From Dream to Reality: Fast Track Your Specialty Practice

Thanh Mai: Don’t tell me your priorities, show me your calendar. So what that means is, don’t tell me that you want to work out and be healthy if it’s not your calendar. Don’t tell me you love your kids if you don’t schedule play dates with them. Don’t tell me you want to build a specialty practice if you’re just doing primary care all day long and you’re just in patient care five days a week and that’s all you do.

Bethany Fishbein: Welcome back to the Power Hour podcast. I am Bethany Fishbein, CEO of The Power Practice, host of this podcast. And I’m excited for a conversation today with my guest, Dr. Thanh Mai. Thanh is the founder of and partner in Insight Vision Center Optometry, a private practice in California. He’s a director of myopia management at Treehouse Eyes. He’s a vision source administrator, all-around a super knowledgeable guy. Excited to have you here and to have you share some knowledge about establishing specialties in your practice. Thanh, thank you.

Thanh Mai: Hey, thank you for having me. Super excited. I didn’t realize this, but this is actually my third time on The Power Hour.

Bethany Fishbein: Really? Yeah. You did one with me on virtual assistants and then you did one with Gary before that?

Thanh Mai: That’s right. I did one with Gary. And so what I’m hoping for is that this is kind of like SNL, you know where you get the jacket on the fifth time or something like that, the five-timers club. So what I’m going to do is I’m going to clock in, this one is the third time, and I’m going to convince you to get me on two more times and then you’re going to send me a jacket. That’s my long play here. I’m always thinking long term.

Bethany Fishbein: All right. And I’m in my head thinking of who else is up there at number three and number four, and I did not know about the SNL jacket. So now that I do, I’m going to have to be very careful about getting people on for that fifth time. I’ve got to figure out how to order some jackets. But yeah, thank you for being the three-peat guest. That’s awesome.

Thanh Mai: Yes, thanks for having me. I prepared for this more of my entire life. And so yes, thank you.

Bethany Fishbein: Okay, good. One of us has. So, Thanh, talk about your own practice, just because I think where I’ve seen you talking and presenting recently has largely been in the myopia space, but your practice doesn’t just do myopia management. You’ve got all kinds of specialties in there. Talk about your own practice a little bit.

Thanh Mai: Yeah. So we opened our practice cold in Southern California. My professors told me don’t open a practice cold. And then I did it because I actually took it. I don’t want to get to weeds of it too much, but I tried to buy three other practices when I first graduated and I failed three times in a row. And then I decided, you know, if I’m going to not pan out, I’m just going to open my own because there’s no one can stop me if I do that, except for a bank. They don’t give me the money. Yeah. Practice in Southern California. We do a lot of specialties, not only myopia, but also a lot of crazy cornea cases, scleral lenses, vision therapy. We dabble in dry eye, but I’d say the three biggest ones is basically the special contact lens, myopia and vision therapy. We love what we do. We’ve got a really cool team right now. I say I’ll start with why. One of the things that right now I say this is that I’m actually really happy these days. That sounds kind of funny, but my number one thing I’d say in 2023 is I’m just really happy. I think I’m really happy because time is kind of slowing down for me. When time slows down, we get these really cool patients. And I’ll give you an example. Just like last month, one of our doctors, Dr. Nathan Schramm, who used to be in the power practice too, he saw a case of a patient coming in, got palpated edema. Patient comes for regular eye exam, diagnoses it, sends the patient out, and they get brain surgery the next day. And we basically potentially save the patient’s life. And they’re carrying a lot of problems with that. We do a lot of vision therapy as well. So we have a lot of kids coming in and they come in every week and we give them a lot of prizes. We play games. It’s a blast. And then lastly, I do mostly special contact lenses and a lot of myopia management. Happy to say that my son Jackson, do you know Jackson at all, Bethany?

Bethany Fishbein: No, I don’t know him.

Thanh Mai: Okay, I don’t think I’ve ever mentioned. Okay, so Jackson’s seven. He’s in first grade. It’s his last week of school, by the way. So it’s kind of funny, the last week of school, they don’t have to do any homework. They don’t do any work at school. They just literally go play games like every day for the next week. It’s amazing. He’s been in my myopia management program for a couple of years. He was on Atropine. I started on Atropine when he was five and now, he’s on Ortho-K. I just started him this week on Ortho-K. What’s interesting is that when you’re a parent, are your kids myopic, Bethany?

Bethany Fishbein: No, not yet.

Thanh Mai: Oh, you’re lucky. Okay. Are your kids, are they growing up, or are they?

Bethany Fishbein: They’re 16 and 19. So I got my first myopia glasses at 17. So, they are not fully out of the woods yet. I was very late onset myope. But so far, they’re taking after Jonathan and have not needed glasses.

Thanh Mai: Nice. Okay. They’re pretty good then. 16 and 19, the chances of them becoming myopic is really, really low at this point. It’s worth it for the 19-year-old especially. Though I think 20% of people progress adoptive in their 20s. So it could still happen, but hopefully not. So Jackson now he’s doing Ortho-K. When I’m doing it on him, it actually has made me a way better doctor now because now I’m actually living what the parents lived through. And what’s funny is that like, I got the lenses for him and I forgot to like, even get contact lens solution. I was like, oh my gosh, that didn’t go. And I actually went to the store to buy some because there’s a shortage of tear care and hydroxy stuff everywhere.

Bethany Fishbein: Right.

Thanh Mai: And so I don’t stock in the office anymore. So I would have been a guy from the office, but now I can’t. I literally just bought it from the store to give them because I didn’t even have the stuff and I had it. Then I forgot to get the plunger. And anyways, I just realized that myopia management is hard for parents.

