Is there a formula for successfully building a specialty practice? In this episode of the Power Hour, Bethany sits down with Thanh Mai, O.D., who shares his inspiring story of building a “super-specialty” practice focused on myopia management, scleral lenses & vision therapy.
Dr. Mai is the founder of Insight Vision Center Optometry and has been involved with Treehouse Eyes scaling their myopia management business. He shares insights about building a specialty practice from scratch, and provides doctors with resources to go from “dabbling-in” specialty care to jumping right in.
His conversation with Bethany offers a unique perspective on what it takes to fight imposter syndrome, stay accountable to your own goals with realistic timelines, and find the right support to help you along the way to help you make your dreams a reality. In discussing his journey, Dr. Mai shares a formulaic approach that includes setting the vision, identifying the “how”, picking your supporting “whos”, and building systems that replicate your success.
This advice has helped him, and many other practice owners build their cash-based specialty practices. Listen in to get inspired and take action towards the practice of your dreams.
July 12, 2023
Read the Transcription
Becca Starks: We have the ear with the students to hear what they’re looking for. They’re very, very few students that we’re working with, with the class of 2023 that will even consider an opportunity that is not private practice.
Dr. Bethany Fishbein: Hey, I am Bethany Fishbein. I am the CEO of The Power Practice and Host of The Power Hour Optometry Podcast. And I just want to first congratulate all of the new optometrists graduating this week from the optometry schools across the country. It’s such an exciting time. It doesn’t feel like that long ago since I and my classmates at New England College of Optometry in 1997 graduated. It goes fast. It’s really an exciting time. So congratulations, first of all, and this show is inspired by and dedicated to you and all of the people that you are hoping will hire you. Once you get your licenses and get out there into the world. So I’ve invited a guest, I have Becca Starks, Becca handles Enterprise Accounts and Operations for KMK Careers. And she’s here to help me sort out some of the things that today’s optometry students are looking for, and help educate some of the optometrists who are looking to hire young optometrists about misconceptions they may have or differing perceptions of this graduating class. So, Becca, thanks for doing this your second podcast ever. That’s awesome.
Becca Starks: Yes, thank you for having me. This is exciting.
Dr. Bethany Fishbein: Yeah, thank you. It’s an interesting time because we work with mostly established optometric practice owners. So most of the people that I’m speaking to day to day are employers of young optometrists, and they have this vision of what today’s graduates are like, and then I get the opportunity to speak with optometry students and recent grads and they’re not necessarily like that perception at all. So hopefully, you can help us bridge the gap a little bit.
Becca Starks: Yeah, absolutely.
Dr.Bethany Fishbein: So, talk about yourself for a minute here. I want you to just talk about KMK and KMK Careers because when I want to data on students, I knew you were the one to go to. And so I want all of my listeners to understand your involvement with young optometrists today.
Becca Starks: Yeah, absolutely. So KMK for those that don’t know KMK’s foundation is the KMK board review, which was started 18 years ago by Dr. Kyle Cheatham. And now fast forward 18 years we are inside of all of the 23 optometry schools nationwide. We have a team of optometrist instructors that traveled to all of the schools and we have a relationship with both third and fourth-year optometry students and 98, This is a big number to remember 98% of optometry students utilize KMK to pass their boards. So essentially we have a relationship with almost every single optometry student nationwide from the board’s perspective. And so we now have a new division of KMK specifically on careers which is just a natural extension of supporting those same students and finding their first career.
Dr.Bethany Fishbein: So you’re initially talking to these students when they’re students studying for boards. And then they hopefully pass boards and you know, move on and take more boards and pass those and move on. So what are the services that you’re providing for these students once they’ve graduated as doctors?
