, genuinely wanting to learn more, genuinely want to educate.

But there’s a difference between pandering. There’s a difference between, you know, they have a term like white savior complex where I want to save everybody. Sometimes these communities aren’t asking for them to be saved. That’s not what they want because you’re not going to be able to save it. You’re not going to be able to fix it, right? They can’t get a raise on their job because they’ll lose all these other services. So you’re not going to help them by saying, oh, I’m going to help you do this and I’ll help you do your resume. Fixing my resume, I can’t get a raise. Otherwise, I’m going to get kicked out of my house and I have nowhere to live. And homes in South Florida are ridiculously expensive. I would need to be a doctor to afford a house around here. Like, that’s different. So how you’re approaching the person, I think, start off with genuine relationships.

And then the rest of it, you can ask any question because you can ask them a question and they can ask you a question because you have a genuine friendship with that person that will allow you to ask those questions. But I think most people would ask, people that get offended, is why are you asking the question? Do you genuinely care or just being nosy? It really does matter when they want to, because like, why would I want to give out all this energy and educate somebody all the time on these different things? It matters.

And for people in eye care, when we’re talking and just center this around the eye care discussion, realizing that people of color are used to being in situations and being around people that are different than them. That’s the norm for us. So that doesn’t bother us. That is the norm. We’re good in those situations. I think most people of color, patients, doctors, anybody, just want somebody that genuinely cares and is genuinely compassionate.

If you’re genuine about it, the conversation usually doesn’t go to a place that’s wrong or harmful. And even if you meant it in a certain way, if it was received wrongly, then it’s still a place for you to apologize because you didn’t mean to hurt my feelings. But maybe you did hurt my feelings and what you said.

Maybe your off-the-cuff comment was not received well. Maybe when I come to your office and I see no people of color that work at your office, I think to myself, is this place inviting to minorities? Because there’s no minorities working here. If you’re in a community and you have a big Hispanic population, you should have your charts and forms in Spanish. You should have a translator. You should have one person that can translate if you’re in a huge Hispanic population, right? You should have a telephone service that you could call and you talk into the telephone and the telephone talks back in Spanish to communicate with the patients.

If you’re going to be servicing that community, then realize I want to make it easy for that community. But if you’re going to serve as a huge Hispanic population and you tell them you have to learn English to come to my office, then you’re servicing the population for the wrong reasons. You’re trying to take the money and the resources out of that community to go into your own community and that’s not because I care about the people there. That’s different. I just saw a need and I’m feeling the need but I’m not being compassionate to those people, being compassionate to the people in those communities. So, your why matters. Why are you asking the question and why are you doing what you’re doing? If you’re doing it from a good and genuine place, it’s going to be received well.

Bethany Fishbein: From the perspective of a practice owner, you have new employees. You don’t have that genuine friendship right away. There’s always that little bit of maybe like mistrust or something that comes from a previous employer they had before. I had a staff member and she jokes about it but she’ll do something unexpected and I think, what is that? And she says, oh, that was PTSD from my old job. So, people kind of bring their own baggage in from previous jobs. And so, that’s the part that’s hard to figure out. When you meet somebody new and it’s somebody you’re going to be working with every day, are you married? Do you have kids? Like, yeah, that’s being nosy but it’s also genuinely getting to know you and your family and how you have that connection. And sometimes it’s those kind of questions. Are you married? Why do you think I wouldn’t be?

Adam Ramsey: Now, the question I ask you is, did you ask them that question before they found out you had kids? Did you open up about yourself first? Or did you ask them about them first, right? Because somebody may think you’re asking about if I have kids because I need to leave early or if I’m going to be difficult to work with because my kids have to go to the doctor all the time, etc. So, the why you’re asking the question matters, right? So, the place in which you’re coming from when you ask the question matters.

So, if you open up with here’s my beautiful family, my kids, my son, he’s going to be going to this school, blah, blah, this is my husband, he works over here, blah, blah, blah. Then the person a lot of times opens up about their own family. Like, oh, yeah, I have a picture of my family. Here you go. Totally different conversation, right? If you just stand by the first day I met you, hey, my name is Bethany. Hey, you got kids? You married? Does it matter if I’m married or not? Like, what if they’re divorced?

At the end of the day, if somebody wants to tell you they’re married, they’ll tell you. If somebody wants to tell you about their kids, they’ll tell you. You know, I ask people, do you have any restrictions on work when I’m hiring you? Do you have any time restrictions that you need to leave out of here by a certain time? You can’t get here before a certain time, etc. Right then and there, if they need to leave because of kids, they’ll tell you, right?