Bethany Fishbein: It is. It’s a whole commitment. But how cool to know that you’re changing the trajectory of anyone’s life, but really very cool when you’re able to apply that knowledge to your own family. We were up in Toronto over the weekend and saw some relatives we don’t see all that often. They had a seven-year-old with them. And so, they started telling me about how he never needed glasses and then they thought he was going to need them. And then he was a minus 0.75 and then he was minus 1.75 in less than a year. And dad’s a minus eight or minus nine. So, I said, oh, you know, is he in treatment for that? And I was so happy to hear their response. Sounded like their doc was on top of it. They were up in Canada. So, he was in myopia management spectacle lenses, which was cool to hear about. And then they had talked about starting him on atropine as well and then going to contact for us. Okay, as he got a little bit older. So I was like, all right, this is now not only affecting the practice, but influencing the people that we care about. So that’s nowhere closer than your own home, right?

Thanh Mai: That’s right. And it’s huge when you have by the way, Canada, I mean, yeah, some of the best ideas you can just study other countries that are ahead of the United States. Healthcare in United States is not the best in the world. And we all know we spend way more money and get way less than a lot of other countries. And your friend in Canada is an example of that. They can get myopia management glasses. We can’t. I got a pair of myopia management glasses for a patient here, actually for one of my patients. And it took a little bit of work, but we did it. We wrote a letter to the FDA, actually. And we said, Hey, FDA patient is kind of too young for any kind of lens of any sort. They’re already on Atropine. We want to try this, you know, combo treatment with myopia management glasses with Atropine. But obviously it’s not approved yet. Will you give us permission? So I wrote a letter to the FDA and I thought it would take them like five years to respond. But they actually respond within a week and said, yeah, go ahead and do it. Order the glasses.

Bethany Fishbein: Oh, how cool.

Thanh Mai: And it was so great. Yes. And then so the company, I won’t name names in case, you know, I don’t want to make a big advertising for anyone. But basically, they sent me the glasses. I worked with their team. They were great. They’re so easy to work with. And now the patient’s wearing the glasses.

Bethany Fishbein: That’s pretty cool.

Thanh Mai: Yeah.

Bethany Fishbein: Did not know that was an option. So, we got on a whole tangent here about myopia and family, but it’s amazing to hear from a practice owner that feeling of I’m happy, I’m content with what I’m doing. I’m enjoying my days. When you set out to open or start a practice, did you have this vision of wanting to do specialty care right from the beginning?

Thanh Mai: Definitely. Right from the very beginning, I knew that that’s just what I wanted. And so, you know, you always start with why, right? Let’s talk about time, for instance. I talked about how happy I am. You know, they say that if you live in the present moment, you’re going to be happy. But that isn’t quite accurate because really the present relies on how you frame time around it. So, for instance, if you have stuff that’s unresolved in the past, that it will distract you. Or if you have no goals for the future, if you have no goals to create a specialty practice in the future, you’re just going to kind of float around. You’re just going to just kind of chill. And so what psychologists say is that what most people do is they project a path onto the present. And they say that, well, I’m here because of where I came from. But they say it’s actually more accurate to basically say the present caused the meaning of the past than to say the past caused the meaning of the present. So what I mean by that is you’re constantly remodeling things in the past, saying like, let’s say you had a failed business plan or like a pissed off patient, or you had like four staff members quit on you. You could say, well, I guess I’m just never good enough. I’m not a good doc. I’m not a good leader. I don’t know what I’m doing. And I’ve got this imposter syndrome. I’m never going to get there. Or you can frame it this way. You know, all the things that happened in the past that helps me get to where I am today. It’s going to help me. I learned from it. I’m better because of it. And then you reframe the past that way. Same thing about the future in terms of setting goals. Most people, what they do is they’ll look today and they’ll, let’s say they project three years from now where they would be. Let’s say I open a practice cold, and I said, okay, well, I want to have a specialty practice that grosses $500,000 and, you know, maybe a net 30% or something like that. And they look at where they are now, or they say, well, I want to grow 10% a year for the next two, three years. Because they’re looking at their present self and what they’ve accomplished already. But what’s actually better thinking about to say that what the psychologist was mentioning was that they should actually, instead of projecting the present self onto the future to make their goals, they should actually use the future to determine what they do in the present moment. So, let’s say you say, I am already a guy that has not even like a $500,000 practice. I have a $10 million practice. I’ve got a $100 million practice. And then now that’s who I am in the future. And I’m going to use that future person of myself to inform who and what I do today. And so if I’m a guy that has a $100 million practice, I’m not going to say yes to certain things because I don’t have time for it. I don’t have the energy for it. And I’ve got many resources to do it. And so that’s kind of a way to think about it in terms of setting your goal setting, because it’s going to dictate what you say yes and no to.

Bethany Fishbein: I mean, kind of in your head, if you’re mentally already there, I mean, you can take it out of business ownership and everything else. You say, we’ve talked about it like in the context of exercise or, you know, other stuff. Somebody wants to become a runner and it’s okay, so what’s a runner going to do in this situation? How is somebody who runs every day or how somebody who runs marathons going to attack this challenge and start doing that until you actually become that? Kind of acting as who you want to be.

Thanh Mai: That’s right. You’re there and you’re working backwards to today. Whereas today, you’re still getting there.

Bethany Fishbein: In your life, just your story, where did you have this vision of this guy who is happy with a practice doing multiple specialties? When did that start for you?

Thanh Mai: Yeah, I went to a conference and honestly, he’s one of my big inspirations. I went to this Vision by Design conference and his name was Nick Despotidis. And he does this conference called like Supercharge. He’s just really happy. And he’s seeing patients three days a week and he’s seeing all the patients that care and he dropped all vision plans. And that started it for me. And that’s when I kind of was inspired to do it myself. And so I wanted a practice that didn’t rely on vision plans. I wanted to spend more quiet time with the patients. I wanted to be reimbursed as well, because having a successful practice is part of my dream in terms of financial reward as well as also taking care of patients.

