|| Fly on the Wall ||
Our guest today is Dr. Dori Carlson. Dr. Carlson was the first woman to serve as President of the American Optometric Association. During her tenure as President in 2011 she visited every school/college of Optometry and lobbied extensively for children’s eye exams to be an essential benefit in health care reform. Optometric Management named her as one of the “Most Influential in Optometry” and Primary Care News identified her as a “Pioneer in Optometry”. She was also the 2019 recipient of Women of Optometry’s Theia Award for Leadership.
Today on the show we got to rehash the history of the profession of optometry and the historic movements that led us to where we are today. Additionally, we discussed how we can improve our relationships both inside and outside of the profession.
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Podcast
Episode 189: Fly on the Wall
Dr. Christopher Wolfe: [00:00:00] Hello, and welcome to Christal podcast on I code media today had a great conversation with Dr. Dory Carlson. We rehashed a lot of the history of the profession and some of the movements historically that have led the profession to where we are today. As well as have some conversation about how to improve some of our, uh, relationships within the profession and outside of the profession.
I had a lot of fun with this conversation. I hope you do as well. Uh, please be sure to subscribe to the podcast, write a review, share it with your friends and support those. Who support us. So today I wanna talk about the, my day multifocal for just a second. It has been a really great thing in our practice for our patients who are presbyopes of all areas, but you know, those tricky presbyopes are always the ones that are kind of emerging, where they don’t want to give up any of their far away vision.
But they’re having some struggles [00:01:00] up close. And so what, uh, the mighty multifocal has been able to do for us is to allow those patients to transition into a multifocal more easily. And then as we have those patients progress into other levels where they need more ad powers, it’s been a nice, smooth transition.
So the ultimate hurdle that we’ve seen in our practice before the, my day multifocal. We’d have patients who would resist any transition to a multifocal lens because of that distance blur. We just haven’t seen that. So if you haven’t started using Mida multifocal in your practice, I would encourage you to start check it out.
Uh, contact, reach out to your Cooper reps for those trial lenses, uh, and commit to mighta multifocal for your patients. I think they’re gonna like it. If you haven’t checked out Macia health yet for your patients in category one through category four, I think there’s a lot of evidence that you should be considering.
The first is if we just look at a reds two and what they, they talk about, MACI health is a, so for patients in category three and category four, um, AMD Macia [00:02:00] health is a great option for them that follows that entire, um, that entire protocol. And it also add. Meso Z is Anine to the mix, which if you look at some of the evidence, I believe shows me that it’s going to thicken the macular pigment better than without meso Zanine.
It also uses the, a correct, a reds two dose of zinc, uh, at 25 milligrams. And so you don’t have to worry so much about the potential side effects of zinc. The other thing to, to think about. And it’s beyond the scope of this, although you’ve probably heard me talk on other podcasts, is that in patients in category one and two, there may be some additional benefit, uh, to supplementing them with something that may be a little bit less than the, a reds two.
So you don’t have to add as much to it. And that’s where I use the Mac health LMC three. And so I think if you haven’t done this yet, I’d consider Mac health in your practice and for your patients. And it’s been great for my patients. Um, and we really feel like we can have the ability to, uh, help those patients in all categories of macular degeneration.
So you were one [00:03:00] of our, one of the first guests on the podcast years ago. And, um, I don’t know if I can share this and tell me if I, I shouldn’t, but we were, um, we were in Washington, DC and I was sitting at dinner with my dad and my sister. And, um, One of my friends growing up with right next door and he he’s a priest now.
And he, uh, is a priest out in, um, in Maryland. And I think actually I think he’s gotta be in the archdiocese of Maryland. Um, probably the Washington DC archdiocese. Anyway, he’s kind of north of Washington DC. And so we were having dinner and I look across the room and I see, I see, uh, Ron hopping in Dory Carlson sitting there and I made a comment to my dad.
I said, If I could be a fly on the wall for that conversation, what sort of perspective they’ve got of, um, of just the history of the profession and where we’ve gone in the last 20 years. So was I interpreting that right? That like, there is this sort of wealth of, of kind of perspective that is untapped apt.[00:04:00]
Dr. Dori Carlson: Oh, I don’t know if it’s untapped or not. I don’t know if that’s the, it’s probably the right way to. but, you know, certainly I find myself being in the place of historian, which is kind of weird, cuz I don’t think I’m that old, but I I’ve been doing this a long time. So yeah. You know, you, you, um, you know, one of the things that I learned, so when I went around doing the school tour, and I went to every single college school and college of optometry when I was president and president elect.
And, um,
Dr. Christopher Wolfe: now do, sorry, I’m gonna pause, cuz I wanna refresh the audience memory. You were president and president elect. What year of, of the AA?
Dr. Dori Carlson: 2011 to 12, right. Okay. Okay. So the year I was president and president elect, um, I went around to every single school in college of optometry. And in fact I’ve been to every single one except for the new one in Chicago.
And I haven’t been to the one in Worcester Massa. I think those are the only two I’m missing. I, I actually got [00:05:00] to Pikeville after I was off Thea board. Um, but I learned things as I was doing that. And I’ll never forget sitting down with another past president, um, Dr. John Don GaN, and he was Dean of Arizona at the time when I was at the school.
And there’s like this fraternity that happens when you’ve been a past president and it’s kind of a cool fraternity because there is baptism by fire maybe. And you just have this comradery that nobody else has quite gone through that. And we all have different stories of when we are on the airway board and such, but you still have stories.
So I was in thoroughly enjoying visiting, listening, or visiting with Don that day. And he said, well, you know, therapeutic started really with the Vietnam war. really. Hmm. So, and I verified this with, um, a couple of other people, Dr. Joel Byers and some other folks, and I said, is this really true? [00:06:00] So before I go out and tell people this story, is this probably accurate?
