More Pumpkin Planning

Dr.Bethany Fishbein: Sure you can improve your practice by doing any of these dozen things that you get in your email box. The thing is, you cannot humanly do a dozen things to improve your practice today. And what happens is most people look at them, pass them by, file them, maybe they don’t do anything or maybe they listen to one. They think, oh, that’s going to improve my practice, but it’s in a different direction than they’ve identified. They want to go and so putting time and effort into making a little pumpkin grow bigger is taking away from time and effort that you could be putting into the ultimate prize. 

Hi, this is Bethany Fishbein, CEO of The Power Practice and Host of The Power Hour Optometry Podcast. On last week’s episode, I talked to Mike Michalowicz who is the author of a book The Pumpkin Plan and that episode and the conversations that followed it led to a lot of questions about “What does it look like when somebody’s trying to implement this in their optometry practice?” So, for anybody who missed it, go listen to last week’s podcast first. If you didn’t, then you’re not going to, here’s the one-minute summary. The book The Pumpkin Plan is a great book totally worth reading. And it talks about the lessons that business owners can learn from these farmers who grow these giant 1000-pound prize-winning pumpkins that get blue ribbons at the county fairs like the ones people take pictures next to because you could be five and a half feet tall standing up and you’re the same height as this pumpkin. The author, Mike goes on this journey to understand how people grow these giant pumpkins and he takes the lessons that he’s learned and he applies them to the business. So here are just some of my thoughts on what this looks like and how to do it in your practice. And I will say I was doing some research and I went on the website and there are certified pumpkin planners and I will just establish that I am not one of them. But I am a big fan of his a big fan of the book and it’s something that has absolutely shaped how I think about business. And so my thoughts are coming in that context. So here’s the idea behind how you grow these pumpkins.

Number one you got to start with the right seeds. So these pumpkin farmers pay to get special seeds from other pumpkins who have been big prize-winning pumpkins in the past I guess. Once you plant the right seeds, you got to water them and keep watering them and make sure that they’re getting the water and the sunlight that they need. And as the vine starts to grow, I don’t know that much about pumpkins which is gonna be evident like a second if it’s not already, but as the vine starts to grow, there are going to be multiple pumpkins that grow on the same vine. So first you got to get rid of any of the pumpkins that are clearly bad. Like if there’s a damaged pumpkin growing or the pumpkin with any kind of mold or disease or whatever. Instead of letting it stay on the vine and take resources away from potentially your prize-winning pumpkin. You just want to get rid of it so it doesn’t take resources. You want to keep weeding the pumpkin patch so getting rid of all the other things that are sucking nutrients out of the soil, whatever it is that weeds do. And as the pumpkins continue to grow, you start to take the healthy pumpkins that are fine pumpkins but they’re not the big pumpkin off the vine. Again allowing all of the nutrients and resources to go to what you think is going to be the prize-winning pumpkin you’ve identified and you keep pruning and you keep weeding and nurturing the one special prize-winning pumpkin and it gets bigger and bigger and bigger until it’s time for the county fair and you can win.

So to translate that into business. A lot of us as Optometry practice owners are trying to be all things to all people and you look at your schedule and you have patients that you love and patients that you don’t love quite as much and patients that you’re really miserable to see. And so a lot of people have favorite people favorite kinds of patients and you know, they think, “Oh, it would be great if I had more like that.” But the reality is I don’t and they go in and they see whatever they see. And they have some mediocre level of satisfaction and they go home. So instead of that, the idea is that we want to plan the practice, just like the farmer is planning to grow this prize-winning pumpkin. So the first step to do it before you can even start “gardening” in air quotes is you need to decide as a practice owner who your big pumpkins are. Your big pumpkins should be those people that are in the middle of the Venn diagram of people you really enjoy working with, the people who enjoy working with you and see value in your services, and the people who generate healthy revenue for the business. And who those people are or who that category of people is, is going to be different from one practice to the next. When you think about who are the big pumpkins in your practice, I would encourage you to do this. Just pay attention the next week and as you look at your schedule for the day and see the patients who are the people that make you think, “Wow, that was really fun. I really liked working with them. If every patient could be like this patient, I would be a much happier camper at the end of the day.” And it’s not personality so much. There’s always those people you enjoy working with because you catch up on your kids and their kids and they’re funny and they tell jokes and but the ones that clinically you enjoy personally you enjoy. They’re easy to work with a go they follow your recommendations. They appreciate what you’re doing. They thank you as they’re paying their bill. Whatever they’ve paid is enough that you think if I saw four or five of these people a day, that’s all I would need to do, and I would love it. Those are your big pumpkins. 

