0:00:02 - Mark Henderson Leary

Welcome to Practice Freedom. What if you could hang out with owners and founders from all sorts of healthcare private practices, having rich conversations about their successes and their failures, and then take an insight or two to inspire your own growth? Each week on Practice Freedom, we take an in-depth look at how to get the most out of both the clinical side and the business side of the practice, get the most out of your people and, most of all, how to live the healthy life that you deserve. I'm Mark Henderson Leary. I'm a business coach and an entrepreneurial operating system implementer. I have a passion that everyone should feel in control of their life, and so what I do is I help you get control of your business. Part of how I do that is by letting you listen in on these conversations in order to make the biggest impact in your practice and, ultimately, live your best life. Let's get started. Welcome back. Practice leaders Got another great conversation with my good friend, dr Jason Lake, who, if you don't recall, is a lifelong entrepreneur. 

Eye care industry. Leader runs two great organizations, perc and Optiport, which are really organizations that collect the sort of the best and brightest of in the eye care industry for optometrists and his own eye care, regional eye care practice. So we talk a lot about the state of things right now and I think you know there's a lot in the conversation about what's going on in eye care, which I think applies to a lot of health care and really the profitability side of things. Consumer confidence has been flat a little bit. The retail spending we talk a little bit how that's unfolded. We talked about a lot of the impacts of how optometrists which we're speaking from the lens of optometry, but this is across all healthcare we're seeing doctors graduating with a different ethos, different mindset. We talked about the consequences of that and the good and the bad and how to use that and some of the things that are going on with that. We talked about subspecialty and what I think is in the bucket of value creation how does your practice evolve and what do you add and how do you add? And I think there's a lot to the resistance that goes with that and the revolution. It's not so it doesn't. These practices don't just evolve smoothly by adding a little more. There's resistance and there's chunking and things that go with that, and so it's a good conversation. 

I enjoyed it. I hope you do too, if you're interested in eye care. I think it's a lot of the great stuff If you're just generally applying this to healthcare great stuff in there as well. And, of course, before I let you in to listen to this, don't forget, if you are really trying to figure out how to build that high value, high growth practice that has an amazing culture, that gives you the life you deserve, allows you to lead the way you want to lead. But if you're stuck, please don't stay stuck. Please reach out. We'll have to get some time with you and talk about what a first step or a next step could look like to get that practice, to make that high-impact practice you deserve. At practicefreedomcom slash schedule, this will take a couple minutes and talk about that. So, without further ado, my conversation with Dr Jason Lake. 

0:03:24 - Dr. Jason Lake

Let's wing it. Can you hear me okay? 

0:03:26 - Mark Henderson Leary

Yeah, man, yeah, you look good, you sound good, we're recording, so let's catch up. Man, we talk somewhat regularly, but the last time we talked in depth was some time ago. 

0:03:40 - Dr. Jason Lake

I mean, was it a year ago? We did the podcast episode? Yeah, it's been over a year. It was warm, it was summertime. 

0:03:43 - Mark Henderson Leary

Wow, that's okay. Yeah, well, it's Houston, so it's always warm here we literally have become Thailand in temperature and monsoon season. 

0:03:50 - Dr. Jason Lake

Yeah, it's really hot there right now. 

0:03:54 - Mark Henderson Leary

Yeah, it's super humid. But luckily I was like what happened to that hurricane Because there was another one coming. We were going to hit a three for a hat trick. We were looking for a hat trick this year. Well, I guess one was not a hurricane, One was the derecho, which I think they made up just to sort of explain. 

0:04:08 - Dr. Jason Lake

I thought derechos were like what happened in the Southwest. 

0:04:14 - Mark Henderson Leary

I did not know that you could get a derecho in the Gulf. Well, I still think you're making that term up. 

0:04:17 - Dr. Jason Lake

No, it's a real term. 

0:04:18 - Mark Henderson Leary

It's just a Spanish word that has nothing to do with weather. 

0:04:25 - Dr. Jason Lake

And they just sort of said, hey, the white people don't know what it means, so just say derecho and we'll call it wind. I do know they have monsoon season in the desert in southern Arizona and I think they call it that, but I don't know. I'm certainly not a weather prognosticator. That sounds right. 

0:04:36 - Mark Henderson Leary

I'm sure that's possible. But the hurricane has sort of done a U-turn. It was just like headed towards us and I was like, nah, maybe not. And I mean it's really a strange little kind of zigzag that's just going back towards Mexico. Maybe it was the election. Maybe it was the election, maybe that's what happened. Yeah, actually, you know that's, the only logical explanation is that once the election did what it did, then that took away the you know the weather control the angst. 

0:05:00 - Dr. Jason Lake

There was a lot of angst. Yeah, something that's okay, all right. 

0:05:04 - Mark Henderson Leary

Well, so I would love to catch up on your perspective on all things you know healthcare, economy, optimism, leadership in healthcare, particularly eye care world. Yes, that's your world, eye care world, Lucky you. What are you seeing, what are you hearing? 

0:05:19 - Dr. Jason Lake

man, lucky you. We are prepping for our national meeting next week. We are prepping for our national meeting next week and so this morning's task, at about 5 am, central Standard Time, was I am reviewing six years worth of data and looking at economic trends within our study group members and it's really interesting. We are seeing a trend back towards profitability. If you look prior to COVID, it was a pretty, you know, I care. 

I think health care in general is a pretty straight line, right Like nothing. Really. It's a big enough industry that it doesn't capitulate. And then COVID made it crazy because then you had a period where people had a lot of money in their pocket and it drove a lot of spending. We saw a $70, $80 jump in spending per exam. Then it kind of cratered out and we saw as an industry a slowdown kind of this summer. Now what we're seeing is I wish I had data that went back into the teens, but I bet if you took and drew a straight line from 14, 15, 16, 17, 18, 19, I would bet that we kind of had this virtuous sine wave that it kind of went up, then went back down. We're seeing profitability come back up, but in our industry it's called a capture rate. It's when the patient comes in do they make a retail acquisition, and that's yeah, retail. 

0:06:43 - Mark Henderson Leary

So that's, I don't know how geeky we want to get into that Capture aid, true capture aid glasses only multiple pairs, contacts. 

0:06:51 - Dr. Jason Lake

I have it all sitting in front of me, but I do not suggest for your listeners that, unless they're having a hard time sleeping, I would recommend that absolutely, but not today. The reality is is we did see a pullback and I think, economically speaking, we've seen a pullback in a lot of industries this summer, and I think eye care is no different. But my consensus, my thought is, is that if you looked at it over a period of time, it was such a massive dump of money into the market rightfully so to solve some problems. People were nervous. I think you're finally seeing some of that level out, and I don't think that's president, I don problems. People were nervous. I think you're finally seeing some of that level out, and I don't think that's president, I don't think it's politics. I think people had a ton of money and now they don't. 

I'll tell you, mark, I live in Kansas City but we have practices in a rural area. Gas does that to us, so we are such an agriculture-based community. Certainly, kansas City has a lot more than that, but our communities that are outside of Kansas City are very ag-based. When gas goes up and those towns are commuting in, they don't have that money in their pocket and we see a drive down. So gas prices are relatively down. So I think it is interesting and I think we are going to see a little bit of normalcy and I think most economic forecasters are saying that we have a Okay. 

