The Optometry Money Podcast Ep 165: Finding the Bottlenecks Limiting Your Practice’s Capacity with Kerry Reeves, OD

Transcript for The Optometry Money Podcast Ep. 165 Finding the Bottlenecks Limiting Your Practice’s Capacity with Kerry Reeves, OD

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Introduction to the Episode

Evon: Hey, everybody. Welcome back to the Optometry Money Podcast, where we’re helping ODs all over the country make better and better decisions with their money, their careers, and their practices. I am your host, Evon Mendrin, Certified Financial Planning Practitioner and owner of Optometry Wealth Advisors, an independent financial planning firm just for optometrists nationwide.

And thank you so much for listening. Really appreciate your time and your attention today. On today’s episode, we have Dr. Kerry Reeves, owner of Advanced Eye Care, with locations in North and South Carolina. Kerry unpacks how optometry doesn’t have a growth problem, it has a capacity problem, and we dive into how important systems are to running a smooth optometry practice, how optometrists can find and fix the bottlenecks in their practice to improve capacity, and how dependency on the owner causes fragility and impacts the value of your practice.

And finally, [00:01:00] we wrap up with AI. We talk about how optometry will be impacted by and be able to use artificial intelligence. And I’ll throw all the links and resources we mention in our show notes, which you can find at our education hub at our website, www.optometrywealth.com. Reach out if you have any questions, and without further ado, here is my conversation with Kerry Reeves

Conversation with Kerry Reeves, OD

Evon: Welcome back to the “Optometry Money Podcast.”

I am excited to welcome onto the podcast Dr. Kerry Reeves. Kerry, thank you so much for coming on.

Kerry: Oh, thanks for having me. For sure, excited

Evon: I’m excited to talk with you about, operations and capacity and improving capacity within optometry practices. But before we dive into all that fun stuff, I wanna get to learn a little bit more about you and your practice.

Tell us, y- you’ve got a few things you’re working on, right? Just looking through your presence online. You have your practice, Advanced Eye Care in North and South [00:02:00] Carolina. It looks like you’re working on a patient engagement platform in EyeCoin. You have a skincare line with your wife, and y- you’re working on a lot of really interesting things.

Tell us about your background. What got you into optometry? What led you to practicing where you are now, and tell us about your practice

Kerry: All right. it kinda turns out that I just realized this week that the group of students that are graduating and going into practice may not have been born when I started practicing. It’s the first year that I have been practicing longer than they have been born, and so that was a, an awakening moment for me.

So yeah, I just started off doing this about 27 years ago, and started off, came out of optometry school, went to UAB, went into private practice in Newton, North Carolina, a little main street-type practice with a, optometrist that had been there for 40 years, and he had a junior partner, and then I came in and did that for about 10 years. and just through some crazy stuff, I ended up… We sold everything and moved to Haiti and, started doing [00:03:00] optometry down there where we were setting up clinics throughout the, the country where they

Evon: Wow

Kerry: clinics. And then six months after we moved is when the earthquake hit in 2010, and so that changed everything.

And so we spent about five years down there doing that, mostly changed from just optometry to earthquake recovery. and then after that, moved back to the US. We have, I have a lot of kids. I have, we have eight kids total, four of them are adopted, and a couple of them had some learning stuff that we couldn’t do down there, so we moved back to the US. actually, before I didn’t have a… We moved back to Florida where we had a little condo, but I didn’t have an optometry license in Florida, and so I didn’t know what I was gonna do. I actually applied to be an RV salesman and didn’t get hired for that. then I started working as a tech at Florida Eye Institute.

So I worked as a tech, for an ophthalmology group, until we figured things out, and then I ended up moving to Georgia, where I’m from, and spent five years working with a cataract surgeon. learned a whole lot working in ophthalmology with him. And then in 20- end of [00:04:00] 2018, we moved back to North Carolina.

I bought a practice up here in Fayetteville, North Carolina, to be closer to kids and, grandkids. We have actually, have a grandchild number seven being born

Evon: My goodness.

Kerry: Yeah … and one more later in the summer. So I’ll have eight kids and eight grandkids by the end of the summer. and so moved back up here to be closer to them and, and then we since then have added a practice in Myrtle Beach, South Carolina as well.

And that’s our optometry practice side is we’re in Fayetteville, North Carolina, Myrtle Beach, South Carolina. and then we do the, whole EyeCoin thing has been really an engaging, fun adventure, of establishing, building a software program for patient follow-through to try to improve follow-through.

you know how talk to patients, oh, I’ve come up with this great diagnosis, man, I did great job on all my stuff and I thought I educated them good and had them all pumped about doing what I recommended, and then three months later they hadn’t done nothing. It’s not any better. They’ve not used the drops or, they’re not [00:05:00] following through on the myopia stuff.

And we’re developing a software program to help improve follow-through, patient engagement follow-through, so that’s been exciting. Learned a

Evon: Wow

Kerry: what I didn’t know about software and, stuff. So that’s been exciting. and then just really working with systems. I got into systems when we lived in Haiti, because everything there is broken.

Evon: system you can imagine is broken, and, so we had to, create our own electricity, pump our own water, do everything, and and then also just with the education, with the economics, started looking at systems. And then when I moved back to the US, I began to realize a lot of what my issues were in optometry were also revolving around systems.

Kerry: And so really got engaged in realizing that systems and capacity and bottlenecks and, that kind of fun stuff, really has helped me understand optometry better, understand healthcare better. and so that’s, I think, what we’re gonna spend a little time talking about today with friction and systems and, those kind of fun things.[00:06:00]

Evon: Yeah. Man, what a journey. I feel like we can spend a whole episode just talking about different parts of that journey there. going through Hai- stops and starts, going to Haiti, coming back, having to start over again and get yourself to where you are now. it’s pretty amazing.

Does Optometry Have a Capacity Problem, Rather Than a Growth Problem?