Yep. I I’ve heard that. It probably is. So. And I hated history when I was in high school, but now I find myself in that, that venue of being the historian or telling the stories. So these guys got drafted. Right. And they go over
Dr. Christopher Wolfe: to Vietnam. So Vietnam war. So would’ve been sometime in the sixties sometime during that Vietnam period?
Yep. Okay. They
Dr. Dori Carlson: get drafted. Um, and so they, they got drafted because we had a draft. Um, I thoroughly remember my brother. calling home because he had gotten drafted and he had an option to go to Vietnam, or he had an option to go to the national guard. And I remember really vividly that phone call with my parents about what to do, because he had gotten drafted and my brother-in-law was drafted and he was over there that old Dory.
So, but I came 16 years behind my siblings. Okay.
Dr. Christopher Wolfe: Okay. So that’s, that makes more. Yeah.
Dr. Dori Carlson: So I was just a little kid, [00:07:00] right? Yeah. But I remember those phone calls. Um, I was like four when my sister got married. So, um, but these folks got drafted and they go over to Vietnam and they’re in a battle environment.
Uh, people are getting injured and there was optometrists that were drafted. Uh, so they went over to Vietnam because this was their obligation for a country. And what happened. People had injuries. And as they came in with these injuries, the eye stuff got thrown at these optometrists. Okay. Whether or not they had training, I don’t, I’m not gonna speak to the training at that point in time.
And those that age group, cuz I wasn’t around to know what that training was, but I can, well imagine that nobody was being taught how to do antibiotics. Maybe I, you know, I don’t know, but what happened was, you know, they were just told, well, you know, more about the eye than we do, so figure it out. So that’s what happens is, you know, I talk about baptism by [00:08:00] fire.
So literally here’s our colleagues that are over there in the Vietnam war situation, and they are treating eye diseases. Whatever happened in a war situation, they got it thrown at them. So they come back from Vietnam and. , you know, then it’s the GI bill and some of these are going back to school. And I don’t know, according to Dr.
Jar, again, some of these folks came back and said, well, wait a minute. You know, I was doing all this stuff when I was over in Vietnam and now I came back to the United States and I can’t do that. And you know, people will talk about meetings that there was, and I don’t even know this because
Dr. Christopher Wolfe: there’s other people ner.
And, uh, what was that meeting called? I remember that. I don’t remember. What was the meeting called? Yeah. I, I don’t either. I, I don’t remember. No, I don’t either.
Dr. Dori Carlson: There was a famous meeting of getting together and kind of deciding it or the folklore of it anyway, of getting together and deciding what we should do as a profession.
But you can, well, imagine there were some of those folks that came back from Vietnam or that were part of that conversation, or if they [00:09:00] weren’t directly, they had friends that were part of that conversation. Um, and, and I was told. In fact checked it with some other people that came before me that, yeah, that’s what happened.
And so that started our whole therapeutic actually diagnostic, um, diagnostics first, um, and then therapeutics after that. And so it’s just been really kind of interesting that I remember when I got outta school, um, I looked at the AA map. I don’t know about you. Probably most places had therapeutics by the time you got out mm-hmm , but I looked at AA maps and there was a lot of states that didn’t have therapeutic privileges.
And I got done with the residency in the VA and thought, well, I wanna use what I’ve done. You know, I, I don’t wanna go backwards. Um, I’m from Minnesota originally, and I really didn’t wanna go to Minnesota because they had a crappy therapeutic law. They did. Ah, um, you know, so it’s like it, but you, I remember vividly studying those maps as a student, trying to figure out where it was.
I wanted to
Dr. Christopher Wolfe: [00:10:00] practice. Yeah. I mean, I, I think you’re right about, I, I mean, I, I, there was no reason for me to doubt you, but I think I can say that I verified what you’re telling me. Not that I verified it, but I’ve heard the same story. Ed Schneider, who God rest, his soul was, um, a member of the NOA and then a third party consultant for the NOA for years.
and, um, and he was one of those guys. Uh, I, I don’t know if it was Vietnam, but he was in the military. I think, I think I remember he was either telling me that story or I think that the story was about him. Uh, same thing, you know, and he’s, uh, went through those things. He had to learn it. He had to learn how to use a slit lamp, you know, out of necessity.
And, um, yeah, I think, I think the story is valid. So, you know, I think the, the thing that I, I kind of think about. because, well, I was in school, so I was in school in Oklahoma from 2004 to 2008. And what I remember was one of the distinct reasons I chose Oklahoma was I had already looked at PCO. Well, Salus [00:11:00] now I had been accepted a PCO and accepted a Houston.
And, um, and it, my dad called down to Bobby Christensen and he said, Hey, Bobby, what do you think about? Cause he knew Bobby for, for years, everybody knows Bobby. Sure. And he said, what do you think about. Where Christopher should go, you know, should he go to Houston? Should he go to PCO? And he goes, has he checked out qua, they’re doing things down here that you can’t.
And my dad knew. Right. But he didn’t even really think too much about it. And he goes, you gotta, you gotta check out qua. So that was like in December. And, um, and so, you know, having my dad’s consultation and, and saying like, look, you’re gonna have an experience here that it’s gonna be hard to get other places.
And so I went. I toured it. I, I could kind of re rehash the, I remember walking in, so one of the things, it was just even the, the, the culture there. So I walk in on Sunday, my, my wife now, who is my fiance then, and there’s a door unlocked on a Sunday morning, Sunday, midafternoon I guess. And I pull on the door [00:12:00] and it opens.
And, uh, so I I’m like, all right, well, I’m just gonna go inside and I kind of walk around and, um, and then I’m encountered by, uh, bill Edmonds. And, you know, as a professor, you can do a lot of things, but he like immediately was like, he identified that I was not supposed to be there maybe. Uh, and he goes, what can I, can I help you?