Becca Starks: Yeah, so it’s really fun. Personally, I am mostly an employee you’re facing so those that are looking for these candidates. However, we have a team of career advisors and all day long, they’re the luckiest ones in the world. They get to speak to these upcoming grads. So right now they are around the clock talking to those that are about to graduate here and a couple of weeks or maybe have graduated just recently. And uncovering what they’re looking for in a practice is really it’s a one-on-one relationship, so it’s totally free to students. They sign up to get a career advisor. They have calls with that career advisor to uncover what are they looking for what type of practice is it specific specialties, just anything that may be the true motivating factor as to why they want to go to a certain practice. And then essentially we play matchmaker so the career advisors speak to students all day long. I speak to employers all day long, and then we come together and get to build a bridge between the two and hopefully connect great candidates with a great opportunity.
Dr.Bethany Fishbein: Maybe it’ll be the next Netflix show after Indian matchmaking, Jewish matchmaking. It’ll be optometric career matchmaking. And be a celebrity.
Becca Starks: I think some of us would watch that, at least your listeners would probably enjoy that.
Dr.Bethany Fishbein: My husband and I would watch it so
Becca Starks: same.
Dr.Bethany Fishbein: So I mean, you’ve got a line of sight into exactly who today’s optometrists or today’s graduating class, today’s brand new optometrists are, can you give some facts and figures of what that class looks like?
Becca Starks: Yeah, so essentially, from a demographic perspective, it’s highly female. The data is showing 70% female and 30% Male.
Dr.Bethany Fishbein: 70?
Becca Starks: 70 Percent.
Dr.Bethany Fishbein: Wow.
Becca Starks: Yes. And there’s information I believe you are going to be able to put in the show notes. But there is a really robust report. I believe it’s lots and lots of pages. I don’t remember how many but there are highlights within that on pages nine and 10 that give a really good but really quick summary of demographics of this class, within gender within race. There’s even financial information about how many needed to have financial aid, that sort of thing, and some really detailed information even about by school breakdown.
Dr.Bethany Fishbein: Are you able to roll through some of the things in there that kind of stood out to you?
Becca Starks: So the biggest thing that stands out to me is female and how as you it shows kind of year over year how that transition has changed from much more female than male as it was in the past. Same thing with race, I believe I don’t remember how many years ago it was but just not too long ago. It was predominantly white for professionals graduating and now that’s shifted to highly other races, whether it’s Asian or black or other races that are included in that.
Dr.Bethany Fishbein: And what about the financial piece? Because I feel like that’s such a big topic for new doctors. Is this need to pay back student loans? Do you have any stats on the amount of debt that students are graduating with?
Becca Starks: Yeah, so the report itself shows 85% of students are utilizing some type of support financial aid, loans, and the average for a graduate right now graduating is about $200,000 in debt. So definitely it is.
Dr.Bethany Fishbein: That’s just from optometry school or that’s including undergrad debt?
Becca Starks: That’s actually a good question. We just get the stat of 200,000 and I assumed it was just optometry school. But that’s a good question.
Dr.Bethany Fishbein: So young, female, and any change in like age demographic? Or is it typically right out of college a year or two out of college starting into Optometry?
Becca Starks: Yeah, So typically, it is kind of a typical route straight out of undergrad and to optometry school. There is about of the 16-1700 graduates there are about 150 of those that are considered you know, like other avenues whether that would be part-time or returning back in at a later point in time.
Dr.Bethany Fishbein: Okay, so out of 1500 you’re talking about? Very typically, right? 1000 young, female, probably non-white doctors.
Becca Starks: Yeah.
Dr.Bethany Fishbein: If you had to say this is what’s typical. This is the majority.
Becca Starks: Yeah.
Dr.Bethany Fishbein: With debt?
Becca Starks: Yes. A lot of it.
Dr.Bethany Fishbein: Okay. So, when you talk to this typical doctor and are getting into the field of matching into a career of their dreams, what are they telling you that they want?