Bethany Fishbein: When you went to that, did you even have a practice at that point? Or you went to that before you even owned a practice?

Thanh Mai: I went to that conference without even owning a practice. I was just an associate in a private practice. This was over 10 years ago. And so I knew like, I’m going to do this.

Bethany Fishbein: You’ll laugh tons. No, I actually recorded a podcast with Nick this morning. And he mentioned your name as somebody who had taught and inspired him as well.

Thanh Mai: That’s insane. No way. Oh, he’s, my hero. And so I can’t believe he would say that about me. But yeah, going back to building the practice. So again, let’s say we’re going to build the $10 million practice or the $100 million practice that has specialties. You got to frame what you do differently. So let’s say I was going to do a $100 million practice. What I would do is I’d probably, okay, well, shoot, I actually can’t see patients anymore in order to get there. What I need to do is I need to start probably raising money, meeting investors, raising capital, looking into acquiring 40 practices, and then installing specialties in these 40 offices or opening 40 locations and doing that in order to get to $100 million. So I can’t be in patient care. I need to be now, again, refining my pitch, raising money, and then hiring people that are talented in terms of who are really good at opening locations, hiring staff, training them, and building out a team right now. That’d be a completely different type of way to go about it. Versus if you say, okay, my goal is actually a $1 million specialty practice, which I can talk to you about how to do that because we’ve done it. So that’s much different. I would say, hey, you can stay in patient care. Now probably you shouldn’t be doing it five days a week though. I probably recommend no more than three days a week because it’s going to take some time to build specialty practices. It’s going to take some time in terms of building the systems, training the staff, doing marketing, doing even self-education. So if you’re like a cold start like me, you’re fresh out of school, you actually know what you’re talking about. And then we talk about how to get there. But the steps are vastly different. But it has to start again with what your vision is three years from now, five years from now, 10 years from now. You have to start with that.

Bethany Fishbein: So step one is really to refine that vision and to figure out what it is that you want and what kind of timeline are you usually recommending people work with on that vision? I’m a big fan. I do the three years. I feel like it’s accessible. It’s real and aspirational at the same time. A lot can happen in three years, but it’s not somebody with a cold start isn’t going to turn into $100 million practice specialties with 40 locations, probably in a three-year timeline. That might be their 10-year plan. What timeframe do you usually use when you’re encouraging people to set that vision?

Thanh Mai: By the way, Bethany, you did something interesting there. For someone that might be their three-year plan because they’ve decided, I’m not going to limit myself right now when I create my vision. I’m not assuming where I am now. I’m just going to get there and then make the steps to get there. But yeah, honestly, the most of us are not going to get there. So I’m totally on board with you there. I personally use the three-year goal as my benchmark. So that’s not the crazy goal that’s 10 years from now. That’s kind of something you can’t, it’s almost like you said, out of reach and you’re not really sure you’ll get there because things can change along the way. You might even change your mind. One year is probably too short. But again, three years I think is perfect. So the first step, I think, to building a specialty practice, again, be very, very clear three years from now exactly where you want to be and paint the picture. I think we went to this conference together, Bethany, to create the vivid vision of it, understand exactly what it looks like. And that’s always step one in any venture you do.

Bethany Fishbein: Yeah. I mean, I think that that’s something that a lot of people struggle with because they come up with a vague idea, right? I’d like to do more specialties. Like, okay, great. Which specialties? Well, you know, dry eye or myopia or VT, you know, specialties. Okay. Which, what do you see yourself doing? What do you see your personality meshing well with? What do you see in your practice? Like if you have a largely pediatric practice, it would be a much bigger shift to decide you wanted a low vision specialty than a VT or myopia, which if you want to work with kids all day is probably more aligned. So I think that idea of asking yourself the questions to paint that picture, like, okay, so maybe it’s VT. Okay. Do you want to just do VT or do you want VT to be part of what you do? I want VT to be part of what I do. Okay. Is it a little part or a big part? And you know, really getting granular that it may feel, I know some people really have trouble with goals. They feel like they’re just setting them for the sake of setting them and you know, well, fine. You want me to write this on the paper? I’ll just write it. You’ve got to have it in a format where you can see it, feel it, taste it. Like it’s right there.

Thanh Mai: I agree. And you should revisit it probably on a quarterly basis and then review it with your team or you can make sure your team is yourself. That’s fine. I think it’s so important that one thing that I do also, I teach practice management at SCCO. One of the things I do at the end of my lecture is I, one of the homework assignments we make them do, we actually will pause the lecture for 10 minutes, five to 10 minutes and we’ll say, okay, lecture’s over. Everyone get a piece of paper because you have to turn it in to get credit. Because by the way, if you make them turn it in, otherwise they’ll get past credit, then they’re going to do it finally. And so I say, okay, now you’re going to write down your one, three and 10 year old goal. And I want you to write it down and then I want you to save that, take a picture and save it on your phone. But I want you to turn it in to me because I’m trying to basically kind of hack their mind in a way and be like, okay, now you’ve set a goal. We all know that if you set it in your mind or if you verbalize it, we’ll put it in writing. But if you have it in writing, it’s kind of one of the highest levels of things to do. So I try to do that with a student that we do, that we have.

Bethany Fishbein: I mean, let’s say there’s somebody out there and I think the path we typically see, and it certainly is not the only path, but the path we typically see where someone’s interested in a specialty is that they’ve created a primary care practice where they’ve maybe done a little touch of specialty here and there when the opportunity comes up. But they’ve gotten into that hamster wheel a little bit. They’re seeing the patients; they’re taking the vision plan reimbursements and starting to feel like there has to be something more or better than this. So they set their sights on doing this specialty. We get the vision clear. What’s next?