So, the way you ask the question, you can still get the same information you want to get out of the person without asking it in an offensive way. It just matters in what you’re saying, how you’re saying it, and the way it’s coming across, and your why you’re saying it. Like, do you genuinely care? If I say I’m not married, are you going to help me find a husband? Like, why are you asking me? What does that matter to the… Like, you have to build that rapport, build that connection with the person. My staff have been to my house. Most doctors would not say their staff have been to their house, in their home, ate at my dinner table. I cook for them, right? Their husbands and spouses came over. Their kids go in my pool.

Most people don’t have that relationship with their staff, right? And that built rapport and relationship and connection with them, right? Because I care about them, right? Two of my staffers, I made phone calls so they can get homes. I called Habitat for Humanity and got one of my staffers a home. I called for the low-income housing and got another one of my staffers an apartment, and I made some phone calls because I cared to make sure they had somewhere to live, right? That’s the difference between asking what their living situation was.

I remember going to my staffer’s house and they were in a trailer, and the trailer was collapsed on one side, I think from one of the hurricanes, and they were still living in it. And I’m like, you’re coming to my office every day with a smile on your face and caring about my patients, and that’s where you live? Yeah, there’s no electricity on the left side of the house. There’s electricity on the right, so we run cable cords across. And I’m paying them fairly. I wasn’t unpaying them. They just started working with me. I called somebody that day. I said, I got to get out of there. You can’t fully give me everything I need from you if you’re living in there. I called somebody the same day. I dropped them off. I called somebody the same day. I said, I need a favor. I said, I don’t care how you do it.

I need this person to have another home, somewhere else to live. Because I asked somebody to live in a situation, because if it was bad, I would do something about it. If you ask me about something that you’re not going to do anything about it, then why do you want to know?

Bethany Fishbein: I hear you, and I hear the difference in tone in your answers, right? And the difference in tone in your answers, it can be the same question, right? So as you’re talking, are you married? If we’ve built a connection, are you married? And you say, oh yeah, here’s a picture of my family. And then are you married? You’re hearing it a different way. Why do you need to know if I’m married? So what if I’m not? What if I’m divorced? Is that going to be a problem here? The question is the same. So to conclude, what if it comes out wrong, right? And I ask a question and get the answer that I’m not expecting. When I ask, hey, so are you married? I’m expecting that you’ll tell me if you’re married or not. And if for whatever set of circumstances, your answer is, why would you ask that? What does it matter if I’m married? Like you’re obviously hearing something different than I’m asking as the employer or just as the other person in that conversation. What should happen then? Because the goal is to get to some kind of better understanding where a week from now I can ask something else and the perception is understood or where it can be an easier conversation. So how do you fix it when you’ve screwed up?

Adam Ramsey: If you screwed up, I apologize. Think of it. If I ask a new staffer if they have kids, maybe I said it the wrong way, right? They may take it the wrong way. Yeah, I got a bunch of kids. Is that a problem? My last employee had an issue with me having kids. Now I have a two-year-old. Before I had my two-year-old, I was not as understanding about staffers with kids because I didn’t really understand it and realize it. Now having to drop my kid to a daycare realizing that most daycares have to pick up by six and every minute after six is a problem. The reason I ask the question now is if you need to leave because nobody else can pick your child up, I totally understand. We can make sure you can leave here by five o’clock.

The reason for my question was because I understand now how difficult it is. I understand now as a woman when your child gets sick, you want to be home with them because when my child gets sick, I want my wife to stay home with my daughter, right? So, the reasoning for my question is coming from a concerning place now being like, if you have kids, I get it. Don’t take advantage of me because I get it. But I truly do get it. One-year-olds get sick a lot when they go to daycare for the first time, right? And then they’re going to get you sick.

So, you’re going to be calling in sick. It’s going to happen. But I’m coming from a concerning place but if I ask the question and it’s received wrong, first, you apologize. Say, Susie, I’m sorry. I didn’t mean it that way. You know, I really apologize that the way I said it came across wrong. That wasn’t my intention. My intention doesn’t matter to you. I’ll try and find other ways to talk to you and communicate with you in the future. But understand, I was asking you about your kids because I have a two-year-old and I showed you the picture of my daughter. And I understand, don’t feel like you need to be super mom here. If you need to leave, let us know.