Evon: And, let’s talk a little bit now a- about that exact topic. I- just following some of your content online, following some of the things you’re talking about. You talk a lot about operations, a lot about systems, and one of the common themes that you, that you hit home through your experience, ’cause there’s a lot of experience that you just mentioned, both in Haiti and now in, in your own practice, right?

Seeing it through the lens of your own practice. y- you talk about how optometry doesn’t have a demand or growth problem, optometry has a capacity problem. Which is interesting because we– when you look at a lot of the conversations, like in online forums or just in conversations I have, a lot of those conversations are centered around growth.

how do we engage more patients? How do we bring more patients in? How do we increase gross revenue? [00:07:00] And a lot of times justifiably we do need to see revenue coming into the practices. But your contention is, not quite. Optometry maybe as a whole doesn’t have a growth problem, optometry has a capacity problem.

Can you unpack that? what do you mean by that?

Kerry: it’s kinda two-tiered, and so it is the profession and then the individual practices. but both of those are in the same boat. So when you look at overall optometry, I’m talking about capacity versus growth. capacity-wise, we are… The population’s getting older. Our scopes are expanding.

We’re doing more stuff than we’ve ever done before. We’re having more visits per patient than we’ve had in the past. and so we’ve got plenty of opportunity and plenty of patients coming through the door, but a lot of times the issue is not that, it’s we don’t have enough capacity because we’ve not changed our systems.

We’ve not changed the patient scheduling, we’ve not changed how we see patients on the schedule. We’ve not changed any of the systems that were in place 20 years ago. [00:08:00] when I started practicing, yeah, when I was that young guy in that practice, and there were two older partners, and I sat around half the time just trying to think how to get more patients, that was different. That was a growth thing. I needed to grow my practice. but most practices that I work with and talk to now, they feel like the best way to improve their bottom line is by getting more patients through the door. But

Evon: if you don’t improve the systems before you just get more patients through the door, then your bottom line’s really not gonna increase like you think it’s going to, and you’re gonna uncover problems that you didn’t realize you had because we didn’t increase the capacity to handle that growth before we actually just go into getting the growth.

Kerry: So when, when a lot of times when I talk to doctors, they feel like the number one thing they need is just more patients. then as we begin to unpack things, we realize it’s not just about more patients. There’s plenty of patients that are out there, especially as our, profession as a whole, because we are doing things that, nowadays we didn’t do 10 years ago.

you look at all of the dry eye [00:09:00] advancements and how many times you see the dry eye patients, how much follow-up is required for that. You look at, dealing with kids with a myopia progression, how many times we see them versus that one-off eye exam that we would used to do. all the progression of myopia with all the handheld devices and things. so much in our profession is awesome, and it’s changing, and it’s growing, it’s expanding. It’s, more exciting than it’s ever been. There’s opportunities in ways there’s never been. but it’s not just about the growth that is the problem. It’s about we have gotta find ways as a profession to make sure that we are able to handle expansion of the number of patients.

And I like, like you had, I think it was Dr. Edison on a couple weeks ago. Yes,

Evon: yeah

Kerry: and her talk just about all of doing the remote work and all of that, and that’s a huge part of, the opportunity when we talk about, what we can do to increase our capacity. we’ve got an optometry school that’s actually…

I’ve got a farm about an hour away from here, and right down the road from our [00:10:00] farm, they’re o- opening a new optometry school right here in North Carolina. to try to increase the number of people in the practice, number of people that are in our profession. So we’re doing some things, but I think that’s gotta be more our conversations is talking about the systems that sit in, inside of our practices before we just start bringing a bunch more people through the door.

Evon: because as we bring more people through the door and as we, with all the consultants that we talk to that say you need to be, doing this type of practice and that type of practice, if you haven’t done other things to sure up your systems, to sure up how your schedule’s gonna work, how your tech’s gonna handle it. Is the doctor gonna become the bottleneck? Are the patients gonna, be able to get the quality of care that they need to have? Are you just gonna speed everything up? how are you gonna handle getting more patients through the door to increase that revenue, versus doing– getting the systems healthier and then the revenue itself will help to, will kinda come along. especially talking specifically about the bottlenecks and how things happen in my [00:11:00] practice. I’ve learned that, I don’t know if you’re familiar with, have you ever heard– read the book The Goal by Eliyahu Goldratt? I can’t hardly

No

Kerry: his name. it’s really a really cool systems kind of book, sort of one of the gold standard books in systems.

And he talks about– He’s got the example that everybody uses for bottlenecks, and he talks about there’s a Boy Scout troop, and you got this Boy Scout troop, and they’re going on a hike. And the line, instead of staying compacted, the line keeps getting longer and spread out and longer. And so as the scout leader begins to look, he discovers that there’s one kid there, his name’s Herbie. And so you always hear Herbie. We’ll talk about Herbie. is the slowest one in the pack, and so he is the one that is actually causing the problem. So what the bottleneck, finding the bottleneck and then what they, what he did was he took and put Herbie at the front of the line and took a lot of his equipment, a lot of his pack, spread it out among [00:12:00] a lot of the other Boy Scouts.

And then because of that, he was now able to move faster, be more efficient. The pack stayed together. He was setting the pace. The pace was better. and so all of that kinda comes down to so wh-when I look at my practice, when I look at things going on, it’s you’re constantly– You’ve gotta go in before you start talking about growing and just getting bigger. like that Boy Scout troop could’ve had, could’ve doubled their number of Boy Scouts, but it still wouldn’t have been any more effective because you had– they had one bottleneck

Evon: Hmm.