Thanh Mai: Yeah. So what’s next is, again, one of the major problems is they’re probably comfortable. And comfortable is where dreams die. But anyways, I say the next step is after you figure out where you want to go, you decide why you’re doing it. You know, first of all, you’re doing it because you want a happy life. You want to take care of patients. You’re doing it for all the right reasons. Then you figure out where you want to go. So you’ve set your three-year vision plan in terms of what your specialty practice looks like. And then the next step before the how, I’d say, is the who. So who’s going to do it? First of all, is it you? Are you the guy or gal that’s going to do low vision? Are you the guy or gal that’s going to do vision therapy? Are you the guy or gal that’s going to do myopia management? Because it could be you, but it doesn’t have to be you. So we do vision therapy every day at our practice, but it’s not me. It’s Dr. Valerie Lam and Dr. Ariel Chen. We do scleral lenses myopia. It’s not always me. Dr. Nathan Schramm is way better at scleral lenses than I am. I do it too, but I’d say he’s better. And so first of all, your next year, you’re going to determine who. Is it you? Is it someone else? Also, who’s going to help you get there? Are you going to hire the power practice, which you should, by the way, everyone should hire The Power Practice. That’s a no-brainer. The ROI is 10x easily, maybe 100x.

Bethany Fishbein: Thank you. I think we just got our quote for the beginning of the podcast there. Excellent.

Thanh Mai: Right. Quote me. I allow it. So who’s going to help you get there? Because most of the time, if you’ve never done it before, you’re not quite sure how to get there. You don’t know the steps to take. Where someone that’s been there has done it and done it multiple times, I would ask that person. So for instance, let’s say it’s myopia. I would ask, you know, Treehouse Eyes or Power Practice who’s helped dozens and dozens of practices how to do it. If it’s like your vision therapy, there’s vision therapy consultants we’ve worked with and hired that helped us get there on top of using the Power Practice. And so anyways, I would find the next step is who. First of all, who’s doing it and also who’s going to help you. You need a coach.

Bethany Fishbein: This is maybe an aside time, but it’s something that comes up periodically is a practice owner will have an associate interested in a specialty. And there’s always an interesting conversation that happens about the risk of letting someone else build a specialty within your practice. And I’ve talked about it a number of times. It seems to come up with vision therapy more than other stuff. But if I’ve got a doc who wants to do vision therapy and I say, okay, great, three years, that’s my vision. We’re going to have this whole vision therapy practice. I did the who, it’s going to be this other doctor. Stuff happens with associates and all of a sudden, they get married to someone who lives in another state. How does that factor into the decision making when it’s not you?

Thanh Mai: Yeah, good question. So really the best practices don’t rely on people. They rely on systems. You and I both know this. What that means is that if you have a practice that person relies on you to generate all the revenue, it’s a very dangerous place to be in because what if you get sick? Or if you are relying on just an associate doctor to grow the specialty for you, you’ve got no hand in it and no one else besides the associate knows what to do in terms of the whole program. That’s a dangerous place to be in as well. I would never put all my eggs in one basket. I would spread the risk out. I would systematize things. So for instance, yeah, the associate specializes in vision therapy, but what are they actually doing? Well, what they’re actually doing is they know how to do visual efficiency examinations. They know how to do a strabismus evaluation. They knew how to do a really good cover test. They know how to have a conversation with parents about that. Well, sure. Why don’t I just capture how to have conversations with parents and write down as a script in one hand, but also in the training manual or videos on how I would do a vision therapy evaluation. And if I had to hire another doctor, why can’t that doctor learn how to do that as well? Why can’t I, as well as the other doctor, me and my associate both know how to do it in case they get sick and I have to fill in? Every practitioner at least has two people that know how to do the role. And then I would cement and have in writing and or video format or both on how to do anything in your business.

Bethany Fishbein: Yeah, that’s smart. Maybe they’re the one to set up the processes and to document them in a way that would allow someone else to pick it up should they not be there. That’s exactly right. That’s how you ensure that the practice can be able to have that and not be relying on that one individual. Smart.

Thanh Mai: Exactly. By the way, some good books I recommend in terms of systems and doing things. We both read this book. We both love it. Traction. It’s going to teach you the system. And by the way, this is part of growing a specialty practice. If you don’t have good systems in place, you’re going to be in trouble. Read Traction and do it. I love the E-Myth. So do you. I love If Disney Ran Your Hospital. How to Find a Zomato to read that one. Great book. The Pumpkin Plan. Four Disciplines of Execution. And like the Four-Hour Work Week. All those are good books I would have as like a foundation. Oh, also Getting Things Done. It’s one of my favorite books in terms of execution and reducing stress in your life by David Allen. That’s the steps that you got to do to build the practice. So after you’ve picked out who, the next step is to figure out your timing. It’s kind of a funny story, but when I was a fourth-year optometry student, I was having finals and everyone’s studying for finals. But I knew at that point I wasn’t doing a residency and the grades don’t matter. And so during finals week, I got kind of distracted and I picked up the book. I was at Barnes and Noble and I picked up the book, The Four-Hour Work Week. And I read the first two chapters of it and I just couldn’t put it down. I literally just finished the book in like five hours. And this was during finals week. And one of the things I learned from that book is basically don’t tell me your priorities. Show me your calendar. So what that means is don’t tell me that you want to work out and be healthy if it’s not your calendar. Don’t tell me you love your kids if you don’t schedule play dates with them. Don’t tell me you want to build a specialty practice if you’re just doing primary care all day long and you’re just in patient care five days a week and that’s all you do. And so the next thing I would do is I’ll look at my calendar. I’ll create certain blocks of time where you’re working on the specialty. So what Valerie and I did was we opened the practice and from day one we said, hey, we’re not going to see patients more than three days a week no matter what. That was just our crazy thought. Now, of course we did in the initial because we had to pay bills. We saw we did fill in work. So if I was opening a practice cold, I’d recommend for everyone working in practice as much as you can. But you’re probably going to want like another job at least one or two days a week.