I said, yeah, I’m coming for a tour tomorrow. And I’ve got an interview tomorrow and et cetera. And he goes, let me take you around. So he he’s showing me the surgical suite. He’s showing me all the different things. I mean, on a Sunday, he doesn’t have to do. And so that was the first part is like he took management and then I’m, I’m seeing all these areas where I’m like, I get, do these things.
That’d be great. I get to do this. I that’d be awesome. And so then, um, so then I go and the very first it’s my freshman year, my, my, my, my first year of optometry school and I go and there, um, the, there was a, I think it was the attorney general. Who interpreted the law in 2004, that optometrists couldn’t [00:13:00] do Lazin.
They couldn’t do injections. They could do lasers in Oklahoma, cuz that was codified in law, but it was sort of silent in the law to do the other minor procedures. And so from the very beginning that very first semester we were on, you know, we were talking to legislators, we were going to the capital in Oklahoma to make a difference and I’ll tell.
That, um, that sort of solidified the importance of all of that in my mind through fire, because I was down here and I’m thinking, well, you know, the main reason I, I chose the school or one of the main reasons I chose the school is so I could do things that I couldn’t do anywhere else and hopefully be able to do those things in, in Nebraska, in the future.
And, um, and so that was a wonderful experience for me. It really cemented, um, kind of my purpose in a lot of ways, uh, for our patients and, and then ultimately for the profession to try to work towards those things. Um, but here we are a, and um, you know, we’re getting these states as sort of this tidal wave.
In some ways it feels like this tidal wave of states that are kind of incorporating these things. [00:14:00] And I do believe that it’s gonna be, you know, it’s gonna really continue to accelerate. And we’re now forced again with places where people are gonna go back and practice where they’re looking at maps. Can I, can I do this there and states like North Dakota and South Dakota and Nebraska are wide open states and, uh, and you know, we’re kind of middle of the pack right now, uh, in where people could practice.
Dr. Dori Carlson: Yeah. Yeah. It, it’s really kind of interesting just to watch all of that happen. And the, like you said, the waves.
I had a thought while you were talking and now I just like went right outta my head, but it had to do with, oh, I know what I was gonna say. What a great way to train future advocates. I mean, the fact that your school got all of you guys involved and, you know, taught you the benefit of what that really meant to our profession and, and, you know, it’s and the other part of that is we have to remember that our [00:15:00] population is aging and there’s no more ophthalm.
Residents there’s, it’s a finite number of people. So we are gonna be the ones that provide that care and we just have to be ready for that. Um, yeah. And it’s funny. I was visiting with somebody, um, from my state. Okay. So my state needs to do some stuff legislatively and you know, it’s kind of a, I, I think what happens is sometimes we hit complacency cuz everybody’s fat and happy,
Dr. Christopher Wolfe: the hard part, right.
Interrupt. So you have to
Dr. Dori Carlson: overcome that inertia of the complacency. Um, you know, but, and something will happen, but it was funny because I was in a meeting in June and I was sitting next to another person from North Dakota. Who’s probably 10 years older than me. eight years older than me. And he asked, well, when are we gonna do legislative push in North Dakota?
And I, you know, so we talked about that and he said, I won’t use it, but it’s the right thing for our profession. So I’m on board and I just looked at him and thought, wow, we need more people [00:16:00] like you cause it’s the right thing to do. And it’s about, you know, it’s one of the things that my mantra that I said when I was on the school tour was leave optometry better than the way you found.
Dr. Christopher Wolfe: I think that’s true. And I, I think the, the, the hard part, the thing, I, you know, every time I talk to young doctors and students, there’s, there’s this fire to like, want to do those things. You know, I was trained to do them. I want to incorporate them into my practice, but then I think there’s this switch.
There’s a little switch that occurs. And I want to get your perspective on this, that the rubber meets the road. Now I’ve. debt. I’ve got a new practice. I’ve got, you know, any litany of things, kids. Yep. Kids. And then that’s why I think where complacency happens.
Dr. Dori Carlson: Cause you get busy with your own life and then you kind of forget about the professional part of things.
Dr. Christopher Wolfe: Yeah. And I think it’s also hard. Yeah. That goes back.
Dr. Dori Carlson: That goes back to leadership.
Dr. Christopher Wolfe: Yeah. So tell me about that. What, what do we [00:17:00] do as leaders? And when I say we, I mean, You from a historical perspective and, and your perspective on what our leadership needs to, to be doing. I, I’m not asking you to criticize.
I know you, you wouldn’t do that. I I’m just asking, like, in your view, from a leadership perspective, how do, how do you know I’m in my forties now? Um, How do we, you know, middle of my career? Uh, I would say you’re probably in the middle of your career. You tell me whether that’s accurate or not. I’m not ready to go retire yet.
So I’m still going. I I’m being, I’m being cautious with my words because my dad just retired and he’s relatively young in my mind. But anyway, the, the point is, is that, um, that, you know, I, how do we as, how do we. Where we’ve kind of come through, how do we, how do we bring those people up so that they can do all the other stuff?
They can focus on their family, focus on their practice, but still feel like I’ve gotta do this.
Dr. Dori Carlson: You know, I think the thing is, is people take on too many. They, they think of too many big [00:18:00] bites at a time. It doesn’t have to be that big of a thing. Um, and you know, I, I think for you and I, if you and I pick two people to mentor.
you know, cuz you can’t send out an email. Yeah. You’re not gonna get people to be engaged by Facebook. You’re not gonna be able, Hey, would you like to do this? Um, nobody’s gonna come forward and answer the email and say, oh yeah, sign me up. And that that’s not how it’s gonna work. At least that’s not how I’ve seen it work where I’ve seen it work is I’ve gone up to somebody.
