Time Value with Dr. Adam Ramsey

Dr. Chris Wolfe: [00:00:00] Hello, and welcome to podcast on I code media today. I’m excited to have a conversation with Dr. Adam Ramsey. This is the third time I’ve had Dr. Ramsey on and he is always a pleasure for me to speak to and pick his brains. Uh, it’s been a couple years now, since, since we’ve talked on this and, uh, please enjoy our conversation.

I know I. As always 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 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 [00:01:00] 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 mighta 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 my, a multifocal for your patients. I think they’re gonna like it. If you haven’t checked out Mac 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, Mac health is a, so for patients in category three and category four, um, AMD Mac health is a great option for them that follows that entire, um, that entire protocol. And it also add. Meso Z is Aing to the mix, which if you look at some of the [00:02:00] 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 maca health LMC three. And so I think if you haven’t done this yet, I’d consider MACI health in your practice and for your patients. And it’s been great for my patients.

And, um, and we really feel like we can have the ability to, uh, help those patients in all categories of macular degeneration. So Adam, last time when we were trying to get this done, the tech, uh, didn’t work very well. So you were talking about ups and downs in practice and how, you know, it was back to [00:03:00] school and things were getting busy.

What I want to know is. You kind of manage a bunch of different things. And, and one of the things that people always ask about is how, how I have time to do that kind of stuff, but I’m gonna put out on you, how do you have time to do all those things? Tell me about kind of the stuff that you’re involved in, uh, in practice and then also within the profession that, that you’re, you’re juggling right now.

That’s 

Dr. Adam Ramsey: a great, great question. Um, I think, you know, people talk about time management, but you can’t manage time. If it takes an hour to do a task. It takes an hour to do a task. It’s literally priority management. What are you doing first? You know, there’s a, a, a great video. I watch with this guy named he’s stuffing these balls into a container.

And he’s like, if you put the big balls in first, you have space to put the little balls, but if you put the little balls in first, you’ll never fit the big balls in afterwards. And it just goes into say, you gotta figure out what’s most important, do that first. And you [00:04:00] will fill in the. Of your life in the things you want to do.

And when I realized that, because I was really struggling and I still struggle, you know, anybody who’s doing a lot of stuff, it’s not easy, right? Anybody’s schedule, that’s easy. If you’re always available, you might not be the person I want to talk to because if you can always pick up the phone, you got nothing going on, which means you have nothing to offer me.

So I like talking to people that are busy. I like talking to people that I have to schedule to figure out because that’s the person that I wanna learn. The person that I can always talk to. I don’t really have much to learn from cuz you’re not busy enough. I, I, in that regard, so I can’t learn from you at that point.

So for me, I’m doing a lot. I speak for like a bunch of companies, but I. also only spoken for the companies that I actually believe in. You know, I’ve had people, you know, reach out to me and ask me to speak for them. And I’m like, but our values don’t align. I don’t really love your product that much. I might use it here.

It might be good for a patient, but that might not necessarily be who I want to stand up [00:05:00] for you because do you stand up for me? You know, I has to actually be mutually beneficial in, in that regard. So. I try to pick, you know, one company needs genre and contacts and in equipment and in drugs, um, and uh, the medical side.

And then just trying to find the one that’s the best fit for me. So I, I love it, but I’m now realizing I have to be more selfish of my time and. Being able to say no is the most freeing experience that I have that I can now say no. When I first started, I said yes to everything, cuz I didn’t know when the next opportunity was gonna come.

Anytime somebody requested me. Sure. Let’s go. No matter what it did to my schedule, no matter what it did to my life. But now that I’m a father and a husband. Um, I can’t do that. That’s that’s not, that’s not fair. Um, you know, so when I see my, my daughter on the camera and she’s screaming, daddy, daddy, because I usually put her down and I’m in another [00:06:00] city, what is that time worth?

And that’s where the hard part comes in is that sometimes companies and people don’t value your. And the value I put on my time and the value you put on my time may not actually be the same. Um, so this is where I became more picky and more selective, um, and having to, to, to find things that actually speak to me.

And, um, I love giving back and I love being able to impact other people. So if the opportunity allows me to have impact, then I try to find ways to make it work. Um, but I’ve come to terms that I have to set boundaries within that. And I think when everybody realizes that, then you’re in a much freer position.

Um, and it’s, it is much easier. 

Dr. Chris Wolfe: You know, when I think about that, I mean, you know, last time, obviously how’s your daughter doing by the. 

Dr. Adam Ramsey: She’s good. She had her ear tubes quit in last week and, uh, so far we’re so far so good. Um, and, uh, I’m really, really happy [00:07:00] about really happy about that, but I I’ll tell you something about that in a second.

All right. Do you wanna tell me now I can tell you, I, the day before the surgery, they call at four 30 and says, you gotta pay 5 4300 for surgery tomorrow. This is four 30 for five o’clock and I’m like, Going through insurance, you gotta beat your deductible, blah, blah, blah, blah. No choice. It’s either that or you don’t do the surgery.

Yeah, they didn’t tell me in advance. They said nothing. We get in. There we go. The surgery was just putting tubes in the ear five minutes to put her under five minutes to do the surgery and five minutes to get her out 15 minutes. So by the time I went to the waiting area, I sat down, watched one thing on YouTube.

They called us and said, come get your daughter. I sit there and I. I am not doing procedures that are expensive enough to value my time. I literally sat there and came right out and [00:08:00] said there is an issue with my value for time that I’m exchanging even in the office. Even when you sell a kid, a pair of glasses that costs you 200 bucks and your cost may be 30 bucks or whatever.

The value on time is not there. I said, damn like this guy spent five minutes and charged me 5,000. Cause that’s what I paid. The insurance is paying something else too. So yeah, I said I had to sit down, I racked my brain and I’m sitting there like. What is going on, Adam? This is I’m. I appreciate it. Thank you for helping my daughter, because I had to say yes to that.