Bethany Fishbein: Just have a little bit of income.

Thanh Mai: Because you’re not making any money. But once the practice is able to pay you, then we stopped doing the fill in work and then we just still saw patients only three days a week. And then we spent another two days working on the business and or not even working on the business, just spending time with family. And so the next thing you want to do is you need to determine your time. So then you figure out why you’re doing it, where you’re going, your three year plan, who’s doing it, and who is you or associate doctors and or who on the team needs to be trained on it. So let’s say you’re doing something like low vision, you should have a least one person on your staff that is the resident low vision expert. I’ll tell that person or myopia management counselor or scleral lens super tech. I would pick at least one person. But ideally, you’re going to improve the who’s on your team and do some internal marketing. You’re going to basically teach them all about their specialties as if they’re a doctor. You’re going to do lectures to them, which is by the way, a good way to train yourself on public speaking and get better at doing lectures when you do it external marketing on practice on your own staff first. And also helps you refine your messaging to patients and have a live Q&A with your staff and like your staff is going to ask you the questions that patients are going to ask you. Is Ortho-k safe for you? Is what’s the difference between a scleral lens and a soft lens? What are hybrid lenses? And what are these magnifying glasses with low vision? Why don’t you pick a telescope over a hand magnifier? And so like you should start with your training your staff. And then from that on, that’s when you start doing your internal marketing from there.

Bethany Fishbein: So at the point you’re well, actually, before you’re at the point where you’re ready to go, I guess, how do you determine that ready-to-go point? Because sometimes we encounter docs who want to do a specialty and the first patient that walks in that’s a candidate, they’re like, you know what, I’m going for it. And they just tell the patient, they make up a price, they kind of pull it out of their butt and we’re good, we’re going. And then I work with other docs who want to have all of those ducks in a row. And I can’t offer this, I’m not even going to mention it, because I don’t know how much the third year of the plan is going to cost. And what if this and what if that and they want the whole system? Is that a personality thing? Or do you think there’s a right answer?

Thanh Mai: Yeah, it’s a personality thing. It’s a low self-esteem issue. So, they say the symptoms of low self-esteem is someone who procrastinates a lot, has imposter syndrome and is a perfectionist. So those are three qualities of people with low self-esteem. I’m not saying you got low self-esteem, I’m sorry, Doc.

Bethany Fishbein: Oh, I was like running down the mental checklist with you. I was like, uh-huh, got it, got it.

Thanh Mai: Yeah, yeah, yeah. And so like, I struggle with it too, by the way, I’m not saying I don’t, but I fake it till I make it. Those are symptoms of you don’t feel like you’re the right person yet, because you have by now low self-esteem. And so you have to, again, don’t think about where you’ve been. Don’t think about the fact that you’ve got no experience. Don’t let the past dictate your present. Again, let the future, project the future onto the present. I’m someone who’s the world’s greatest scleral lens fitter in the world. And that’s who I am today. And you’re going to use that hack to act like it, to go past your imposter syndrome. And then so the doctors that do better are the ones that just say, you know, my systems, you know, technically, of course, I want you to iron out some systems. I don’t want to just I don’t want you to go for it. But ultimately, the doctors that do better are the ones that just say, hey, next patient. Hey, we got you. Hey, I can fit you a scleral lens. I’ve never done it before, but I’m going to do it. And then I’m going to call a lab consultant to figure it out.

Bethany Fishbein: Right. I mean, that it’s so tricky, right? From a practice management standpoint, absolutely.

Thanh Mai: Yeah.

Bethany Fishbein: And then at the same time, there’s imposter syndrome and then there’s reality. Like you’ve never fit one. And your colleague 15 minutes away has done 60. You have to find reason why that patient truly is better off to see you. Maybe they’re just going to get so much more of your time and attention, maybe because you are new to this, even if they don’t know it, you’re going to be very concerned about precision. And, you know, I don’t know. But even in the beginning, there are reasons why somebody would choose to do this with someone where they can get a different experience, a different level of attention. Maybe they have curiosity, too, and are willing to do some learning with you. Like, you know, they’re kind of a friendly first.

Thanh Mai: That’s right. Let’s talk about that right now. Let’s solve this issue right now, Bethany.

Bethany Fishbein: Okay.

Thanh Mai: So let’s say your son has imposter syndrome and you’re like, ah, you’re my first. But I’m trying to tell you I’m the world’s greatest. I just can’t do it. What if you did this? I have a patient I saw last Thursday who like 20th scleral lens consult and she signed up with us. Why did she sign up and pay us out of the 20th person? It’s because do this. Even if you don’t know everything, what if you are the doctor that cares the most?

Bethany Fishbein: Right.

Thanh Mai: We are in this society that no one cares anymore. No one listens to our patients. It is such a Seth Gordon talks about the purple cow. Have you read that book? Yes. In my opinion, the purple cow in health care is a doctor that cares. It’s so unusual now for you to not be rushed in and out of your appointments. So time on the timing, if I were to book a new consult for vision therapy, I wouldn’t do it in 15 minutes like my primary care exams or 30 minutes or 20 minutes, whatever your cadence is. I book a solid hour. And when you do that, now you’ve got all this time and attention to the patients. And as you as a new person, the patient goes, wait a minute, I don’t know other doctors might have more stuff on the wall, but this doctor listened to me and no one listens to me. My wife doesn’t listen to me at all.