We have other staffers here that have older kids or don’t have kids, etc., etc., that they can stay here for the last 15 minutes. If you got to go, I’m not going to look at you wrong because you got to go pick up your kid from daycare. It’s okay. I understand. I appreciate you coming to work and I appreciate you giving me all your effort today. The reason I was asking you about your kids or if you had kids, it’s just to let you know there’s a safe space. And it’s okay if you have to leave or you got to come in late because you took them to the doctor or they forgot their book bag so you had to go back home and then come in. I get it.

It’s going to happen. Those situations are going to happen. I hope it doesn’t happen every day, but I understand and I’m coming from a concerning place because I’ve had to do it and I’ve gone through that and my daughter got me sick last week, etc., etc. Now, all of a sudden, that staffer’s going to look at me different because for one, I apologized. And sometimes as a doctor, as the owner, you got to put on your big girl boy in pants and apologize and say I was wrong because the words matter. You can’t just brush it over. You can’t just say, let’s just move on. Let’s all be friends. That’s not how I meant it. Doesn’t matter how you meant it. Matters how it was received. So start off with, I apologize. I was wrong. I’m going to try and find a better way to communicate with you in the future. This is what I meant by what I said. Oh, okay. Now I get it. Okay. No harsh feelings. My last employer was just really a jerk about me having kids and my kid getting sick and it’s not my fault. My kid is autistic or whatever, whatever, whatever. My kid has a lot of illnesses and I have to be there for him, but I want to work. It’s just once in a while he gets sick and somebody has to be home and I have nobody else there to help me.

Bethany Fishbein: I have one more question and it’s when you get that reaction, then you know right away and you can course correct and you can apologize. In a lot of cases, somebody who is offended by the question or is offended by something won’t say anything. That makes it harder because then the person who asks, are you married? And they get back, no. And stuff goes on and you don’t realize. Help me understand. You can’t generalize. I get it. Everybody is different, but help me understand the reason that I feel anyway, like it’s so often silence instead of why’d you ask that or being able to have the conversation in the moment.

Adam Ramsey: Yeah. So what I would say is the only time a staffer is going to bring it up to you is if it matters that I bring it up to you. If you ain’t going to apologize and you’re not going to see it my way, why would I waste my time telling you, right? Nobody wants to be labeled the angry black woman. Nobody wants to be the militant black guy that’s always talking about race and talking about my feelings and making it an awkward, uncomfortable place. So they’d rather be awkward themselves and everybody else be happy than bring up the fact that you made some comments that were insensitive and make everybody else feel uncomfortable. A lot of times, minorities walk through the world and just say, I’d rather be uncomfortable because I’m used to being uncomfortable.

People will stay quiet because if I tell you a problem and it’s going to make it worse because you’re not receptive to understanding that there are comments and things that you do that are offensive, then why would I waste the effort? I don’t want to get fired. I don’t want to get written up. I don’t want to make it awkward here. I don’t want to get let go. I mean, you probably not going to let me go for that reason. But if I’m the outlier and I’m the one that feels different and is always offended and always sensitive, maybe I’m the one that loses hours. Maybe I’m the one that doesn’t get promoted to be your office manager. So the why matters. At the end of the day, be nice, put yourself in their position, put yourself in their shoes and be genuine about it. If you’re genuine about it, you shouldn’t have issues.

Bethany Fishbein: Adam, thank you so much for this conversation, for your openness, for your honesty, just for talking. I appreciate it and have some things to think about from here. Hopefully we get to do another one soon on a practice management topic. Don’t have to talk about race at all. But if someone’s looking for you, where would they find information to see your practice website that they spoke about, the book you mentioned?

Adam Ramsey: Yes, I own Socialite Vision, socialitevision.com. You can go on dradamramsay.com. I have a book called Play Chess, Not Checkers, The Practical Guide to Warm Start Your Dream Optometric Practice. It pretty much teaches you how to start a business. So, if you don’t know anything, you’re working in a commercial setting, you’re an associate doctor somewhere, or you’re in school and you want to start a practice and you want to know the basics to start, my book can help you there. And then there are other great books that help you once you get going. There’s going to be a part two to that book, I’m working on it. Maybe I’ll add some of these conversations that we talked about here today in a few of the chapters. But yeah, you can find the book on Amazon. I’ll be typing Adam Ramsey, it comes up too. And LinkedIn is the easiest way to connect with me, not on Facebook right now. LinkedIn, you can find me, Instagram, anywhere. If you want to find me, I’m not hard to find.

Bethany Fishbein: Thank you again so much. For more information on us, you can find us at powerpractice.com. Thank you so much for listening.