In fact, I went up to a young female optometrist just this weekend at a wedding. I met her and I said, I wanna be your mentor. you do you step that? And I’m like, yeah, we need future leaders. So I wanna be your mentor. Um, so. I mean, I think that’s where it starts. It’s incumbent upon us to create leaders for the future.
It’s, you know, I went to the AOA meeting this year and I saw so many people that I’ll call them. My students, the people that I met when I was on the school tour, they’re giving lectures, they’re involved with legislation, they’re running [00:19:00] for office and their state associations. You know, they’re one of them that I met who’s younger than me, you know, was really super involved.
And, um, I almost was gonna mention the name, but I’m not gonna do that. No.
Dr. Christopher Wolfe: Well, you can, if you blind, cause then I’ll talk to, I’ll talk to her. I’ll just contact.
Dr. Dori Carlson: Yeah. I’m seeing these people get really involved, but it was because somebody encouraged them in the first place and let’s, let’s be honest.
That’s how I got involved. Um, okay, so I’m dating myself big time again, but you know, how I got involved was, um, pat Cummings and Vic Connors put me in a. and they were on the AOI board and, you know, I looked up to them and they were from the Midwest ish, you know, Wyoming and Wisconsin. So I, you know, I thought the world of them, we kind of had these small states and upper Midwest and I thought, wow, you know, these guys are big guys, right.
And tall, but also big in leadership with our profession. And they just, they put me in a corner, literally at a meeting and said, [00:20:00] Dory, you need to be more involved. We think you have the skillset, we think you need to do this. And now, you know, here I am, I’ve been president and everything and, you know, unfortunately, both pat and vicar gone.
So, um, but I, you know, those are the two people that put me in a corner and said, you need to be
Dr. Christopher Wolfe: involved. So I think that’s, it’s really interesting that you share that because I, you know, for my dad’s retirement party, we reached out to a bunch of people to see if they had some comments recently. And so this is from I’ll drew.
I, I don’t think you would care if I shared this, uh, drew Bateman is a past president of Thea. One of my really good friends. I’ve had him on the podcast, a number of. He practice in Lincoln. And, um, and so he was out of town, so he w he couldn’t make the retirement party, but, um, he said, so he, he said, I, I, uh, I didn’t put it in my video.
So he made a video for my dad, but the thing I’ll always remember about your dad was, um, was coming back to Thea during my fourth year of optometry school. He may have even been president. I can’t [00:21:00] recall my assigned mentor did not make it out there to the association meeting and, and he lists who it is, which I know.
I know him. He’s a great guy, but I won’t say it here. Uh, and then he says, um, so I was wandering around and your dad saw me outside of the door from, from a meet and greet. He stepped outside the room, asked me what I was looking for. Then when I explained I couldn’t find my assigned mentor, he invited me to the.
And said he could hang out with him for the evening. It was so inviting. Um, and, uh, he’ll, I’ll just never, I’ll never forget it. And I think, I think if you asked drew, you know, there’s a number of people who inspired him, not just my dad, but I think to your point, it was all it took was somebody who is just, you know, a, a kind of a stall wart in the association to, to recognize that somebody needs just some, you know, Need somebody to be there with him, you know?
Yeah. And, uh, and that, that all of a sudden now spawn, you know, Drew’s, Drew’s been all the way through the chairs. He’s been in [00:22:00] the, the NOA. He will probably it, you know, I don’t know if he has the aspiration, but drew would make a very good AA president. Uh, and he would make an excellent addition to the AA board of trustees.
He’s not running that I know of, but, uh, uh, that might be my encouragement to, to make him, uh, to make him do it. No pressure drew. Yeah, no pressure. But anyway. Um, yeah, I think, I think to your point, and, and I think we need to recognize that. I think I don’t recognize it that often. I I’m kind of quiet generally when I’m in those meetings, I like to listen to people and I like to, I have my perspective for sure, but I need to be aware that, you know, coming out in the hallway and seeing somebody that looks a little.
Probably makes all the difference. Well, you
Dr. Dori Carlson: know, just when you meet somebody that, you know, is, is a newer to our profession and you just shake their hand and say, you know, I’m really glad to have you part of our profession. You know, we need people to be new leaders and just, it’s just the verbiage you might know or recall.
I don’t know. We talked about this before, I think, but I’m a huge John [00:23:00] Maxwell fan mm-hmm and one of his more recent books is, um, change your corn, change your world. And, you know, the premise is. you don’t get involved and you have to be on the away board. Okay. That’s not how this works. Right. But you can change your little corner of the world.
You know, you may know one or two people and you have influence over those two people or, you know, something that you can do that makes your piece of the world a little bit better in our case, we’re talking about our profession. So you know, our little piece of our profession, if we can make that better and start.
um, Pete Kek, we’re talking about past presidents. Pete Keho came up to me at the airway meeting this, um, summer and he said, I want you to meet somebody. So, okay. Come over. I meet this young woman and she’s thinking about running for, um, the board. Okay. That’s how it was worded. Mm-hmm . So I’m all over the AA board stuff, you know, and, and her husband is standing there and they’ve got kids and, you know, and so I’m all over this.
And anyway, [00:24:00] she goes, well, I was thinking of the Illinois board and I’m like, oh, well, that’s no big deal. just, yeah. That’s, that’s a no brainer. Just do it. Yeah. Yeah. And she kind of looks at me and I said, well, it is, it’s just, it’s small compared to the other
Dr. Christopher Wolfe: stuff. So, well, from a practice commitment standpoint, you know, um, I’ve heard you.
That, that if you’re on the board, you’re traveling what a hundred days a year or something like that, it’s a bunch. And then if you you’re through the chairs, it’s even more. And so it’s like
Dr. Dori Carlson: 180 when I was president president elect. That’s crazy. Yeah. For a couple
Dr. Christopher Wolfe: years. Yeah. That’s crazy. Yeah. So, so that’s,
Dr. Dori Carlson: but you know, here’s the thing is yes, I did that.
