How Mindset Impacts the Success of Your Practice

Char Watson: Getting better at what you do is number 1. Number 2 is to develop yourself. So at this stage, this is a really crucial time for you to really get mentorship on yourself, really develop that mindset, that ability to get to know your strengths and be able to acknowledge your weaknesses. Get to know your blindside. So the dark and light side of who you are as a person is because you’re going to have to be able to find those people that can fulfill the areas you can’t. And then third, is to finish things.

Dr.Bethany Fishbein: Hey! Welcome back to the Power Hour Optometry podcast. I’m Bethany Fishbein CEO of the Power Practice and host of the podcast. So thank you for listening. So today is interesting. My guest is Char Watson and Char works in consulting in the Dental industry. She’s the founder of the Providers DOO Certification and the Director of Operations. She’s the host of the CEO Doctor podcast and she helps Dental practices grow. And I reached out to her because of some of the observations that we make in optometry. There’s always so much insight to be gained from other comparable professions. And we found in the past, dentistry, veterinary similar like healthcare practices that kind of run like we do, have a lot of great insights and a lot to offer. So I am looking forward to our conversation today. Char, thank you for taking the time and for doing what may end up being part one of a two-part podcast or may not we’ll see how it goes.

Char Watson: Thank you so much. I appreciate that.

Dr.Bethany Fishbein: If you don’t mind, will you share just your personal evolution and how you came from working in a Dental office to doing what you’re doing now?

Char Watson: Yeah, absolutely! So I’ve been in the healthcare space for about 15 years and then I kind of accidentally tripped into the Dental industry about 13 years ago. I was kind of in that transition phase, has got a job that’s out at the place we were living in, out of the city we were living in. And so I kind of needed to get a different position and couldn’t find a position where I was working. So long story short, I worked in the brick-and-mortar space for about 10 years. I moved my way up through the practice. The last five years, I was  Director of Operations for the brick-and-mortar space and I was helping him spearhead mergers and opening up additional locations. But then we were facing a family lifestyle change. Basically, my husband was getting deployed and so I was soon needing to be a single parent. And so I need to reduce my working hours so I can really focus in on home. So we kind of took that leap of faith and decided to go out on our own. So I’ve been doing that for about three years and I started out just doing Front Office Training and Development but I found that my heart just really wasn’t on fire. I wasn’t doing what I really loved to do, which was really coaching and mentoring these office managers to be Directors of Operations. And when I was going through that transition, I couldn’t find that level of mentorship and training and development. I couldn’t find anything online and I couldn’t find a mentor. And so through trial and error, I really learned how to be in this position, how to be the number two for the practice I was in. And so after about a year of running different office trainings, I decided to really go where my heart lied and I developed what’s called the Providers DOO. So it’s a Director of Operations Certification Program and it’s to develop office managers to help them transition into a Director of Operations, essentially being the number two for their providers. So that’s where I have gotten myself to today. And today we’re just really going to talk about the patterns and recognition that I found through my journey and also going through my clients’ journey and kind of codifying what I saw within these practices.

Dr.Bethany Fishbein: That sounds great! And I liked when we had talked previously and we were getting to know each other something that you had said at that time. You said, “I’m an observer of patterns.” Right? 

Char Watson: Yeah! 

Dr.Bethany Fishbein: And I feel like that’s what we do in consulting. We’re observers of patterns, sometimes good patterns and sometimes not-so-good patterns. So the pattern that we’re talking about here is really the stages or evolution that a business goes through or a business owner goes through from conception to the end. There’s so much parallels in what we’re doing. Talk about what you consider to be the first stage. 

Char Watson: Okay. 

Dr. Bethany Fishbein: Is that like, just thinking about it? Deciding to take the leap?

Char Watson: No, obviously that’s I mean I think that’s more just coming up with the idea. I would say the first stage identifies as Early Struggle but really all of us would think of it as Startups. So the Early Struggle stage obviously we’re looking to identify our market, be able to have an existential fight, to be able to find a sustainable market that is going to let us have a lifelong practice, right? Cash is typically our lifeline until we’re really sustained. So that gives us about two to five years where we’re really at that sustainable factor. But the fact is, in that Early Struggle there’s about an 80% mortality rate with those starting a business. And I don’t want that to scare anybody, but it really does take so much to get through that Early Struggle stage. And the interesting thing that I think is the founder’s evolution to that Business stage and adjust as an entrepreneur. Really and truly that’s really what it comes down to. And that’s basically it, someone who quits their 9 to 5 working 40 hours a week to do an 80-hour week job to get paid less, right? And so you have to have your heart so in what you have this big vision for. You have so much you have to work. There’s so much that you have to do. And really to succeed in this stage, you have to become really great at what you are doing. Right?  You don’t have to necessarily be a great leader, you don’t necessarily have to be a great manager, but you have to be able to be an all-star player for you to get through this stage. And at this stage too, we’re not really thinking about teams, we’re not really thinking in that terms either. And so unfortunately in this stage, if you get through this stage and get to the next stage we do tend to build a lot of habits or immediate reactions to get through challenges or to face opportunities because we just have to get through it. It’s such a hustle and grind mentality and force of nature to be able to get through this stage. But that will cause problems later on and we can talk about that later.  So essentially at this stage, the only strategy you have is to get through it, or else you are out of business. So obviously it’s getting better at what you do is number 1. Number 2 is to develop yourself. So at this stage, this is a really crucial time for you to really get mentorship on yourself, really develop that mindset, that ability to get to know your strengths and be able to acknowledge your weaknesses. Get to know your blindside. So the dark and light side of who you are as a person is because you’re going to have to be able to find those people that can fulfill the areas you can’t. And then third, is to finish things. When you’re in this stage, it’s so easy to just start a whole bunch of things. We’re so excited about all the things that we want to do and where we’re going and half of the time if not most of the time, those projects don’t get finished. And so it’s really hard to get that progress. So that’s the third of the three strategies. Is just to finish your pending projects to help you get that progress.

Dr.Bethany Fishbein: And when you see it in Dentistry, are most dentists who are deciding to start their own offices, are they fully leaving the job where they were? Or are they still working for someone else a couple of days a week just to have income while this is going on? What’s the typical pattern?

Char Watson: So you know, to be honest, I don’t see a lot of associates being with another location and then trying to start their own. There’s usually a conflict of interest there and it’ll be in their contracts as well. They cannot go off and start a business while still working for us sort of thing. But we will see associates stay with these organizations for about five years or so. So they can really get comfortable with what they’re doing. They have that coaching, that mentorship, they get to learn the systems and the processes of the practice, and then they fully go out on their own.

Dr.Bethany Fishbein: Gotcha. So they tend to kind of once they make that decision, they go all in. 

Char Watson: Yep.

Dr. Bethany Fishbein: It’s a little bit different. I mean some optometrists will do that but I think there’s a little bit less of that concern about competition. That a lot of them will still be working a day or two or three somewhere else and trying to do this other as you said, “80-hour a week job for no pay on their own.” So that adds in a layer of time. That makes it even tougher. 

Char Watson: Yeah.

Dr. Bethany Fishbein: It’s a tough stage but it’s an exciting stage for sure. 

Char Watson: Yeah, that’s amazing. 

Dr. Bethany Fishbein: So then what happens?  You survive, right? And so is the milestone that you hit predictable profitability like you can cashflow things or? Like how do you know when you moved on to stage two?