And it’s an interesting exercise to start to talk about with the people in your practice, especially if you have partners, you have associates because in a practice the big pumpkins should be the same roughly throughout the business if each doctor can specialize a little bit, but within the same general category. So who the big pumpkins are, it’s going to look different from practice to practic last e. In week’s episode, Mike gave the example of athletes because he’s an athlete, he’s a lacrosse player and he talked about a practice really being able to cater to athletes. And in this practice, they found that providing great eye health care but more importantly super well-fitted athletic eyewear made them really attractive to athletes. They loved working with athletes, and because of that synergy they love working with athletes, athletes love working with them. Athletes appreciate the products and the service that they provide. Athletes buy those things which creates financial health for the practice, and that was that practices big pumpkins. Another practice it might be different. Another practice, middle age women with dry eyes might be the big pumpkins. A different practitioner might hate working with middle-aged women with dry eyes and find that they are willing to tolerate middle-aged women with dry eyes but only because they have myopic kids. Sometimes it can be a specialty. Sometimes it can be a hobby, sometimes it can be a certain type or community of people. Some practitioners have found that their big pumpkins are somebody who speaks their native language and becomes great people to work with and great patients for that reason. 

So you talk to your staff, you talk to your associates about who their best patients are not necessarily most profitable, not necessarily those you like most because of personality. But who are the ones that I think Mike said “if we could clone them we would and come to an agreement on these are what our big pumpkins look like.” As you do this. It gets easier, almost inevitable that you start to see the little pumpkin that you’re thinking, “Okay, well, it’s definitely not this”. And as you start to do this exercise, people start to realize that certain patients bring value differently than others. It’s not that they’re more valuable people. It’s not that you can bring more financial value. It’s they’re the ones who kindergarden language fill your bucket where there are other patients who dump your bucket. And what you’re looking for is commonalities in both of those groups. So we’ve got to start to identify who the big pumpkins are. 

Now as you have that, now we start the process of growing the big pumpkin, which is creating your practice, curating your practice to see more and more and more of those people and less of the smaller pumpkins to make you happier and more profitable in business. So then you start evaluating your business evaluating your pumpkin patch, and the first thing is that you’ve got to identify the right seeds. So we know who the big pumpkins are. And we want to make sure that we’ve got the seeds in place to be able to plant more of these big pumpkins. In an optometry practice some of the things that I would qualify as right seeds are. 

Number one is having a strong patient base because some percentage of those patients will be big pumpkins and some won’t, but you have a strong base of patients to start to select from. I think a seed for growing a big pumpkin is a really strong patient experience, where the patient journey is just smooth start to finish. They’re happy in the office, you’re getting positive reviews online. I think seed you need the equipment, especially to do the type of care that you want to do. If your big pumpkin is a middle-aged woman with dry you’ve got to have this staff there to take care of them. If you’re big pumpkin as athletes, you need that selection of eyewear and people who know about it to be able to provide the service that they’re looking for. And I think there’s a really important piece of having strong clinical confidence in the area that you’re trying to grow in. Sometimes I meet doctors who will say “Oh, I want to grow a myopia practice. How do I do it?” And you know, we can talk about marketing and all of that stuff. But before they can even get there. They’ve got to feel clinically comfortable seeing those patients. And passionate about learning to be better and better and better. I think it’s important. So as you put all of these things in place, think of it as planting the seeds for you to start to grow your big pumpkin.