I didn’t have a choice, right? It was, she had six ear infections in five months. She was on every single antibiotic. They knew antibiotic antibiotic made you put on an antiphonal. Antiphonal made you do this and you gotta do the probiotic. Then it is a whole thing that I learned as a parent. So in that moment, what are you gonna do?

You’re gonna say you’re gonna have to figure this out. And I came out of that. You need to find procedures or something that [00:09:00] values your time more appropriately, the way I’m doing it right now, I make a good living. I have a nice home and I have a nice car. I go on vacation everywhere. Yes. But every time I don’t show up to the office, I don’t make money and that’s not a value for time and the transactions were not good.

So I sit in there and I says, I gotta figure something. So I go down there and I says, what, what can I do? Let me go through. Okay. I, I don’t really like low vision VTS, not my thing that I’m going through the whole thing because I was at, and this is all happening within the last month. So you’re asking me, you know, I’m spilling this stuff out as it’s great.

As it’s processing, I was at a scleral lens conference. I CSC in Fort Lauderdale and everybody around the room was talking and they were like, oh, I’m I’m I specialize in this. And I specialize in. And I was just sitting there and they turned to me and says, Adam, what do you specialize in? And I felt like a lump in my throat because I do a lot of things.

I do a lot of things. I like helping a lot of people, but I didn’t have that [00:10:00] one thing. That was my thing. And sometimes I feel guilty, you know, being the, uh, I was the only black doctor in my county. Now I have one doctor. He only works two days a week, but he doesn’t work for me. He works somewhere else. Um, so most of the patients come to me, so I try to cause they don’t.

And when I try to refer ’em out, they don’t want to go anywhere. Right. They tried to refer them and they never show up at their other appointments. I call, I check. I see them back in three months. Did you go to so, and. No. So I try to then take on everything, but because of that, I’m a Jack of all trades master of none, because I don’t have enough time to specialize in one thing because I have to do the glaucoma and the dry eye and the cataracts and the floaters and the contacts and the neural and the, this, and the, that, and that to help everybody.

But it doesn’t let me plan a flag and I sit down there and I says, I’m gonna put my flag into context. Custom context, sclerals myopic control, whatever. And I am going [00:11:00] equated to braces because I posted on, I posted on Facebook last week and I asked people that followed me. I says, Hey, how much are braces?

People thought they were responding because I wanted braces that wasn’t it. I wanted to know what are people and that people posted. I just paid five grand. I just paid 7,500. And then one person said I had to do two of them last week for 5,000. And I says, they are trading money for a service that is, that has a need.

And I says, I have to sell something that people want enough. They’re not gonna buy $5,000 glasses. But if their prescription for their child keeps going up and there minus is seven, would they pay $5,000 for the braces of the. And then I says, okay, now I gotta create a program in which there’s a need in which patients want it.

And then now that I’m solving that need, so it’s, do you want your, your child’s prescription to keep going up or not? [00:12:00] Yes or no? No, this is the cost and people make a transaction. So I, I, I said, okay, I gotta have something. And this is all literally me trying to figure this out. The last couple of months being like, I need, I gotta, I gotta find something else and all the other stuff, wasn’t it.

So I’ve, I’ve been, uh, going heavy on trying to, uh, trying to, uh, find a way to get my own little niche, because if I really feel optometry is gonna become a niche profess. you’re gonna get the VT guy. You’re gonna get the dry eye guy. You’re gonna get the peds person. You’re gonna get the MYP control.

You’re gonna get the SC lens person. You’ll get the ocular disease, tertiary care optometrists that sees all the glaucoma people. You’ll get the magnet generation, doctor, whatever, but being the all around or not having your one thing, I think in 10 years, it’s gonna be, it’s gonna be tough to make a living cause they’re not paying you anymore.

Your cost to do business keeps going up. So if [00:13:00] you don’t go somewhere where you can go outside of that insurance realm, you’re gonna be in trouble in five years. 

Dr. Chris Wolfe: Yeah. I mean, I think, I think you, there’s probably a lot of people who are in trouble right now, Adam. I mean, you, I did a, I did a, kind of a brief podcast on this and actually Aaron Newfeld with, um, ODS on finance, just posted about this again today, but you know, the, the visibly slash alternative stuff, I mean, it’s available.

I think, I mean, on the one hand, I think. Patients that are gonna seek that stuff out are gonna be patients that are probably not gonna find a lot of value in the services you’re gonna provide and I’m gonna provide until they really need it. Like what you’re talking. But then, um, so it is kind of there, but that’s only gonna get larger and patients are only gonna get more and more comfortable with it as time goes on.

So I think you’re, you’re absolutely right. The, the challenge that I would have for you is you say that there’s sort of this silo for all these different things. You know, you’re gonna have somebody that’s gonna do low vision. Somebody that’s gonna do binocular vision. Somebody’s gonna do, um, [00:14:00] you know, specialty contact lense.

But who’s gonna take care of all the other patients that don’t want to see anybody else, but you you’re still gonna have to do that at a really high level. Right. So seems to me like you’re already doing a lot of this stuff, you know, if you know, I know I re I know your practice relatively well from having a conversation with you.

And my sense is that most of the things that you’re already doing, you’re doing really well. So you’ve sort of built, like you’ve probably heard me talk about you’ve built sort of these, these pillars or these silos that, that you’re able to take care of patients. And now this is just a new silo, uh, or a new pillar, right?

You have a patient that has a need. These patients don’t need to keep getting more nearsighted because of all the downstream effects that occurs now, you’re like, all right, I’m all in. Right. And you believe here’s, here’s what I. Is that you, I, I can, I can sit and talk to you and you believe that, uh, you’re the best guy to do that, right.