Char Watson: Yeah, so stage two, we call it Fun. This is where you’re mining your profitable market. So this is essentially, you’re just selling, selling, selling. You’re flexing your sales muscles. You’re flexing your marketing muscles. So you’re not reliant on cash to get you through the next sell and to get you through the next sell. You’re out of that. So instead of being cash-focused, you become revenue-focused. So you’re not struggling just to make it paycheck to paycheck. You’re not trying to find your mark. You’re not trying to find your next patients. You’ve already found that market. So now, you’re just working on that loan hanging through. So this is the area that is really highly flexible. We’ll see a lot of the practices that kind of punch above their weight. They are you know. This is a really fun stage. I really do love it. But we’ll see practitioners are like, “Oh yes, we do do orthodontics even though we haven’t started it yet.” or “Oh yes,  we’re going to do implants here although I’ve never done it.” And it’s exciting. They’re super excited and they’re super enthusiastic. There’s just a wide means of flexibility that will get them into trouble later. But for this stage, you just want to say yes to everything. And that enthusiasm and that willingness, patients love it. They just soak that right up because then they’re like, “Oh, you see me. This is easy. I only have to go to this one provider for all these things.” They love it. So the problem is though is that this causes increased complexity because we’re saying yes to too many things. This is where we started to see projects start to fall off again. And the founder’s evolution, this is kind of where they hit a brick wall. So they kind of become the reluctant manager or the captain on the field per se. So they have a job to do just like everyone else but to win, they really have to make sure that everyone else is winning too. And that’s so different than the Early Struggle. In the Early Struggle, you’re just doing everything. You’re the all-star player like everybody works around you. For Fun, it shifts and now you’re having to look at your team like, “Oh hey! Are you doing good over there?”, “Do you know how to do your job?”, “Have I given you that support and clarity that you need to be successful?” But then they still have to perform just as much as the team too. There’s nothing. It’s not that they’re sitting down any less. It’s just that they’re moving it out and around them, right? They have to build a call to play and then be able to play that call. That’s one thing that I’ve kind of noticed a lot with practitioners. When they get to this Fun stage, this isn’t quite encapsulated like it should be. Meaning that they’ll make a call. They’ll say like, “We need to do this.”, “This is our strategy.”,  “This is our plan.” But then they’re doing something different than what they’re asking the team to do. They’re not seeing it as if it’s a whole team involvement including themselves. And that starts to cause that complexity and that’s where we started to see culture start to break down. And that’s where we started to see teams starting to break down, right? And so you have to be able to hold yourself accountable for what you’re asking the team to do and hold others accountable to be successful in this stage as well. Oh, sorry. Go ahead.

Dr.Bethany Fishbein: I mean as you’re describing that. My background is I opened the practice 21 years ago like. So as you’re talking about this, I’m thinking back to those days and being in these stages. And what you’re saying is just really hitting a little bit. Like it’s fun for the provider because “I can do this. I can do this. I can do this.” But everybody trying to support them is like hanging on to like a chain whipping around. Because it’s you know, “We’re going to do this thing.”, “Okay, we’re all going in that.”, and then, “Nope, we’re going over this way. And so I remembered those days and that enthusiasm. And that’s where sometimes the frustration with stuff starts to kick in because like you’re saying, “You need to, at that stage, start to know how to lead a team.” In dental education is there practice management? Like do they learn that anywhere along the way?

Char Watson: So you know to be honest, no.  We see a lot of office managers move up through the office just like I did. Like that really is normal to start as that receptionist or account manager, coordinator, or whatever and then move your way up to office manager. And you just kind of stumble into the role and more or less you just have different responsibilities but the actual training of how to be a manager isn’t there. The way that it or the strategy to it isn’t really supported correctly in this stage. So for most practices, it’s about command and control. So it’s the provider saying, “Hey! This is what we’re going to do team. Go do it.”  Just like you were describing. And so then everybody’s just trying to follow him around like lost puppies. But really at this stage, this is when I really suggest getting your number 2 actually because of that. You need to have that person that provides that yin to your yang. The person that can really step in where you have more of your weaknesses and more of your blind spots thus running the day-to-day. But also that person that can say, “No we can’t do this. We have to finish this priority.” or “We have to finish this imperative that we’re working on.” Right? They’re going to keep that balance and play or otherwise you have a visionary that is like running everywhere and has a whole bunch of sandboxes that nobody knows which sandbox to play in anymore. 

Dr.Bethany Fishbein: It’s totally true because that’s the voice of reason or like when we’re training, we call that thought partner.

Char Watson: Yeah. 

Dr. Bethany Fishbein:  To say no, that’s huge because the other thing that I see when we see providers in this stage is that it can get expensive. Because all of those things that they say, “Yeah, okay.” you know and you’re saying implants and orthodontia. In our world, it’s aesthetics, and myopia treatment, and you know just different specialty areas. But it’s, “Oh! You’re interested. Great! Yes, this is a direction we could go in. I’m gonna go buy this piece of equipment that lets us do that.” And all of a sudden $70,000 later, it’s like you don’t know yet if you can support it. So I feel that when we’re supporting owners in this stage and it’s hard. You don’t want to be the unfun one. Somebody’s super excited about something and they want to do it and you’re like, “Yeah, not today. No. No.” But that voice of reason is important.

Char Watson: Yeah. It is really important. And honestly, it happens in the dental industry too. We see a lot of these in solo practices. I mean most of the solo practices are hanging out on the  Fun stage.  I guess you should note too, that the Fun stage is only one of the two out of the seven stages that are sustainable. So the Fun stage is your growth stage and you can stay here as long as you want. But to you’re point, you have to keep up focus until we actually have a market here. Number one for us to invest in this tech, or this service, or this whatever. Is it minable, right? Like it’s like, “Does my market actually want it, or is it just this one patient that wants it?” So does that make sense? And then two, you have to reduce that complexity if you want to stay in that Fun stage and sustain this growth stage. You have to actually say no a lot more and that’s where that number two comes into play to help keep that balance. Otherwise, you push or the provider will push themselves into that third stage, which is the Whitewater stage. If you want to right we can jump into that. But that’s really that number two is really going to help you stay in that Fun stage as long as you want to. If you’re willing to say no a lot more.

Dr.Bethany Fishbein: Okay. There’s something to that. My thoughts are brewing here. So is the goal to move through all the stages? Or like, ideally, you just stay in the Fun stage and that’s your growth stage and you just keep growing, and growing, and growing forever?

Char Watson: No, I’m glad you asked that question. No, because with Fun you have to have an expectation on your cap. It isn’t growth indefinitely that would be Scale. So growth, you have to have that cap on your expectations. You have to know you’re going to eventually reach that ceiling and you can’t keep pushing it further. Unless you’re willing to go and push to this next stage to get into Predictable Success. So Predictable Success is stage four. Right now the stage we’re talking about is stage two. So it’s that stage in between. Are you willing to go through what we call Whitewater? Because it’s very very difficult and it’s your growth transition phase to get you to that scalable phase.

Dr.Bethany Fishbein:  Gotcha. So let’s talk about Whitewater. 

Char Watson: Okay.

Dr.Bethany Fishbein: Because I know you know we want to be rock stars. So if you tell us we’ve got to get through, we want to get through it. What is it?

Char Watson: Well okay. Obviously, it belongs to anybody who wants to get to scale but growth really is. Fun is a good stage to stay in. So don’t feel like the Predictable Success or stage four is the only sustainable stage. You absolutely can stay in stage two as long as you want. Okay, so Whitewater is when the growing complexity inside an organization is starting to cause problems. So this is where we see mistakes and errors happening. The cost of rework is happening. Profitability is plummeting. There’s a loss of control, doubts, loss of confidence, loss of alignment and so there’s a lot of fighting or firefighting every day. Typically, at this stage, to be honest, I usually see it around three to four locations. And when I’m coming into the practices to help them get through Whitewater because so what I do is I develop emerging leaders. So I either meet them at the Fun stage and develop the office manager to be the number 2, to be the Director of Operations. Or I come in at this Whitewater stage and develop the Director of Operations and the processor and build that alignment for the Executive team.  So when I’m coming into this Whitewater stage, typically, there’s a non-executive team present. Typically there’s three to four locations and when you’re actually talking to those locations at that practice level, they are so disconnected from that DSM management from that executive level.  They don’t have any alignment from top to bottom.  They don’t know what their goals are. They don’t know why they’re there. They don’t have support. There’s no communication, right? And so then they silo themselves out just so that they can barely survive, but they’re not growing. And if you don’t acknowledge the problems in Whitewater and get through Whitewater, you can fall all the way back down to Early Struggle if you let it go long enough. But Whitewater is really great. You have to choose. Do you push forward and get to Predictable Success where you can scale? Or do you reduce the complexity and fall back down to just Fun where you just have to deal with the expectation on your growth capped?

Dr.Bethany Fishbein: So is that progression from one to three, or four, or five offices fairly normal in dentistry? Because we see some in optometry but it’s pretty unusual. And so typically, what we’re seeing is somebody starting with one office and growing that one office to sometimes ridiculous levels. Ridiculous in a good way. So you know you’re describing it and I’m hearing it but I don’t know that it has to be growth in multiple locations. I think like in one office it can be starting to departmentalize a little bit more to say, “Okay, now we’ve got. It’s busy. So we’ve got people who just do this.” And before everybody did everything and so.