0:08:08 - Mark Henderson Leary

So I want to understand exactly what you're saying. So in profitability, I think of two ways that, at least two ways that profitability can manifest here, and one is in the margin side, and so we're just doing better on the cost side. So that's helpful. I don't sense that's what's changed. But you're saying that discretionary spending. Because in eye care there's two very clear streams. There's the eye care side of it, which is sort of making sure your eyes are healthy, getting a prescription, and the services and fees that are associated with that. Then there's the what do you do with that? You buy contacts, what type of contacts? You buy glasses how many pair of glasses? So it's very there's a huge amount of elasticity on what you do after the health side is handled, and so you're saying that's lifting a bit. People are spending a little more on the discretionary side. 

0:08:56 - Dr. Jason Lake

We saw a slowdown. So what we are seeing, though, is sometimes profitability in a healthcare space. Profitability in a healthcare space, it's an illusion of profitability. So when you slow down, you are if you do professional fees only, obviously the margins are very good. It's 100% or minus staff. If you do retail, you have cost of goods that are factored into that, so when you see a slowdown in retail purchasing, you will actually see a rise in the percentage of profitability. 

Margins go up Because simply, yeah, there's no cost of goods engaged right, but it doesn't mean the total top line is growing. Now the industry is healthy. It just took a little bit of a capitulation and I mean you saw it really most this year in. You saw it in kind of more what I would call value providers, like National Vision. They're a publicly traded company that has a lot of stores. We saw them slow down quite a bit. 

I have not seen their most recent reports, but we saw a big pull away recently from internet. We saw an effect there. We saw a push back into brick and mortar and I wonder, if things are, you know, people had some money they could go in, they valued their healthcare. I think there's got to be a bit of you know, everything capitulates one way or the other, but it ends up in the middle right Like we saw this massive push into online and I think it's still there, and then that's where the lower-cost online options tended to go down and we saw a big push back into brick and mortar and I think it'll kind of level out where it's supposed to level out, somewhere in the middle. But right now is a good time to be in healthcare because people are valuing it. It's just capitulating a little bit. But when I say a little bit, one or two points, I mean we don't. We're not a crazy industry that capitulates rapidly. 

0:10:41 - Mark Henderson Leary

Okay, so you said a lot of things that I think need to be Some were probably true, at least for me, I mean at least some. So I want to make sure I understand everything. So we're saying that the trend you're seeing is the increase in profitability recently was actually increase in margins, because less sales of lower margin things, which is actually not a great sign, but that's leveling out, we see. 

0:11:04 - Dr. Jason Lake

Yeah, I think the demand is starting to return and I, you know, I've done this for 26 years and so I've lived through I don't know how many, is that five, four or five election cycles. 25 divided by six is at least four or five. It is interesting to me this seems to happen if people have angst and you know it's been economically proven. It really doesn't affect it. The demand returns. 

But every election cycle that it seems the four or five months preceding are just they're hard to predict, right, Like nobody knows what's going to happen, but it doesn't. You know I don't talk about politics, but I will tell you, no matter who wins, half the people are mad and so it ends up kind of balancing back out with time. I mean, historically speaking, our industry has maintained a very solid footing because it's healthcare, healthcare in general. I mean that's where your expertise is. But I don't think you probably get many people on your show that say, unless it's an item like LASIK or aesthetics, that it's a big ticket, must have I got a little money in my pocket. Those tend to capitulate pretty big, but the rest of it tends to be pretty stable. 

0:12:11 - Mark Henderson Leary

Well, yeah, I mean healthcare. I think it's that grossly overstating or oversimplifying to call healthcare healthcare without being more clear, because there is, you know, required healthcare, you know stuff that's covered, insurance-based things that really don't interfere or don't get interfered with much on economic concerns and conditions. But the retail discretionary side varies massively. And that's one of the things that I think is interesting about iCare because it has a little bit of both and I think of it more as the influence on it is very sensitive to retail. People don't buy expensive extra pairs of glasses if they don't have the extra money. They buy the minimum and you can see that. But you can potentially have a similar amount of eye exam traffic and have a whole lot less revenue. So you kind of you get both sides of that and I think that all the healthcare is moving more and more towards that. I mean some much less Like anesthesiologist doesn't have a lot of retail cash pay. 

No no Products they offer in the value chains. But you know, I say that like that's actually not. Depending on how you look at it, there's ketamine therapy that anesthesiologists might be doing on the other side of the curtain. So it's not. I say that and then kind of contradict it. Every part of healthcare is figuring out how they can add more value to make sure that they can expand margins and ever decreasing margins and decreasing reimbursements. So it's becoming less and less stable, which is a good thing because we're allowing healthcare providers to create more value and market it to people who want to buy it. But it does create more sensitivity when the buyer is the person who feels the cost, whereas they were previously 100% shielded by the insurance. 

0:13:56 - Dr. Jason Lake

Yeah, it is bizarre. My wife and I had dinner last night with a friend of mine. He lives in the Dallas part-time and Oklahoma part-time I won't use his name and it was interesting. He was telling me about he and his wife. He's an executive physician and I kind of laughed and I said explain to me what that means. He said, well, it's $25,000 per person, anything you want. And I was like what? That seems insane to me. Oh yeah, we go in and get MRIs and we get everything looked at and hormone therapy. I'm like I don't know, man, that seems pretty expensive. 

It's popular. That's certainly one end of the spectrum and you're seeing that pop up because people want access to their healthcare providers because, quite frankly, the general physician, the optometrist and, I think, for the most part, dentistry I wouldn't feel a hundred percent confident saying that, but we are required to see more and more people. You know, and in iCare we've gotten the same reimbursement from a lot of vision plans for over 20 years with no increases, and you have to make up for that in technology and seeing people and I think there is a sub-market that wants that concierge service. But for the most part, to your point, there's the meat and potatoes of what you have to do and then there's the stuff, as you said, behind the curtain. That I think is healthy for an industry if people are looking for ways to offer services and offer differentiation. I think what I would caution, what I do, caution, young optometrists is don't forget your core audience. I mean I think I liken it to a story that I tell and it's really interesting. 

I was reading an article, I think it was in Bloomberg. It was about John Donahoe or Donahue, I'm not sure how to pronounce his name. He was the CEO of Nike and took over. He really hit it with Panda Dunks and that was like an $800 shoe and you couldn't get them. It was kind of I don't know. You know it's a black and white kind of looks like an Air Jordan I don't own a pair, but I think my wife does actually and then he hit it. 

And then he just stopped investing in research and the headline of the article was the man who made Nike uncool and he stopped recruiting to his core market and Nike lost 40 billion in cap value over the last his tenure. He was fired about three weeks ago. Shockingly. Losing $40 billion will get you a pink slip pretty quick, but I think that's what I caution young doctors about is like listen, you certainly need to offer dry services and all these services in the industry, but never, ever forget that while those things do capitulate, the beauty of healthcare is it stays pretty consistent. The business side of healthcare is a consistent winner. If you're running your business, you do need to differentiate, but you have a core that you still need to speak to to be true to. 