Becca Starks: Yeah. So it’s been interesting to learn that so the things that I came into this thinking people would want my background was actually at LinkedIn for five years before coming on to help launch this division of KMK and I thought it would be very different. I would think pay would exceed everything else. But, interestingly, location is the top deciding factor for these new graduates in determining which practice they want. Obviously, that is the hardest answer because no one can do anything about the location of their practice. But we can touch on this later. Kind of some ideas and tips for those to try to recruit folks into harder locations but definitely the location. Again, before and above pay even this work-life balance coming into play that is much more of a topic. Then I think it has been in years past. Not necessarily meaning, Hey, I want to come in and I want to never work. But this generation is much more just passionate about having that work-life balance of the work to live not live to work mentality. And so location, work-life balance, obviously pay, and structuring pay in a way that is understood to the candidate as well too. So being very upfront about what that pay is so that they know before even applying and putting that in a way that they understand what they actually can make because sometimes it can be hard with percent of production, knowing what that means.
Dr.Bethany Fishbein: So let’s go into those a little bit more and I want to just go back one to work-life balance because I think that’s probably the biggest misunderstanding between a doc maybe in their 50s and a doc in their 20s. This idea of working to live instead of living to work and it’s respectable and it’s necessary and mental health is important and it’s and life has to work for you. But these older docs, that was not their world. And so when I hear it, it’s complaints. They won’t work weekends, they don’t want to put in 40 hours. They’re asking for a four-day workweek. They’re like it’s coming across as we’re lazy. We’re not dedicated to the practice. We don’t want to be here we’re not going to work as hard as you and it. It creates a disconnect from the start like somebody interviewing, who says I don’t want to work every weekend. All of a sudden has all these judgments thrown on them that they probably don’t deserve. Do you see that with the docs that you’re talking to and you’re matching?
Becca Starks: Oh, absolutely. Yeah, it’s the same thing I hear to have. You know, that’s typically the demographic of employers that I’m talking to all day long to have, you know, they came out and maybe cold started or they came out and bought a practice and they’ve been doing it for 20-30 years and like. What?
Dr.Bethany Fishbein: Right and they remember, or maybe they’re still working 70 hours a week and they’re there, you know, every day in the practice and their day off there when the cleaning themselves because that’s what the owners do. How do you coach of 50-something and 60-something-year-old practice owners into understanding that it’s not laziness and it’s not to they don’t want to work?
Becca Starks: Yeah, so that is it is a big misconception of the students that it is laziness, and specifically, most students are expecting to work at least one to two Saturdays a month. So it’s not that they’re coming in and saying I only want four-day workweeks, and I’ll never work a weekend. They are expecting a true full work week and one or two Saturdays per month. To your question about how to coach an owner in that situation. I think it’s just taking a step back and looking really high level at your practice as a business and I’ve had this conversation with many owners of I don’t know why we are open Saturdays, honestly, we’ve just always done it and so determined are we doing this because it’s just always been done or when determining this because it is a true business need. And so same thing with later hours or that sort of thing. If it is a true business need 100% voicing that to a candidate that’s a friend and that’s that’s great, but there may be situations where again, it’s just we’re doing this because it’s been done forever. And actually, our patients wouldn’t mind if we didn’t have a late night or we had a late night instead of a Saturday or vice versa.
Dr.Bethany Fishbein: Do you think docs have like a little bit of that? It’s like that hazy mentality? Like I went through it I put in my time therefore you you need to.
Becca Starks: I think it could be a little of that. Me not being an optometrist. I have to tread lightly because I have not earned my dues. But in the conversations that I’ve had, I think it is a little bit of that at least.
Dr.Bethany Fishbein: Yeah, I worked weekends for 23 years. I’ve never missed it Saturday. I’ve never called out sick. And now I’m going to change my whole practice because this 24-year-old kid doesn’t want to work, like there’s that so what are the students are the new grads thinking about these practice owners, doctors who are in a different demographic from them because there’s got to be misconceptions going that way also.
Becca Starks: Yeah, I don’t get to hear a ton of the misconceptions from the student side. But I think there’s just both sides can teach each other something right like maybe that student can come in and show this business owner who’s been doing this forever, like, wow, I could totally do this differently. And, wow, I’m kind of relieved that you came in and brought up the idea of work-life balance because I as the business owner, really needed that, and wow, my life is different because of it and vice versa. There’s obviously so much that the practice owner can teach and pour into these new grad optometrists. But as far as misconceptions from them, I haven’t heard any to be honest.