Char Watson:  Right.

Dr. Bethany Fishbein: Sometimes they’re not talking to each other. Or there may be an Associate Optometrist and so now the owner and the associate do things differently, right? This can happen in one spot.

Char Watson: Oh yeah, for sure. You won’t see it though if it’s just a solo practitioner. They don’t typically move through these stages. They really do kind of stay around that Fun stage. If they’re trying to get a partner within that practice or associates within that practice then yes, that practice certainly can evolve through these stages. But if we’re just talking about a solo practitioner with no additional providers in the office, typically we won’t see them move through these stages. They typically just go from Early Struggle to Fun and then just hang out there.

Dr.Bethany Fishbein: Okay.

Char Watson: Yeah.

Dr.Bethany Fishbein: What are the keys to getting through the Whitewater?

Char Watson: So Whitewater,  I think to me, I kind of think it’s fun. So the reason why is because you’re looking at things in such a different perspective. So in Fun, we’re really focusing on systems and processes for the team underneath us. Okay, so we don’t have a lot of in-house services such as HR. Typically, we outsource that. We typically outsource that. So we outsource a lot more in Fun and keep it pretty minimal in-house. So those systems and processes are just focused on the team. For Whitewater, we’re actually developing the systems and processes for the executive team. That’s what makes it so different and so unique. So we have to completely shift the way that we’re approaching the practice. So in Whitewater, we’re really focusing on building the Predictable Success team. So that’s your visionary, your operator, and your processor. That additional third row. We have to move to making high-quality team-based decisions. So it’s not just that command and control structure, right? We have to move away from that. We’re making high-quality team-based decisions. And that’s a whole like. We could dive into Whitewater and all of this like on a whole other podcast because there’s a lot to go into it. And then what we call Growth Imperatives. And again, like all of these could be its own episode to really get through and like understand all of these different meanings. But those are the focuses for us to really get through Whitewater. Additionally, the founder also has to go through their own evolution to really help them get through Whitewater. They kind of move from being like the captain on the field to stepping off and being the coach on the sideline. And that transition is really hard for most providers because especially if you started your own practice and you moved through all these stages. You can’t be the one that’s calling the shot and then making the move in the field and then going back on the sidelines to coach and then jumping back in on the field and that’s what we see happen. And what that’s doing is that’s causing chaos and hurricanes all around. And you’re not empowering your leaders to step in fully because you’re still playing in the field. So this evolution, you have to take a step off of the field and coach from the sidelines. And that can be really hard. And so the focus here is to really choose if you’re going to be going up, going through to Predictable Success, or are you going to step out and let someone else step in as the visionary. That’s a choice you have to make. What are you willing to do at this point? Next is to leave but not to leave. We’ll see the practitioners get to this Whitewater stage and honestly, if you don’t notice it soon enough, you’ll get burnt out from the turbulence of this stage really fast. And so they tend to just step out. But the problem is this being absent isn’t being a leader and walking away isn’t delegating. You can’t just leave, you have to still lead. You still have to have a presence within your practice and really have to focus in on your leaders. So not just focusing on breaking them up and choices. The first choice is your Senior Executive team, so that’s a visionary, an operator, and a processor. You have to focus on that first choice. But the second choice, that’s your leadership team within the practice, that’s your office managers and your associates. You really have to focus in on those leaders and get them strong, get them empowered, let them make decisions, and have the independence to do it without you micromanaging or stepping into the field again and or stepping off the field and then coming back in. It’s just causing hurricanes everywhere. So don’t do that. And then finally you just really, the best suggestion I can say is to find a guide, find a coach to help you get through this stage because there’s a lot of blindspots here and a lot of unknowns. It’s hard to see what’s in front of you when you are so sick in the weeds of it.

Dr.Bethany Fishbein: Yes, that we know and that’s what we do. We find that. So talk about Predictable Success because that’s the goal, right? Is you get through this to Predictable Success? What does that mean in your language here?

Char Watson: Predictable Success just means you can deliver quality in the face of complexity. It means you can scale to whatever level you want to get to without your quality dropping, without your team isolating themselves, and without developing these silos. It’s a continuum of getting through Whitewater. The key there though is developing a synergist. That’s the person that’s basically the love language for the organization. They are the ones that are focused on the culture. They have a high EQ. They have a high HQ. They are really in tune with their team members. They understand their strengths. They understand their weaknesses. Oftentimes, I’ll put that synergist person on say like an HR role as well because we need that person anyway. They really help to glue and solidify the culture that has been developed. Once you get to that Whitewater stage and Predictable Success, you really get to see the value of your culture and your organization. Whereas, I don’t feel like you can really see that when you’re in those earlier stages because you’re just busy working. You’re just flexing those sales muscles. You’re just working and producing but you’re not really like taking a step back to see just how valuable your culture is and what you’ve done here, right? You haven’t taken a step back to enjoy it yet. And when you get to Predictable Success, that’s when you get to.

Dr.Bethany Fishbein: So what’s usually the founder or the provider’s time spent in patient care? Like are they decreasing their time and patient care or are they increasing as they build that leadership team? What usually is happening here?

Char Watson: Yeah. No, I love it so much that you ask that question. So in Early Struggle, they’re obviously that single contributor. In Fun, typically they’re the single contributor but they’re kind of taking a step out. So typically, we’ll still see them working at least three to four days a week but usually, they can start carving out at least a day a week to really be the CEO and do the CEO things. In Whitewater though, we’re really going to ask you to take a step down out of clinical because we need that visionary. If you’re capped on your time and your energy because it’s being spent so much on patient care, it’s really hard for us to really get through that. So in Whitewater, can we go 50/50? You know? Can we get down to like two or two and a half days a week? That will make phenomenal progress. And then in Predictable Success, I feel like that they really have more of an option there. We’ll see some providers do one or two days a week and some that just step out altogether and they will become more like part of the board per se. So they’re still very much involved in the organization but they are not providing that clinical care.

Dr.Bethany Fishbein: What percent of dental providers go this multi-provider, multi-office route versus just building up a practice? I mean, I’m sure it’s changed over the last 20 or 30 years.

Char Watson: Yeah, it has changed, and honestly, I feel like the pandemic has really caused like a hard turn right for this kind of emerging DSO route. So it really kind of was about 30% of like DSOs versus 70% solo practitioners, but the pandemic, like I said, it scared everyone. And so I think we’re seeing a lot more retransition into this more DSO route. And so right now it’s about 50/50. I honestly won’t be surprised. So within the next few years, if we see more of an 80/20 or 20% is more of those solo practitioners and 80% is more in that Dental Service organizations. 

Dr.Bethany Fishbein: So will you just define it, Dental Service Organizations because I’m not sure that there’s a popular direct parallel in our industry.

Char Watson: Oh yeah, sure. So the Dental Service Organizations, they become partners with their practice, typically, or you can start your own. And there’s that and that can mean a whole different thing. If you want to start your own, basically what you’re doing is you’re bringing in other practices that’s typically a merger and you partner with them. So the DSO typically has like 49% ownership and the practice has 51%. The DSO Management provides services. Again, this can be something we can really dive into on another podcast. But they provide a certain level of services, depending on the model, either all the practices get the same exact services or they can pick and choose. So essentially, the Dental Service Organization is a support to the practices and provides the admin support. And the practitioners can take a step out of having to do basically a call to CEO needs and they partner with this company. Or the founders will just make their own DSO. They’ll just build their business towards that model.

Dr.Bethany Fishbein: So in these stages that you’re talking about, this is kind of the founders building their own. If there’s somebody else to do it, it lets you skip a lot of that Whitewater.

Char Watson: Yeah, for sure. I think it’s still worth saying. We’ll have to do another podcast because we don’t have enough time to talk about those declining stages. Just because on that note, when you have these big DSOs, these corporate-level organizations, they can get into these declining stages. So even though on the outside they seem really successful, it doesn’t seem like they’d be having any of these problems. There are certain problems that happen within those declining stages but we’ll get into that in another episode.

Dr.Bethany Fishbein: Yeah, I definitely would like to talk again. I mean, it’s a model that we’re talking about in optometry. There are people doing it very successfully outside the US. There are some things here that have made it a little bit complicated to do that way. And what’s happening because that’s not as viable an option is some of these practices are selling out entirely. I’m sure that’s got to be a thing in dentistry also. It’s just private equity companies buying 100% of the equity and now the founder goes to being an employee, right? 