0:16:34 - Mark Henderson Leary

So let's talk about that. So I talk about this a lot that there's really only two ways to improve the performance of a healthcare business, and that is either, if you're on the insurance reimbursement side, you must increase efficiencies, increase your margins by reducing costs, because you're not going to be getting more and more reimbursements. That's not an option, and it's surprising how often that can actually pay off a lot. We can increase a lot of efficiencies, either through scale or relationship or simply making the operation way more efficient inside itself, just by process and things like that. The other side of that is adding more value that people will pay for somewhere in this, and so iCare really has particularly thinking from the lens to use a strange metaphor there of the optometrist. I think that the mindset has and you would know better than I would this has been your world. 

The traditional model was you know, we're doctors and we're eye doctors. And well, how can we expand that? And well, we can sell them some stuff. Okay, fast forward. It's like the industry is defined by the stuff we sell. We think that their exam is like so locked in, so dialed in, there's only so many levers. We don't even think about that anymore we only think about what products did they buy, that added value. And that has created this almost stuck industry of it only knows how to measure itself against selling eyeglasses. 

And so now enter specialty care. It's like, well, we've actually got some high margin health care options that we could add, and it seems like it's being digested in a very inconsistent way. It's not like, oh well, we know how to do the doctoring, let's add a subspecialty and do that. It's going a little wonky and it's only a few, some of the more capable practices who are really understanding how to invest in this, who are more sophisticated and complex, and it doesn't seem like it's so accessible to the smaller shops. And so talk to me how you see this sort of evolution, value creation, unfolding across the small and the large. And you know, talk now. 

0:18:41 - Dr. Jason Lake

Well, it's two things. It's interesting that we started with profitability whichever one you have to have right. And so I think it's two things is you have to have the margin to be able to expand. So number one you look back to the roots of optometry probably dentistry, chiropractic as well. It was a single door, single shingle. You went and you did your job and people came in and you did services and you made it because the margin was there. And that margin we watch, we teach in business is so important because you got to keep the doors open. So it is to your point. 

A couple of things is why are some groups able to increase in their subspecialty? The ones who are successful with it have a huge patient base. So it is really hard say whether it's myopia management which is really standard of care now, but then if you want to take it into vision therapy or dry treatments, you have to have a set base of people. You have to have enough people assuming it's one out of 10 or one out of 20, that are going to do it to make those subspecialties work. You can't I can fix any problem in your business. I can't fix demand. And if you don't have demand, you're cooked. 

0:19:46 - Mark Henderson Leary

So I hear that as if you can't market to yourself. It's going to be hard. If you think you're going to expand your practice by bringing a new patient to that, by adding a subspecialty like that, that's probably not your first step. You're just not going to hit a huge number of them. 

0:19:59 - Dr. Jason Lake

So you're already talking. There are certainly people in large density areas like Houston, texas, that have done a great job of putting in subspecialties so they grow because it attracts new patients. But I would challenge it isn't the new patient that comes in, it's the with-ems, as we like to say, it's the people that come with them, it's the other things that build up that foundational base. You can certainly run a subspecialty practice. It is not the norm at all. 

Now there is another lever Mark that I don't know that you probably get into on your podcast, but I think, as you see, optometry and I can't speak for other healthcare but as they're expanding their scope of practice, that certainly appeals to younger practitioners who are really really smart on the medical side, who are really really smart on the medical side, and as they expand that scope of practice I do not believe you know injectables, yag, things like that, the procedures that they do these are not huge moneymakers but it expands the base and if you have that foundation to stand on, then it allows you to be able to reach out in different areas Optometrists have two. 

0:21:03 - Mark Henderson Leary

You say medical you mean things outside of just the optometric and medically necessary or ophthalmological. You have to have an MD to do it. 

0:21:11 - Dr. Jason Lake

I think that's been ongoing. You know, you got to remember, optometrists 40 years ago couldn't even dilate eyes. 25 years ago, really, 25 years ago they had no medicinal. This has all been won on a state-by-state basis. Ophthalmology and optometry have been arguing for, you know, since Ben Franklin got bifocals probably right. So you see a lot of states that are pushing the scope of what optometrists are trained to do and you would hear the other side from ophthalmologists that that's outside of their scope. 

I tend to, as an optometrist, tend to side a little more in one direction than the other, but, to play fair, there are a declining number of ophthalmology residencies and I think it is changing. The trend of the profession is optometrists want to be seen as a primary care provider and I think you have to expand scope to include some of those things, and I don't think, in my opinion, that you're going to see this go into LASIK and things like that. This is more about YAG, which is a cleanup procedure post-cadaract, not getting into it or injectables, it's just it's primary care stuff and so injecting eyes no like injecting things in the lid, like if you have a little bump, like what you call a stye. 

You know every state's different. So there's a lot of states that you can do basic laser procedures. There's a lot of states that you can't. So even across the United States I think every state you can treat glaucoma. Now I should know this. 

It's been a few years since I've been active politically, but I think those things are drive a lot of that. It's how big your basis and once you build that base and you have that huge patient base and you get them coming back and doing the right things, then I think it's way easier to build a subspecialty. I'm not saying you can't build it, but the path to easy success for big primary care practices that have bases. I mean I don't fit specialty contact lenses anymore because I practice one day a week. I send it to my associates because, quite frankly, I'm not any good at it. I used to be okay. I think that will continue on, as you'll see, that within practices and I think, as you see, one doctor offices, regardless of healthcare, I don't think it's sustainable, like I think inevitably they're going to do it. 

It was an interesting example. I don't know if you saw the article on the Wall Street Journal this week and they were interviewing physicians around the country and they talked about this is something we see a lot of pressure on. This thing's like a kitten chasing a ball. You're on this podcast going all over the place. But it talked about how older physicians were agitated because younger physicians are like yeah, I'm not working 80 hours a week. 

0:23:43 - Mark Henderson Leary

And. 

0:23:44 - Dr. Jason Lake

I get that. And the younger physicians are like I'm just not doing working 80 hours a week. And I get that. And the younger physicians are like I'm just not doing it, I'd like to work three or four days a week. And the older physicians are like, yeah, I probably have worked too much, but it also helped me to get really good. Like it's repetition right, the 10,000 hour rule, and where's the truth in the middle of it? And one of the things that I thought was really, really interesting and it stuck out to me in the article is it's the physician said medicine used to be a calling and when you call it that, it in the quote was it triggers the younger generation calling it a calling. 

And I think that's an interesting thing that you really do a great job of diving into on your podcast is there is a way to do both. There's a way to run a really great business that is core value centered. And I think the mentality, particularly my age and up, of I'm just going to work 80 hours a week and see a ton of stuff and this is going to consume me and I'm not going to have a life, I don't think that's sustainable. For a lot of reasons. It's probably not healthy, even if it was, but I think that that is what drives people. You say why do subspecialties make it? Because if that's what your core value is and that's what you're super interested in, I think it's great. Let me help you build a business model that's sustainable to that, Because you're not just going to say open up a practice in rural Missouri treat and dry. 

0:25:09 - Mark Henderson Leary

you brought up an interesting point. I hadn't thought of the 10,000 hours as being a factor, and it makes perfect sense, though, because what I tend to help people discern is do you want a culture that is driven, do you want more partner level mindset? Is that where you're trying to collect, and what I think oftentimes happens is people realize like, do you want a partner or do you want an associate who goes home and is quiet on the weekends, or do you want an associate who goes home and is quiet on the weekends, or do you want a partner who will not stop bugging you about something and feels like they need a voice in absolutely everything? And oftentimes the light bulb goes on. It's like you know what I really actually don't want a partner. I actually want maybe one or two partners, and I want three or four associates, and I'm totally fine with paying for performance at a lower level of quantity. And if I had some flexible schedule associates, that actually helps me keep my margins in check, because I can send them home early, give them an extra day off. It's amazing. 