Dr.Bethany Fishbein: I hear that they look at a private practice. They think they’re not going to be paid as much. So they’re thinking that not necessarily that the owner is cheap, but that it’s not. It’s not as profitable, therefore there’s not as much money in it for them. You didn’t mention the mode of practice. You talked about location, work-life balance, and pay. Are students coming out looking for commercial opportunities? Are they looking for private practice or looking for MD offices? I mean, obviously, students are looking for each of those, but what are you seeing most frequently?
Becca Starks: Yeah, great question. So motor practice is very important and private practice remains. Top of the list for I’d say close to 90% of the new grads.
Dr.Bethany Fishbein: Serious?
Becca Starks: Yeah, because I hear the same thing. I hear a lot from private practice owners that say that almost come to the call with me very nervous, like “Becca, what’s going on? Why might all the new grads want private equity and why do they want retail? And can I really afford to hire them? Because it sounds like they’re throwing all the money in the world with them.” And then it’s interesting because we have that ear with the students to hear what they’re looking for. They’re very, very few students that we’re working with, with the class of 2023 that will even consider an opportunity that is not private practice. So there’s just a handful of folks that have said all maybe look at private equity or retail, but the vast majority say I truly, truly, truly want to private practice and there’s even a really good group that says, “Not only do I only one a private practice, but I already know that someday I want to partner slash buy this practice as well.”
Dr.Bethany Fishbein: Do you think though that it’s, it’s like self-selecting a little bit because retail opportunities are so easy to come by? That they might not even consider needing to work with a company like yours? They just need to go on Ziprecruiter, Indeed, and type in optometrists job and the geography they want and they have their choice. Are you talking to them before they’re job-seeking?
Becca Starks: Yeah, so we actually start a process with them a year before they graduate. And so we have them fill out a profile with us it looks just like a LinkedIn profile, but it’s specifically for KMK, and go in and select all of the different types of practices that they’re open to. And so, we have both from the data from what they input on their profile and then they all have a one-on-one call with a career advisor as well. And so that’s where those points come from, both in the data they enter and then the conversations they have with a career advisor.
Dr.Bethany Fishbein: And is that when a student should be starting their job search is early in fourth year?
Becca Starks: Yeah, so we were really surprised in the timeline as well that a lot of students start having conversations about the fall before they graduate. So this class of 2023 they were starting interviews, October timeframe, and then a lot of them were during their Christmas break, timeframe holiday break, going on visits to practice owners. And then as soon as the New Year transitioned over there were many that were in contract. So definitely, Fall time is like you can feel good. About yourself being ahead of the game, wintertime is still very safe, you still have a lot of opportunity to be reaching out to candidates, and then as we enter into more of the springtime, a lot of I’d say probably half if not more of those that we’re working with are 100% in contract ready to go.
Dr.Bethany Fishbein: When you start working with them. Is there any issue with students who are starting the search and still haven’t passed their boards or won’t have the credentials to work when they graduate?
Becca Starks: Yeah, Yep. There is information from ASCO also about passage rates. And it goes into detail even of school by school, but it essentially shows year over year the decrease in passage rates, and I think we’re at about 70% passage rate, right now. 73%. And so there’s a huge population of students that don’t pass typically it’s part one where the struggle is and so there are some students that will even graduate and still have not passed boards. And another misconception there is, “Oh, these students are lazy or they’re not understanding the information, and I don’t want those students because they won’t be good doctors”. And completely not true. Those are students that could either be not very good test takers. These are also the population that came into optometry school right in the heart of COVID. There are some that have just had really rough life events around the time that it is to take boards and so but they are all great people that will be great doctors, they simply just need to pass this test. Many of them have had really great GPAs some of them have other degrees that help them with the practice management side and so it’s just a matter of getting past that one test or many of them.
Dr.Bethany Fishbein: And how does, how did they navigate that with the job contract like, will an employer sign something with a student who hasn’t yet passed boards?