Okay. But I I’m a far better leader having done that. Right. You lived through those experiences, but, but the bigger part of it is. I always took something back home to our practice. Mm-hmm I know that our practice in this tiny little place in North Dakota is a far more progressive practice, far more medical [00:25:00] practice far.
Um, more into leadership and culture and you know, all of those things in our little corner of the world and we’re little, um, than it would’ve been had I not gone out there and, and visited with people like you, you know, it’s the conversations that you have, the things that you learn when it’s not necessarily the education, but it’s like, well, this worked for so and so, and they live in a similar.
Population that might work for us, you know? So it’s those exchange of ideas that I found the most beneficial. And I know I took stuff home.
Dr. Christopher Wolfe: Well, I think that’s the thing is that, you know, it, you are doing so much stuff, but you’re not, you are not staying put, it’s not like when you’re traveling 180 days, your practice isn’t benefiting from a whole number of reasons, like you said, And you’re encountering people who are thinking at a whole other level than you would’ve ever thought.
I that’s how, that’s what I always think. It’s like, yeah. Wow. They’re doing stuff. Just like you said, like, well, we could do this in our practice, but even just from a standpoint of, of [00:26:00] encountering people who are doing new things that you would’ve never known about. I mean, even just in the limited, and I always find when you’re on boards and I’ve said this before, but when you’re on boards, you sort of.
As a member and then you’re on a board and then you kind of, you peel back some of the onion and then you get into the executive committee and you peel back a little bit more of the onion and then your president is like the onion completely unfolds. And then maybe after you’re president, then it, it keeps going.
But, um, but I think the, the, um, the point is, is that, you know, you learn about even just different pipeline, pharmaceutical agents or pipeline therapeutics that are, are four or five years off. But you’re coming and then you start to think, well, how would I incorporate this in my practice? What could it look like?
I remember, um, at a meeting probably four or five years ago. Um, I will, I will. It, it, it was not Viewy. Um, but David Coroll, I was just talking to David about this and he, this was four or five years ago. And he goes, you know, Chris, there’s gonna be medications that do X, Y, and Z. That’s going, that’s gonna give, um, give VI near vision [00:27:00] back to patients.
And it was not Viewy, it was another one that I’m gonna remain. Cause I don’t know what confidentiality stuff was there but the point was is that, um, there was, he was on the, I mean, this was a long time ago and I, would’ve never known about that, you know, and I, I had thought about it. And so I’m paying attention when you see little blips in here and there it’s like, oh, okay.
That’s relevant. I, you know, I talked to somebody that had told me about this. And, and so then by the time it comes, it’s not something that I’m hearing about for the first time or even the second or third time. It’s something I’ve kind of followed peripherally for a number of years. And I’ve been able to wrap my mind around that, you know, the same thing about, you know, we’re seeing with I P now it’s just generally mainstream you and I have been talking about that in, in different circles for, I mean, what 5, 6, 7 years probably.
Yeah. And so the, the same thing is, is to be said. And so, yeah, I think that’s the benefit of, um, of being involved, that that’s not a tangible benefit and it’s not one that you go into expecting. Right?
Dr. Dori Carlson: Yeah. It’s [00:28:00] not tangible, but it, it there’s something that it, and then it, I, for me, it kind of creates some excitement about my profession, cuz you kind of.
Like you, you know, I’ve had opportunities where I’ve heard about things and like, then you start following them for a while and like, and then you start looking at ’em from a different perspective. I now I’m on our state licensing board. Imagine that. Um, but so now I sat at the Arboe meeting and they start talking about different things about what’s happening with licensure and kiosk eyecare came up, um, as one of the conversations.
And, um, using artificial intelligence, that’s kind of the auspices of why the conversation came up and, and I had my AOA hat on. And so I approached this individual and I said, have you thought about the fact that you need to talk to AOA because they might be portraying it as a comprehensive eye exam and it’s not, you know, and I, I.
And it was somebody that is in the know he’s a very smart person, but he hadn’t thought of it from that perspective. And so it’s [00:29:00] just, you know, we all contribute something to, um, the betterment of our profession. And you may look at it from one direction. I may look at it from another direction, but that makes it what’s great about our profession, cuz we have all these different, um, points
Dr. Christopher Wolfe: of.
Yeah. I mean, yeah. Well, I just had a conversation with, with Jeff Olasky, uh, last week and, um, mm-hmm and you know, Jeff well, and yeah. Um, you know, it it’s, it, his, we were talking more specifically about politics in general, um, but he’s running office. Right. But it, it is the exact same principle here where I think as a society we’ve become fractured.
Um, and even as a profession, we’ve sort of been, become fractured in these other small little pieces. And, um, and I’m concerned that that’s gonna eat away. It has the potential to eat away at the, at the, at our ability to, to have an impact for our patients. How do we prevent that? Or how do we adjust for it?
Is it the same thing that you’re talking about right now?
Dr. Dori Carlson: Million [00:30:00] dollar question? You know, I, I still think it’s about educating people and, and change your corner of the world and, you know, it’s you and me. all of the, the Jeff Alkis and the PKI host and whoever else it might be reaching out and just saying, Hey, we need you to be part of our group.
We need you to be, we need you, um, and, and appealing to it. One person at a time. And I know that that change doesn’t happen quickly when you do that. But what I know it doesn’t work is it doesn’t work to send out a mass email and say, would you volunteer for the, to be on the Nebraska board?
Dr. Christopher Wolfe: Yeah, no. So I gotta share this with you, cuz it’s fresh in my heart.
Um, I was, uh, and I wanna get your reaction to it cuz it was illuminating to me. So I, you know, I do a, a workout group called F three and there’s a lot of leadership principles within F three, but, but the whole idea is men get together, uh, and do hard things. Um, and that builds community. So you’re working out, uh, doing things that you didn’t think you could do before.