And so they realize that that actually is an asset to them if it fits their design business. It doesn't always. Sometimes they really want an aggressive culture and you got to choose. But that idea of is there a cost If you get a fresh associate who's only ever worked three days a week? Hmm, that's interesting. Like what kind of optometrist is that after? 

0:26:17 - Dr. Jason Lake

two or three years I got to be honest. I got everybody gets better with 10,000 hours right and you eventually get there right. Like I love the story on the Beatles and you know I think yeah. Malcolm. 

0:26:27 - Mark Henderson Leary

Gladwell of course. 

0:26:28 - Dr. Jason Lake

I mean it's a classic bathroom read, right, but at the end of the day, there's a lot of truth to it. Like I am a lot better than I was my first five years in. It's funny that the younger doctors that come out their understanding of things and understanding of things you also forget stuff, right, like you don't remember the minutiae because you don't see it. You see it just rarely and that's life, but it is 100% true. Now what I would tell you on the flip side is I think there's truth in both of them. 

The problem that I see and my concerns we're coming to ahead as an industry, is, if you would have five years ago, mark, I would have banged the drum that we have too many optometrists, and I can remember being actively involved in the AOA saying we don't need more schools. This is a huge mistake. And now you would ask doctors with bigger practices what they want and everyone says we need more optometrists. So in five years it's changed and what really happened? I have some thoughts that I think kind of relate back to what you said, to tie it together a little bit. Number one a full-time equivalent doctor used to be five days a week, 40 hours. So if you say I want to work 30 hours a week, we just lost 25 of our workforce. 

Well, it wasn't nobody saw that coming right well, I'm sure really smart people did, but I didn't that that truly changed the paradigm. Now they're going to get 10 000 hours. It just may take them 10 years to get it and they're coming out of school, they're fully trained. They know so much, but what they don't know are the nuances of seeing patients and how to the little things. Because I mean they may be able to quote pathology better than someone with more experience, but what they don't know is how to field sometimes a complaint and read behind the complaint. Are you just anxious or is there something really there? 

And that bedside manner develops with time, because I can remember early on I was shocked that not everyone liked me. Mark, I've known you a while. You're not shocked at that, but I was incredibly surprised by that and it's funny. It's a lot of it is learning how to how to handle people and when handle. I don't mean inappropriately, I mean in a way of your need to people you're treating the same thing, whether it's pathology or whatever. Sometimes they just need reassurance. It's how you handle it and I think that's what you can't teach in school. It just takes time and I think that's. Our more experienced doctors tend to do better simply because they've just done it more, they're not better, they've just done it longer, just done it more, they're not better, they've just done it longer. Right, and I think that's a legitimate concern. The other paradigm of that, as you brought it up, from a business perspective if you're going to work three hours, three days a week, don't ask me to compensate you for five, because the hydraulics don't change. 

And I sat on an industry panel about six months ago and I don't think I shared this quote with you, but it's funny. They asked the panel and these were CEOs of some of the biggest companies in eye care. They said what worries you most about the future? Across the board and it was interesting. It came down to three answers. Let me see. I don't know if I can remember all of them answers, let me see. I don't know if I can remember all of them, but one was they were deeply concerned about the. The primary one that stuck out to me was they were deeply concerned that optometrists don't have a business acumen. And as we dug into that, they quite frankly I'm probably gonna get in trouble for saying this I they don't do a good job. A few schools do Most optometry schools do not do a good job of teaching practice management, and a lot of that is simply because the students that's how they're still across the board. 

0:30:01 - Mark Henderson Leary

I have yet to find any specialty where they're like yeah, I learned how to be a radiologist and Well, I think optometry is there's still not that. 

0:30:08 - Dr. Jason Lake

There's some schools my alma mater in Memphis, southern College, dr Wade they do a good job of it, but the majority the interesting paradigm of that is, people don't want that. They, you know we ask associates yeah, I don't, I sell you man, he's 60 staffs. No, I don't want any. That looks miserable. It's herding cats, right, but it's also what creases financial rewards and that I. I promised I wouldn't. I told this guy I was going to use his quote. I promised I wouldn't. I told this guy I was going to use his quote and I promised I wouldn't use his name. He was from a very large company and he said, in general, he says what I see with our teams and I'm going to hope I get the quote right. He said whether it's young doctors or it's staff and he said what I see is I don't know how the lights turned on. I don't know why the lights are on. I don't know why the lights are on, but I do know I want them brighter. 

0:31:03 - Mark Henderson Leary

And whether you're going to go into private practice or not, if you don't understand the mechanics of what you're doing and how you get paid that does concern me for healthcare and because, quite frankly, I mean, there is you don't have to know how to run a business, but you do have to know how it produces, because if you have, you're never going to be happy't want to learn about business, like that doesn't bother me, because I work with so many different healthcare aspects. 

What I see is that the entrepreneurial fruiting and like, like when you get a crop or you get all these leaves, you know every hundred leaf, there's a fruit and there's a flower in terms of and that's the entrepreneurial leader, and that's what I. 

As long as we got those coming and I'm confident that we'll get those, because people are always going to do that You're going to have one out of 100 who's like look, I don't care what's going on, I got to fix this, I'm going to go against odds and I'm going to lead us to some better place, and so those are the people that I love to find and teach them how to run these great businesses. But you bring up a really good point, which is where do they get the awareness of the capitalist society in which they live? Is this all for altruistic reasons? That's not going to be a healthier place. I don't believe that's a healthy attitude to have, because you'll wind up in an institution and you'll feel like the world's against you and you won't understand how any of this works. And what I think works better is understanding economics on a basic level. 

You don't have to be the business leader. You should know what value is. You should know what supply and demand is. You should know that customer satisfaction and profit go together Value equals profit and that the company you're working for is profitable. It's probably related to perceived value it's giving its patients and customers. And so at least if you understand that at some point now, I do think that a lot of these associates and any kind of human being value contributor can be educated on that by a well stewarded entrepreneurial organization. And if they don't get it until they start working for one of my clients, I'm okay with that. But I like your point because I think at the very least the more people who graduate with a sense of how the world works in economic and capitalistic terms, that actually helps us all. 

0:33:33 - Dr. Jason Lake

I think it's and make no mistake, there's still great entrepreneurs coming out and it's just a psychographic shift in what people want out of their careers and it's not. I don't think it's isolated to medicine at all, and that's okay. People tend to consternate and get frustrated about things like that. I'm like listen, you can't. Each generation has their own jam right, like that's. It's there. There's a value principle that matters. My deep concerns are I'm okay with you wanting a three-day work week. Just understand you're going to work a really, really long time because eventually you're going to be 60 and want to retire, and that's the part that's like. I worry, probably irrationally right. 

0:34:14 - Mark Henderson Leary

Yeah, that's good. I'm really stimulating my thought on the consequences. I do think in the short term it's very manageable, like it doesn't bother me at all, but there are consequences to this that I think are real, and so I can really appreciate what you're saying. 