Kerry: And so you have to go into your practice before you start talking just about growth and adding numbers and start looking for Herbies. And, so that’s– And, when I fir- when you first start off, the simple little thing is, yeah, the schedule is the Herbie. that’s the bottleneck. That’s what’s setting the tone of how much revenue you can generate. That’s your bottleneck because you’re not full. But once the schedule starts getting full, that bottleneck changes.

and that’s one of the keys of systems thinking is realizing that it’s constantly gonna change. You’re [00:13:00] constantly gonna have to be searching to find where is the Herbie in your practice. What is the thing that is limiting your effectiveness, limiting your potential, limiting your, ability to generate the revenue that you’re wanting to grow into, is there’s some- a Herbie in there somewhere. ‘Cause the thing that you have to come to understand is your s- your practice, my practice, every system in our lives, it’s winning. The system is already at work. It’s not a matter of whether or not there’s a system at work. There is a system at work in our practices, and it’s producing exactly what it was designed to produce. And so the system in my practice is producing exactly what it was designed to produce. And sometimes, man, that stinks, ’cause sometimes what it’s producing is not what I want it producing. I do not want discontent staff and disgruntled patients and backups and, remakes and, that’s not the stuff I want it producing. but instead of just saying, “Who did it?” [00:14:00] I’ve learned to say, “What’s, what system, what is going on in the system that’s producing this outcome

Evon: Ah,

Kerry: I don’t like?”

Evon: yeah

Kerry: so because it’s easy to just blame a person, but it, but that becomes just temporary. But when you go in and say, “What in the system is producing this outcome?”

Th- because that, then that can be changed, and then you can get the outcome that you’re looking for. So if the outcome that you’re looking for is higher revenue, yeah, the low-hanging fruit might be growth, but a lot of times there’s a lot of other things in the system that might be your Herbie, that if you go and change just your scheduling, you just,you go and you hire the greatest marketing firm out there.

And there are some good ones. And man, there are some that are just– They can get more patients through the door than you ever dreamed possible. And man, you start just packing them in and do… now you haven’t built up the rest of your system with your staff, with your equipment, with [00:15:00] the, type of exam that you’re doing and all those things, to maintain and that, increase that capacity

What Happens When Practice Owners Increase Patient Demand but Don’t Improve Capacity

Evon: And I wanna pull the thread on some of these things you, you’ve been talking about. and first let’s lean into the pain a little bit, right? So let’s imagine, we do a really good job of marketing our practices. Patients are coming in, they’re becoming aware, they’re interested, they want to use your services.

what happens when demand is increasing but capacity can’t meet it? in my mind, I just go to, okay, the schedule’s being booked out too far, and so patients aren’t wanting to wait that long, and they decide to go elsewhere. maybe the patient experience suffers because no one’s answering the phones or no one’s at the front, or paperwork’s being processed slowly or whatever it is.

things have to be remade, l- lenses have to be remade. pa- the patient experience, the patient care potentially even decreases because things have to move along a little bit too quickly. And, I start to think about all those things, and the inevitable outcome if that’s happening, well, [00:16:00] patients end up going elsewhere anyways, right?

you end up losing the demand because the experience is suffering. what do you think about what happens when demand is increasing but y- your practice can’t handle the capacity?

Kerry: Yeah. I like to say that growth without redesign becomes pressure, not progress.

Evon: if you’re just growing, then all you’re gonna do is build up extra pressure on all of the little points. And so a practice, a system that was able to handle 14 patients a day may fully crack at 22 patients a day. And so it’s not just, it’s not just about the patient experience, but it’s also about staff experience, that doctor experience, that, daily routine experience of, is the system in a way that not only can the patient get quality care, can the patient receive the experience that they want and that they’re paying for and that they’re, they were marketed by for that great marketing company that said you were the best thing since sliced bread, and man, you’re gonna give the most [00:17:00] comprehensive dry eye evaluation in the history of, dry eyes. Not only are you having to deliver on that, but also just on the fact that you’ve got to be able to handle it as the practitioner. And if you have multiple practitioners in one practice,does the practitioner’s level of fulfillment… Because if you increase the growth without redesigning everything, it becomes pressure, and then that pressure becomes an extra level of breaking point for the people involved.

Kerry: And so then your revenue is, again, you’re not gonna still increase your revenue, long term, and you’re definitely not gonna increase the value of your practice. Because what I’ve found a lot of times too is the other sort of piece that falls into that starts getting into, is the doctor, or the owner especially, we’re talking about this in private practice, is that owner having to handle everything?

is it, is everything escalating to that one person? Is everything… Because if you don’t, if you [00:18:00] just get all the people in there, but you’ve never had to have staff that could solve the questions, solve the problems, when it was 12 patients, 14 patients a day, you may have gotten one or two questions that came up to you that you had to handle other than your practice, the patient encounters. But then when you got twice that many patients, then you’re gonna have twice those many issues that get escalated up to that owner. and that becomes a pressure point, and a bottleneck as well. and so it, you’re right.

Why Optometry Practice Owners Should Map Out The Systems in Their Practice

Kerry: And so the way that we recommend doing is you start off before you go into just, “I need more patients.” You go in and you develop a map, a layout of the entire system in your practice. And so the first thing you do is you go in and you find, you gotta break it into all the different pieces. And so you find out not just the people, but you find each handoff. And ’cause the handoffs are usually where things, when the pressure gets on, so if you don’t redesign and you just get growth and it increases the pressure, where you’re usually gonna break is with the [00:19:00] handoffs. And so it’s gonna be from the first, of course, the first encounter is your telephone call. So from your telephone call to set the appointment, back when you were seeing 12, at that front desk technician or receptionist, she talked to them, she told them everything they could expect to happen. She made sure they got the or the email with the forms in advance, and they were gonna know, and she checked their insurance while they were on the telephone, and she became friends with them.

She knew their kids’ names, where they went to elementary school. She, she got all the information that she needed, made sure that patient was prepared to come to your clinic

Evon: Then you ramp things up though. Things start getting a little busier. You start getting more patients in there ’cause your marketing company did really good, and now all of a sudden that very first handoff, you start losing momentum because now she doesn’t gather all that information.