Even though right now seems like you got a lot of learning to do. But you’re delving [00:15:00] into it. You’re, you’re figuring out how to help these patients. You’re figuring out how to make it worth your time, uh, because it is a service that nobody else in your community is probably offering or going to offer at the highest level that you’re, that you’re gonna do it.

And that’s how you, that’s how you build a practice. You know, I love it. I love that, that, that ambition to say, look, I’m gonna do something different. And that, that something different is gonna be able to help me take care of patients. And oh, by the way, it should really help me spend more time with my daughter and more time with my wife and, uh, and add value to the practice.

Have you been good at that? With 

Dr. Adam Ramsey: everything else? No. Okay. I’m not gonna say I was good and perfect with everything. It is totally a work in progress. I am, uh, figuring some of this stuff out on the fly and I am trying to, to figure out, I, I, I didn’t have the bread crumbs laid before me. I didn’t have the yellow brick road.

Uh, you know, I opened my practice outta necessity. You know, it, it, it wasn’t. It wasn’t that I had, I had [00:16:00] everything figured out. Um, I use, I, like, I read a lot of books. I’m listening to like 12 podcasts at the same time. I try to consume a lot of content. Um, most of it on two X, you know, listen to it in fast audibles, you know, all that kind of stuff.

And 

Dr. Chris Wolfe: I can’t do that. My brain doesn’t work that fast. I, 

Dr. Adam Ramsey: I, I have to, I, I, I, I consume it quickly. Uh, and then I go back sometimes and go back through it. But, um, I look at the analogy that I, that I’ve seen and some I’m a picture of visual guys, so it kind of helps me, um, of the frog water. and you can raise the temperature of the water for the frog one degree at a time and he won’t jump out and then he’ll just die in the water.

But if the water was hot, initially when he jumped in, the frog would jump right out immediately. Yeah. And I think that is what, what is happening right now in optometry is that our cost of doing business is going up 3%, 5% of the time. And we’re staying in there until we eat it up until we can’t eat it up anymore.

And that is the hard part. So I don’t. [00:17:00] Alternative or visibly or anything like that? My patients aren’t gonna leave me. Uh, they have that access right now. I have the busiest, uh, lens crafters in the country, two minutes from our office and the second busiest Costco in the country, three minutes from our office.

And I still do well. So it isn’t, it is not that it is. Those transactions. They’re still gonna come to me and they’re VSP and their I at, and they’re gonna pay their 120 or $210 and get their glasses and leave the cost to me delivering that service keeps going up. So unless I can, the reimbursement doesn’t go up commensurate.

The reimbursement does not go up, but I was talking with my office manager and I was like, Hey, we need this HR health and we need. Uh, you know, this thing and HIPAA compliance and this and this training software, and we’re doing this and we’re getting new uniforms and, and all that stuff starts adding up.

And I’m like looking at it. I’m like these numbers do not add up. Those things do not equate. [00:18:00] So you have, we have to find something else. So I don’t think those people do not deliver the service. You can look at my reviews online and people tell you the exam we deliver is not the same exam as everywhere else.

So I’m not concerned with that. I think I would’ve done fine. Just going $200 or $500 at a time. My issue is that I’m exchanging time for money and I have to, I, for me, I gotta find ways in which I can give somebody a service that’s worth more to them. And I agree. Because the other ones is not gonna work.

I still want to deliver the, the, for the patients to see the 12 year old, that just needs 200, $200 glasses. That’s fine. I want to be the doctor for that person, but I also want to be the doctor for the Konic patient that actually needs that. And they go from 2100 to 2025. And I’m actually making a difference in their life.

Dr. Chris Wolfe: Um, so tell me then what, so in your process, let’s, let’s think about it. I kind of wanna process this out with you because it [00:19:00] sounds fun and it’s kind of the stuff I love to think about. Um, so I have an answer, you know, I could say, Hey Adam, I want you to do these things, right. And, but that’s not gonna always work for your practice.

So you have sort of, um, mulled over what your plan is. How are you establishing the value and then kind of walk me down the path of what that patient is gonna do. So if it, whether it’s a Konic patient or a myopia patient, um, how, how are you going to establish that value in terms of a dollar amount? And then what’s your plan in terms of follow up and, and those sorts of things.

Give me a little sense of where your head’s at right now. 

Dr. Adam Ramsey: So I told my staff that I have to. Busy and booked out enough that I can bring an associate on in which there’s the trend like to see Dr. Ramsey in six weeks to see Dr. Smith is, is you can see them next week. And I have to have that separation. If I don’t have that separation, everybody’s gonna choose to see me, cuz I see that happening when I go to visit expo and I’m gone for a week.

If I try to bring a doctor in there, uh, if my [00:20:00] staff gives ’em a pair of contacts to hold ’em over until next week, they’ll wait, cuz it’s not an emergency. Right. So if they’ll wait a week for that, they’ll wait a week for almost. You know, so. Unless I have a bigger separation, it’s gonna be hard for me to bring somebody in.

And I’ve been looking to hire a, a, a doctor and everybody that I’ve looked to to hire asked me for 200,000 to work, no weekends to work, no nights to not be on call, to have benefits, to have a 401k. To have loan reimbursement. They’re trying to make it an equal transaction. And I’m like, do you know, you should be happy to work in my office, not the other way around if you want to come and work in my practice that I put my blood, sweat and tears in these walls, literally.

And figuratively, if you want to come here, it’s gonna be D. It’s gonna be different, but you’re gonna learn here how to properly do an eye exam, how to properly care and treat for your patients. How to actually [00:21:00] be a part of the community. And that’s not what you’re gonna get over there. And I’ve had a hard time finding somebody to, to, to that would actually understand the difference.

Dr. Chris Wolfe: Where do you think they get that dollar amount in their mind? Like where does that come from? Cause I’ve heard that number before and it, it sort. um, I mean, it seems like a lot. I mean, if they’re not, they gotta produce a lot in order to generate that revenue. 