Char Watson: Yeah. They either step in that way or they just step out altogether and retire.

Dr.Bethany Fishbein: Yeah. One of my philosophies that I talk about is that understanding how to build leadership and to have a team that can carry out the plays on the field so that the provider can be in the exam room if that’s where they want to be. Or be CEO and employ someone else in the exam room. But not be in that position where they’re, your analogy, like calling the play, running in on the field to do it, checking it out, coaching everyone else, jumping back out to think strategy, right? Apparently, a lot of people are in that but that leadership team in place makes a tremendous difference in the ability to make that happen. I would love to talk again. We promised seven stages. We hit four here. Will you give a quick like, here’s what the next three are, and then we can go into them in more detail another time.

Char Watson: Yeah, absolutely. So the next stage after Predictable Success is called Treadmill. This one you can get out off and you can move back to Predictable Success. The stage following that is called the Big Rut. Just to highlight that’s basically the organization is too big to fail. It’s really hard to scoop them back into Predictable Success. Often times you will see them fall all the way down to Death Rattle, which is the final stage and this is where the organization is sold or scrapped or merged or acquired with another organization.

Dr.Bethany Fishbein: Char thank you. This is interesting. It’s so interesting the similarities but also the differences. There are some things that you said that just hit right on and then some things that are like, “Yeah. Okay. We’ve got similar stages but different milestones that are creating them.” So it’s something that I will absolutely think about, and I hope we can talk more on about. Give the details on your podcast or if people are interested in hearing more from you. Where do they look?

Char Watson: My podcast is the CEO Doctor podcast and then if you want to get in touch with me, I’m on LinkedIn just under Char Watson, or my website is called the www.theprovidersdoo.com

Dr.Bethany Fishbein: Alright, Char. This is part one. Thank you so much for taking the time today. And I am absolutely looking forward to next our conversation.

Char Watson: Perfect. Thank you so much.

Dr.Bethany Fishbein: Thank you and for anyone out there listening who’s interested in knowing your blind spots, helping develop your team, and helping to stay in Fun or get to the stages of growth, please check us out online at www.powerpractice.com Thank you.

Dr. Bethany Fishbein: I’ve met doctors and clients we’ve worked with who’ve come in initially saying, “I don’t want to practice anymore. I’ve made a mistake. This is not the right career for me. There are too many external factors making it too hard.” And then when they learned that they’re able to shift their reactions, and make the decisions, and pivot the business, and choose their direction. They are like, “Oh, this is fun! I want to stay with this.” And years later, they’ve gone from, “I don’t want to do this anymore.” to “I’m opening a second location. I haven’t fully decided if I’m going to sell off the first one or partner with someone there so I have it as a source of passive income.” And you’re like, “Yes, you get it!”

Dr. Bethany Fishbein: Hi! I am Bethany Fishbein, the CEO of Power Practice and host of the Power Hour Optometry podcast. Today I’m not hosting. I am the guest. This is a replay of a podcast episode I recorded with Evon Mendrin, who hosts the Optometry Money podcast. Evon is a Financial Planner for optometrists. And he asked me to share some thoughts on the importance of mindset and how your mindset impacts the success of your Optometry Practice. I hope you enjoy it!

Evon Mendrin: Hello and welcome back to the Optometry Money podcast where we’re helping ODs all over the country make better and better decisions with their money, their careers, and their practices. I’m your host Evon Mendrin, Certified Financial Planner and owner of Optometry Wealth Advisors, a no-commission financial planning firm just for optometrists nationwide. In today’s episode, I am joined by Bethany Fishbein, CEO of the Power Practice as well as co-owner of her own Optometry practice. We talk all about how mindset impacts the success or lack of success of your Optometry practice. And we dive into a few common mindsets or beliefs that we’ve seen that really limit the potential of optometrists and how we should approach changing the way we think for the better. And I think we all underestimate how much of our success and enjoyment in life and in our careers and businesses are limited by or created by what we believe in and how we think. And even if you’re not a practice owner, this same concept can be applied to your approach, to your career, and your potential as a great, excellent practitioner. And if you have any questions on today’s show or ideas for future episodes, you can send over an email to evon@optometrywealth.com. You can check out today’s show notes on the Education Hub on my website, www.optometrywealth.com. And one thing I wanted to mention is I’ve been getting some questions about President Biden’s recent student loan announcement about the payment freeze, about forgiveness, and discharge, or about the new income different repayment plan. I wrote an email newsletter diving into the details and what that means for optometrists last week, and I put a link to that newsletter in the show notes. So take a look at that. Check that out. And I’ll plan to put that on my website as an article as well. If you have any questions about that announcement or your student loans in general, reach out to me, or feel free to schedule a time through my website. For a no-commitment introductory call to talk about that as well. And without further ado, here’s my conversation with Bethany Fishbein.

Evon Mendrin: And welcome back to the Optometry Money podcast. I am here with yet another fantastic guest and would love to welcome to the show, Bethany Fishbein, CEO of the Power Practice and host of the Power Hour podcast. Thank you so much for coming on.

Dr. Bethany Fishbein: Thank you so much for having me.

Evon Mendrin: I really appreciate it. I have been looking forward to chatting with you for a little while now. And I think today is going to be a fun conversation all about mentality and mindset and how that impacts success or lack of success in an Optometry practice. But before I dive into that, I just want to get a background from you. Because you come to this conversation with a lot of experience, both as an optometrist and practice owner and also consulting other practices. So give us a little bit of your background. Where did your career start? And how did it eventually lead to a role as CEO of the Power Practice?

Dr. Bethany Fishbein: Sure. I graduated from New England College of Optometry in 97. I met my husband there. We were classmates and we got married in August after graduation. So coming up on 25 years, in about two weeks. 

Evon Mendrin: Oh, congrats!

Dr. Bethany Fishbein: Thank you. And we both went to school thinking that we wanted to be in private practices. I actually got a job while I was still in school. Right after graduation, I started working in a private practice in New Jersey. And honestly, at that point, I thought I was done. I was where I wanted to be. It was a great practice. I was going to become a partner and all of that. And on that path, I realized that there were things in that practice that maybe just weren’t being done the way that I would have done them. I was very much considered a junior partner and so my ideas weren’t always taken or things like that. And on one hand, I know now they shouldn’t have been. I was like 26 years old and I don’t know if they seem like the best ever ideas at the time, but they probably weren’t. But it started to become less happy and less satisfied there. And ultimately, I ended up leaving after a couple of years. Jonathan was in a different private practice and the same thing. It was a great practice and a great experience. But when you’re an employee and you have complaints or concerns, you come home and there’s only so much you can do about them. And so we started to get the mindset that we wanted to do our own thing and we opened our practice in July of 2001.

Evon Mendrin: Yeah, so you saw things that you would have done differently. You had your own ideas about how maybe the practice should be run and you wanted to blaze your own trail. So you ended up doing that with your husband. And I can definitely relate to that in my own experience and my own career decisions to cold start a financial planning firm and I think probably a lot of other ODS can get that as well and in their own cold start experiences. And so you started a practice with your husband. How long has that practice been running now?

Dr. Bethany Fishbein: It just hit its 21st birthday.

Evon Mendrin: Twenty-first birthday? Wow!

Dr. Bethany Fishbein: Yeah, I know. You came into this saying, “Oh, Bethany has a long history of experience.” I’m already feeling old and yeah, just celebrated 21 years.

Evon Mendrin: So how was it then? What was the experience of working with your spouse for that long co-owning a business together?

Dr. Bethany Fishbein: It’s amazing. And we’ve done it for so long, that it’s only recently in the last year since I’ve been working with Power Practice and I’m working at home more than I’m at the office. That this is our first experience having different jobs. And so, you know, for our whole marriage really, we come home and talk about work stuff and it’s the same work. And so, it’s the same level of care. And it’s hard to imagine what everybody else sees is normal which is spouses talking about different work people and the other spouse being like interested because it’s your husband and so you have to kind of listen. And, you know, you’re interested. You’re invested. You want them to do well but it’s very foreign for us to have that different level of investment ourselves.

Evon Mendrin: Yeah.

Dr. Bethany Fishbein: We’ve loved it.