0:34:25 - Dr. Jason Lake

I was in. I moved my oldest daughter for the summer to Copenhagen and we went over and toured around Copenhagen with my wife and I and my daughters and we dropped her off and it was lovely country, nice, super nice people in the. You know the little tour person you hire, we had a she. She was great, super nice. And we say, hey, we're going to get a cup of coffee. Would you like to join us after the tour? She's like sure, you guys are great. We all sit down and shared a cup of coffee and we're just chatting and me that you know that you guys Copenhagen's a very expensive place. 

You guys make more money. Yeah, yeah, we don't have exports. We just it's our brains that people come to Denmark for, like they want our astuteness. And I said, okay, that's interesting. I said she was talking about how 50 or 60% of their wages went to taxes and I said, well, how do you save for retirement? She's probably mid-20s, if I had to guess. And she kind of cocked her head and looked at me like I was nuts and I said yeah like don't you save 10 or 15%? 

She goes. No, you might save for a trip, but you don't save for retirement here. Government gives you your retirement, I go what she goes. Yeah, I mean, it just allows you to chase your dreams. Like you know, I was an anthropology major and she goes. You know, people just do what they're passionate about here. They're not driven by any economic sense of what they do. Now I also understand I'm talking to someone who probably believed that and I don't think that's entirely true. It gave me such reflective thought of. That's so beyond my brain to think like that, like I wouldn't want to count on somebody to take care of me when I was old. I don't even want to burden my children with that, and I, you know, when I was 25, I thought I'd live forever right, 10 foot tall and bulletproof. That's how it works. But I do wonder at some point if there's going to be a moment of I got, you know I'm 45. I haven't. I need to kick it in gear and then at that point, do you work till you're 95? 

0:36:26 - Mark Henderson Leary

So that's probably just maybe me being 53. Right Outside of the US, it's easy for us to forget the entrepreneurial barriers that many other countries have, and I think that's a good example. Like in the United States, you're like, I want to be an entrepreneur. Like later today, I've got a business, yeah. 

0:36:41 - Dr. Jason Lake

File an LS and save 30 bucks with your local state. 

0:36:44 - Mark Henderson Leary

But, like in other countries, it's a serious commitment of like this business plan has to work. You know we're going to have to figure out the tax strategy, and so when people make the jump to starting a business, creating a practice, doing something that would put them really in control of a significant shift of their life position, that's rarefied, not many people can make it and there's a lot of things that happen to happen there and I can't speak to exactly how Denmark works, but it sounds like that. 

0:37:13 - Dr. Jason Lake

It's not like it is in the United States. No, no, no, I think it's socialist but it's kind of an elected officials type of a deal, but very much egalitarian To me. I think that that's interesting. I think not of. My bigger concern is as a profession, whether it's MDs or ODs or DDS or you see so many people working for hospitals and things like that. Where they're taking, they're allowing someone to control their fate and that, to me, is tough. I think you can. If you're not built, like you said, to run a business, you can be an amazing best doctor ever. To run a business, you can be an amazing best doctor ever. You do have to have an organization that is core value-led and I know you spend a lot, yeah, and that's my people. 

0:38:05 - Mark Henderson Leary

Totally, that's what we're doing. You know, like you said, the mom and pop, the single doctor shop, that's not super viable anymore and that's true across all healthcare Institution in large scale. That's kind of what we see is the place to go to die, and but there's and that's that's the even the private equity, the large side of that, at least in terms of the perceptions there's. We can unpack that there's that is about three podcasts, but to me it's really about yeah for sure, and so we there's lots of middle ground there's. There's these regional players there's. There's lots of middle ground. There's these regional players there's, you know, even large locals that really run a great business and a great culture and going to work for them is a great thing. 

So we're really trying to cultivate the awareness, really help those business leaders do the things that they weren't taught to do and really kind of fill that middle, and I think that's the whole mission of this thing, and I think that's the whole mission of this thing. But I want to take it back to the mechanics of what's happening here, because one of the things that I see across all parts of healthcare is the leverage of the scarce resource, meaning we don't have as many ODs or MDs or whatever, and they're expensive, the ones we got, and with hours or less. So how do we distribute the workload so we can, with lower margins or higher margins, rather lower cost, get the same patient experience, patient outcome, and it ends up being using different people more people, less and less of the expensive person's time more and more of something mid-level or something not licensed. 

So I want to hear about it. I want to hear how you see this, because I see people who are saying you know what? I can see twice as many patients as an OD if the pre-work is done by a great lab tech and so, and surgeons, same kind of thing. We need surgical assistants and medical assistants and these mid-levels taking the load off of us. So go. 

0:39:56 - Dr. Jason Lake

So right now it's virtual employees. You know that's the big, big rush. We see anything that is not patient facing. Particularly, we're seeing the virtual scribes which we align with. 

0:40:08 - Mark Henderson Leary

I got a friend who runs AI scribe he says my AI scribe is way better than my human scribe Never loses focus, Never never, never, daydreams. 

0:40:15 - Dr. Jason Lake

So that's the next thing is I actually think virtual employees, for the most part, will be non-existent within. Not non-existent, perhaps they'll turn, but it's all AI. My wife uses a physician at a local Kansas City clinic and she's known the doctor for several years. Comes in, they're just chewing the fat and she's watching the computer fill in behind her and this was just this year this year. 

She said tell me about what you got going on. He goes yeah, we went to a compute, complete virtual scribing system. He goes I was ready to retire. I just put 10 years on my career because all I do is I go out. She goes. We just talked about basketball, for it was the ncaa tournament for 15 minutes. You know about the local teams. And she goes yeah, I just go out, hit delete, it's all filled in. It knows where to put things in the right spots. It's proof that you've had these great conversations and it's all in there. I remember he has my notes. He goes. I can spend 30 minutes updating my charting at lunch before I go home. I used to spend three hours and I have not yet seen anyone do it in optometry because there is certainly a prohibitive cost for that technology. But what I'm seeing now. 

I think you know Eugene Schatzman at National Strategic. He's building bots and he put his office manual on a bot and I think anything that is capable of reproducing information. I mean this is just is it called custom GPT or open GPT? I can't remember what it's called. It's chat GPT, but you can do a custom version of it for a fee. That's the stuff that's going to get outsourced. 

What I hope and what I think is going to happen is great doctors are going to lean into that kind of technology and they're going to see more career satisfaction and they're going to continue to do great patient care probably a little more of it, but the workload will be lessened. And if I could, you know I don't know if any elected officials listen to your podcast, but I think getting rid of the ridiculous redundant healthcare record keeping. I mean the amount of buttons you have to hit to say I dilated a patient. Then you have to hit a button layer that says I hit a button that said I dilated the patient. The redundancy, it's clunky, it's useless, no one does anything with the data, and that's kind of what I see from the successful practices. 

Those are the culture-driven ones. But I mean, yeah, I mean to your point, you've got to be in an organization that's going to go after and attack this AI and machine learning in particular. I mean it's. 

0:42:43 - Mark Henderson Leary

Yeah, I think that's again. That's the entrepreneurial hotbed. That's when we entrepreneurial leaders are willing to obsess, try things, make mistakes, and that's the place where this lives and there's not enough risk tolerance or time in a super small practice and the institutions just make money different ways. And so I really think the risk tolerance is in that mid-side space and I think it's both of what we're talking about here. You talk about expansion of scope, having an OD that can do more and more. 