Dr. Adam Ramsey: Yeah. I think you gotta think about when they’re in school, you have every single commercial entity going in there multiple times a year.

For four years, they have touch points. They’ve been told over and over and over and over and over. This is what it is. How many times does private practice go into a. Not once a vision source, maybe once a VSP, that’s it. So if you have 20 times, these people say, I’ll give you 200 grand and you have two [00:22:00] times that private practice goes in and says, come to me.

Uh, you’ll be great. It’s fun. Over here. It’s a hard thing and they come out and they, all they’re concerned with is the student loans and they can’t get over that. And I’m like, I got student loans, I got a practice loan, I got a house loan car loan. It, this is business. This is life like, you know? Um, yeah.

And then optometry is promoting this profession as the work life balance profession. That is where is that? The branding message. Where’s that coming from? Uh, that is an ASCO message. That’s an ASCO message. Mm-hmm optometry gives me, gives me life. Their message is we are the worklife balance profession.

That is what they’re using in high schools. That’s what they’re using in colleges. I don’t actually agree with that. Do you think they’re saying they’re meeting the student where they are, the students want that they want those easy Instagram living life. It’s not the hardest thing. It’s, you know, we can just have fun profession [00:23:00] and I’m like, that works.

No see that, but the issue 

Dr. Chris Wolfe: is, are they doing the same thing in medicine and dentistry? Are you seeing the same stuff? I haven’t looked, I haven’t even paid attention to asking, 

Dr. Adam Ramsey: but medicine, dentist is not giving work life balance. They’re 

Dr. Chris Wolfe: saying, want people coming to this profession that they’re saying, we’re gonna bust your butt, but when you bust butt, we’re gonna, we want that kind of person that’s gonna work hard and, and we’re gonna, and, and when you do that, you’re gonna reap the benefits and the benefits.

Oh, by the way, are going to be, you. You know, you get to have whatever, nice car or whatever, nice business you can take vacations, but look, it’s gonna be work. You’re gonna, but you gotta get there. Right? You’re gonna have to grind. We 

Dr. Adam Ramsey: cannot. That’s not the message they’re getting though. That’s not the message they’re receiving.

So if you attract the student because you have numbers that are lower, right? Cause we, our, our acceptance rate is down or a number of applications down. So they’re trying to reach the, to reach a broader pool applicant. You have more schools opening up, et cetera, et cetera. You’re trying to reach a broader [00:24:00] applicant.

They’re giving it to ’em. Now that that student comes in saying, this is the work life balance profession. Then I come back in and somebody says, this is work life balance. And I say, Hey, but are you willing to go to happy? After working, pass us in a car, shake, hands, kiss babies. So that people in the community know you, cuz you’re not from this area and no that’s not getting paid.

That’s, that’s what you have to do. That’s what, that’s what you do. You know, that’s what we do here. Um, they don’t want to do that. That’s not, that’s not what they, that’s not what they want to just make their money go home and live their life, which is cool. But it doesn’t necessarily work in all instances, in all situations, unless you’re old track 

Dr. Chris Wolfe: translate into the big, yeah.

It’s not gonna translate into the big bucks, right? That you, you could probably find someplace that’s gonna pay you the 200, a thousand dollars or whatever. But that’s what you’re gonna make, man. Like, that’s what you’re gonna make. You’re you’re gonna be probably, if you’re gonna, if you’re gonna take that attitude, you’re gonna go in, I’m gonna work.

I’m gonna go home then. That’s what you’re gonna make because because business owners, um, because you’re not gonna probably, [00:25:00] probably, I mean, I know there’s people, but probably not gonna, um, You can, there’s a finite amount of 

Dr. Adam Ramsey: time in that. Yeah, there there’s a limit. There’s, there’s a limit to that. So it’s, it’s just hard, but I know for myself what I’m looking for and I says, I’m gonna create the life that I like and create the way I like to live my life.

So I started off working six, seven days a week. For the first five years outta school, I was working everywhere, everywhere in all there. And now I mainly see patients three days a week, Tuesday and Wednesday, Thursday, mostly. Um, and then I’m flying around speaking, writing lectures. Before I got on here, I was writing up a lecture for optometry management, uh, uh, conference, uh, in Disney, uh, in December.

So. I make my I’ve made my life the way I like it. And I’m, I’m happy that I get to do so much variety, but I’m also wanting to hone in a little bit more, but I’m definitely looking for somebody to come to my practice that I can find the right, the right fit, because this is my baby. I know 10% of the patients that walk in my office.

I [00:26:00] actually physically know they have my cell. Some of them have been to my house. Like I would have a drink with them. I would eat dinner with them. That is not common. Most doctor’s offices. They could go a month without seeing a person. They physically know everybody else is Mrs. Smiths from the office.

But Mrs. Smiths never been to your house. Mrs. Smith doesn’t know your kids. Almost every single day. One of the patients I actually know, and the staff sees them and they’re like, oh crap, he’s gonna talk forever. and it’s true. Right? So that’s a different feeling of a community iCare experience where I’m actually in and apart of the community.

And I know the patients, patients drive far, I mean, I’m in, I’m in Palm. Orlando is about two and a half, three hours up. It is not uncommon for once a month for somebody to come down from Orlando, from key Largo or the keys, which is four hours away. I got about 10 patients that drive four hours up, you know, so that’s a different experience in my office and that’s [00:27:00] where the, the guilt has been for me in that I’ve been all things to all.

And then now I gotta figure out what is actually best for my office and how can I deliver that? And as I do more specialization, be able to have another doctor to do the general stuff, um, is where I’m, I’m leading to. And I just gotta figure it out because I realize that current model is not sustainable in the long run.

It’s okay. You can do. um, I, I make a good living now doing, doing that, but it’s not necessarily a sustainable model because the cost to do business is going up and you can’t just do it on volume. And if, if a vision plan limits what you can charge, there’s nothing you can, there’s nothing you can do. If it’s all copays, there’s no 90 10 on, on anything where you can try what you.