Kerry: She doesn’t make sure, “Oh, we didn’t realize that you had that Blue Cross policy. No, we’re not on that panel.” Or, “We didn’t realize that you were doing this, and oh, we didn’t… No, I’m sorry. [00:20:00] No, we’re not open to do that,” or, “No, we don’t carry that kind of, frame.” that she would’ve handled before now doesn’t get handled in advance. Patient shows up, then there’s already friction in the system from that very first handoff before it ever even gets to the patient coming in the door. and then every handoff along the way, from there to the patient arriving, to the initial encounter at the front desk, to the front desk giving to the technician to the doctor to the optical, every one of those handoffs what you need to go through before you ever start thinking, “I just need to grow my practice.” You need to go through and find all of those handoffs and find, okay, what’s gonna happen to this handoff if we increase our volume? if we have more patients coming through the door, is our system at this handoff able to handle that? Because then you can start improving those handoffs before they start breaking.

Because once you get the… you… It’s not that you only get one shot at it, but if you really do go in, we’ve seen where practices have gone in, had the marketing, [00:21:00] man, and it was just this great influx immediately. Usually it’s not just like what we’ve seen, and most of the time it’s not just been like routine exams.

It was when a practice decided they were gonna become, really focused on dry eye, and so they went out and they got their Temps or NV, or they got IPL, or they got these other devices. And man, then that company helps. They, part of your package when you buy the product, when you buy the piece of equipment, they’re gonna do this great big marketing scheme for you, and they’re gonna get you in all your Google reviews and things going on. And so it’s not just when it’s for regular exams, it’s when they, when you take on these specialty, types of changing your practice, adding on to the, what your practice is gonna be doing. And the most common, of course, right now we’re dealing with are, dry eye treatments, aesthetics, adding aesthetics to your practice, adding, really intensive myopia control to your practice, or you’re really converting.

Maybe you’ve been a little slow to convert to becoming a full medical practice where you’re really gonna take on glaucoma [00:22:00] management, and you’re really gonna take on these other medical, types of, practice issues usually that’s when we start seeing the break is because it’s not just all of a sudden the marketing company says, you’re gonna just do your eye exams.

It’s when you decide you’re gonna expand your scope or expand into a specialty area, specialty contact lenses. We’ve seen it when, when practices decided they’re gonna do scleral lens fits for the first… they’ve got a guy, man, he can just fit a scleral lens like you’ve never seen. He can get it perfect.

It is looking good, and those patients are happy with that. And then every cataract surgeon in town or every person who’s ever had a- an issue with a cornea sends them all of their patients all at one time, and that, two-hour scleral lens fit, changes everything. and so if nothing has changed beforehand, that pressure is gonna become a major capacity problem, because they didn’t anticipate…

They thought the problem was growth. They thought what they needed was a bunch of the patients, but what they didn’t realize was that growth can actually be what [00:23:00] creates the rupture

How Lack of Capacity Creates Stress and Burnout for the Team and Optometrists

Evon: A- and all of that pressure on the internal side, on the owner and the staff side, on the team side, it- it’s, it leads to stress and burnout, right? Higher turnover on the staff. It leads to a pretty miserable ownership experience for the owner. And, a lot of the times when you hear about people just can’t wait to get out of their practice and sell or just close down, a lot of the times you hear it’s ’cause of burnout like that.

They just cannot handle that experience

Kerry: Yeah, no doubt. And it’s not And that’s the m- the so- probably the most discouraging part too is because once you realize you’ve got all this going on, but then now there’s just so much more stress, and what you thought you wanted is exactly what ends up becoming that level of pressure that ends up, creating so much because, doctors aren’t proud when they burn out. doctors are ashamed and they’re, and it… But a lot of times it’s not a lack of work ethic, it’s not a lack of ability, it’s not a lack of knowledge, it’s not a [00:24:00] lack of desire, it’s a broken system. Their system wasn’t able, wasn’t in a way, wasn’t put in place in a way to help them be able to reach their goals without it being too much pressure.

and so you’re exactly right. We see it. And especially it’s even worse it’s because what you went after, you actually got it Man, I went after it, I wanted to be the best scleral lens fitter in the central part of the state, and then you got that, and now all of a sudden, Even like in our practice, one of the things that, that unintentionally happened in our practice, was we had a, pediatric ophthalmologist in town, just one pediatric ophthalmologist in town that did, had a huge pediatric ophthalmology practice, all of a sudden decided to leave, okay? one of that pediatric ophthalmologist’s techs was a patient of ours, a friend of ours. so [00:25:00] now at the pediatric, ophthalmologist office, they got in contact with the pediatr- the pediatricians in our area that said, no. Hey, we’ll just, you can just send them over here to this practice.” We weren’t set up to start seeing kids all day every day, and babies and, everything else. now we have full scope practice. We see, any age, but we weren’t set up to where all of a sudden we had this huge influx every day of patients that we weren’t equipped to handle. Now, it wasn’t, we didn’t set out to get it in that particular example, but it still led us to a place where we, our system couldn’t do it,

Evon: so we had to start evaluating our system. What all in the system has got to change in order to handle this, influx of patients or this change in our practice, look? and so

also just think,

further downstream, I think of some conversations I’ve had with associates that are dead set they would never wanna own a practice. Part of that is because [00:26:00] conversations they’ve had with burned out and stressed out owners that tell them, “Do not get into practice ownership,” because they are so burned out and stressed out.

And I just wonder how much of that can be changed by creating businesses and practices that run more smoothly and are just more enjoyable to own

Kerry: Man, but no, what you said, just creating the practice that runs more smoothly. Okay? So the… that is the gold standard, and what it- so what we’re trying to say in that is reduce friction, Small friction creates large failure. one of our slogans is, it doesn’t take a lot of friction points to completely create failure in a way, in, in failure, not meaning like I didn’t do it, but just in the system breaking.

And you’re right, And it’s not always, of course, the clinical side that, a lot of optometrists, a lot of, practicing doctors don’t wanna deal with. It’s not necessarily just the clinical side, it’s the administrative

Evon: Administrative [00:27:00] insurance. yeah

Kerry: the insurance stuff, the pre-op stuff, the, all the, different pieces that go along with it. but there’s still that, you’re exactly right.