I think that's part of the trend and I like the idea of how AI takes some of the load off the truly low value work, the tedious work that we're. I mean my friend the orthopedist. I had coffee with him in the morning. He's like, yeah, this AI scribe translates it to English and Spanish, creates the soap note, does more than one person could do and it's more reliable. That's a value for sure. 

But it's also like, well, do we expand the scope of these mid-levels of things that aren't software, actual clinical care, actually putting hands on things, actually fitting contact lenses, actually doing these things? What can we start pushing down and expanding scope of all the people to the point where the bottom drops out like we don't answer the phone. I'm assuming that's what's happening At some some point. We are not answering the phone at all. That is entirely ai, because I don't know if you've done any work with those voice-driven ai, but they are unbelievable in terms of like. It's so different than it was five years ago it's. It actually sounds like a friendly human being. That is so much better than somebody outside the country who's clearly from a different culture. The AI can way better emulate culture than cultural training in another country. 

So that stuff's gone. But I do think that there is. 

0:44:28 - Dr. Jason Lake

the whole value chain moves down a notch and there are those people who were answering the phone who can maybe do something a little further up the value chain and I think it's how you can continue to pay people a higher wage, right, like it's going to continue to go up, but you've got to. There was a study that said AI was actually not going to cost any jobs. It's just the jobs are relocating and what I mean by relocating they're moving into more technology-driven. My daughter is finishing up the University of Arkansas in December. She's going to be an architect and it was interesting to me. She was showing me how she uses AI to go through a drawing and to check things and relabel things. The tedious work that they used to have the junior architects do is now being done by AI and she's doing the stuff she wants. Where it's creativity and it's thought, I am a firm believer. I, you know I'm of the Terminator generation, right, you know, with Arnold Schwarzenegger, I think we're a long way from that. 

I think it's terrifying a little bit because the algorithms, I think can be thought to be creative, but I think we're overlooking the 80% of the thing. That does good if you can control the 20% of the potential to go bad. And I think in healthcare I got asked to serve on a pilot last week of a new screening mechanism at primary care offices for people who don't get a dial-ed fundus exam. Go to an eye care provider. You can screen them and it automatically sends them to the local optometrist to go get an eye exam. If they find any diabetic and it's just using AI algorithm of what they're finding they're like, yeah, you need to go in and get this monitored. 

So everything we should be thinking about in the industry Mark is based on two things Number one are we doing the right thing? And number two, how are we expanding the pie? It's not. We tend to get in that scarcity mindset we don't have this, we don't have that. If you flip that around and say, how do we grow everything? Two or 3%, how do we get faster? But don't give up a heart and soul. And if you do those things, it'll grow. 

0:46:30 - Mark Henderson Leary

Yeah, I think I don't want to sound negative on this, but if we were close to curing blindness, close to people no longer having any kind of eye issues, then we would have something to talk about here. But healthcare has so much surplus value yet to be delivered in all aspects. If we get way more efficient in doing this and we just got more problems to solve because people can get healthier and healthier, there's so many chronic problems and so many things that people just sort of live with because they haven't figured out how to deal with it. They're just too lazy to do it or cost too much, and as soon as we remove any barriers to that, you just open up that aspect, like you know what. You can get that fixed. Now there is time to do that, so I think it's 100% right. There's plenty to do here with lots of moving cheese, that's for sure. Lots of moving cheese, but there's lots and lots. But even though, what? 

0:47:16 - Dr. Jason Lake

you talked about with and I say I'm going to we paint it. Probably too broad of a brush because I think it's it's all healthcare providers but yes, nobody likes their cheese move but the reality is you have to start to embrace this stuff and maybe that, maybe that is the advantage of working a lower schedule is that I find that if I need to be creative and again, jokes aside, maybe I'm 53 and I don't have the creative juice I had but if I need to go create content, like I did this morning and I knew we had a meeting I made sure I had three or four hours before this, with two cups of coffee after a workout, and that's when I'm doing great creative work. Maybe that's you know. Maybe we need to start thinking. Maybe that's the upside, maybe the experience happens a little slower, but the creativity and the passion grows and maybe we can end up getting a better overall product. 

I don't think that you can change somebody's willingness of how they want to attack their career and how they want to use their time, but I think you can choose the hours that you get, how to maximize them. I think it's where you ought to spend your time. I think the days of 120-hour-a-week residence are. I am certain that no one is functioning at a super high level after 120 hours during a week. It's just not possible 100%. At least I don't Anything over 30 or 40,. 

0:48:41 - Mark Henderson Leary

I'm shot right. Exactly, I wish no, but I think that you're on to a point there. I think that the short-term feeling of like I'm not as motivated to work a million hours. I want some freedom in my life, does give way to the economic reality. Do you want more? Okay, then you got to add more value and you have autonomy and agency. Now I think that's the sort of the give back. You're giving people freedom. 

Like before the graduate, it was like there's no choice here. You're going to be a servant and that's how you're going to get great, and so no thinking required, just compliance. Now it's like well, you know what? I have an economic way to use you part-time. It's totally fine. You're going to pay the price for that and I'm going to actually reap the benefits as somebody who can consume you at a reasonable price. 

And you as an individually capable person is like well, let me compare myself to my peers, my friends, the more senior folks, and I want more, need more. I'm having having a family, I have some levers I can pull. I can work less, my spouse can work more, we can do that, but then in the end of math still is gonna work out and you're and you're gonna either be left with working less and getting less and be in having less, which might be okay, but I think a lot of people are gonna be woken up to that one, unfortunately, and they're gonna feel, I think, frankly, a little confused, like I don't and like and I was here to tell you it's, like, it's not a surprise. 

0:50:01 - Dr. Jason Lake

I remember in 2024, Mark Leary was very clear with you on what you needed to do. 

0:50:07 - Mark Henderson Leary

Especially when you do this breakup, the career thing. That's a whole other topic. But I think that when two partners sort of, hey, we're going to split the load, you end up with two non-masters, right, you end up with two people who are very mediocre in their career and have very mediocre lives as a result, and so that's another podcast entirely. But at some point you have a lot of people who just kind of snap and go exactly like you said. You know, I really think I could add value in this area. Specialty care is something I want to figure out. I'm going to launch a TikTok channel on dry eye. Okay great, that's actually awesome. And maybe the passion yields reward in very unequal ways, which I think that's what capitalism does so well. That massively disproportionately rewards people who take risks and punishes people who don't, and so that's actually really good and it feels unfair to people who lose that amount. But that's actually the incentive we need for people to take really significant risks. On inventing and creating. 

0:51:04 - Dr. Jason Lake

You can't fail forward without a risk and a reward. 

0:51:07 - Mark Henderson Leary

Yeah, so disproportionate rewards are actually really important to make people do otherwise insane things, to take risks, to create innovations and do things. 

0:51:16 - Dr. Jason Lake

I mean, everybody in iCare would tell you that they hate online purchases, right, that you know why can't it go back the way? It was? A brick and mortar and dah, dah, dah, dah dah. You can hate them, and I probably do, if I'm honest. You can also point out the fact that they have probably expanded the pie more than they stole yours, and it's opened opportunity and you've got to wrap your arms around what's coming at you. But since I've been in practice, I was going to be replaced by autorefractors and LASIK. 