The next step two is watering the seeds. And this is starting to give the big pumpkins and honestly while you’re doing this, you’re given all the pumpkins, the water, and sunlight that they need to grow. In practice, how I interpret this is that you are improving constantly improving your patient experience. Because for any part of the practice to grow, people need to be having a good experience in the office. You might want to refine your processes and make your practice more efficient, especially for the type of care that you want to be able to provide to your big pumpkin. You’re further educating your team, you’re coming up with materials that you might need to give out to support this area of your practice putting information on your website, and marketing things in place. All of that stuff is starting to kind of water the seeds. And the thing is, as you water everything grows. As you make your patient experience better. More patients are going to want to see you not necessarily just your big pumpkin patients but your little pumpkin patients everybody is happy to be better-taken care of. So as you do this, and you see more pumpkins starting to grow. 

The next step is to start to take the damaged ones off the vine. And these aren’t even the healthy little pumpkins yet. Right now. We’re just trying to take out the ones that are broken. Examples of this are things like an insurer that is not paying enough to cover the costs of the way that you want to provide care, right? You have this idea in your head. You want to be the spot for people to come to for a particular type of service. To do that, you’re going to plant the seeds of having a well-trained staff a beautiful office space. You’re working on a patient journey you want to have time to spend with your patients. And maybe you have an insurer that is not either paying you enough to allow you to do it, or maybe is paying but it’s forcing you to provide a different level of service than you know you need to provide in the office to attract the big pumpkins. An example I can think of is an insurance company that requires you to use their lab for glasses. That is going to take four weeks or five weeks or six weeks when you typically can turn around your glasses in a week to 10 days. Right? Because if you continue to see those broken pumpkins, what happens is they’re unhappy with your service. They don’t understand even if you tell them that, oh, it’s the insurance company. We have to use their labs. So they’re blah, blah, blah. All they know is that they can’t see and it’s been five weeks and they don’t have their glasses yet, and they’re likely to go post that review online. They’re not posting “Oh, I have this certain insurance and therefore they’re posting I went to this office, my glasses were broken. I ordered new glasses. It’s been five weeks I’ve called four times I still don’t have them.” And this is something that your big pumpkins are reading online when they are starting to research or practice to figure out if it’s the right place for them. And might think oh, it’s not. So things that are just really broken things that are wrong. Those patients and this is maybe even an individual thing, but the ones that just really make you and your staff unhappy when you see your staff member starting to shuffled for position so that somebody else has to check in mister whatever. Like that’s a patient that’s taking away from what you’re trying to create in an office. 

So first you’re just getting rid of the things that are broken, continuing to water and then you start to weed the pumpkin patch and in my mind the weeds are those distractions that come up that might benefit your practice, but take away from growth of the big pumpkin. You probably get a dozen emails a day like I do have new pieces of equipment new content, another webinar, another class on how to improve some segment of your practice. And probably most if not all of them are really quite valid. Sure you can improve your practice by doing any of these dozen things that you get in your email box. The thing is, you cannot humanly do a dozen things to improve your practice today. And what happens is most people look at them, pass them by file them maybe they don’t do anything or maybe they listen to one. They think oh that’s going to improve my practice, but it’s in a different direction than they’ve identified they want to go. And so putting time and effort into making a little pumpkin grow bigger is taking away from time and effort that you could be putting into the ultimate prize. So for me, weeding is splitting off distractions, not the distractions are things that make your practice worse, although there are some of those. These are the distractions that make it better but not better in the way that you’ve identified it to be better. And just like weeding out in the summer sun is one takes discipline. Not always fun. You’ve got to do it. I think another weed or distraction is new technology that might benefit some of your patients. But doesn’t benefit your big pumpkins. If you are working to build a myopia practice and you have identified that children and their parents, myopic kids are your big pumpkins. This is what you want to grow. And sure you’ve got a whole practice. And so you see people of all ages, but you want to increase the percentage of myopic kids that you’re seeing. And then a rep comes in and they’ve got a device that lets you measure something critical to older patients and they tell you you can measure this and it takes 10 minutes and you can bill $113 for it and you do this and you can do this, right. But unless you’re trying to build care of elderly people as your big pumpkins it’s not technology that puts you in the direction that you want to go. 