But you charging you, you you’re dictating what I can charge. You’re dictating my cost. I have to use your lab. I have to use your frames. Yeah. That is a, that’s a no win situation. 

Dr. Chris Wolfe: Yeah. I mean, I [00:28:00] think, I think the, the story that you’re telling is essentially the one that, that probably needs to be told in, in that when, when we’re recruiting, um, new students, you get to live the life you want right now that you’ve described the life that you wanna live.

But, but you’ve. You gotta get there somehow. And it doesn’t mean you’re gonna get there. You know, you got, you gotta get through there through the grind, just like, as you’re adding new services, you’re gonna grind for a bit, you know, you’re gonna say, gosh, okay, this is what I think is gonna happen. If I were gonna encourage you, I would encourage you to start thinking about your time.

It sounds like you already are, but I would, I would say, all right, well, You know, you’ve heard me give this talk a million times, but I would say, look, what’s your average revenue per OD hour right now? What, what, what’s the revenue when Adam Ramsey’s in the office for an hour? How much, how much, how much receipts do you collect on average?

And then I’d say, okay, this new thing that I think, uh, patients are gonna want. I, I need my average revenue for every hour that I spend on this thing is gonna be [00:29:00] at some level. So I would presume that you’d want it higher than what your current one is. And then you, and then you figure out how much time am I gonna take doing this.

And then, uh, and then I would always overestimate that time early on. And then once you get good. Then your, then that bonus is, um, is yours to keep or yours to share back with the patient, but it can be super easy, right? Like if, if you were gonna say, I wanna do a thousand dollars per OD hour on this service, and this service is gonna take me two hours of my time to do, uh, my clinic time, then that’s an easy answer.

Uh, if it’s gonna take four hours or five hours, or maybe you say, it’s gonna, I’m gonna have to learn this, right. So, you know, it’s gonna for early on, it might take me three hours to really get this perfected for a patient. I’m gonna do that 10 times. And now all of a sudden it takes me two hours instead, or an hour and a half instead.

And now that’s where you really reap those benefits in terms of your revenue. So anyway, you know that already, but I think just for the listeners, [00:30:00] that’s just really helpful to kind of think through is like, for example, you thinking about myopia management, ortho, cariology, let’s say it’s gonna take you, you know, your initial evaluation, you’re gonna spend a half hour.

So you do comprehensive exam. Let’s say it’s a half hour, half hour for your initial. Uh, fitting consult, and then maybe you schedule back 15 minute, uh, appointments, or maybe let’s say it’s a half hour appointments, just so you can monkey with it, get used to stuff. And that’s gonna take you, uh, on average four appointments.

So maybe you add a couple more appointments in that. So you’re kind of maneuvering. So now you’ve got three and a half hours, four hours a time. Okay, well, we gotta set that fee. And then as you, as it doesn’t take as long, maybe those follow ups aren’t in a half hour, maybe they’re 15 minutes, but look, Adam, Ramsey’s established himself as a, as a, a premier myopia manager.

And, uh, and you can deliver that service total in two hours, but you’re collecting, like, it would’ve been four hours because nobody else can do it. Like you can do it. And that’s, that’s exactly 

Dr. Adam Ramsey: what you’re talking. So I, I, I, a hundred percent [00:31:00] agree. So I sat down and I did some of, some of that math that you’re, that you’re talking about there.

And I, I looked at it and said, okay, what is it gonna take for me to do this? So I I’m jealous of dentists, very jealous, because be 

Dr. Chris Wolfe: shouldn’t be, they have way higher anxiety than I’m certain they have more anxiety than 

Dr. Adam Ramsey: you. They do. I hear it about the suicide and all this stuff. But the reason why I’m jealous is that their message is.

If you ask a random person on the street, how often should get your teeth clean every six months, a random person would probably get that right. Would a random person get right? How often you should get an exam? No, no. 

Dr. Chris Wolfe: Right. Cause we, we’re not even clear about it. You know? I see, I see on sorry to interrupt, but I see on, on kind of chat forms and I want to, I want to jump in, but that, that to articulate this point is hard to articulate via text, but I’m gonna articulate it now.

I see people they’ll say, well, I pre-app appoint. People who are, who buy glasses every year or who buy contacts [00:32:00] every year. But the people that don’t need anything, I just tell ’em to come back in a year or, and I really don’t really want them to, but I’ll tell ’em and sort of, and, and so I’m like, man, what kind of message are you sending people?

That’s 

Dr. Adam Ramsey: what you’re saying. The value they get for their eye exam is not worth it. Time from selling the weight. And if somebody does not buy a product. it’s not worth the exam time. And I said, that’s where we have an issue. Yes. That’s where you cannot do it. My service, my time is what I’m charging for.

Yeah. The buying the product is an extra and see the difference is people can see the desperation and they can see that out there. And that’s where they get the, a bad impression of us. Now I look at, I look at dentistry and I say, people know exactly what that is. And then I say, there’s a clear path in going from a dentist.

To an, to an orthodontist. I looked it up. I says two years to be, go from a dentist to an orthodontist. So I sat down there on the couch with my wife and I says, am [00:33:00] I willing to devote two years to my next craft? Because I am seeing myself going from a dentist to an orthodontist. And I’m saying, am I willing to put in the time.

That’s what I see. It’s gonna take a serious commitment and dedication to be half decent at it. And I’m not saying I’ll be the best in the world after two years, but I say, am I willing to, to vote that time? Cause I say, there’s a clear path of, okay, this is where you want to go. This is where cuz even if you go to the dentists office, have you ever been to a dentist office where they did not offer you the teeth whitening or brace?