Evon Mendrin: And are there any particular challenges that come with co-owning a business with your spouse? Or are there certain conversations that you only leave at work and don’t bring into the house? Like what are the different things you have to keep in mind for doing that?

Dr. Bethany Fishbein: I mean, there’s lots of challenges and lots of wonderful things. That’s probably a podcast episode in its entire self because there’s a lot of husband and wife Optometry practices. I think one of the biggest challenges for us was learning. When learning to communicate so that I understood when he was venting and when he was looking to problem solve, and vice versa. So always Jonathan has been like the practice guy. He loves seeing patients. He likes insurance. All the things that were his areas of interest and I like the Staff Management side and the goal setting and that kind of stuff. So sometimes, he would complain about something like you know. I’m sure it’s happened once or twice that he’s come home and complained about a staff member or something that they were doing. And immediately because I was hiring and training and managing the staff, I would jump into, “Okay, this is a meeting the boss wants me to fix this.” And he was coming into it as a husband venting to his wife about a bad day at the office. 

Evon Mendrin: Yeah.

Dr. Bethany Fishbein: And so we really had to learn like, “Wow, you know, that must be frustrating.”, or “Oh, that sucks. Here let’s go sit outside and have a beer.” versus, “Okay. Let me  schedule a meeting to correct this immediately.” 

Evon Mendrin: Yeah.

Dr. Bethany Fishbein: So that was one of the challenges and I think the other is just that because we work together and because most of the time we both absolutely love what we do. It totally bleeds into all of the outside-of-work conversations. And we’ve sometimes, on and off,   any advice like, “Okay, let’s have a meeting once a week and talk about work and then we don’t have to talk about it.” But we like talking about it. And it generally isn’t a problem for us to have that be part of our home life as well.

Evon Mendrin: Yeah. Yeah, that’s interesting. You’re kind of juggling hats and you got to figure out mid-conversation which one you need to be wearing at that point. And you came together with a mutual fascination and excitement around optometry and what you’re doing. But also complementary skills or at least complementary interests, which I think is important in any partnership or any co-ownership relationship. It is you’re bringing together interests that complement one another. So I think that’s pretty cool. How did you get started then and get connected with the Power Practice? How did that start?

Dr. Bethany Fishbein: We actually hired Power Practice or at that time, it was just Gary Gerber as our consultant when we were opening. We were very much optometrists and have thought about private practice, but had never really thought about opening our own. And so when we started to talk about, “Could we do this? Is this a feasible path for us?”  We didn’t know. And so we contacted Gary. He was in New Jersey at that time about an hour and a half from us and we went up to his practice and just talked about, “Could we do this?” And once we determined that we could and we were going to, it was really such an easy decision to have somebody who knew all of that stuff, be able to guide us, to fill in all the things that at that time we didn’t know. We knew how to do Optometry. We knew what we wanted in a practice. But we really didn’t know how to get there and how to make the zillion little decisions that a new practice owner is faced with every single minute of every day. And having somebody to lean on for help with those decisions was invaluable in just getting us through those initial months and years. 

Evon Mendrin: Yeah.

Dr. Bethany Fishbein: I think the other thing that he did for us and now we get to do for clients is really giving us a whole different perspective on what our dreams could be. We went to him and he asked, you know, all the right questions and said, “Okay, what are your goals?” And we had talked about it on the way there and so, you know, this was 22 years ago. So we had decided that “Wouldn’t it be amazing if we had this practice that would gross $300,000 and we would be able to take home $100,000?” We thought that would be like the ultimate at that time. And, you know, I remember Gary saying, he listened very carefully and then he kind of nodded and said, “Okay, you know, I think we can do that.” And Jonathan and I are smiling at each other and he looks at us and goes, “Alright, what do you want to do the second year?” And we were like, “Whoa!” like mind blown. And at that time, people were still chasing the million-dollar practice. And, you know, Gary said, “A million-dollar practice? You should kind of get that just for showing up, you know? Let’s think about a $ 3-million-dollar practice. Why not?” And so, that shift in perspective of what we could be, I think, led to everything that’s happened since then.

Evon Mendrin: So he helped you change your mind about maybe limiting beliefs or just about just opened up about what’s even possible in Practice ownership. Above and beyond maybe of what you’ve seen from other practices or what you’ve seen in your own experience as practitioners. And so how did you end up working with Power Practice outside of your practice?

Dr. Bethany Fishbein: So once we got started with that and as we’re building the practice, I got really into the Prractice Management side of things. Those were the courses that I wanted to take. Those were the books that I wanted to read. That’s what I was going home and thinking about and Jonathan was thinking about, you know, some new way to treat glaucoma and I was like,”Can I go take this workshop in New York City to be a better manager for staff?” It’s just what I gravitated towards because I realized from working on this actively, that number one, it’s something that you can learn and work on. Right? We spend all that time to learn to be optometrists and then you open a practice and it’s like, “Poof! You’re a business owner and a boss.” And you’ve had no training. So I realized that you could learn to excel at those things and I loved that and found it more interesting than the new drop that just came out for glaucoma. And also, I saw even then the difference that it could make in determining the outcome of what happened next. So I remember coming up with an idea for marketing. And again 22 years ago, pre well not pre-internet but early internet. So at that time, we had this idea. We wrote a letter. We were going to do direct mail. So we bought this big mailing list and we sent out these direct mail letters and we sent them out and then people came in. And this realization of something that I did three weeks ago, affected what happened in my practice today. I wouldn’t have seen this person if I didn’t send that letter. If I had sent twice as many letters, maybe I would have seen two people. And that realization, that whatever happens next, I’m going to be in control of was addicting. What else can I make happen? What else can I make happen? And that’s what we started to do. So I love that. And as Gary grew his company and got more clients, he was looking for people to go out and help other practices. And we had a couple of false starts. He needed it when my kids were tiny babies and I couldn’t travel. But anyway, ultimately it lined up and to go out and be in another practice and then. But even now, I’m learning as much as I’m teaching, right? Because optometrists very rarely get to go into another office besides their own and see how things run. And there are things that were better and I would come back and say, “Oh, They were doing this and that’s great.” and things that I knew could be better. And being able to work with these doctors to take control over their own futures and reach their goals was incredible. So I was really hooked.

Evon Mendrin: So you got sort of an inside scoop to sort of a lot of different approaches to Practice Management. And I like what you said earlier in that like you, you can learn to get better at Practice Management. Whether it’s managing people, looking at making decisions with financial stuff, and KPIs like you can learn to run a business better. We don’t live in this binary world where you’re either born and you can run a business or you’re born and you’re a practitioner and you’ve got to be split one way or the other. Like you can gain skills. You can learn about how to do things better and to become a practice owner. Because I think any optometrist is going to school to learn optometry and they’re not learning about it, maybe they may take a class about practice management but they’re not really learning what it means to own a business. And so almost everyone early in their careers is starting from scratch a little bit. And I think that’s such an important point like you can learn to get better at these things if you want. Now if that’s what you really want.

Dr. Bethany Fishbein: Absolutely! And not everybody realizes that. 

Evon Mendrin: Yeah. 

Dr. Bethany Fishbein: So that’s like, people don’t know that. And it’s not that they don’t know. They kind of know but they don’t know where to go or where to look. Or they think that, “Oh, I must need an MBA. Should I go get an MBA?” Because our whole lives, the path to learning more about something is getting into a school program, sitting through the school program, doing the classes, taking the test, completing the program, and getting the degree. That’s an optometrist. You don’t need an MBA to run an Optometry practice. You could but there are so many paths to learn more about Business Management. Many of them are free, inexpensive, and some are just as simple as having conversations. 

Evon Mendrin: Yeah and then putting that knowledge to use. Like you put it into practice and then see what happens. And then learn from that and then make the next decision and then see what happens and learn from that. And you just get better and better over time. So you started consulting with Power Practice and now you’re working as CEO of the Power Practice. And are you still involved in your Optometry practice as well?

Dr. Bethany Fishbein: I’m there in a leadership role. So it’s still my practice. You know, I still am part of the leadership team for the practice but I’m not seeing patients. It’s been about a year since I stopped seeing patients in the office. I’m really working to shift more into a consulting role with my own practice where other people are running it. Let me take what I’ve learned and what I know to make sure they’re running as wonderful a practice as possible and reaching their own dreams in the practice.