So Weeding is getting rid of the distractions making decisions about technology to say yes to the ones that help you build your big pumpkin and to say no to the ones that help you build something else. Another discipline, an area of discipline that you need is in your marketing. The temptation is what many optometrists are doing just to market to bring in everybody. And they figure, yeah, I mean, the more people I have, the more myopic kids all have. And so numbers game, I will end up doing more of that, which we probably will. But if you really want to do more of that and you want that segment to increase in practice, like the percentage of people who are myopic kids to increase, you can’t grow everything. You’ll see number-wise, a few more but percentage-wise, it’s going to stay the same. So as you are weeding, you’re focusing your efforts on the things that are going to grow that big pumpkin. So maybe you ignore the 11 webinars teaching you how to grow your practice in a different way, to watch the one webinar that tells you how to improve your care to your big pumpkins. Your myopic kids, your binocular vision dysfunction, you’re dry, your people interested in aesthetics, your athletes, your Hungarian speakers, instead of language, whatever your thing is, that’s the one you attend to. 

You bring in the technology that’s going to serve that population that you’ve identified wanting to increase your market share, or increase their market share in your practice. You’re starting to market specifically to those patients. And now you see the big pumpkin starting to grow a little bit. Now with this marketing with this equipment, you’re getting a referral and it’s starting. And as that’s happening, the next big challenge is start to remove the smaller perfectly healthy pumpkins these guys are not broken. They’re not leaving you terrible Google reviews. They’re not wreaking havoc in your office. They are fine, they’re fine, nice enough decently profitable categories of patients. That just aren’t the ones that you ultimately want to be working to get more and more and more. So here’s where you’re maybe looking at insurance, again, not the insurance that’s broken that can’t deliver the level of service or isn’t providing you enough to even make it worth showing up that day. This is one said it’s making you some money, but not as much as the ones you’ve identified as your big pumpkin opportunity. Maybe it’s starting to remove certain elements of your clinical care. It’s hard because as Optometrists, we can do everything. And at the same time, if you think about specialists ophthalmologists who are specialists. They are specializing in one specific structure of the eye. They’re saying I don’t even want to see cataract I don’t want to see dry eye. I don’t want to see strabismus I only want to see retina and have set up their office to give the best possible care to people who need to come in for the care of their retina. So as your big pumpkin starts to grow, you’re starting to say things like “well, I really am wanting to increase the number of myopic kids that I’m seeing. I’m seeing two or three glaucoma patients a month. If I have to go to a CE I want to go to a myopia CE, I don’t want to necessarily go to a glaucoma CE. if I want to bring in a new piece of equipment, I want to biometer, I don’t want to newer better visual fields.” And so you may even start to refer clinically some of the patients who are perfectly fine patients wonderful people, and are just not in that niche or that sweet spot of the people you really want to see more of the people who you’re trying to clone the people who if you could see them all day you would be happy and you leave space for them by sometimes letting a different perfectly fine patient go to somebody who’s going to provide the absolute best care to them. Because ideally, you find the colleague who that patient is their big pumpkin. They love glaucoma and they go to all the CE and they get the latest toys for that and they want to really be able to just do a bang-up job so that everybody with glaucoma refers their friends from the glaucoma support group and they get more and more and more of those. And ideally, as they’re building that, maybe they’re not super interested or comfortable in seeing kids. They say, “Oh, a seven-year-old minus two. Well, I’m not going to touch that. Glaucoma I can deal with but I don’t have the equipment. I don’t have the desire. I don’t have the setup. I don’t have the staff training to be able to see this.” And the best synergies are where those practitioners find each other and trade, not like an official trade deal. But I know you, I trust your work. I see what you’re doing clinically. I know this is the type of patient you’d love to see. I don’t love them as much. Here’s my glaucoma patients, but hey, I’ll take your myopes and give them that level of care that you’re giving my glaucoma patients and now you’ve got two neighboring farmers growing awesome pumpkins. 