Dr. Chris Wolfe: Yeah. And most of ’em, that’s what they’re looking for. Right? Never because their teeth cleaning again, their teeth, I’ve seen what, what they submit. I’ve seen what they get paid. That’s it’s, it’s a bad, as bad as, as it’s 

Dr. Adam Ramsey: covering, it’s covering the cost of the, uh, the hygienist. Yeah. They only make money on the braces or on the white.

That’s it or [00:34:00] pulling teeth over near or fillings or yeah, procedures. It’s, they’re looking for something, but everybody in that dental office understands the mission. We are not here to do the teeth cleaning. They came for the teeth cleaning. We are here to find whatever else needs to be done. The, the x-rays everything else is to find the something else.

The problem in optometry offices is that people are misunderstanding. What your mission has to be. Your mission cannot be to sell $200 glasses. We will lose our shirt. If that is everybody’s focus. But when you go into dental office, those texts that make $15 an hour, have no issue in telling me Dr. Ramsey, you’re on TV a lot.

You should probably get braces. You know, it, it would be nice to straighten out curly 

Dr. Chris Wolfe: whites. Let me see. ’em uh, they’re not bad. They’re 

Dr. Adam Ramsey: not, they’re not bad. What I’m saying 

Dr. Chris Wolfe: is I get braces. I get. I 

Dr. Adam Ramsey: I see it, but, but what I’m saying [00:35:00] is these girls have no issue and they say it with a straight face that it’s $3,500.

When would you like to come for your eval? I mean, with no issues, I’m in there getting the team, you should get your teeth whiten 1200 bucks with no with no, you know, have you ever thought about veneers? We have the, and I mean, they, because they understand the mission, right? When you go into an optometry offices, how many staff understand that we don’t make money on the first pair of glasses from IED or VSP?

Very few. They don’t understand the chargebacks cuz the lady in the back is doing the billing. So they don’t realize when I get $400 on this IED patient, I may have a $200 chargeback and then I may have a hundred dollars for the frame and I got a lab bill for the glasses. Like, you know what they should, they don’t 

Dr. Chris Wolfe: understand.

What, what, what we should do. I’ve said this before, and I would love to see this on max, although I’m not optimistic, but, um, so on vision source, max, some of the tools that we use for those view, who aren’t in vision source, but I would [00:36:00] love to be able to print out. And it doesn’t just say you saved this, you know, Mrs.

Smith, you say this and your costs now are this I should also said, and your insurance company is gonna get. , you know what I mean? Cause patients don’t think that like, if, if, if the patient’s paying you $400 and the chargebacks are 200 bucks, the patient thinks you still made 400 bucks on the. Right. Uh, so I wish we had a tool that could say, okay, this is what, this is what you would’ve paid out of pocket.

That’s great. Okay. This is what you’re paying now because of your vision plan. And this is how much well, and, and of that, this is how much, uh, your managed vision care plan is gonna make off of use of buying glasses, cuz patients are not aware of that and they ought. 

Dr. Adam Ramsey: That’s why I separate myself from the transaction.

I do pretty good at selling the glasses, but I try to stay away from the money. Cause people feel like that’s, you know, Dr. S is going on vacation off of my $200 and that that’s not it. But like I said, I looked at that model and I says, okay, this is where I need to [00:37:00] go. Cause I sat down and I said, the orthodontist, these people are talking about getting braces.

Imagine braces cost $5,000. And that orthodontist does 10 in one. That is $50,000 of revenue in a credit card machine. The, in a single day. Yeah. I says, name me an optometry office that has one doctor, not multiple doctors. One doctor that can bring in 50,000 in one day. You’d be, I would shadow them for a year if I could find one that did that.

Like, so you, you look at it and you say, okay, there’s something broken with our model. There’s we have to find another way. It cannot be this way. Cause I, I sat down and this is just me, literally just telling you what I’m really thinking. Sure. Yeah. I probably shouldn’t. I probably shouldn’t share this with everybody, but I I’ll share where you are.

Dr. Chris Wolfe: It’s do like we’ve been recording 

Dr. Adam Ramsey: for the last, uh, I know, I know, I know you guys can take, take, take what I’ve been beating on my head for all these these months and, and go ahead and do what you want with it. But I sat down and I [00:38:00] says, the model is broken. I sat on my optical and I said, I have $85,000 of my cost in frames sitting on this wall.

I says, would I just sit $85,000? On a wall. I said that is, and I sat back and I saw we sold eight or 10 pairs of glasses that day. I saw that. I said, yeah, but I told y’all you have 800 frames and you also ate today. I says, I have $85,000 there for you to sell eight frames. That transaction is broken. I says, they’re coming in, we’re coming in to, to refresh.

And every time they come in and refresh, I get a bill for five grand and this, that, and the other, I says, but hold on. If I have a product and I sell it for 300 and I bought it for a hundred. But I gotta leave one on the shelf. So that one cost me a hundred. Every time you guys sell one, we reorder. So the other one cost me a hundred I only got a hundred.

I said that isn’t that model, that model is not working. I should get the frames for free. I am showrooming [00:39:00] somebody else’s product because I only make money when I sell it. But I have to, have you ever asked 

Dr. Chris Wolfe: this? Huh? Have you ever asked somebody to do. 

Dr. Adam Ramsey: oh, I ask ’em all the time. They look at me like, I’m crazy.

And I said, but I’m show your product. You know, even dealerships, they don’t pay for the vehicles that are sitting on the lot they pay for ’em when they sell ’em, they’re getting a, they’re getting the, the Toyota is letting you hold them. And then they like where else? This model doesn’t work. Because think about it.

I brought in frame lines that I tried to, you know, I went to Italy and Mito and here, and I tried to bring in different stuff and say it doesn’t work. So I took a $8,000, $6,000 flyer on a product. And we sold 4, 5, 6 of ’em and they become under stock. Who that is that you can’t absorb that cost over and over and over.