Anyway, one of the things that, um, that [00:31:00] about a year and a half ago, a couple guys in the group decided that they were gonna run a half marathon every month at the end of every month. And I, I was like, yeah, I, I run all the time. I’ll, I’ll run a half marathon every month. And so we started that out and, uh, those two guys have sort of, um, cultivated and it’s, it’s become a big thing.
There’s 20, 20 to 30 guys every, every month that are getting together and, and running this half. And, uh, so then we extended it to have a 5k option and a 10 K option. And it’s, it’s informal. It’s basically you get together, you’re running, you got 13 miles to gibber jab with guys. You don’t know. Well, so when a site, when we make a site, uh, what we call an official site, it gets a name and, uh, me, so I’m, I’m gonna basically lead that site and make sure that it I’m kind of cultivate it and, and make sure that it stays going.
And, um, and so I was communicating with the two guys that originally started. And we were kicking around. What’s gonna, what’s the name gonna be is we’re gonna name this. And so, um, you know, we threw around some jargon, like running [00:32:00] jargon and, and all this kinda stuff. It never really stuck. And so, uh, and I threw out halfway house and, um, and so, you know, you’re running a half, there’s this underlying thing, theme with people running a marathon or a half marathon.
There’s a lot of guys that do a in, in our group that do a lot of hard things, you know, they’ll. They’ll do MEFs, but they don’t think they can run a half. And so, um, so I, I thought, look, this is a way we can encourage people to do something they’ve never done. You’re, uh, you’re sort of doing something hard.
You might be pushing yourself at a level of adversity that you’re not ready for, that you don’t think you’re ready for, but you are. And so there for my peripheral knowledge, never having been in a halfway house, um, I, I think this is perfect. You know, this is a perfect name for this. And, and then I realized there’s some guys, and I only realize this because guys reached out to me and said, Hey, this, this, um, this name, I, I don’t love this name.
I’m not gonna get a t-shirt that has this emblem on the back. And, uh, and they, and so I [00:33:00] was like, wow. You know, I, I didn’t think about it from that perspective. And so yesterday I was, I was running, um, I, I was gonna work out and there was a guy who I respect a ton. He’s a couple years older than. and, um, I’m hoping he’ll come on the podcast to talk about it just because it’s a great story.
But he, he said, you know, we were, we’re, uh, kind of just starting and he, and he goes, when you get a chance, sometime I’d really love to talk to you about the name of, of, uh, the halfway house. He goes, that kind of struck a chord with me. And, um, and I wanted to get your perspective and, uh, and. The reason I bring this up was then he kind of shared his, he, he asked me kind of why we named it, that I explained it to him.
Then he shared this really great story of his experience. Um, where, where for him this a halfway house, a literal halfway house. This guy, by the way, is wildly successful. He’s got a great family. He’s, he’s got this awesome business that he’s built from nothing. Uh, and so, but his story was, you know, he was, uh, in, in.
In deep with, you know, with, [00:34:00] with addiction and, um, and it was his way out. So we had this love, hate relationship, and he, you know, where almost to some degree, I’m wondering if I’m cheapening right with the name halfway house, if we’re cheapening the experience of some and also belittling, um, you know, minimizing the seriousness for others.
Right, right. Um, but, but through his story, it, it made me realize. Uh, had we not had a relationship? The, the whole reason I share this is had we not had a relationship where I’d been doing hard things in the, you know, in the dark, in the morning with him. And he just approached me, uh, and didn’t share back and forth and we didn’t have a trust involved in that.
Um, I, would’ve probably been like, what do you, you know, I’m gonna dig my heels in and I’m gonna. Whereas if, but, but the fact that we had that relationship built and I had trust and he trusted me as well to open up, then, then I was able to get so much from that. And I think what we’re gonna do, [00:35:00] why is gonna wind up like really being fantastic way better than it would’ve been before in a lot of ways with being respectful to people who have been through that and not cheapening the process, uh, not minimizing the name or belittling it in any.
So anyway, that could have never happened if we didn’t have a relationship.
Dr. Dori Carlson: The, like you said, it is the trust.
Dr. Christopher Wolfe: Yeah.
Dr. Dori Carlson: Steven Coby. Oh, have I told you my story about getting a book in the mail from, um, president of Elcon? uh, so Jim Murphy was the president of Elcon when I was president of AOA nice guy. Um, and I don’t, I think he’s in Japan or I, I’m not sure I’ve lost track of where he is at, but he actually used to live Inre forks, North Dakota.
So when you talk about trust, um, we kind of struck up a friendship just because he loved hockey. I love hockey, you know, it was like he knew our culture up here and stuff. And so we, we got to know each other that way. Um, and I had. I had a little bit of an experience, interesting experience [00:36:00] with, um, the pediatric vision benefits was being defined in, um, the affordable care act and some of our, um, three letter managed care plans.
Fair enough. Um, you know, wanted to be the owners of that benefit and, you know, actually called me out, um, did some really interesting things as far as trying to call on AOA and, and kind of make us do things. And anyway, so I saw Jim at a meeting and he said, well, you know, you know what the problem is here.
And, um, he goes, there’s no trust there, there’s no trust between these groups. So it’s just not gonna happen because these two, three letter. Um, don’t have that relationship and consequently, nothing’s gonna get done, you know, because of the lack of trust and the lo behold, like a week later, I get Steven cubby used the speed of trust in the mail.[00:37:00]
And so I just, I kind of started laughing. So every time I see it on my bookshelf, I always think of Jim Murphy. It’s like, how true. I mean, if you don’t have that relationship, if you don’t have that trust, um, it’s gonna be really difficult to get things done.
Dr. Christopher Wolfe: yeah, Dory. So I, yeah, I, I don’t, there’s nothing else to say about that.