Evon Mendrin: Got it. Okay. Interesting. So in in your experience, I want to ask you about kind of the main topic for today. And that in your experience cold starting and then owning and building a practice over all these years and then now consulting. And you’ve been able to see how the minds work and how the practices work of other Practice owners, successful ones and ones that are not quite as successful. I think you and I would both agree that owning a business owning or a practice can be like super rewarding, but it is challenging, right? Like it’s really hard to grow especially from scratch to grow and build a practice successfully. And you experience a lot of ups and downs in that. You’re on one day experiencing joy and like celebrating wins. And on the next, you’re feeling the stress and doubts and worries about the business’s success and about your financial stability and patient experiences and things with staff and all sorts of stuff. So there’s a lot of things that go into owning a practice that really influenced the way you think about yourself and about your business and about the industry as a whole. Plus all the opinions about, you know, the future of optometry and whether it’s viable or not viable. So you’ve got all this stuff sort of impacting the way that an optometrist feels and thinks about owning a business. And so in your experience, again, in your own business and consulting others how important is the practice owner’s mindset and belief system, about their work and their business and their industry? How important is their mindset like the way they think to the success or maybe lack of success of the practice?

Dr. Bethany Fishbein: I can’t think of anything more important.

Evon Mendrin: Really?

Dr. Bethany Fishbein: Like I can’t even imagine what someone else would put on the list of things that are more important. Let’s assume they’re a decent doctor, right? So okay, they need some clinical skill, but after that, I think that mindset trumps literally everything else. Because mindset is what lets you know that you can change anything that’s not working. So, if you open and you make poor financial decisions, and you’re in a terrible location and you hire bad staff, mindset is what is going to get you out of that or let you drown in it. 

Evon Mendrin: Yeah. 

Dr. Bethany Fishbein: Right? If you go gangbusters in the beginning and then things fall like for every single thing. I think it comes back to mindset because that is what lets you change something for the good or for the bad. So I think that a practice owner has to own that responsibility. That ultimately, whatever happens in this practice, is really up to them and there are outside factors that you can’t control. There’s payments from insurance. They’re going to reimburse you this amount. Like you can’t change every little thing. But changing how you’re going to deal with those things is what determines not only success or lack of success, but the level of success that you’re gonna get to. So to me, it’s important enough that I don’t even know what else is on the list.

Evon Mendrin: That’s interesting because I think we sort of want to rush to like, the most important things or like the tactical things like how do I do XYZ in the practice? Or you know, financial stuff, or marketing, like it’s more like the tactical stuff. But it’s kind of interesting to think about like two Practice owners can look at the same scenario and see different things in that scenario. Like one can see opportunity like, “Oh, I can make these changes and improve XYZ and there’s opportunity there.” And another can see no opportunity. I mean, you can see some sort of like, “I’m just gonna throw my hands up because nothing’s gonna work and I have no impact on it.” And in the Financial Advisory world, there’s a coach that does a lot of work with the way we think and the way the brain works. What I hear her say a lot is that you know, “We attribute meaning to events.” Like things happen. Yes, some of it’s out of our control, but we’re the ones adding meaning to that event. We’re the ones adding meaning to that. And we can either say to ourselves or we can either believe that there’s nothing we can do about that and kind of throw up our hands and just say, “We’re out of control and it is what it is.” Or we can think to ourselves something like, “What can I do to make this the best thing that happened to me?” Or like, “What can I do? What can I do to make sure that I’m taking advantage of this moment to improve the situation?” And a lot of that does come from sort of self-accountability and that I need to make sure that I’m doing what I need to do to improve the practice. And are there certain things that you see in like certain either beliefs or mindsets? Like are there certain ways of thinking that you’ve seen in your experience that have either really helped Practice owners excel or really limited them? Like are there certain things you’ve seen that Practice owners believe that way?

Dr. Bethany Fishbein: Sure. One of the greatest limiting beliefs I think that we see is people who don’t yet understand that they’re driving the bus. They’re in control of what happens. So you think about optometrists, you know, and I think about optometrists that I’ve met at meetings and there’s this mindset of people feeling that everything’s happened to them. Right? And they can’t do anything about it. And it’s just not true. So when you feel like that, if you feel like these things are happening to you and you can’t do anything to control them therefore, you’re limited on how much money you make. You’re limited on how much the practice can grow. You’re limited on how much space you can have. You’re limited on the type of care you can provide. You’re limited on the type of contact lenses that you can use or whatever the limitation is. That’s one of the biggies. I’ve met doctors and clients we’ve worked with who’ve come in initially saying, “I don’t want to practice anymore. I’ve made a mistake. This is not the right career for me. There are too many external factors making it too hard.” And then when they learned that they’re able to shift their reactions, and make the decisions, and pivot the business, and choose their direction. They are like, “Oh, this is fun! I want to stay with this.” And years later, they’ve gone from, “I don’t want to do this anymore.” to “I’m opening a second location. I haven’t fully decided if I’m going to sell off the first one or partner with someone there so I have it as a source of passive income.” And you’re like, “Yes, you get it!” So I think that that’s one of the biggest. And it’s something that when I talk to students or people just opening practices for the first time, I think like that’s why you do all this work. That’s why you put yourself on this roller coaster that you described, you know? One day it feels great and then a family of three cancels and they were the only people on the schedule and “Oh my gosh! You’re gonna lose your house but tomorrow is awesome.” And you’re doing this up and down. If you are stuck on a roller coaster with no control over that, it’s hard to imagine anybody wanting to put themselves through that.

Evon Mendrin: Yeah.

Dr. Bethany Fishbein: You know? But if you’ve got that control panel with all of those gears and switches where something happens, right? And you say, “Bam! There’s an electrical situation in the town. My power is out for today.” You know we all went through it a couple of years ago. Bam! Pandemic. You have to close your office for 10 weeks. Like you know? I’m sick. Staff is sick. All the things that can happen but you’ve got the control panel and all the little gears and switches to say, “Okay, bad weather with an electrical emergency. Here’s how I’m going to change course.” And you just do it and that’s fun for some people.

Evon Mendrin: That’s it. I can see how that is such a limiting belief and I think it can work with or  work against a Practice owner when they want to try to do things and not just like the risks of business ownership but about trying to change their lifestyle in a way that they want. You know? One example is,  “Okay. How many days would you like to spend outside of your practice? Like enjoying life? Vacations?” It’s okay to take vacations practice centers. Like how many days would you ideally want to spend outside of your practice? And a lot of times the first reaction is, “Well, I can’t. Like I have to be in the practice.” or Like, you know, “I can’t. I can’t control the days I’m out of it because I need to be there.” Well the change in mindset is well, what would it take? What changes would you need to make in your business in order for that to happen? You know it’s giving yourself that gear switch like you said. It’s giving yourself the remote or whatever metaphor you want to use. Like it’s giving yourself the power, the authority to say, “I’m in control here. I can make the changes I need to make in order to get the result I want.”

Dr. Bethany Fishbein: Yes. And I think that there’s different reasons people come to opening up a practice. And so I think a lot of people see the appeal of that independence right? Maybe they’re working for someone and they only get two weeks off or they’re working a five-day week and they wish, “I want to work a four-day week. I want to have four weeks off. I want to be home at 3:30 every day when my kids get off the school bus.” Whatever the thing is, so they see the path to independence or the benefit of the independence. And that has to come with the responsibility of holding the remote, you know? 

Evon Medrin: Right. 

Dr. Bethany Fishbein: Sure you can take four weeks off. You can take eight weeks off if you want. However, you’re at some risk here, right? You’ve made a financial commitment. You’ve borrowed money to do this. You’ve made a commitment to pay your staff and see your patients. So I want to take eight weeks off it’s not quite as simple as saying, “I’m gonna take them off.” Right? 

Evon Medrin: Right.

Dr. Bethany Fishbein: You’ve got to say, “Okay, that’s my goal. I can do that in private practice because I’ve met other people who do it. So they can so therefore I can. Now, what do I have to change?” Do I, you know, work six days a week for the two weeks before and the two weeks after? Do I hire an associate? Do I make a change to limit the number of patients that I’m going to be seeing and increase the revenue per patient so I can be profitable without the need for volume? And maybe it’s one of those. Maybe it’s a combination. Maybe it’s something different. But it’s thinking it through and making those choices to allow the lifestyle things that you want. If you don’t do that, it becomes what we call a hobby practice. Where it’s somewhere where you can go and do stuff and have a fulfilling career but it’s not making money. And it doesn’t have tremendous value at the end of your practice life.