How the Practice Becomes Fragile When it Depends Too Much on the Owner

Kerry: The key is to try to go in before you’re overwhelmed with the number of patients that you’re seeing and create systems that help you be able to smoothly handle even that part of it. You’ve gotta build that into the system. and also it’s got part of, a lot of that all comes down to, on your practice operations part, being too dependent on the owner, too dependent on, like for me.

and a lot of that seems like leadership. like I’m just a good leader, so every time there’s a problem, they bring it to me and I solve it. that sounds like good leadership, but that leads to fragility of the practice. and so putting into place systems to where every person on the team is able to own individual pieces of the daily process so that it’s not constantly escalated to [00:28:00] the owner. And so the optometrist that is the doctor that’s practicing, his goal should be, he should be able to practice, he should be able to see patients, and then a lot of the other stuff needs to be able to be handled from him. that doesn’t just happen naturally, That’s

Evon: A-

Kerry: to be built

Evon: and you’ve,

Kerry: That’s got to be-

Evon: you’ve talked about and you’ve written about this sort of dependency ladder of how much the business depends entirely on the owner making decisions, right? Of, of doing things, doing stuff, and making decisions. And, talk to us about that. Like, how, where does that start?

How does an owner get out of it? ‘Cause at that point, the owner is the bottleneck, right?

Kerry: Oh, 100%.

Evon: how does that work, and how does an owner sort of work out of being so heavily dependent on his or herself to make the practice run?

Kerry: Yeah. And w- that’s a hard question. That’s a big question ’cause there’s a whole lot packed into that one little question. But co- yeah, but the dependency ladder, we, when we talk about that, there’s four rungs of dependency ladder. and the optometrist, [00:29:00] the goal is to get to that fourth rung of the dependency ladder to where the practice does not depend on you every single day to be able to operate as the owner.

So talking about the owner, not just the seeing the patients, but the actual owner part. and but most practices operate at a much lower rung than they would think they do. Most owners don’t understand how much that practice depends on their every day solving little problems, every day taking care of that phone call, every day taking care of that insurance question, every day taking care of that, problem with the staff and, And so we have to get to a place where we are… There’s a couple things. One, there’s like a feedback loop to where the more you solve that problem, the more that the system automatically now that’s your problem. the more often you’re willing to answer that question that staff member has, and you get, it’s not like you can just all of a sudden decide tomorrow, “I’m not gonna answer any questions my staff brings to me.”

yeah, [00:30:00] that’s gonna be a fun day. Yeah, let’s see how, let’s see how your Monday goes when you’re there by yourself. but, but it is coming up to where are those points though? and so we have, we’ve developed a whole… Actually, it’s crazy, funny you ask. We had a, just today or we got a manuscript back from the editor, for a book that’s ex- about that exact thing on the practice, that’ll be being released.

But that you’ve got an assessment where you can have a full assessment done of what, asking questions about W- h- to– In a normal day, how many things get escalated to that level, where the owner is having to solve the problem? How many things that are, And it will break it down into all the different categories, whether it’s a communication problem, whether it is a technical problem, whether it is,

for a long time when I, first got into practice, I used to do a lot of, My dad was an engineer, and so I grew up building computers with my dad, and so did a lot of the, computer repair and those things, and did that all the way through college. And, so when I first got into practice, I thought it was the greatest thing.

And my senior partners thought it was great when we first started automating [00:31:00] everything. It’s “Man, Kerry can fix all of it, Hey, every…” So every time when, every time a computer didn’t print, I come out with a patient and they’re like, “Hey, you gotta come up front. The computer’s not printing.

You gotta come over here to the optical department because we can’t send this to the lab because we got– we lost internet.” And so I became that, that guy. and so that’s an extreme, example, but that I’ve learned that’s been the way all the way through though, even now, is I can’t be the person who, if the phone’s not working, I can’t be the person that’s gotta solve that. If the internet goes down, I can’t be the person that the owner, the… Because that’s not where my value is. My value is not even collecting data. you gotta get to a place where the doctor, and that’s what we talked about with the capacity part, is you’ve gotta get to the doctor needs to be analyzing data and coming up with a plan, and then Handing that off to other staff members, and when we start talking about [00:32:00] artificial intelligence, that’s the place where artificial intelligence kicks in,

The Less Reliant the Practice is On the Owner, the More Valuable It Is

Kerry: helping the doctor be the person who interprets data and develops the plan, and then the rest is handled by everybody else. and that, that is not just who’s gonna fix the computer, but that’s also, in, in the day of a doctor being able to, we used to, when I first got into practice, we would buy retired doc- retiring doctors’ practices. And so doctor would give them an exit strategy, we’d buy their practice, and then we’d let, if they wanted to, they could still work a couple days a week, and then we would, bring in a young doctor that would cover a couple of those doctors’ practices. and some of those doctors, they were doing absolutely everything. they would… The patient would come through the door, they’d greet them at the front, they would take them back, they would do the pre-testing, they would do the exam , they would fit them with glasses, and when they came back in, they’d dispense them. those days are just long gone if you’re gonna be able to have a practice that is able to be sustained in today’s market, and if you’re gonna actually… That goes back in some way I haven’t even, won’t even be able to touch [00:33:00] on much today, is just the value of your practice. the most valuable practices are those doctors that are on rung four of the dependency ladder. when somebody’s coming in to get the, to look at the value of your practice, the more that practice depends on you, the less valuable your practice is.

Evon: Absolutely

Kerry: and so that helped me really come to a place of realizing, as I would start recognizing, okay, this particular problem has came to me a whole lot of times over the last month. So I’ve got to find where in the system is that not working, ’cause I can’t be solving that problem, ’cause that decreased the value of my practice. If I’m the one that has to solve that problem every time, I’m hurting the value of my practice. And so that’s really helped me be a, just my standard of, “Hey, I can’t do that. I want my practice to be as valuable as it can be.” So of course, that comes d- that’s the top line, and then that’s the bottom line, but that’s not your only things that’s gonna determine the value of your practice. I don’t care if [00:34:00] you’re trying to sell eventually to, a big group, whether you’re trying to sell to another optometrist, whether you’re trying to sell to venture capitalists, the more that practice depends on you, the less valuable it is. and that all comes down to, are you a system-driven practice or a personality-driven practice?