Becca Starks: Yes, we are running into that actually part one. Board scores were just released this past week. And it was a lot of that there was a lot of celebration and there was a lot of sadness around those that didn’t pass. And the good news is, I don’t know that I’ve come across a single employer partner that we work with that isn’t at least open to the idea of bringing on someone that’s graduated in kind of a super tech role. It’s kind of how we position it to practice under that optometrist owner until they graduate and we even have some that say, “Hey KMK I know that you, as an organization, do great at coaching them and helping them after they fail boards.” I will even invest in that side of the house to ensure that they can pass boards not only to show that, hey, I believe in you and the hardest time in your life student but also that gains them a really loyal employee that again, is going to be a great doctor has just had trouble taking this one test.
Dr.Bethany Fishbein: Coming in as a super tech though, obviously, they’re coming in at a lower pay scale and they would come in as an optometrist, and they have those student loans. So let’s talk about compensation of obviously it’s going to vary around the country and regionally and how many hours and all of that but what is it that a new OD is looking for as far as the ability to earn money?
Becca Starks: Yeah, good question. So, specifically with this new grad population, the way that I kind of coach, the employer partners that we work with private practice owners is, a lot of times they’ll come into the call and say why pay 16% of production, but with this new grad population, they aren’t able to really wrap their brains around what that is, you could have a $1.5 million, your practice and they still just don’t, they can’t really understand that. And so the recommendation that we give is to at least have some sort of salary and we have information and concrete data on specific areas of the nation. So by all means, if, if we can support you in any way with that, I’m happy to to make sure that you’re competitive, but having some type of salary listed up front is what’s going to entice these new grad population because they can wrap their brains around 140,000. They can’t necessarily wrap their brains around 16% of production. And so totally understand, then obviously the argument private practice owner, I hear you what’s going on in your head is. “Well, I need to motivate them to work hard. Like if I just give them a salary, then what’s the motivation to work hard”, and so there’s been kind of this really nice avenue that we’ve taken with a lot of partners that’s worked well in that advertising a salary a little higher than you probably would have normally, but then decreasing to a really low percent of production, so that there’s some salaries that’s there that’s enticing to a new grad, but a lower percent of production. So for the first year only, so year one higher salary and lower percent of production, and then having that shift for year two and year beyond your two to a lower salary, higher percent of production. And so what that does is again, entices this new grad to apply, and even want to learn more about your practice because there’s a salary, but that little bit of percent of production will get them to realize in their first year of working well. I’m doing the math, and if I would have went on the percent of production, I probably would have made more than my salary. This is making sense this is motivating me to work harder. And then again, you can even have it in the contract that upon year two that shifts to a lower salary that’s guaranteed and a higher percent of production. So as they’ve gotten their feet wet, they’ve learned they’ve been mentored that first year shifting then into percent of production.
Dr.Bethany Fishbein: So you’re coaching your doctors to do a salary plus a percent of production?
Becca Starks: Yeah, that’s pretty typical.
Dr.Bethany Fishbein: And what about benefits and stuff like that is that important? Yes, it is important. Is that something that a brand new grad is going to give enough importance to that it’s going to help them decide one place versus another?
Becca Starks: Yeah, such a good question. So I’ll give both sides just agree very important. I would say the majority of private practice owners that we’re working with are offering some sort of benefits, whatever that might look like. Some are very comprehensive, some are very “Hey, we will pay 50% of your medical and leave it at that.” But now that we are in this lane of there is competition from private equity and from retail. Those are just a no-brainer. In those avenues. And so to remain competitive from that regard. They will get a full package of 401K’s with matching with benefits with PTO, all of those things, if they’re considering a retailer or a private equity opportunity in comparison to your private practice opportunity. And so, again, I think most I talked to very few that say “Hey, I’m just percent of production and I don’t give any days off you just you if you’re here you make money if you’re not, you don’t but you can take whatever days you want type of thing”. I have a handful of those but for the most part, most private practices are offering the salary with percent of production, at least something towards medical, and then most do have a 401K whether there’s a match or not with that.
Dr.Bethany Fishbein: Are there other intangible benefits, other things that would make a practice more attractive?