Evon Mendrin: Right. I think that is another good point you made too is that other Practice owners have done it. Almost every practice management challenge, issue, or concern has been seen and solved by some peer of yours. Like it’s been solved before, you know? None of these challenges are new. And so you just need to give yourself the ability and the power to make changes and to go find the answer because someone’s done it and the answers are out there for you. I want to ask you about a mindset that I’ve come across in my conversations, which is pretty much what you’ve just described earlier, which is “I don’t have control over what comes into the practice. I only control what goes out.” Basically, meaning, “I don’t control the income. I don’t control the patients that come in. I only control the expenses. You know what I’m spending money on.” Is that true?

Dr. Bethany Fishbein: No. 

Evon Medrin: Okay.

Dr. Bethany Fishbein: No, right? Like, there are a hundred ways that you control what’s coming in, right? Number one, you schedule the patients or you train the people who schedule the patient. Right? So are you going to schedule four patients a day? Are you going to schedule six patients a day? Are you going to schedule 18 patients a day or 24 patients a day? Right? So right there, you’re controlling the faucet of patient volume? Right? A brand new practice says, “We don’t have 24 patients today.” Okay. You control the marketing budget. You control the marketing guy. So are you going to actively market? Are you going to post on social media? Are you going to look for ways to meet your neighbors and introduce yourself to the community? Or are you going to turn that faucet back? And at different stages of the practice, you might be doing one or the other. The thing to remember is that you’ve got your hands on the faucet. Once the patients are in the office, what are you going to do? Are you going to take a retinal photo before their exam? Are you going to require the retinal photo? Are you going to charge for the retinal photo? How much are you going to charge for the retinal photo? Are you going to discipline or correct the staff member who’s not doing what you want with the retinal photo? Right? So you’re controlling that. In the exam room, you’re making recommendations to your patients. Your patients are coming to you with a problem. They’re saying, “Doc I’m having a hard time seeing because I’m on three different computer monitors at work.” Are you going to tell them their prescription hasn’t changed? Or are you going to tell them their prescription hasn’t changed and that the glasses they’re wearing, the progressives they’re wearing aren’t the best visual option for their workday that they’re spending nine and a half hours a day. And by the way, they should also have sunglasses for the way home. Right? Are you going to listen to your patients and have products that they want to buy? Are you going to be aggressive and timely in collecting insurance money? Are you paying three people to take care of patients when you don’t have enough patients to require three people to take care of them? So you are very much in control over the amount of money that comes in. Are you going to prescribe glasses for that eight-year-old minus two? Or are you going to treat their myopia? It’s a clinical decision and it’s a financial decision at the same time.

Evon Mendrin: Yeah. You just listed like a hundred things that the owner has direct control over. 

Dr. Bethany Fishbein: Correct.

Evon Mendrin: I mean in one way or another and all of those directly or even indirectly impact revenue in some way.

Dr. Bethany Fishbein: Yes. And I’m gonna say one more thing. Sorry. I get passionate about this. 

Evon Mendrin: Yeah. 

Dr. Bethany Fishbein: But it’s not only affecting revenue in that encounter. The other thing that is important especially for newer Practice owners to understand is that they’re setting at that first visit the precedent and expectation for what’s going to happen at every visit after that. So if somebody comes in and they’re getting a retinal photo and they’re getting this exam and they’re walking out with a year’s supply of contacts and two pairs of glasses, and they’re spending $2,000 that day at the eye doctor. In their head next year, when they come, is “Oh, eye doctor. Alright, so that’s going to be about $2000.” Where as if they go and they do their whole thing and they get what’s covered by the plan and they walk out and then a $10 copay. They come back next year and they think, “Alright, eye doctor $10.” in their budget column. And so it not only affects you right then but it creates habits for years to follow.

Evon Mendrin: Yeah. And how much does that or how much does the way that a practice owner feels about that and thinks about that and shows up to work each day around that? How much of that thinking and mindset impacts, I want to say culture but like just the way that the staff and the other optometrists show up to work? Like how much? How much does mindset spread? You know, from the practice owner through the rest of the team?

Dr. Bethany Fishbein: The practice owner largely creates a mindset for the rest of the team. So we’re talking about money today because you’re a financial planner. It’s your podcast. It’s what you talk about. 

Evon Mendrin: Yeah. 

Dr. Bethany Fishbein: The danger in this mindset if you look at all these things of – Here are ways I can make more money, right? And then you’re constantly talking to staff or associates, “Here are ways I can make more money. Here are ways I can make more money.” Then it spreads but what spreads is, “The owner is out to make more money.” and as an employee, you’re not making more money. And it’s not super inspiring to make money for someone else. So the piece that I didn’t say but the thing that you want to spread is that all of those things that I rattled off, really when you think about them are in the best interest of the patient. Right? Let me properly document so that regardless of what doctor you see next year, we’ve got a photo of what it looks like today and can instantly know if anything has changed. Right? Let me listen to how you’re using your eyes at work and recommend the best solutions to solve your problem. Let me make sure that you’ve got enough contact lenses that you never have to feel like you should wear your daily lens for two and three nights in a row because you’re almost out. Let me make sure that when you’re driving, you’re not looking at glare. Let me try to keep your eye as small as you can and not let it grow so that it decreases the risk when you’re older. So that’s the mindset. It’s the same things. But when you’re setting a tone as the owner about doing what’s best for every patient, I just spoke to a client and he said, “You know for every single patient, I’m going to do whatever I would do for my mom.” And if you go into that, where you’re treating every patient the exact way that you would treat your own child, your own family member, your own spouse, or honestly your own self, spread that. Because staff can get on board with that, associates can get on board with that, and most importantly patients will get on board with that and come to you and say, “I trust you because I know you always recommend what’s best for me.” And that’s a great culture to be part of and a great culture to go to as a patient. 

Evon Mendrin: And all of that flows down from the owner. All of that is seen and is brought down from the owner to staff, to other optometrists, and then eventually down to patients. Because the patient’s going to feel that too when they are interacting with your team and with you as a doctor.

Dr. Bethany Fishbein: Yeah. One of the other like mindset things is the other one that I see that sometimes creates a problem and it creates because it takes away the ability to have that impact. Well sometimes the owners, when they’re uncomfortable in a situation or they’re not sure what to do or something’s not going the way they want and they’re not sure how to fix it, tend to avoid it. I remember a practice that I was in and the doctor had an office in the very back and it was his goal not to get anywhere near the front of the office ever because he didn’t want to know what was going on out there. And so he was like hiding and looking at cars on his computer instead of getting out there and dealing with it. And so I think one of the big things that I see that creates success in really successful Practice owners is a willingness to be part of the situation even if it’s bad and have the opportunity to address problems head-on.

Evon Mendrin: Yeah and that particular belief that we talked about and I would say is a myth. It is a really big limiting belief. And what I’ve seen in my conversations is I’ve seen that sort of belief where I don’t have any control over the growth of the practice only what I spend. Like I’ve seen that sort of leached down into other areas of their life and their finances. It’s you know. They don’t. Just in my limited conversations, there are those particular owners who aren’t really having a focus or a concern about the details in the practice like the financials or any operational KPIs or on like the performance month to month, quarter to quarter. There’s no real focus on that. And why would you if things are out of your control? It just sort of is it is what it is, you know? There’s no bookkeeping. It helps. You really don’t know whether the numbers are even accurate. I’ve seen where, you know, when you think about that as things that should be investments in the practice are really just looked at as expenses to be cut or limited. Things like marketing or other things like bookkeeping and other professionals like consulting that will help you grow your practice or free time. And then it leads to a lot of those Practice owners looking for other ways to grow wealth. Like what are ways I can grow wealth? What are other shiny things I can invest in that are going to get me to my goals? But that’s neglecting the incredible investment and asset right in front of them like their practice. And the reality is the formula for a lot of Practice owners is to focus on and run a successful healthy practice and then use that cash flow to do a lot of the boring stuff, the vanilla stuff that’s already at your disposal. You know? It sort of leads them away. That sort of thinking leads them away from focusing on the practice as an investment, as a key part of their wealth building, and looking for other things. So I definitely see that as a limiting belief. Do you have anything else to add to that before I jump to the next question?