Evon: Yeah

Kerry: so many practices are personality-driven, and that hurts

Evon: I couldn’t agree more. it’s going to impact the value of the business as well as the risk of the business. the more the practice depends on you, the more risk there is to the business in case something happens to you and you cannot go into work the next day. And so the less your practice relies on you in the day-to-day operations, the more valuable, as we talked about, it’s going to be to another buyer that can just step in and run it very easily.

But also the more you protect your business from something happening to you a-and still continuing to see patients, through a variety of different ways. And a part of it, just hearing you talk, it sounds like a part of it is just also just being aware [00:35:00] that there are, there are things that are the best use of your time,you meaning the owner doctor.

There, there are things that are the best use of your time in the business that really drive the business forward, and there are things that are not. And even just being aware of that and maybe just listing out those things h- can help someone say, “Oh my goodness, these things are coming up constantly that I need to answer or do.

I shouldn’t be doing that.” Maybe it’s just that awareness of, “Okay, th- it’s costing my business for me to be spending my time doing these things. There’s someone out there better than me that can do this more quickly than me, and maybe enjoys it more than I do.

All let’s let that person in my business do that.

I need to focus on seeing patients and growing my practice.”

How Does a Optometrist Find the Bottlenecks in the Practice?

Evon: And, I, I wanna, I wanna make this maybe even a little bit more concrete. we talk about systems, we talk about bottlenecks. You’ve mentioned some of them already, the biggest ones potentially being at handoffs. where do patients move from one person to another or one s-step to another [00:36:00] i-in the practice?

Yeah, how does someone really look at their business, look at the way it’s running, the systems, as we say, like the list of steps of everything that’s happening, and find those bottlenecks a-and know where to start first? how should they do that?

Kerry: Yeah,the first thing, and so what you’re asking is where, how do you find Herbie? Okay? ‘Cause that’s the easy way in my mind to think about it. Where is Herbie

Evon: you go. Yeah. Where’s Herbie?

Kerry: now? where is Herbie in my practice right now? And the very first thing is you gotta realize there is a Herbie in your practice.

There is something is a bottleneck. There’s something that is limiting your potential for growth, for, for profitability, for smoo- just the smoothness of your practice flowing. So m- no matter what your goal is, ’cause we think, there’s not a bottleneck in how many patients I see or wh- how much money I’m generating.”

It’s not even just about that. It’s just what is limiting your practice from being the best practice it can be for you, for your patients, for your staff. and [00:37:00] so the first is just realizing there are things that are, that are bottlenecks. and of course the simple ones, low-hanging fruits, just, getting enough patients, filling the schedule, marketing. But for most practices that are mature, that’s no longer the bottleneck. the bottleneck, a lot of times it becomes at your pre-testing. so you’ve gotta start looking at pre-testing. What is my capacity at pre-testing? how much do patients back up at pre-testing? where are patients having to wait?

Where are patients having to, to stop in the flow for the longest period of time? Which means you have to start assessing those things. You have to say, okay, from the time the patient walks in the door, it took them this amount of time for them to get all their paperwork and get everything ready for them to be taken back. And then from that point, once they were taken back, how long was it before they were s- into the doctor’s exam room and then seen by the doctor? And one of the easy things to kinda check out is time, of course, is the, your flow. So where’s the bottleneck in your time flow? and then that can be, a lot of times it’s [00:38:00] pre-testing, a lot of times it’s, doctor time, which we don’t like to talk about it being our fault, but sometimes it is our fault. and so a lot of times it’s the doctor’s fault. optical, can be, if there’s an issue with being able to get them, into optical when they’re supposed to, getting them to check out. a lot of times the backup will be at, the checkout desk. I know that’s one of the things I struggle with is, getting to where we get the checkout flowing, at a healthy rate.

A lot of times a bottleneck can be stuff like no-shows. you don’t even think about no-shows as being a bottleneck, but if you’re talking about the, just the effectiveness of your daily routine, man, no-shows can be a huge bottleneck,

Evon: that needs to be addressed. And there’s a lot of ways to address, no-shows, but you’ve gotta first realize that is your bottleneck.

Kerry: a lot of times it’s follow-through. When you talk about, when you’re not talking about just getting the patient in and getting the patient out, but if you talk about outcomes, what is the, what is keeping us from achieving the highest level of outcomes with our patients? a lot of times it’s the follow-through.

We’re not, we don’t do a good job of setting up systems for follow-through. instead of doing, when the, in [00:39:00] the EyeCoin thing we’re building, the software, they’re called eye care plans, where you plug a patient into a plan that gets them every step from the time I recommend it to the time that we achieve the desired outcome, everything is my fault.

Everything is on us. Everything is on the system, not on the patient. Because in the past what we would do is if a patient didn’t follow through or they were just non-compliant. You know what I mean? Man, that’s just, that’s just our easy, throw it at… If a patient didn’t, if a patient didn’t do their glaucoma drops, they’re non-compliant.

If a patient didn’t do their, hot compresses and lid scrubs and drops 17 times a day and everything else they’re supposed to do that I told them was gonna be best for them, if they don’t do it, they’re just non-compliant And so it’s easy to, abscond ourselves from that responsibility versus saying, maybe they weren’t.

Maybe they were living regular life, and regular life got in the way of them because we didn’t help them with a system once they left our office.” We’ve always said, we get what? Maybe two [00:40:00] hours out of the year, and then they got the other 8,000 hours that, we don’t have anything to do with, but that’s not true.

Evon: we can actually take responsibility, take ownership of more of those hours. And so a lot of times the follow-through is the bottleneck to our outcomes. but a lot of times, outcomes don’t, aren’t near as cool as bottom lines. You know what I’m saying? Yeah.