Becca Starks: Yeah. So I think the thing that’s so such a great opportunity with all of the listeners that would have that are trying to hire than our private practice owners that have been doing this for years to a new grad specifically is mentorship. And so those that are willing to do that are excited about that. Well, maybe “Hey, I haven’t really even thought about that. But I’m gonna share over the last 20 years, I really have learned a lot that I could pour into this next upcoming generation”. And so being very vocal with that, even in a job description, or whatever it is that you’re creating, to entice candidates to come your way and some people put a really extensive plan behind, “Hey, we have a weekly meeting, and you get lunch hour with me every week and we will cover XYZ and some it’s kind of informal of just “Hey, I’m going to be with you I’m alongside you. You can call me when you want”, whatever that looks like, or even if you haven’t, some team members that are fairly recent grads, being able to vocalize that to have hey, we’ve got folks that I brought on board as new grads and couple years later looking them go and so the mentorship side is again that intangible free opportunity that I think a lot of people don’t even necessarily recognize they have the ability to give.
Dr.Bethany Fishbein: Is it mostly clinical mentorship they’re looking for? is it practice ownership? like when you say mentorship, what are they hoping to learn from you?
Becca Starks: Yeah, definitely medical at the top of that, but there are again, those those candidates that just know that they know that they want to be very involved in the practice management, the business side of the house. And so for those candidates that are interested in it, being willing to say “Hey, here’s I’ll show you all of our programs and all of our software and how I design the day and this is how I designed the business side of the house”, and so in those situations for folks that are interested in that side, I think it’s important to have just kind of an open door policy of “I’ll show you all that. I’ll show you that number. So I’ll let you in on this.”
Dr.Bethany Fishbein: So for practice in a particular geographic area, if you can get your salary and benefits close, but they don’t necessarily have to be higher. They just have to be within range and you can kind of check off all the other boxes. Is there a type of practice like heavy medical versus refractive versus specialty that people are looking for?
Becca Starks: Yeah, so definitely looking at highly medical. And then what I would also say is kind of another somewhat intangible, but if practice owners are open to new specialties that maybe you don’t have in your practice right now. But hey, if there’s somebody who comes in and is passionate about whatever it may be, and they want to bring that into my practice, that’s a really enticing thing for a candidate to really see themselves. They’re in the long haul of “Wow, I’m passionate about myopia management and this practice says, by all means bringing that on.” That’s such a great thing to be able to offer to a candidate and so definitely, medical and specialties are really where the candidates are wrapping their brains around of how do I see myself there.
Dr.Bethany Fishbein: And what if you’re in rural Wisconsin, where there’s just not a huge population of optometrists looking to settle? What’s the best way for a practice like that to set themselves up to find somebody to join because so many of those are great opportunities to become part of a community to ultimately partner buy a practice have a really low cost of living like it’s how do they make themselves attractive or show how attractive they are I guess I should say.
Becca Starks: Yeah, and I think that so often because I get the luxury of talking to these practice owners in some of these more rural areas. And every time I’m just like, Wow, if I could just record this and let all of these candidates see this owner care about the type of patients they get to see a lot of times it’s the smaller communities that because there’s not a nearby ophthalmology or another office like those are the most medically focused practices.
Dr.Bethany Fishbein: Absolutely.
Becca Starks: Yeah. And so, so often I feel better. Oh my gosh, if I could just package this up and get a candidate to truly wrap their head around it. So one of the things that we do on the candidate side is our current advisors do as soon as a student comes in and says, “I only want Miami in New York and LA”, we try to mentor as well and show your kind of cost of living and let’s truly take a look at this and let’s look at your lifestyle and look at
Dr.Bethany Fishbein: Miami, LA, how about rural Wisconsin?
Becca Starks: Right? Yep.
Dr.Bethany Fishbein: And consider Minnesota.