Dr. Bethany Fishbein: I think when you’re doing that, you’re missing the fun of it. Like of course, you can be a wealthy optometrist without owning the practice. So there are a lot of other investment vehicles but the fun of our practice is that it serves multiple purposes, right? It creates. It creates cash flow and the amount of cash flow is largely within your control. It lets you work in a place that you want to work in. It lets you create a workplace that you want to be in every day. And you’re building an asset just like when you own your home and you’re paying off your mortgage and you redo your kitchen. It gives you a nice place to cook and then it increases the value of the house when you sell it to someone else and the practice is doing the same thing. So at that point, you’ve made this step to have the practicee and then do the things. Because they increase the value and make it more fun and increase the cash flow. It feels like a win win win all around.

Evon Mendrin: Yeah, and I definitely don’t come to this conversation as someone who doesn’t have a lot of this like head trash, you know? Like I think any business owner to a point is going to have maybe any professional any optometrist is going to have doubts and fears and worries and concerns about their ability to serve patients and to run a practice and to provide for their family and to do all these things. So I definitely carry all those things as well. So Bethany, how would you coach another practice owner? Like how would you help them to get out of their or out of these limiting beliefs? To retrain their brain? To seeing opportunity? Like how would you help them change the way they think?

Dr. Bethany Fishbein: Okay. I think one of the. There are a couple of things I’m thinking about. One of the first things I think is to get them to have conversations with people who know that their limiting belief is a myth. And I think that that’s one of the dangers today. There is so much conversations on social media that you don’t know who’s answering. And so everybody has a bad day, but you put or post your bad day and if you get 50 other people saying, “Yeah, me too. I also had a bad day.” It makes you feel like that’s normal. On one hand, it’s good. It’s normal to have a bad day. But it’s not normal to assume that the rest of them are going to be bad from here on out. So I think that being part of a community where people believe and that the people know that they can actively make changes in their practice to improve things is important. Because then you have a bad day and it’s like, “Yeah, today is a bad day. Yeah. Oh, I was in that situation four months ago. Here’s what I did to get out of it.” which is very different. So that’s one. The second thing I think is that I think that one thing we do with clients when they feel that way, is we encourage them to make one small change and measure it to see the impact that it has. So I’m thinking about a client now and they knew things could be better but they didn’t quite know how to make them better. We looked at some of their numbers and we said, “Okay.” They were doing some screening tests before the exam and they were doing them for about 12% to 18% of patients. So it’s, “Let’s work on this one thing.” So working on that and getting that from 12% – 18% to 70%. Sure that in itself generates a lot of money for the practice so it’s worthwhile but more importantly, it teaches the entire practice from the owner on down, that they can make a change in their business. Sometimes it’s helping somebody address an issue with a staff member. “Oh, I can’t ever implement anything new because Lorraine at the front desk, she won’t have it.” So let’s test that, right? Because either she will have it or she can’t work there. And that can go either way but you can have what you want. So working on small changes and seeing that those happen and that you made that happen, you impacted that. You did those hundred extra procedures that equal $5,000 a month. Truly a net income because the building is paid and the staff is paid whether you do it or not just because you changed something. Look you can do it. Here’s what you should change next. And here’s what you can change after that. So I think those two things are mindset-wise what I find people respond to the quickest.

Evon Mendrin: Yeah, and I love that because I think it’s so important who you surround yourself with and what you’re feeding your brain with. Because you can create all kinds of narratives about your business and your abilities on your own. And if you’re not balancing that with other peers, other professionals who have been through what you’re going through and who are going to a place or have already arrived there have built a business where you want to go then you’ll never get out of those limiting beliefs. It’ll just keep compounding. So I love that. Being careful about who you surround yourself with. Surround yourself with the people that are going or are already at where you want to go and people who understand what you’re going through and can talk to and can lend an ear when needed and reassure you, you know? Give some optimism and balance out those hard times. And I like that, try one thing and then test it, right? Like you don’t have to solve everything all at once. Like it’s just, “Okay. Here’s what you think. Let’s prove it.” or “Let’s try one thing within your control.” And all of this is within your control. Try one thing within your control and then just test it and see the results. And then when you see those results, take another action like you just see how things play out. Knowing that it’s your decision and it’s your actions that are impacting these things, I really love that.

Dr. Bethany Fishbein: Yeah. And sometimes it’s just helping them know that some of the things that they want or that they’ve thought about are okay. So, one of the things that we see in cold start practices is a lot of cold start Practice owners come out of a retail background. They’ve been working in a retail optometric setting. And what’s interesting in a retail optometric setting is that there are beliefs that hold true in retail that they’ve been taught by their practice owners  (the retail Practice owners) as truths that aren’t direct translations into private practice. So one of the biggest ones we see when I’m working with a client, they’ve had a practice for two or three years and they worked in retail before they opened their own and they’re struggling, right? If I come into that situation, I can almost predict that number one, they feel like they have to be open six days a week on long days. Right? Because in a retail setting, if you’re in a shopping center or a mall or whatever, the number of hours that you’re open determines how many patients you’re going to see. So hours are something that a retail location very often has its hands on the faucet. Right? In a private practice where people call to make appointments especially if you’re not in a walk-in traffic kind of street, it’s much less important to be open six days a week for 8 to 10 hours a day because people call for appointments. And if you don’t have one at six o’clock, they’ll come at 4:30. You can control that. So helping them understand this isn’t needed anymore. You might only have 30 patients on your schedule a week. You certainly do not need to be open for 50 hours to see them. Let’s lock that day. Let’s close that day. Let’s take that day as Management Time. It’s not the same. And so having some guidance on which factors are the ones to try, I think helps as well.

Evon Mendrin: Yeah. And that’s again, needing to surround yourself with a different perspective, right? You need to either work with a consultant like yourself or work with other peers to see or get those new ideas and the different ways of thinking about different things. And it’s hard to, I mean, it’s hard to quantify, like, how important or how much of our success lives between our ears or in our brain? Like so much of our own beliefs limit the amount of our own accomplishments and limit our own potential and limit the actions we take day to day and limit our own enjoyment of our profession or our businesses. A lot of that lives right between the ears just in our brains. So I think you gave some really really awesome guidance on how to start changing that. How to at least begin to change that a little bit. Well, I guess as we sort of wrap up, do you have any final thoughts or takeaways that Practice owners and I know a lot of the listeners here are mid to earlier in their careers or at the first half of their journey or practice ownership? Any final takeaways or thoughts from you as we wrap this conversation up?

Dr. Bethany Fishbein:

 Early career is the best time to create some of these great habits. Just like we said, the first time a patient comes in, they’re establishing a habit and a mindset about what to expect. When you’re new in practice, you’re setting a standard for how your practice is going to be in year five and year 10 and year 15 and beyond. And there are Practice Management courses exceptionally valuable. They are given at a rough time usually when everybody’s studying for boards and it’s not on there. So it feels unimportant. Having some guidance to set things up for maximum success to know how big you should dream. Like us, if we would have gone in thinking maybe someday we’d have this $300,000 practice honestly, that’s probably what we would have had. Right? So understanding how big you can dream, what’s on the control panel, and what you can adjust to get there, and of all the things you could adjust which ones are going to get you to where you want to go the quickest? I feel that the earlier in your career that you do that, the better your setup to have what you want the quickest. It is absolutely within your control. It’s so much between your ears. And even dreaming big enough is an exceptional start.

Evon Mendrin: Yeah, I love that. As someone who’s learning how to work through all these beliefs and thoughts about our work along with everyone else, I appreciate that and it’s something I can learn from too. And as we wrap up here, how can people follow you, get to know more about what you’re doing, and get in contact with you if they’d like? How can they learn more about you?

Dr. Bethany Fishbein: So they can find out about our company on www.powerpractice.com. If you want to hear me rambling more usually not in quite this deep of a voice but you can look for the Power Hour Optometry podcast. And I’m on LinkedIn and I try to post thoughts from time to time. So anybody who wants to connect with me, please feel free to do so.

Evon Mendrin: I will put all that information in the show notes. Please go reach out and follow Bethany and the Power Hour podcast as well. A great follow. A lot to learn from there. And Bethany, I appreciate you coming on the show today. It’s been a delight. It’s been so much fun. And for the listeners, I really appreciate your time today. We will see you on the next episode. Take care.