Kerry: cool as dollar signs, you know what I’m saying? but if we really wanna talk about our, the most effective practice and the most, engaging practice and the practice that’s accomplishing the most, success, then you’ve gotta take into account the patient outcomes, because that does affect your bottom line. Because that patient that came to you with dry eye and your recommendation was, “This is the best drop.

Go to, go down to CVS, buy this little bottle of drops, use it four times a day,” and then thinking that’s gonna fix that patient’s dry eye, it’s not. They’re not gonna get it. They’re not gonna use it. There’s a whole lot better ways we can build systems to help them accomplish it, and so they’re not coming [00:41:00] back to you.

And if they do come back to you because, they like you, they’re certainly not gonna tell their neighbors how great a dry eye doctor you are. there’s… And so that even the follow-through has a huge part even in your bottom line

Evon: That, that is interesting. As someone who also gives advice for a living, I’ve come to realize my advice is only as good as the impact it has on the optometrist’s family I’m serving, right? and if there is no follow-through, if I’m not helping lead through the follow-through, then my advice was almost worthless to a point, right?

It really didn’t do anything positively for the family. And I’ve found it, it’s sometimes difficult to look at myself and say,I probably should have done better to do that,” even when the advice that we give as professionals is correct and accurate, and it was the right thing.

If the outcome doesn’t follow, it’s perceived by the patient anyways that the advice wasn’t sound, right? That’s still gonna be the perception if,if the outcomes don’t follow.

And it sounds like this process of, getting out of the exam lane and looking at how everything’s working [00:42:00] and seeing where patients are p- delayed or piling up, or where information’s delayed or piling up, it seems like that’s an ongoing process, that these bottlenecks, as you mentioned, just move around.

it’s almost Wh- Whac-A-Mole a little bit, right? you fix one, things improve, and then that leads us to the next one, right? And you just have to continuously improve, it sounds is that right?

Kerry: Oh, so true. Yeah, Herbie never stays in one

Evon: Herbie, come on.

Kerry: Come on, Herbie. And and especially just as you grow, it definitely everything changes, with growth. and so everything is gonna be, at a different place. work, what worked in the practice when it was smaller is not gonna necessarily work as it gets bigger.

and it may be a totally different place that becomes the bottleneck, that becomes that hang-up spot. and whether it would be on the follow-through or depending too much on me,so all the… Yeah, it is. Old Herbie keeps moving on around. You gotta keep tracking him down. If you want to be as effective as you can be, as have a practice that runs as smoothly as it can, [00:43:00] and you continue to build the maximum value in your practice, then you’ve gotta constantly be readjusting for bottlenecks

Evon: the question that might come up is, maybe I just need to mo- hire more staff. Maybe I just need to hire another associate. Maybe I just need a better EHR, better tools, better technology. w- what do you say to that?

Kerry: I say, “If that’s your Herbie, then you’re right. But if it’s not your Herbie, it doesn’t matter what you do, it doesn’t matter what y- else you fix, then it’s not gonna, it’s not gonna improve.” Think back to, Herbie in that line with the scouts. you can take and give all of them better shoes, but it’s still not gonna make any difference.

you can bring on an extra scout leader, and they’re still not gonna go any fa- unless you address the actual bottleneck. And yeah, so unless the, unless what you’re adding is actually the bottleneck, then it’s not gonna help. And because what I’ve learned too, and through mistakes, [00:44:00] is that you’ve got to address the whole.

the whole is n- is much more than just the sum of the parts. And actually improving one part can make the whole worse. just if you increase one thing, without it being the bottleneck or without addressing the rest of what might be issues, then it can actually make the whole system be worse even though you optimized one area, of the system.

If you optimize your, your checkout, but you don’t fix everything else along the way, then you’re still gonna be stuck with the same kind of problems that you had, except you got a really cool checkout now

How Will Artificial Intelligence (AI) Impact, and by Used By, Optometrists?

Evon: interesting. out of respect of your time, I wanna ask you about one more thing. and this wouldn’t be a podcast if I didn’t ask you about AI. And, a- and I wanna talk about, AI because there’s a lot of talk, there’s a lot of doom and gloom talk, at some, in some places about how [00:45:00] AI, artificial intelligence, and that sounds like pie in the sky, this big dark cloud up there.

Let’s just say AI tools. AI tools will impact knowledge workers, will impact professionals. how do you feel AI will impact optometry?

Kerry: Yeah, it’s gonna completely eliminate optometry, and we’re not gonna, any of us have jobs. Yeah, it’s

Evon: we’ll wrap up there? No.

Kerry: Yeah. No, and you’re exactly right. There’s so much, just of trying to take things to extreme levels. I think AI is gonna have a huge impact on optometry. I think it’s gonna have a huge impact on all of healthcare, of course, but it’s not going to eliminate optometry.

It’s not gonna eliminate the need for the doctor, to be in the system. what it should do is remove friction, so not replace care, but remove friction. and I think that the people that use AI and build AI, are… That’s what’s gonna be their focus. the real threat to the doctor-patient relationship is not AI.

It’s the same stuff we’ve been, that’s been the threat for the last [00:46:00] 20 years. It’s, all the insurance issues. It’s all of the prior authorization stuff. It’s having the EHR driving you crazy, that you’re having to spend all evening, trying to put stuff into charts. It’s the things that burn out optometrists and keep them from being in front.

So the goal of AI should be to eliminate that. the goal of AI should be just to actually take us back to where we used to be able to spend that time just in front of the patient and engaging the patient and helping them to understand what their needs are and how we’re gonna help them achieve the outcome that we both want.

and so hopefully, the goal of AI is gonna be to, eliminate those things, that get us back into being there in front of the patient. and it is gonna in- be involved in things like data collection, data interpretation, as far as helping the doctor, know what this particular piece of data looks like or loo- it means.

and then the doctor’s job is gonna still always be judgment and deciding, what does that, how does that [00:47:00] impact the patient? How does that impact the outcome we’re searching for and pushing towards? and ’cause we don’t, we don’t need more noise, in the system. We’ve got plenty of noise in the system.