I, from my perspective, I think that it does, it comes down to trust and it comes down. I mean, the trust comes from the fact that you believe that that other human being, or that other organization does have good intentions towards you. Uh, and once that breaks down, um, it’s hard to build it back up and even, you know, I, I, I, um, he’s been on the podcast before.
I, I don’t think he would care. I’m not gonna mention his name. But again, same thing. There’s a, there’s a gentleman in, uh, an organization. Um, he’s a very, he’s a very avid AOA advocate. He’s a St. He’s in a state that is very progressive, uh, from a standpoint of, of their law. They’ve done some really amazing things and he’s on their state board.
[00:38:00] Um, and, uh, and in general, you know, he’s trying to serve as this advocate where, you know, two organizations. Just generally don’t trust each other, you know, or they’re holding each other at arm’s length because they don’t think that the other one has the best interests of the other at heart. I think maybe that’s not fair, but I think that’s probably a fair assessment.
And so the less of that we can, the, the more trust we can build, I think the better all of those organizations can play in the sandbox together. And it’s hard.
Dr. Dori Carlson: And part of the problem is too, is that the people change. Yeah. The, the characters involved. And so if you don’t have everybody comes with their own agenda, you know, cuz we’re humans.
And so sometimes what happens is if we all could kind of, you know, keep that transition, that knowledge base, that trust level, but then sometimes you might have it for just this inkling of time and then the people change [00:39:00] and then you kind of have to start all over. So, yeah, that, that was my frustration is that you you’d kind of get to this place where you establish this rapport, this friendship dare I say friendship.
And you know, that you actually had this trust that was starting to develop and, but, you know, were, were groups of, of organizations. And, um,
Dr. Christopher Wolfe: do you
Dr. Dori Carlson: remember, I mean, so to the, no, go ahead, American. I reached out to the, um, academy, excuse me. If I can speak the academy of ophthalmology when I was. no one on AOA knew that I did it until after the fact.
But, um, there was a woman who was Ruth Williams is a glaucoma specialist from Chicago. I looked her up, she was president of the, a, of the academy at the same time I was president and I thought. wouldn’t it be cool. If two women could actually work this out and we could actually work together. So I called her just totally as an optometrist.
Yes. Female. Yes. And the fact that I was representing my national association. So was she, so I said, is there something that [00:40:00] you can think of that baby, we could work together that, you know, just brainstorming and I’m not an official capacity or anything. And, you know, my thing was, Hey, we can all get together about the fact that we want kids to be able to see.
it’s pretty innocuous. I mean, what, who doesn’t want their child to see? So I was proposing that we do something with children’s vision initiatives or something, public awareness kind of things. And, um, yeah, they came back with, well, we’d rather do something about the ergonomics of being an, uh, an eye doctor.
And I was like, that’s not quite what I was going for. So we just politely had a couple discussions on the phone. Nice lady. But of course it never went anywhere.
Dr. Christopher Wolfe: Yeah. Yeah. It’s a hard one because you’d think. Uh, I’ve had people say that, you know, you’d think cuz I, I, I think if I didn’t know that story, I have seen what happens politically, because you’d think that we could agree.
Right. We could agree that that, you know, quality eye care for children is a good thing. Right? Yeah. But then it just, it, you know, you [00:41:00] know that what happens is pediatricians get involved and they say, no, we don’t wanna relinquish the control. And you know, this and that. And I mean, it. You know, I don’t know it, but you’re right.
I mean, just people
Dr. Dori Carlson: politics. It’s unfortunate cuz that, that topic, you know, the other topic that I brought up, if we all just had, if we all looked at it from the perspective of our patients and you know, taking care of people and if we truly felt that way and that was the most important thing, I think we could accomplish a.
Um, but unfortunately there’s all these other agendas that happen. And that kind of makes me sad some days, but I choose to be positive.
Dr. Christopher Wolfe: Could you imagine, uh, I mean, it’s kind of baffling that an oral surgeon would not want to have advocate for children to have their teeth examined when they’re young and they would want to advocate that to a pediatrician.
I mean, [00:42:00] that, that would baffle your. and yet it happens, right. You’ve got glaucoma specialists and surgeons largely who don’t want anything to do with pediatrics. And, uh, and they, they oppose having just basic eyecare services, you know, and just abdicating it to a primary care provider. Pretty wild. Yeah.
Yeah. So, um, I wanna ask you one last question. Uh, do you remember the 20, 20 summits? I’m sure you were involved in those. Yeah. Mm. I’ve been thinking about this a little bit lately, cuz obviously we’re into 2022. Do you remember did, is there something I, I don’t, I mean, I, I remember there’s a number of things that we’ve done that I think are advantageous, but is there something that you think coming out of that man that was spot on or that was totally wrong, uh, for what we’re seeing now in the healthcare realm and specifically in eyecare.
So, so let me set this up. So for, for the listeners, Aren’t aware of the 2020 summits in [00:43:00] 2005, uh, all the stakeholders in optometry led by the AOA got together and they sent, uh, representatives to this big brainstorming, uh, event series of events, actually. And, um, I can’t remember if it was three or four do, but it was over the course of a, it was three or four, one of the 2, 6, 6 month period.
I was, I had the, the pleasure of being involved because of my, um, my place in the board of trustees within the a. And, uh, and so I got to meet a lot of you really early on, which is wonderful for me. Um, and so the whole idea was in TW 2005 let’s project forward about what the profession is gonna be like in 2020.
So they called ’em in 2020 summits. And, um, so anyway, that’s the setup Dory? What, what was like spot on in your mind? Is this, or was there one thing that was like, man, we, we predicted that.
Dr. Dori Carlson: well, the demographics was predicted. Mm. Um, I, I, I clearly remember [00:44:00] unless, you know, because it was based upon what it is today and what we think the future is gonna be.