The list goes on and on and on. What we did was we figured out a way to leverage it, to take the best and to grow with it. And overreaction is, I think, what the great ones do, because that's what creates creativity. But sometimes that overreaction is, yeah, my my wife said it best one time the best staff members, we. We always tell them to be calm and finally it was probably 10 years in practice. She says you know the reality, we're never calm. 

The reality is we overreact to everything, and that's probably what creates a great service culture like, like, if you're slightly upset, I need to go over the moon to make you happy, and if that's a core value, we're going to give great service. Well, a, what's great and B, you have to be, by your nature, an overreactor to do that, because people want over the top. If I can get anything from Amazon in 24 and sometimes eight hours, how do we change the supply chain that we can start getting our stuff faster? I don't like amazon for that reason, but I bet right now on my front porch is a stack of boxes that looks like a little tiny snowman probably not a small one, but I mean. 

We may not like it, but how do we leverage logistics that they're doing? How do we leverage logistics that they're doing? How do we leverage it in healthcare? How do we? I guess it's glass half full right. Are you going to look out for what it is and learn from it and get a little bit better every day? Are you going to stick your head in the sand and just hope it doesn't affect you? And I think that's that's what we have to decide is I'm cool with you working three days a week Understand there's a long-term ramification but maybe not if that lack of burnout quote unquote allows you to be more creative and get better patient care. I'm cool with that. 

0:53:26 - Mark Henderson Leary

Yeah, yeah, and I think that's the question to be answered, and we know this, that you work most of your life to create a great business, a great life for yourself. And somebody says, hey, by the way, we're going to change all that and you're like I don't want to reinvent myself, sounds horrible. The old way was great, your way. I don't understand. It's terrible. It decreases in quality or whatever. That's just the monologue that gets repeated every generation. And so the old guard resists. 

And there's good things that come from the resistance. Oftentimes there's a lot of conservation of value that comes from that. But then there's the next generation who's like cavalierly diving in oh, this is going to be way better. And they're wrong. It's not way better. At first it's very chaotic and it's interesting, and then eventually it gets better. So I understand the mental fatigue that goes with. I mean, if you're 70 years old and you're trying to get out of your practice and the whole world is revolving, you're like this is stupid. I put the brakes on the change, I cannot afford the change. It would take 10 years for me to reap the benefit of the change. So don't change, that's fine, that totally makes sense. And so we just have to have both of those forces working together. And it isn't a smooth curve. It's never a smooth curve. So this idea of brick and mortar, getting your frames to the extent that that's, I mean I don't know. Is there a future where there's no such thing as glasses? Are we going to totally be done with glasses at some point? 

0:54:54 - Dr. Jason Lake

I mean, I don't see it in my future, but who would I be to say that? I think the big new wave coming in as you talk about expansion is you've got the new Nuance product coming out, that the hearing aid is embedded into the temple, to the market with things like Ray-Ban, where you've got glasses that are not only interacting with you but they're interacting externally and adding to your visualization. I sat with a gentleman from Europe at a conference this year and he, I believe, is head of AI for Meta and he said to me you think of of virtual reality. Is you looking at something? He said that's stage one. He goes. The next phase is it's going to be looking back at you and how are you reacting to what you're seeing? So you're interacting with people. You know we're all used to the Zoom being. You and I are doing this, obviously remotely. You're in Houston, I'm in Kansas City. Five years from now, we're doing this with virtual reality headsets on. We're sitting on the set of johnny carson and you're sitting behind the desk with a little microphone. Yeah, I think those are the things that are. 

Do I think I care as we do it today? What is the adage? The end result of health care will never change, but the way we do it will. People are still going to be near side, they're still going to be farsighted, they're still going to be presbyopic, have astigmatismism, they're going to have diseases of the eye. That's just genetics. How we take care of it is what will change. It won't be the fact that the human body I should never say that Give it a few million years. I mean, maybe we'll evolve past this, but I'm not. 

0:56:30 - Mark Henderson Leary

I think with genetics, I think at the end maybe we can take away some of those diseases for a time the human Until we crack the aging code, and maybe that's possible as well. But it still seems like, as you approach infinity, there's still an end to this. 

0:56:51 - Dr. Jason Lake

And you delay disease, you delay death, but the game is the same. And, to be frank, what's God? The famous quote is? I think it was Luke Bryan. In a country song he says wisdom in your youth will be a lot less fun. I think there's a. Sometimes the aging process is, I don't know, I'm probably not as agile as I was at 25, but I sure as hell don't do the stupid things I did at 25. So as you become a little wiser, the thought of stopping aging to me seems a little. You know we talk about 25 different podcasts. You know you look at there's a huge boon coming in, particularly women's health care, about using hormones or not, and is is menopause real? Oh my god. And if you stop menopause, what are the six things that happen because of it? Because your body is meant to have menopause right, and certainly, as a male, I have absolutely no opinion on it, nor would I have held a gun in my head. But isn't that anti-aging? Isn't? 

somebody looking at a male and say well, you should boost your testosterone back to what it was, and certainly people, that makes them feel better. But now you have people taking it to extremes because, well, if I take two, it's great, if I take four it's even better. That mentality of I'm just going to look like I'm 25 forever. I don't know what problems begat from that and what opportunities did right, oh for sure you think I'm jumping off that cliff. Well, all technology does that too. Wouldn't touch you. 

0:58:10 - Mark Henderson Leary

I think that's. I love that topic and I think that's exactly right. I mean, it's a little bit of Chesterton's Fence, the idea that, if you encounter Chesterton's Fence, are you? 

0:58:19 - Dr. Jason Lake

familiar with that one. 

0:58:20 - Mark Henderson Leary

I'm sure your listeners will die to hear this. It's really a metaphor for social change, but I forgot his first name. Chesterton was a commentary on social change or a commentator on it, and it was. If you encounter a fence in the woods, the fool says, well, get rid of this fence. The fool says, well, get rid of this fence. 

0:58:35 - Dr. Jason Lake

It's, in my way, the wise man says why is this? 

0:58:42 - Mark Henderson Leary

fence here. This is not accidental. And what are the consequences of removing the fence? And your ignorance of the fence's purpose does not mean removing the fence will have no consequences. And so when we change the game on life and aging, what? 

0:58:57 - Dr. Jason Lake

Pandora's box is that open? 

0:58:58 - Mark Henderson Leary

Yeah, exactly right, we change the game on life and aging. What Pandora's box is that open? Yeah, exactly right. And I think the wise person we can go, gender neutral since Chesterton's time Probably female for being honest, the wise female. But go ahead, yeah, and just say you know what's asked, use humility as our guide to say you know, I'm not. I'm not saying don't take it down. I'm not saying that maybe the time for this fence has passed and we can move on, but I am saying be aware there's things you don't know and be ready to adapt and and and be aware that it could be fatal. Are we opening a gate? That is? 

0:59:31 - Dr. Jason Lake

not closable. Are you keeping the lions from crossing the fence that? 

0:59:39 - Mark Henderson Leary

that that I'm going to work that into. I'm going to work that into a speech and probably not give you credit for it. That's fine. I would recommend you give Chesterton credit for it. I'm going to call it Mark Weary's fence. 