We don’t need that. We need to use AI to help reduce the amount of noise, so that we can be doing what we need to be doing, which is helping patients achieve better outcomes.

Evon: I love that. Human trust, human judgment, human wisdom will always be sought after, i- in my opinion as well, especially where there’s high-value decisions to be made. And I’d say our vision, our sight, i- is a pretty high-value decision in order to take care of our eyes. I absolutely agree, especially where there’s a lot of information, people need to know what to do with it and how to use it appropriately i- in wisdom and good human professional judgment.

I couldn’t agree more. And, let’s make this more concrete. It sounds like you see AI being used both in the clinical side as well as, operationally. what are some examples, of how you see AI [00:48:00] improving the way that practice is run?

Kerry: I think definitely it’ll, like we’ll end up with, AI scribing, to where instead of the doctor having to manually enter data in the exam room,that’ll be done with artificial intelligence, doing scribing, doing, a lot of phone answering, triaging, phone calls, triaging patients when they call of what needs to be done, where…

And that’s already happening. there’s already, our practice already has where, when you call in, they can, the AI can tell where the phone call needs to go to, what needs to be the next step, in the process. That’ll just become more and more effective in saving time, for the doctor and for the staff.

there’s already, there are already, programs of, that we use with AI that’s interpreting optose photographs to,see some little microaneurysms. and then not only, seeing those microaneurysms, but then saying, “Okay, these are some differentials for what we’re seeing in this photo.”

And then the doctor takes and, helps to determine what exactly caused that and what needs to be done [00:49:00] about it. so all those things are already out there. the AI is already available. It’s already being implemented. and so doctors that are not engaging that where it is, are gonna definitely find themselves behind a really fast-moving change, if they’re not willing to embrace AI.

if they don’t embrace AI because they say they’re, believing the doom and gloom that it’s just gonna replace all optometrists, and so the way to stop it from replacing optometrists is we just keep it out of optometry. Yeah, tho- those people are gonna be left behind, in my opinion.

because I believe that’s an,an irrational viewpoint and a, a viewpoint that’s going to cause, a lack of progress

Evon: Where do you feel like AI is maybe oversold or overhyped in optometry, or may actually, negatively impact the patient experience?

Kerry: Well, I think that if, you do see some, people pushing a little harder on, like I was reading where, in a community, a rural community where they were gonna be [00:50:00] using AI to almost do the eye exam and then a doctor just sign off on it. I think that, kind- that’s taking it to an extreme when you start taking, the doctor out of the doctor-patient relationship, and all of it is AI-based, and then the doctor, is only there almost as a rubber stamp kind of scenario.

that’s dangerous. That’s dangerous because, can AI perform a routine eye exam and get a refraction that might work Well, sure.it, it can. Even at this point, even with the amount of AI we have now, it could perform a rudimentary eye exam. but how many patients do we see every single day that’s what they thought they needed, and it turned out being a whole lot more, than that?

They thought all they wanted was to renew their Acuvue contact lens prescription, and they didn’t realize they had a retinal tear or they had these other things going on, or even something more obscure where they didn’t [00:51:00] realize that their, their thyroid condition was setting them up for having this particular problem with their ocular surface and they don’t have all the signs and symptoms at the moment, but we realize they’re starting to go to that direction and we need to help educate them on that and take them into a healthier place for better outcomes.

that’s the kind of thing that you’re not gonna, see, with just having AI do all of it

Evon: we’ve talked about a lot today. this has been a phenomenal conversation for me. I’m even learning a lot as we speak, thinking about my own business too. This has been helpful for me. What are some final thoughts you’d wanna leave with the listeners?

Final Thoughts For Optometrists

Kerry: just basically that is if you’re, as an optometrist, just continue to love the practice, and if you’ve got things in your practice that are the parts that you don’t like, the parts that seem like they’re the friction points where there’s things we can, you can do about it. there’s things that, you know…

don’t just take the short, easy route of blaming an individual or [00:52:00] blaming a particular position. start trying to look at your practice more and saying, “Okay, what system is producing this outcome?” Because the, what I always like to say is the system is winning. So the system in your practice is winning.

The system that was put in place either intentionally or unintentionally, that system is winning. And so if you’re not getting the outcome you want, don’t let that discourage you to the point where you are getting burned out or you are, wanting to hang up doing what you’re doing. we need good optometrists still in there for the long haul.

and so instead, let’s find ways that you can investigate your system, find out what’s going on in those systems, and ’cause the systems are changeable. That’s the best thing about it is when you find out what the problem is, those things can be changed. and a lot of times it’s a lot simpler than you think it is.

and so just, keep working on making that better. don’t get into, putting your practice,on a place of being un- unhealthy because you’re worried too much about artificial intelligence or doom and gloom stuff or clickbait, issues. [00:53:00] folks are, that’s how they get you to look in there is telling you how bad it all is.

Evon: Yeah

Kerry: yeah, so just hang in there. Stay, keep doing what we’re doing ’cause we’ve got the best profession ever, man. we are, we’ve got a profession that, it changes people’s lives. It creates a great living for us that do it. it, rarely do we have patients die. occasionally, but not often are we the cause of that.

and so we’ve got the best profession ever. and so don’t let something come in that’s gonna cause you to be discouraged and forget that, when it’s something that might could’ve been fixed

Evon: I appreciate you saying that, and I think that’s a great place to end.

Where Can Optometrists Find and Follow Kerry Reeves?

Evon: Where can listeners find and follow and learn more m- more about what you’re doing?

Kerry: LinkedIn, is probably the easiest under, Kerry Reeves OD. like I said, we’ve got a book that’ll be released soon. but LinkedIn is the easiest place to, to kinda see what kind of rambling I’m rambling about

Evon: Gotcha. I will throw a link to all that in the show notes once the book’s out. I’ll throw a link to the book in there as well. I really appreciate you coming on. This has been a great [00:54:00] conversation, and I think the listeners are gonna get a lot out of it. for the listener, appreciate you listening.

We will catch you on the next episode. In the meantime, take care