Bethany Fishbein: Patients are assuming a level of clinical competence. Like I’m not equating inexperience with incompetence. So if it came out that way, I didn’t mean it. But you’re right. Patients assume that you’re the doctor. You’ve got your degree on the wall. Good enough. Right. You hear it with students. They don’t know if you were last in your class. You took your board six times. Like, they don’t know that. They know that you’re the doctor. They assume that you’re going to clinically take great care of them. And so you’re right. They are making the decision on other factors. And so someone who is really invested and curious and interested and wants to hear their experience, that that’s going to be very, very appealing for patients. Very often over someone who runs that part of their practice, like a well-oiled machine. Some patients don’t want to be part of that machine.

Thanh Mai: Exactly. They can feel it. What this all is, is technically internal marketing in a way. How you schedule your time in terms of how you build out your schedule blocks for different types of appointment slots. That’s all-internal marketing in a way for these types of specialties. How you train your staff. Patients know when a staff picks up the phone, they say, I’ve got a Keratoconus. And then your staff says, oh my gosh, you called the right place. We do. We see patients with Keratoconus all the time. If that’s the first thing your staff says, the patient says, oh, thank God. Like I’ve been calling around. And when I call the other practice, they go, I guess we can help you. I don’t know. Or you’ll see Dr. Smith tomorrow. I don’t know. He’s got opening at six. And so you’re creating the time schedule correctly in your systems. You’re training your staff correctly. Hopefully your office also looks cutting edge. Hopefully, you’ve got some tech or at least your patients actually don’t know what. Technology looks like anyways, if you just redo your flooring and paint the walls nicer, you know, organize things. So that’s not messy. You’re going to look like you’ve got the best tech.

Bethany Fishbein: I remember, this is going way back, but when we had opened our practice years ago, Gary, who’s I know, a mentor to you as well, had encouraged us to get a separate auto refractor and topographer instead of the all-in-one units that were just becoming popular at the time. And we were like, no, no, the all in one is high tech. And he goes, not to your patients. I said, what a patient see. He said, patients see that you have two instruments and the other guy only has one. And I was like, Oh, right. But it’s true, right? It’s their perception is we’re doing two high tech important tests where when it’s all combined in one, they didn’t even see it.

Thanh Mai: That’s right. Yeah. Patients come into an office and they understand when, when flooring is nice and they understand nice lighting. But they don’t understand what a combo unit is versus when a stud or anything like that. When we opened call, we didn’t have a lot of good tech, but they just thought we were the highest tech office because we had a coffee machine in front that they can get free coffee from.

Bethany Fishbein: Yeah. Very cool. All right. So you’ve got the vision, you know, who’s doing it. You got your first patients, you got your internal, internal conversation going on where you in your own head think that you can actually do this with a patient. The internal marketing, I think, is important. And that idea of time is one of the things you mentioned, Nick Despotidis, but it’s one of the things that I learned from him too, is the value of white space. You know, he said, okay, you’re going to set this amount of time in your schedule for myopia consults, if that’s what you’re looking to build. And I said, Oh, okay, great. And if, if one week nobody’s scheduled in there, we could turn it into exams. He said, no. I said, what do you mean? Like, what if there are no myopia consults? He said, then you take that time and you figure out how to get some. I was like, Oh, like that’s specialty time, whether that’s engaging in the specialty or building the specialty. So big fan of block scheduling here.

Thanh Mai: That’s right. Exactly. You must do that in order to get the way you want to. Bethany, you and I are talking in this power hour, right? As far as I know, you’re not paying me. So why am I even here? Why? I’ll tell you why. I’ll tell you why I’m here. I’m here because I learned early on when I was SCCO, I loved being a TA, a teacher’s assistant, right? I love going into extra hours and helping my colleagues learn how to do slip map and things like that. I love being a TA. Anyways, why I’m here is because I actually find that in my stage of career right now, I love helping doctors. I love it. I love it when they say, I did what you told me to do and the practice is doing really well now. And I create the systems and the patients are, you know, the practice is growing and I’m doing really well and I’m really happy. And my specialty is growing or whatnot. And I just find that really satisfying for some reason. And so why I’m here is because I’m hoping that one person out there says someday in the next four hours, hey, I listened to your power hour. And I took some of the steps and I’m on my way. That’s why we’re here. So anyways, that’s a, that’s a, actually, Bethany, I’m going to throw it back to you. Why are you here on this power hour?

Bethany Fishbein: Yeah, I think we share that. I mean, my entire vision of success around is created around helping other people get success. And so when somebody comes back and they heard something or did something differently because of something I recommended, that’s pretty extraordinary. And the power of one recommendation or one conversation just that happens to fall at the right moment and the right time and the right years makes sometimes a tremendous difference. And that’s the entire joy of doing this when it changes the way somebody looks at something.

Thanh Mai: That’s right. Yeah. And changes the way someone looks at something. It’s just powerful when you can do it. My son, he loves reading riddles. He’s got a book with riddles. And one of his riddles was, what does everyone give but never take?

Bethany Fishbein: What does everyone give but never take?

Thanh Mai: That’s just a riddle in this funny book that is for first graders. The answer was advice.

Bethany Fishbein: Advice!

Thanh Mai: The listeners of this podcast are some of the smartest people in eye care. A lot of them actually will listen to us. But I know that a lot of them, 80% of them, unfortunately, will just kind of listen. And they’ll hear it. They’ll kind of wash it over them, but they won’t take action. Hopefully they do if their why is strong enough. So the reason why I’m here, too, is because, for instance, I’m a high myopia and I’m trying to scratch my itch in terms of treating my son, treating other kids in my family. But also I’m hoping that doctors outside everywhere do more specialties because a lot of patients are suffering from low vision. A lot of patients are suffering from special Keratoconus. And a lot of times I get this answer from patients that have a Keratoconus or transplants or coronary dystrophy of, oh, my gosh. Now that I’m 45 years old, I’m finally getting my life back because I saw you. And I’m like, wait a minute, you’ve had an eye exam from other people for decades. How come this is it? And so anyway, there’s so many people floating around who are suffering in the United States. And I’m hoping that you’re the doctor that cares enough to become really good at something like this, a specialty of some sort and put a stake in the ground and say, this is what I stand for. This is who I help. And that’s the next step of what we’re going to talk about next, which is external marketing.