0:59:43 - Dr. Jason Lake

maybe, I don't know, we'll work on that. That's right. That is a great way to bring it full circle. Mark is no. I think we both agree and it's fun to proselytize on that, but to say, hey, here's what's. I think the industry's healthy. We started out talking about Evita and we ended up here, but I actually think the two are so inexplicably linked together and I think if I had a passion, as you do, it is to give people that basic understanding of the hydraulics, of the economics, of how that's going to affect their life. In the eye care space you can do anything you want to do, but there's an equal and opposite reaction, a perhaps a Chesterton's fence, of what happens if you work three days a week, because it feels really good right now. 

Well, yeah, get back to me it's 68, right, like I don't know. I don't know what that is, but I think that the point is is that there is no right or wrong. There is only giving people the basic knowledge of how to build the right culture, in your case, and how to have basic business understanding in mind. If your job is to figure out how to ask why it is not to make the choice, and whatever choice it is, how do we react to that and maximize it? So, yeah, that's a very lovely way to bring us full circle. I'm impressed with you. 

1:00:56 - Mark Henderson Leary

Thank you for making that connection and making it seem like it was me. But no, I appreciate the conversation. We've covered a lot. Anything you think we need to add to this? Obviously we could keep going and talk about no I think we could. 

1:01:06 - Dr. Jason Lake

No one would listen your podcast downhill. No, I. I think what would be interesting is, as we continue, as we build things out and as we learn more on the economics of what's happening is how does that affect culture? And I think that might be an interesting topic is are cultural business and businesses inherently more profitable, or is it vice versa? Is the profitability creates the culture? And I suspect that's an interesting topic for a future dynamic to dive into. 

1:01:37 - Mark Henderson Leary

That is an interesting topic and we are not going to cover it now because I have had this sort of recent humbling around private equity, cultural impact and it is I'm going to plant the seed for you to think about we'll talk about in the future. It is generally the boogeyman for culture that private equity ruins all good things and the fact remains that is not the case necessarily that there is an impact between vision and horsepower and if there's a powerful vision and some private equity horsepower can create great out. There is also roll-ups who are time-driven only and they do tend to destroy things pretty predictably when there's not a sense of clear vision and culture and value. That's well preserved. But there is also I've seen this phenomenon of really powerful private equity with really lofty goals. That really it's not a surprise. They impact the culture. 

You get a great culture with a great vision. But now there's something a little different. The performance bias is usually it and what I'm finding is that there's almost always resistance to it and a lot of people who feel like this is terrible. The old soft, lovey-dovey culture we had is now gone. It's been ruined. But talking to people who stick with it, they recast their opinion, they look back and say, yeah, it was uncomfortable and we lost a little of what we had, but it actually worked. 

1:03:03 - Dr. Jason Lake

We now are better off. Do you want your metric to go with that next podcast? If there's a burgeoning industry now called the industry of exit planners or certified exit planners? Oh yeah, and one of my dear friends is very engaged in that, a guy named Mark Kipp with Prime Capital here in Kansas City, yeah, yeah, and he said that 70% of all small businesses are going to exit in the next 10 years because of the baby boomers and people exiting and I can't remember 65 or 70, but of that 65 or 70, 65 to 70% of those transitions will fail. It's because mostly, he believes, and as we dive into this topic in the industry, it is because of the poor economics and lack of understanding. But I don't know that. That's completely it. I think that's a whole. Your point is they are slated to fail. What could we do to help prevent that? 

1:03:59 - Mark Henderson Leary

Yeah, Well, I think there's a continuum of reasons for those to fail, and I think that it's at the bottom end. It's because it's just a mess. A lot of those exits are driven by this thing's about to crumble, I don't have the energy to run it anymore, I need to retire, and so they're going to sell under very distressed, chaotic conditions and those emus. 

1:04:20 - Dr. Jason Lake

Right, there's no foundation. I was a hell of a xyz baker, butcher, candlestick maker, but I never built a business that was sustainable. The next person sees the business, but they're not a hell of a butcher, baker, candlestick maker and the next thing you know and then when the energy and as it runs the arc right, the energy to kind of glue it together is gone. 

1:04:39 - Mark Henderson Leary

But there's also just this we had a good enough margin format. We didn't have to think real hard about budget. Well, now we're getting to scale and all our metrics matter and our investment thesis is driven by an actual spreadsheet that actually has multiples where a percentage or two make a huge impact. We are going to do the math and we are going to run a budget and it was great to just sort of like ask and with a good, credible argument, you got it, you got it. But those days are over. We are going to measure ROI on everything and that that's a. That's a pill that's difficult to swallow a lot of times, but I think that that's the nature of a high-performance business and at some point that has to be digested. And I think that when you think from that sense, it's like it's a maturation, not an erosion, and I think that it feels bad for people who didn't want to be accountable. But that's a whole other topic. 

1:05:34 - Dr. Jason Lake

Like I said, Lovely day with you, Mark. It's fun. Bring me back, for we'll do a round table perhaps so really smart people, and we can chat on that topic, and I'll listen intently. 

1:05:44 - Mark Henderson Leary

Yeah, that sounds good and I'll be seeing you next week. 

1:05:47 - Dr. Jason Lake

Probably, by the time this thing publishes, we will have already seen each other Cause. Thank you Two weeks out. 

1:05:52 - Mark Henderson Leary

Hopefully we're still friends then, sure, we will be All right, buddy, awesome man. So how does people? How do people? How does people? How do people keep the conversation with you, follow you between podcast episodes in a simple way. 

1:06:06 - Dr. Jason Lake

You live, probably under my roof. Those are the people that probably end up following me the most. 

1:06:13 - Mark Henderson Leary

I don't. 

1:06:13 - Dr. Jason Lake

I am a horrible interactor. I am trying to be better at LinkedIn, you know. Certainly you can go to perkalliancecom, optiport, but that doesn't probably follow me the best. I think the best way is usually I am fairly good around our events at LinkedIn and, of course, you can always get a hold of me easily through either organization. I'm not hard to find. I am not a good influencer in that regard. I do more podcasts than I do social media posts. How about that? 

1:06:42 - Mark Henderson Leary

Yeah, makes sense, it's all right, and you're in front of the audience and all that kind of thing. 

All right, awesome man. Well, I'm grateful for the time and we'll catch up after the next week and we'll talk again, as always. All so, that's our time for today. As always, if you're a listener and you felt like that was useful, please get it in the hands of other people who could also find it useful. That's how this stuff makes it around. That's how we grow together. That's how we build an abundance-minded healthcare community and help each other grow. 

There's plenty to do, plenty of value to create, plenty of people to heal, plenty of added value to create in the business and make awesome cultures of added value to create in the business and make awesome cultures. And so don't forget, of course, if you're thinking of that amazing culture in your organization, you're thinking about a business that just drives massive value to your patients and clients and whomever. That gives you the life you deserve. But if, for some reason, you're stuck, you don't know what the next step is. Please don't stay stuck. Please reach out. We'd love to figure out what a first or next step looks like. Practicefreedomcom slash schedule, and we'll take a couple of minutes to get you on your way. So, with that, that's our time and we'll see you on the next episode of Practice Freedom with me, mark Henderson-Leary. Thanks, buddy.

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