Right. Mm-hmm and about money, how ophthalmology is educated. The demographics was one thing that I remember that they talked about the fact that there was gonna be fewer and fewer ophthalmologists, and that optometry was gonna have to be taken care of over this care, which was hard to imagine kind of at the time.
So I remember that aspect of it, but that was pretty spot on with predicting the demographics. Um,
and you know what, honestly, I’m not, I just remember one of the other things was everybody was gonna be speaking Mandarin, Chan Chinese. I remember
Dr. Christopher Wolfe: the same thing. Why do I remember that wrong? It’s like, he was the futurist. Yeah, he was wrong.
Dr. Dori Carlson: Yeah. That wrong was so wrong. So every time I think of that, it’s like it was Spanish and Mandarin Chinese and English, those, but everybody was gonna back speaking Chinese,
Dr. Christopher Wolfe: you know what he was.
So he was totally wrong about that. The fact that we would have to speak Mandarin Chinese in the United [00:45:00] States in the year 2020. Yeah. But you know what he was kind of right about and that we’re seeing, which is a whole other conversation, but you know, the impact of China. You know, in 2005, I mean, I never thought twice about the impact of China, uh, in, in the, in the global, uh, sense spec and, and generally, and then specifically in the United States.
Uh, but maybe that was his point more importantly, that, that they are gonna have such an impact that, um, we better be paying attention. I don’t think it was this, this point, I think. Do you.
Dr. Dori Carlson: With that summit as far as the
Dr. Christopher Wolfe: outcomes. Well, yeah, I mean, yeah, I think, um, board certification was, was straight out of that.
You know, one of the things that we were seeing at the time was that healthcare was trying to evolve into these, um, more of a, a global fee model where you’re, you’re getting reimbursed for managing a disease state system. Yeah. As opposed to a fee for [00:46:00] service system. So that was one of the concerns. Uh, there was other concerns about maintenance of certification, which we couldn’t participate in that, and that actually wound up coming pretty close to true, uh, within like within, um, some of the MIPS things, they sort of dropped some of those things, but yeah, you know, it was predicted that, that you would have to show ongoing competence.
And that actually, we saw that in the a ACA and, and some of the, uh, high, high tech acts and, and MI MIPS has sort of evolved. But if you remember correctly early on in MIPS, there was a component of, um, of like educational education. Yeah. Yeah. That was in the
Dr. Dori Carlson: early
Dr. Christopher Wolfe: aspects of it. Yeah. So anyway, I mean, that’s the thing that, that came out of it.
And, um, that I remember, um, that I thought, you know, it was within like five or six years. It, it, you know, it became something. Uh, that was worthwhile. Um, I know they keep
Dr. Dori Carlson: talking about how or the pace [00:47:00] structure for us, you know, they’ve been talking about changing the pace structure for us since I was start when I graduated from optometry school.
And I just think that it’s, so that’s such a difficult topic and it’s such a difficult thing to do. uh, there’s just, so it’s just a convoluted, complicated system that it’s really hard to change, things like that. Yeah. And then they try to give us Medicare cuts every single year. And, um, you know, it’s just it’s formulas that were set up a long time ago.
And how do you revamp the entire system?
Dr. Christopher Wolfe: Well, the real hard part is, is how do you even, um, you know, how, how do you even gauge like, quality care. When, when you could have somebody who is way underperforming based on clinical practice guidelines for a specific disease state, but yet they’re a cheaper provider in the short term.
You know, most, [00:48:00] most payers can’t see out past a year, two years, five years, I mean, five years is a long time for a payer, especially when you get to these, these populations. That, um, you know, you know, you’re gonna offload your population to Medicare at some finite point in the future, usually 65 or something, right.
66, 67. And so, um, so you’re gonna offload your care. Well, any amount of stuff that occurs when, when, you know, you’re, you’re the private insurer, anything that occurs when a patient’s 50 that might have a downstream benefit in 15 years, you don’t care about that. Cause it’s not saving you any money. It’s just costing you.
So, how do you get to the point of like being able to judge that exact same thing? You know, I, you see Chris Wolf and Chris Wolf is really underperforming in the standard of care, but I look to a payer like I’m really cost effective, cuz I only see that patient one time a year, uh, for a patient who’s um, a high risk glaucoma suspect maybe.
Um, [00:49:00] maybe, maybe our ocular hypertension patient with high risk characteristics. And Dory’s seeing that patient two to three times a year and they’re, and you’re really watching closely and, and, um, and, and you’re gonna be on top of it really quickly. Uh, you’ve built rapport with that patient. So if you do need to pull the trigger on treatment, it’s gonna be very certain as opposed to me where I, I might see something that’s like, well, maybe that’s a little difference.
Let’s just start treatment. Right? Something like that. You can’t tease that out of the data. You can’t know that you just see a cost involved. So
Dr. Dori Carlson: that’s hard. You say, like you said, is benefiting them 15 years from now, but they don’t care about that today. Cuz today they want it.
Dr. Christopher Wolfe: Yeah. Yeah. It’s a hard, it’s a hard problem to solve.
It’s a really hard problem to solve and I don’t have the answers for that. No, I don’t either. I don’t either. Um, I’m gonna leave it there. Do, cuz I, I think we could, we could open up a whole bunch of other cans of worms and, and you’ve got your summer shirt on underneath that jacket. So I’m gonna let you get back to your summer.
Um, you know, again, thank you so much for being available to do this. Um, I, [00:50:00] I really just wanted to kind of rehash some stuff with you historically. I think it’s a lot of fun to reminisce a bit like. And, um, and I, and, and your perspective is really valuable to me and it’s valuable to, I think, our profession.
So thanks for everything you’ve done. Thanks for everything you’re currently doing. And, uh, thanks for coming on. Yeah.
Dr. Dori Carlson: Thanks for asking me. And remember, just find two people.
Dr. Christopher Wolfe: Two people. Amen. Two people.