Cause if you go into most offices and you ask them, let me go in those bottom shelves and ask the opticians, where are all the frames in 2020 when 2013. And they’re over there and we’re the ones in 2016 and the ones you don’t sell and they’re over. [00:40:00] You that model. So you’re using money that you made from somewhere else to cover this cost.

So I literally sat in my office. I’ve been having like a serious epiphany cuz you know, I wrote the first book about how to open and now I’m trying to figure out, okay, how do I, because the model is broken. Our current model of doing business is broken. I don’t, I haven’t seen somebody and I tried to absorb contact from everybody else and listen to all the speakers and I go to wait too many damn conferences.

I haven’t seen somebody explain it appropriately and realize, and just say bluntly. The model that we have in our profession is broken. How we are actually doing business is not sustainable. We have to find another way of delivering care and services because my cost is going up. My revenue can only go so much.

They’ll only, they only want to pay so much cuz they’re being told glasses cost two for 89. That’s the difference between us and other professions, our price for services and product. Or put on TV and put on flyers. Where [00:41:00] else does somebody, nobody tells you how much I went and got orthotics put in my shoes.

I don’t have, I’m not, he told me how much it was. I had to decide on the spot. If that was worth it to me, I don’t have a preconceived notion of what that is. They don’t have, they, they don’t have that. Even when you have commercial entities inside dentistry, they’re not operating the same way. We’re not competing against it.

It is very difficult in how we’re doing it. And the patient comes in thinking glasses should cost two for 69. So Dr. Ramsey’s offering it for $400. Framing lenses. He’s overcharging me not realizing that we’re trying to express to them that my product is better. It’s better quality. It’s not gonna fall apart, this, that, and the other, but they have a number in their head that we have to compete against and other professions are not having to do that.

So we have to find another way of doing business and get everybody in the office to understand how we make revenue. And I literally sit down and I had my office, man, cause I used to pay all [00:42:00] the bills. They were griping. I could hear ’em griping, griping, griping, griping about all different things. I said, you know what?

Hold on. Right, wait, wait right here. And I went and grabbed all the bills for the month. I said, here’s the credit card you pay? ’em and I made a put down the, I, I made her pay every single bill. We had a day when it was my admin day. Weren’t seeing patients. I was in there doing payroll and everything. I made her pay every single bill when she was done, it was like $38,000 in bills.

I said any question. All that gripe and stop because they didn’t, because they’re siloed. They’re not understanding how one connects to the other and how you have to do that, to pay this, to make this work. And I think that’s where the model that we have in optometry currently is broken. The tech does not understand the optical optical does not understand billing.

We’re not understanding how it all works together. And everybody feels like, oh, I did a great job at eye exam. Those we made $45. That [00:43:00] that was, you see everybody in here that wants to make $20 an hour. It cost me a hundred dollars an hour. It’s five of y’all. It cost me a hundred dollars an hour just for y’all to stand here.

Right. That’s not 

Dr. Chris Wolfe: that isn’t, that doesn’t include your overhead or any of the other consumable or the technology that’s in your practice or any of that stuff. I think you said, I think you said this really well. And, and I, I, um, it’s, it’s been kind of my, my mantra recently is you. With dentists, that dental exam is there to look for all these other things.

Right. And I, I think that, I think for whatever reason, um, we have not been, you know, our approach when I walk into a patient is essentially in my mind, it is proved to me that there’s nothing else wrong. I mean, you know, that’s my, that’s my approach. That’s, that’s how I was trained. And, and so that’s, that’s when I walk into a PA in, into a room is say, I’m gonna make sure that there’s no signs or symptoms that [00:44:00] make me, uh, more concerned about something else going on.

And if I don’t have that approach then, and all I care about is, is I want you, I wanna give you a good pair of glasses. Um, then I lose all the time. So let me ask you this, cuz I’m gonna be respectful of your time, cuz I, I messed you up last time. Two questions. The first one is, are you gonna, are you gonna put in two years of work to do, uh, to do what you want to do?

Dr. Adam Ramsey: Yeah. I’m, I’m the type of person. If somebody tells me I can’t do something, that’s what I wanna do. And when anybody who, because you couldn’t do that well, nobody else said it. Okay. You, you know, Michael Jordan, I always used to get a little slights from other people just to keep himself motivated. Yeah.

That’s kind of me. I just, I need a. 

Dr. Chris Wolfe: I don’t think you’re gonna do it in two 

Dr. Adam Ramsey: years. Don’t do that. Don’t do that. Don’t do that. Don’t do that. but I, I do think you 

Dr. Chris Wolfe: will, but I’ll give, I’ll give you, I’ll give you that. If 

Dr. Adam Ramsey: you. The current model is broken, so I don’t have a choice. So it’s, it’s the way it is now is [00:45:00] broken.

So I can’t see that as an option going, doing what I’m currently doing is okay. But that model is broken. So, um, you can’t, I can’t keep the status quo. I will be the frog in hot water. And we’ll drown. It’s, there’s no way to keep it going. We have to do it a different way. And I haven’t, I haven’t seen somebody else show me clearly another way to do it.

And so I’m gonna go figure it out. I’m gonna figure out how to change the I’m gonna figure out how to change the model, uh, because I didn’t have to do it for me. Nobody’s, you know, nobody’s coming to gimme a lifeline, so I gotta figure how to do it. And, and this is coming from a place in. I’m happy. I’m comfortable.

Right. But there’s a difference between the Adam, the business owner and Adam, the doctor, Adam, the doctor is comfortable, but Adam, the business owner has to look further on ahead and say, this model is broken, even though I can do it today and I can survive. 

Dr. Chris Wolfe: Yeah, I think I, so I think that’s what, what’s, what makes me [00:46:00] optimistic about, about what you’re talking about is that I look at, I, if I think about all the practice owners, uh, especially like, you know, in they’re in they’re independent practice, they’re super excited about what they’re doing.