Bethany Fishbein: Let’s talk about it because that’s been a career long frustration for me. When we were practicing, I was doing a lot of low vision and low vision is still a big part of our practice. And that was the number one thing that we like. The worst thing to hear is how come nobody ever told me about this? Right. I wish that I would have known that this thing existed before I quit my job, before I moved into assisted living. Before I told my kid they would never drive again. And it’s so hard to hear that. So talk about how do you start to get the word out once you’re doing this thing? And myopia is similar in that way to low vision is that just there’s people that don’t even know that the opportunity for that care exists. Actually, all specialties, vision therapy, I’m sure, is the same. Sclerals is the same. People are being told to live with these symptoms. There’s nothing you could do about it. Maybe here’s a small thing you could try to feel like you’re doing something, but not a full treatment. So talk about getting the word out there.

Thanh Mai: Yeah, let’s get the word out there. And by the way, I felt what you said very powerfully, what you just said, how a patient told you, I wish I’d met you sooner. I just told my son they would never drive again. I can feel that experience that you just mentioned to me. That really resonated. Anyways, yeah, let’s get the word out. This is where most doctors fail, is that they only do internal marketing and then their prices will grow 5 to 10% a year. But if you want to grow like 100% in a year, you have to do, in my opinion, do external marketing. So let’s do some external marketing right now. So I’ll give an example. We haven’t talked about vision therapy enough. Let’s grow a million-dollar vision therapy practice in the next three years. And what I would do first is after you get all your systems in place, you’ve trained your staff, you’ve documented how to do vision therapy activities, how to do vision therapy evaluations, how to do a proper parent conference. That’s all good. Right. And you’re the one that’s doing it. Let’s just say it’s you. To get the word out, first, you’re going to identify your marketing niche for your external marketing. So who is your target? Now, you could do, in my opinion, where most doctors fall short. Most doctors fall short and they say, my external marketing target are patients who are ages 5 to 13 years old who have convergence insufficiency, let’s say. And I say, yeah, that’s not bad because those are the patients who might be sharp in your office. Right. That’s not bad. But a better one, if you want to grow quicker than 5 to 10% a year, would be like, OK, wait a minute. Who sees patients ages 5 to 13 years old who have convergence insufficiency that have problems with their learning, have problems with vision related issues that lead to issues at school, for instance. Now, these types of people would be others. It would be, for instance, not just moms, but it would be educational therapists, occupational therapists, speech and language pathologists, potentially pediatricians. Even though that’s a terrible one, I wouldn’t target pediatricians. I would target all the therapists, all of them, you know, educational, speech, occupational therapy, all those ones first.

Bethany Fishbein: Even like tutors and learning centers, like, you know, probably like a Kumon Center is dealing with people who would fall into that category all day long.

Thanh Mai: Exactly. So that is now my marketing target, not the patient, but people that see the patients. Right. So now I’m clear about who I’m marketing to. So now that I figure out who I’m marketing to, I figure out how to get the message out to those people. So a few things I would do is I would try, first of all, trying to send emails or stopping by and introduce yourself, try to make some lunch meetings. Even this, say, hey, I’m interested in learning about more what you do. Can I even pay you to come to my office and host a little mini lecture to my staff? Because we’re trying to learn more about educational therapy on a child who is on the autism spectrum. Now they’re coming to your office and then they lecture to you. But now they visit your office and they go, hey, wait, what is this? Oh, yeah, this is a box. We do it to kids with double vision. So now you’ve done you’ve helped them and you’ve helped yourself. First of all, you’ve helped them because now you know who to refer to when you have a patient who might need their services. On the flip side, they’ve come to your office and now they realize this is a place that helps kids that have those who have problems with vision, who might have some comorbidities with the behavior that I’m trying to treat. I’m a behavioral therapist. And so that’s what you need to do. You need to do that type of marketing first, not to the general public, because direct to consumer marketing is very expensive, timely and with low yield. But I would do a lot of lectures back and forth between specialists. I’ll take them out to lunch. I’ll try to schedule meetings at least once a week where I take out one of these therapists to lunch, get to learn more what they do. Don’t talk about what you want to do. No one cares about what you do. But they care about what they do and they love talking about it. I’ll just take them out and ask them what they do and relate it back to your practice near the end of the talk. Oh, near the end of the lunch break. Oh, yeah, well, I need your help. Can I get your business cards? Because I have patients that need your help. And if you do that, guess what happens? If you do it just one day a week for an hour, you would meet 52 people in your area. If you meet 52 people in your area, 52 people who are therapists, coupon centers and whatever, if you met 52 of them, your marketing is done forever.

Bethany Fishbein: There’s kind of a brilliance to that because when you do direct consumer marketing, if it works, you end up with one patient.

Thanh Mai: Right.

Bethany Fishbein: So a success is one person hears your message and they decide, OK, I’m going to come there. They come into your office and maybe best case you get their family. Right. But what you’re talking about when it works, you get one person who is encountering hundreds of your target patient every week or every month. So one effective refer can lead to much more yield than one effective direct to consumer marketing.

Thanh Mai: Exactly. Yeah, I’d rather see 100 therapists in a room and do a lecture to that than 100 parents. Though 100 parents is pretty good.

