How a Limiting Mindset Can Cost Practice Owners More Than They Realize with Dr. Steve Vargo

Adam Cmejla:
Welcome back to another episode of 20/20 Money, The Business of Optometry. Joining me back on the show for another conversation, the one and only Dr. Steve Vargo. Steve, good to see you again my friend. Thank you for being here.

Steve Vargo:
Thank you for having me. Always great to chat.

Adam Cmejla:
I am very interested to see where our conversation goes today. When I read what I’m about to read on air, you were the first person that came to mind that I wanted to unpack this with because you come at this from multiple vantage points based on your experience and tenure in the profession.

A couple of months ago, one of the advisors in our office shared something during our weekly internal meeting. We call it Planner’s Club. Think of it like how clinicians might gather to review cases or discuss clinical situations. We do something similar as a firm where we talk through different client scenarios and strategies.

One of the advisors brought up an email from a client who is an OD. There were three agenda items for their upcoming review meeting, and the third item read as follows. I’ll read it word for word:

“Third possible topic. What do other clients do to create more income out of the office since insurance companies have not given us a raise in 25 years since graduation? It’s somewhat depressing that there is no money in just doing eye exams anymore and more people are walking with their prescriptions each year. It seems the truly successful offices have to survive by selling non covered cash pay services to their patients. If I wanted to be a salesperson, I would have gone to sales school instead, but here we are. It seems the real money might be in adding red light dry eye therapy, if you can sell it, MedSpa treatments, if you can sell it, etc. Curious what the best option would be to pursue based on success with your other clients.”

When this was shared internally, there were a lot of thoughts that came to mind. The biggest one was the burden that this owner seems to be carrying around. And as I thought about who I would want to discuss this with, you were one of the first people that came to mind.

So when you hear that, what were some of the first thoughts that came to your mind?

Steve Vargo:
I appreciate the sentiment from this OD and I empathize with what they’re saying. At the same time, if you’re asking my initial response, there is a bit of frustration with a mindset that I see out there that I think needs to be challenged.

One of the statements that stood out was the idea that successful offices are primarily offering non covered services. That simply is not true.

I’ve worked with hundreds of practices across the United States, and many of them are still doing very well with the bread and butter services.

Now I do agree that the market is changing. Reimbursements are under pressure. Competition exists. Those trends are real. Because of that, I absolutely think practices should be exploring alternative revenue streams. Not just to generate income now but to position themselves for where the profession is heading in the future.

But I would not stop selling glasses and contacts right now. There is still money to be made there.

The question becomes: is it truly impossible to make money doing that, or are there internal or strategic issues within the practice that need to be addressed?

For example, if someone tells me they can’t make money selling glasses but their opticians have never had any sales training, or the doctor isn’t comfortable communicating recommendations in the exam room, then we have to look internally first.

Another thing that stood out was the comment about not wanting to be a salesperson. But then a few sentences later the OD talks about adding services “if you can sell it.” So there is a bit of contradiction there.
If I owned any business and wanted to become more effective, I would invest time learning the art of selling. And when I say selling, I really mean communication.

Good salespeople connect with people. They ask better questions. They build trust. They listen.

Those are skills that benefit every healthcare professional.

Adam Cmejla:
One of the things I’ve always found interesting about optometry is that it’s somewhat unique among healthcare professions because of the retail component.

For example, if I go to the dentist and they diagnose a cavity, I don’t have the option of saying “thanks for the diagnosis, I’ll get that filled somewhere cheaper.” The treatment happens there.

But in optometry, patients have options. They can take their prescription and purchase eyewear elsewhere. That dynamic creates pressure on practice owners.

Despite that, we know there are still practices doing very well providing comprehensive eye exams and selling glasses and contacts.

So when you think about the conversations you’ve had with doctors over the years who feel stuck in this area, what is the first domino that should fall?

Steve Vargo:
If I had to start somewhere, I would begin with communication.

Warren Buffett once said the number one business skill you can develop is your ability to communicate well. I think that applies directly to healthcare.

There was a survey of more than two million patients that asked what they valued most in their doctor. The number one answer was communication skills.

If you compare practices with a 60 or 70 percent capture rate versus those with a 30 percent capture rate, often the biggest difference is how the doctor and staff communicate with patients.
One misconception about sales is that good salespeople are good at pushing products. That’s not actually what they do.

Good salespeople remove friction. They remove the barriers that prevent people from making decisions.

That starts with asking better questions and understanding what the patient is really experiencing.

Adam Cmejla:
That reminds me of something I heard years ago. People don’t care about your solution. They care about their problem.

So if we’re not uncovering the real problem a patient is experiencing, it becomes difficult to connect our recommendation to something meaningful for them.

Steve Vargo:
Exactly.

One of the biggest mistakes doctors make is asking yes or no questions like “Are you having any problems with your vision?” Many patients will simply say no.

Instead, try asking “Tell me about any problems you’re having with your vision.”

Then be quiet and let them talk.

Another useful question is “How is that affecting you?”

When you ask questions like that, patients often open up about frustrations or challenges that they didn’t initially mention.

There’s also something interesting in behavioral psychology. The problem people tell you about is not always the problem they’re willing to pay to solve.

Often there is a deeper problem behind the first one. And if we interrupt patients too quickly, we miss that.

Studies show doctors interrupt patients within about 17 seconds on average. But patients only need about 90 seconds to tell their full story.
If we simply listen longer and ask better questions, we can uncover what really matters to them.

Adam Cmejla:
That’s powerful.

And it makes me think about how doctors can practice improving these skills. Communication like this doesn’t necessarily come naturally.

Steve Vargo:
That’s true. It’s a skill that can absolutely be developed.

For example, years ago when I transitioned into more speaking and consulting work, I realized I needed to improve my public speaking skills. I joined Toastmasters and spent a couple of years working on communication.

What I discovered is that those skills transfer into many areas of life, including patient interactions.

When you improve how you communicate, patients become more engaged, they ask more questions, and they’re more likely to follow through with recommendations.

Adam Cmejla:
As we wrap up, I want to bring this back to the original question from that OD.

Whether we’re talking about routine eye exams, red light therapy, myopia management, or any other service, the common denominator is communication.

Steve Vargo:
Exactly. If someone is struggling to sell glasses, that same communication issue will likely follow them into other services as well.

So the solution isn’t necessarily chasing the next new revenue stream. It’s improving how we connect with patients, how we understand their problems, and how we communicate solutions.

Adam Cmejla:
Steve, this was an incredibly valuable conversation. I appreciate your perspective and your willingness to unpack this topic with me. Thanks again for being here.

Steve Vargo:
Likewise. Thanks for having me.

Adam Cmejla:
And we’ll catch everyone on the next episode of 20/20 Money, The Business of Optometry.