Not one of them is stagnant. Not one of them, every guy I know that’s like really passionate about their practice. Like you they’re, they’re always looking for like, how can we make this better? How can we refine this process? How can we take better care of our patients? What else can we do that our patients need they’re Al and, and they, they reflect and they, and, and they’re like, oh, I love practice.

It’s just, it’s. It’s great. And so I love that, that, like you say, I’m happy in practic. But you see all these like potential problems, but then all these potential opportunities to make them better. And that’s what will always make you, uh, a great practitioner and a great business owner. It’s the infinite game.

It’s the 

Dr. Adam Ramsey: infinite game. This is the funny thing. Sometimes optometrist forget when they’re in private practice, this [00:47:00] is a business. There is no, no other organization or other company is supposed to make me profitable. It is my job to make sure that my four walls are profitable. It is not an insurance company’s job.

It is not a frame company’s job. It is not a lens company’s job. There’s not a, a equipment manufacturer’s job to make sure that this is profitable. And I think the issue is optometry was on autopilot in the eighties, nineties, and early 2000. You could, you could, you could make 200 grand, even if you were a terrible doctor, you could just, it was just, okay, now that is not it.

You have to realize that we are in the business and we have to actually be a business owner and make business decisions and they’re not easy and they’re difficult, but. That’s the fun of the game. It’s not supposed to be easy. It’s not supposed it’s. You’re supposed to actually get in there and make some put on your big boy pants and make some serious decisions.

[00:48:00] And, you know, I, I I’m, I’m excited. I feel like, I feel like I got a new lease online because you could do something and not have a purpose. And me without a purpose, that’s aimless, that’s boring, which is better. One or two that is not a fun day for. But realizing that I’m making my practice better. I’m making lives of my staff better.

I’m making lives of my patients better. You know, we brought in neuro and it was, it was one of those things where I, you know, I, I, I took a flyer on it, paid the money. Everybody says it was great. Did it? I am surprised at the difference that it made in people’s lives. Even myself, I sold it to them and then they come back next year and they’re like, oh no, that was the best thing is ever, I’ve been wearing glasses 40 years.

I’ve never, I’ve never felt that good. And it’s. But being able to be in there and say, I made a business decision that makes impacted somebody’s life. And that, that is the fun of it. That’s the excitement. And you gotta figure out how you’re gonna change it. You’re gonna make it better. You know, [00:49:00] every day I try to, to see how I can make this profession better for myself, for my patients, for my staff.

And then I try to do things that are bigger than me than a bigger than my community. Like when we talk about my, my black eyecare perspective on nonprofit that we, that, that we started. Um, before the pandemic to see the students that are in school and thriving, that would, some of them would not have been.

We found some students that, that had 3.7 GPA and were like, why did you not apply? And they just said, I didn’t know if they would accept me. And it was a confidence thing. They just didn’t they needed somebody to believe in them. And literally just having one-on-ones with them and saying, you are enough, you are smart enough.

It’s okay. We’re gonna be there for you. And these kids are doing wonderful in school and to look back and they tell us, thank you. And they write letters and they, they are popping in and sending us emails and we’re seeing them thriving. It’s it is. [00:50:00] That’s why I get up in the morning. Like if it wasn’t for that.

I, I, I, I, I don’t know. I couldn’t, I couldn’t just do, which is better. One or two, uh, smile, give people artificial tears and move all my day. It has to be, there has to be more to it. There has to be something else. Um, You know, and I’m, I’m, I’m loving that. I get to do all those great things, which is what I love about this profession is why I got into the profession.

You know, that it was so much variety in what I, what you could do every day. You know, I could think of myself, I could go and do full time industry and not see patients ever again. And that’s, I didn’t even know that coming into this profession. I didn’t know that when we got in, nobody told us that you could do all this other stuff outside.

They told us you were gonna go see patients. This is what it is. You’re gonna give our minus two contacts. All. That’s what it is. And now I come out and I says, man, there’s so much, there’s so much you can do. It’s so robust. And that’s the excitement. But that message is not being told. That story is not being told.

And that student that wants some variety that wants some [00:51:00] passion that wants something unique or different outta profession is not seeing that from the branding and marketing that we currently have. So we’re getting what we get because garbage in means garbage out. And the people that we’re getting in is from how we’re putting it out into a world.

There is so much life and breath and so much variety in this profession that it gets me. It gets me excited because I’m like, oh man, it’s gonna be, it’s gonna be better on the back end. I think we’re gonna be better when we become specialists. I think we’re gonna be better because. We’re gonna be better at our craft.

We’re gonna be better. We’re better if I do the same thing over and over for one, especially I’m gonna be better at it and it’s gonna be better for the patient. So I don’t think the Jack of all trade’s master of none thing that we have currently, our profession is as good as it should be. Even ophthalmologist the guy who does right.

And doesn’t do cataracts. And the guy who does cataracts may not do glaucoma and may not do. It is a totally, even them within their specialization have decided, this is where, this is where it is. Cuz I’m, I’m good [00:52:00] at this. And I think there’s something to be said that we’re gonna be better. I think on, on the other side of it and the resources are out there for doctors to be able to specialize cuz there’s 1,000,001 conferences and its content and there is industry and there’s products and there is there’s money being invested into the profession.

It’s just upon us to really figure out. You know, what’s, what’s my niche. How do I want to go to it? And am I, am I willing to put in the time? Am I willing to go, uh, a little bit further and push myself a little further? And, um, I definitely, I definitely think it’s possible. So I’m, I’m excited, not depressed.

I’m excited. 

Dr. Chris Wolfe: I think, uh, that’s the way we gotta end this, Adam. So thanks. Thanks so much for doing this. I’ve got some ideas on the back end that I’d love to follow up with you about, but it’s talk. Thanks for doing this again, man. It’s been great. 

Dr. Adam Ramsey: Thanks.