Bethany Fishbein: Talk about the discipline of it a little bit, because you’re absolutely right. If you do this once a week, you will end up with 52 meetings and likely some of those are going to hit and you’re going to be done. But nobody does it 52. They don’t do it once a week. They have kind of a surge of enthusiasm, do two or three. Maybe they have a bad meeting and say, this doesn’t work. I’m not doing it anymore. The first one didn’t work. How do you keep that motivation alive to keep going?

Thanh Mai: That’s right. Motivation will die. What you need is a system. And so your system could be, for instance, we do EOS, the Entrepreneur Operating System, and we’ll have, for instance, a weekly meeting. And the weekly meeting is where that traction happens. Otherwise, you lose traction. So the weekly meeting is where you say, hey, we know our goal for the quarter. We know our goals for the next 90 days. We’re going to talk about it every week. And then we’re going to talk about the milestones of what we’re going to do and create to do’s about it every week in order to get to our rocks, basically, our big projects for the next 90 days. So if my project for the 90 days is to do external marketing for vision therapy, and maybe I don’t want to do 12 meetings that quarter because that’s once every week, that’s 12 weeks. I’m happy if I do three. Then set that as your goal because I know you’re busy and maybe you’re seeing patients five days a week, whereas I don’t. So if you can’t do that, you can’t do what I do because I don’t see patients five days a week. But you saw patients maybe four days a week or if you saw patients five days a week, then I would commit to doing at least one that quarter. If you do one that quarter, you do four a year. That’s still better than 99 percent of optometrists. If you’re better than 99 percent, you know, you become the specialist in the area.

Bethany Fishbein: I’ll put on my consulting hat for a second also and say that, yes, you might be seeing patients five days a week, but unless you’re seeing five days of fully scheduled patients, you could probably see those five days’ worth of patients in four and a half and have time for a breakfast meeting if doing that was what was important to you. And there’s ways that we certainly make that happen in practices with doctors who thought they couldn’t.

Thanh Mai: Yep, it’s much easier to cadastral schedule. They want to book. I read that there was a maker’s schedule and a manager’s schedule. So the maker’s schedule is that you should schedule time when you’re making things and you want blocks of time for that. And then there’s a manager’s schedule as well, which was you’re working on things, doing administrative tasks and things like that. And so that’s two different schedules in a way. And so, yeah, I would just time block it. So the answer is time blocking.

Bethany Fishbein: And so as this starts to build, I think there’s a point where you hit or where people hope to hit, where then to do more and to keep building it further, you have to start to let go of other things. Talk through that process a little bit.

Thanh Mai: Yeah. So as things grow, you need to basically start having a price that relies on you to do everything is a terrible practice. We both know that what you need to do is slowly let go. And in order to do that, you need to trust people around you. So I think a lot of people we talk about low self-esteem to other symptoms of low self-esteem is a lack of trust and also people pleasing. One thing that you need to do is have the confidence in yourself to let go, have the confidence to train others to replace yourself. And if you do that, you’ll be able to help more people. And having a price that relies on you to do all the special care, I think is actually a dangerous place to be in. So I would always look into in terms of creating the system as I move forward, create the training manuals, create the videos and things like that. We have a video library and we have a doctor’s manual of like if a patient has bacterial conjunctivitis, all of our doctors and our practice prescribe the exact same medication. We just made a manual. I go pick one, bigger box of Besivance, pick one, you know, and we just put that in the manual. That’s how I would slowly start to get myself away from things. Most doctors have an issue. The number one issue, the reason why their time is not, why they can’t create the time blocks is because they have an org chart issue. We call it accountability chart, Bethany, you and I. But they have an org chart issue where they put their name in every box on their organizational chart. And that’s the reason why they don’t have time. So you need to look at, you need to create your org chart, write down your name and all the boxes that you’re in. And then you realize, wait a minute, I’m in 20 boxes. One at a time, one box at a time until you can get out of that, until you’re doing what you do best.

Bethany Fishbein: And hopefully somebody out there is hearing this, is taking these initial steps and gets to the point where they are able to start giving up some of the things that aren’t their own highest and best use. And maybe even moving on to build this not only for themselves, but to teach others just like Thanh, you’ve generously agreed to do today. So any final thoughts, anything you didn’t get to say that you were really feeling burning in your brain there?

Thanh Mai: Yeah. Last thing I would say is this. You know, when someone asks you how you’re doing and you say, I’m good. Yeah. Let’s talk about that. Because when you’re in high school or when you’re in junior high, your English teacher would say, no, don’t say good. Say I’m doing well. Right. Because good is not, I guess, according to them, not grammatically accurate. But I actually like that better. I actually, I want you to say good because I want everyone on this who’s listening to this, go out there and make that real. Start doing good. Start listening to your patients. Start seeing what they’re saying in slow motion and really capture every word. Repeat it back to them so they understand that you’re actually listening. And if you’re doing good like that every day, then I know that you’re going to have a successful practice. I know your staff is going to be happy. I know you’re going to be happy because you’re doing good. And so the next time I ask anyone how they’re doing, if you listen to this podcast, I hope you say, Thanh, I’m doing good. And then I’ll be happy.

Bethany Fishbein: Awesome. Thanh, thank you so much. If people want to find you, where do they find you to get more of your wisdom?

Thanh Mai: Sure. They can certainly email me at thanh.mai@treehouseeyes.com. Treehouse Eyes, not to make this a big commercial, is that we are a company that helps practices grow their myopia management programs in their offices. Again, it’s Thanh, T-H-A-N-H. It’s a weird Vietnamese name with two Hs for no reason. Last name dot Mai M-A-I at Treehouse Eyes dot com.

Bethany Fishbein: All right. And for more information, if you want to do everything Thanh says and absolutely hire The Power Practice, you can reach us at www.powerpractice.com. Thank you so much.