The beauty of optometry is in that situation. It’s not a competition. There’s no blue ribbon. Everybody wins. So, as you continue, you’re doing it more and more. And you’re really now working to continue to grow and nurture this one giant pumpkin on the vine your practices big pumpkins. So as you do that, it’s about really figuring out what those big pumpkins are looking for. What makes the practice comfortable for them. You’re going to do a dry eyes aesthetic practice, tea sounds lovely. If your big pumpkin is children with disabilities, you don’t want hot tea anywhere near that office. So you start to put things in place to make everything in the office very comfortable for the type of patient that you’ve identified as the one that you want to grow. It can be things within the office or even things online on your website. The pictures that you have in the office should be pictures that look like people the practice is most wanting to attract. A practice that’s going all in their big pumpkins are elderly people. And those are the target demographic for your big pumpkin practice. Then your website should have older people and yeah, a parent making an appointment for their two-year-old is going to look at this website and see all the gray hair and maybe even a walker, and whoa, wait a minute. This looks like a geriatric practice. This isn’t right for my child. Yes. And at the same time, somebody who fits that geriatric profile. Maybe that same patient says “this is absolutely not the right place for my child but grandma, have you heard of this?” And the patients that you’re looking for are the ones who are going to be attracted to that. When that patient calls the office, the person on the phone has to be ready to take a call from that patient. In an office catering to a geriatric population the people who answer that phone should absolutely know the ins and outs of Medicare and the advantage plans and how to do it and options for transportation if somebody no longer drives. They might have appointments available during the day, a pediatric practice might need to have appointments available in the evening or on weekends to cater to that population. So everything gets set up for the type of patient that you want to be most comfortable in your practice. It’s not exclusion. It’s not that you’re not willing to see the others. It’s that the ones that you want more of are absolutely going to feel fully comfortable from initial look at the website right through that first phone call to when they come in. You’re catering to an elderly population. You want to have arms on your chairs. If you’re catering to a pediatric population you want to have beanbags and toys. Either of those is more productive than a practice that doesn’t know what they want and has elderly people next to children on the website next to hot tea with a beanbag and toys it creates confusion. As that patient moves through the practice. Everybody is comfortable in this specialty to the point that that patient leaves saying “I feel fully comfortable here. I feel like I was well taken care of. I have no doubt that I am in the right place. And I can’t wait to tell my other friends who are just like me that this is where they have to come”. And that’s how they start to clone themselves increasing the percentage of the population in your practice who fits the criteria for big pumpkin status. Decreasing the percentage that doesn’t, because you’re creating space for more of those who do. And you start to feel like those patients who are in that big pumpkin category have started to truly clone themselves. And you go back to thinking at the beginning of this process a year ago, two years ago. When you first started and you thought about if I could clone these patients and just see people like this all day, I would be thrilled. And all of a sudden you realize a year later, 18 months, two years later, that that’s exactly what has started to happen and you keep weeding and you keep pruning and you keep kicking out the smaller ones as you can and let the process continue to go. You watch your great big pumpkin grow and grow and grow and enjoy the results. That’s my take on how to Pumpkin Plan your practice.

So if it’s something that you’re thinking about, you’re looking for some help along the way, please reach out to us. Our website is powerpractice.com  you can email info@powerpractice.com .Connect with me on LinkedIn. I’d love to hear your thoughts on this. This has been somewhat life-changing for me and I hope this gives some benefit to you as well.