Becca Starks: Exactly. We play that game all day long. Yep. And then to the practice owners, a lot of what I tell them is, they’ll tell me I say they get to brag. So give me your brag book, when they come on as a partner to me, tell me what’s so great about your practice. And then they’re typically ready to end the call and I say, “Okay, based on your area, we also want you to brag on the geographic location just as much as the opportunity and so getting a candidate to truly understand what their life is going to be like, not just when they’re at work with you all day, but once they leave work, and what does this community look like and what can I do there? Is it great for hiking, is it great for the music scene, and the art scene? Is it great to raise a family and maybe I’m not thinking about that right now. But in the next couple of years, I will be.” And so I always say “Somewhere in your job description, however, you want to do it. It’s a post that you’re putting on to kind of an Indeed or an AOA. Having information, just typed information about your geographic area and what makes it so great. And then also, the other added thing you can do is you can always create videos.” Videos are I feel like that’s kind of how we’re all digesting content at this point. And especially this generation of these new grads, and so if you can even do a quick it doesn’t have to be professionally shot but videos of you just speaking informally, almost as if you’re speaking to a candidate who wouldn’t be right in front of you talking about again, envisioning their life there, the more that a practice owner can make a job description or job post about the candidate instead of themselves. The better that that’s going to relay to the candidates have just really getting to understand “Okay, this isn’t what I thought I was thinking Miami, but now I can kind of envision how my life could be in Wisconsin.”
Dr.Bethany Fishbein: That’s a really strong and valid point. Because when I think about a job ad, it’s all about what we need and what we want. We’re looking for an optometrist to work these hours to do this and when I’m interviewing candidates for Associate optometrist, but really for any position I’m always sensitive to an applicant, who all they’re telling me is what this job is going to do for them. Right. So I’m very critical of it as an employer when they’re like, I’m looking to build my clinical confidence in myopia. I’m looking into, you know, whatever. And I think what are you going to do for me? But in the ad, maybe it should be the other way off, Here’s what I’m going to do for you so that they’re interested and intrigued by the post enough to then come in and want to tell me what they are going to do for me so
Becca Starks: Absolutely
Dr.Bethany Fishbein: Cool.
Becca Starks: We even have one it’s a Power Practice member that wrote a personalized it looks just like a letter you would receive from your grandma in the mail and it was so different and so eye-catching and so engaging. It was truly just a personalized letter, Dear Candidate, and then it just spoke really informally like, Hey, I get it. Words are hard, school is hard, but here’s what it would be like living here. Imagine if you could leave work and go out and do this, this, and this and your two hours within this big city so you can go catch a basketball game and be back home at night. And so it was just very, again trying to get that candidate to envision their life not only with that practice but in that geographical location. And so that was an incredible example.
Dr.Bethany Fishbein: Did it work?
Becca Starks: We’ve gotten some interest. We don’t have anybody signed on yet, but it has enticed interest.
Dr.Bethany Fishbein: And talked about KMK a little bit again, just before we close. So if a practice owner is looking for an associate, they can reach out to you or how do they go about tapping into this database network matching service that you guys have?
Becca Starks: Yeah, absolutely. Yep. I would be the point of contact Becca Starks. And I’m sure you can put my email in the show notes, but it’s just Becca@kmkodcareers.com. And yeah, we typically just do a really informal introductory call and learn about the practice, learn about what they’re looking for. And then go over kind of our offerings. We’ve got two different offerings to choose from, just depending on what the practice owner is looking for. And then yeah, we just go from there. It’s really simple. It’s free to be in agreement with us and having us promote a practice. And so basically, we get that agreement going and then our current adviser starts promoting any of our partners that we’re working with. And then essentially once we have a student that is a great fit, we play the matchmaking game.
Dr.Bethany Fishbein: I love it. Thank you. I think this is valuable information for new grads to help them understand what they’re going out into and some of the misconceptions they might be facing. But hopefully, we did our part today to try and reduce some of those and really give today’s employers a more real picture of new grads who are looking for jobs. So thank you so much for taking the time to do this and give this service to all of the optometrists out there.
Becca Starks: Absolutely. My pleasure, Bethany. Thank you. So much.
Dr.Bethany Fishbein: Thank you
Read the Transcription
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 firstname.lastname@example.org. 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.