 Well, my name is Paul Sternberg, and I'm visiting y'all from Vanderbilt. Notice how I threw in the awl. I'm here too much. And what I thought I'd do this morning is rather than give a clinical talk, talk a little bit about some of the things I've learned over the years about how young physicians can succeed early on in their practice. So we're going to talk a little bit about growing your practice, growing your presence in the community where you practice, and growing your personal management leadership skills. Feel free to interrupt me. This is not your classic didactic talk, so I'm welcome to make this more of a conversation. So I think the key, the three keys to building a successful practice is first of all, you've got to be good at what you do. And I know people talk a lot about the three As, you know, being, you know, affability, availability, and ability. But if you're not really good, I think it will catch up to you at some point. So I think that really not only being good but keeping up is important. We're going to talk a lot about how to provide good at service to patients. And then one of the most important things that I see changing a lot with subsequent generations of physicians is the unwillingness to actually get out of your office and introduce yourself and meet doctors. And as opposed to kind of feeling like I'm great Paul Sternberg who trained at Moran and patients should come to me. And it doesn't work that way. So I really believe that whether you're going to be a clinician scientist or a clinician educator, a clinician who practices an academic setting or in practice, you need to be a good ophthalmologist. And the people who end up doing science because they're lousy clinicians, you just don't want to be that. I think you've got to be capable. Because, you know, one day you're going to be, you know, if you're a clinician scientist, you may end up being a department chair. If you're a department chair, you're going to run grand rounds. You're going to do professors rounds. They're going to expect you to know the field and be competent. You're going to be working with residents and fellows. And the last thing you want is for them to kind of be deferential or even critical or dismissive is probably the best word. Be dismissive of you as a clinician. You are a doctor first and foremost. And so whether it's your knowledge base, your procedural skills, they need to be outstanding and you need to keep up. It's one of the hardest things to do, quite honestly. This field, all fields, are changing dramatically. And when I reflect on what I learned in my fellowship and what I do today, there's very little that I do today. I mean, we did lasers for macular degeneration. You know, we couldn't treat macular holes. We were talking last night at dinner. We didn't have liquid perfluorocarbons. I mean, you know, there wasn't small gauge surgery. And if you were someone who kind of, I had a faculty member at Emory trained at Wilmer and she was extraordinarily capable. And about a year in, the fellows came to me complaining about they didn't like working with her. And I said, why don't you like working with her? And they said, well, she does everything differently than you guys. And I said, well, differently is good. You know, it's good to have people to train to different places. I said, yeah, but we don't think it's better. We think it's not as good as. And how does she respond when you suggest she do it another way? And I said, well, this is the way I learned it at Wilmer. So I brought her into my office. We sat down and I said, you know, fellows are identifying that you're doing some things differently. I said, that's great. When they ask you, you know, why are you, you know, with a scissors rather than with a forceps, you know, what's your answer? Well, that's the way I learned it from Dr. Heller. That's probably true, but that's not an answer. You need to be able to tell them I do it this way because it's better than that way. And why? And one more thing, if you go to Dr. Heller today, she may not be doing it that way anymore. Just because she did it two years ago when you were her fellow doesn't mean she's still doing it. You have to evolve. And everything you do that you have to have considered the different options and made a decision. So with the residents or the fellows, you're going to be working with a bunch of people who do cataract surgery, a bunch of people, and they will do it differently. And hopefully your technique is not going to be Dr. A's or Dr. B's or Dr. C's. It's going to be yours. Taking what you have decided is the best of all of those. And then when something else comes along, it's critical for you to look at it, evaluate it, perhaps visit someone who's doing it, or go to a course at the academy or ASCRS, and then decide whether you're going to incorporate it into your practice or not. I'm not saying that every new thing that comes along you need to do because a lot of it's crap and a lot of it will be dangerous to the patients. There are people who always feel like they need to be the first person doing things. I don't want you to necessarily be the first person doing things. But I don't want you to be the 20,000th person to do it. Be something like the 100th person to do it. Let it get some traction. Let there be some evidence. Look at it objectively. Is it going to make your patients better? And if so, I think you need to incorporate it into your practice. Service. Whether you're good or not, the patients quite honestly won't know. They really don't. They don't know whether your cataracts, whether your rexus was beautiful or not. They don't know whether the IOL was perfectly centered or not. They just know whether they're seeing better. I remember my resident surgery well enough to know that I had some pretty ugly eyes post-operatively that saw 2020 and were really excited. Eyes that I really struggled with during the surgery. When I wasn't a very good surgeon. But they do know whether you provide good service. That is something they will judge from the minute they call your office to when they try to find parking whether they try to find your office, to whether they try to find parking, to when they check in, to when they check out, to when they try to get the results of the tests, to when they try to schedule their procedures, to when they have any questions afterwards. So these are all things that you can control and make a difference to whether your practice is going to be successful or not. So access is very, very important. You need to have a system where the phone calls are taken or the patients cannot schedule online where they can reach you easily. When they do call, you need to return the calls promptly. There's nothing more annoying to a patient than not hearing back. What you forget is that patient calls leaves a message. I think I need to refill on my eye drops. The access center says, terrific, one of the residents will call you back sometime today. What do you think that patient does for the rest of the day? They sit at home and wait for you to call. They are literally, that 80-year-old woman is not going to leave because she doesn't want to miss that phone call. So they may call at 9 o'clock in the morning for the next six hours, the next eight hours, they're going to just sit there. And then maybe at 4 o'clock, they haven't gotten a call, they may call again. And that's just the way they are. And we don't think about that. We think about how we have to finish rounds, we have to finish consults, we have to finish clinic, then we'll get back to it. But there is a patient that's sitting by the phone waiting to hear back from you. Now it's a little bit different if it's a 40-year-old attorney. But that's not our patients, right? Most of our patients are 80-year-olds with glaucoma macular degeneration waiting to hear back. Referring physicians are the same way. So if a referring physician calls you and gets to the access center and says, you know, I've got a patient I want to be seen, you know, by, you know, Dr. Hartnett at Moran. Access center, you know, can we schedule? I'd like to talk with her first. Great. I'll ping her. How long will that doctor wait before he decides to send that patient to somebody else? Sometimes like five minutes, because the patient is sitting in his chair and he wants to get that, you've been there, you want that problem solved, you don't want to have to worry about it. You may put the patient in the waiting room and say, we're going to wait a little bit and see if I hear back from the doctor, but after a little while you're going to see that patient sitting you know, Hartnett's not getting back fast enough. I mean, it happens all the time and a number of times I've called back and the doctor says, you know, oh, we already took care of that patient. Return the calls promptly. And so I have a process whereby if a referring doctor calls when I'm in clinic, there are two rules that my staff knows. They don't interrupt me except my wife or a referring doctor. And my wife won't call me in clinic because she knows that I'm in clinic. So if she needs me, she'll text me and ask me if I can step out. So if she calls me, you know, it's, you know, like something really fortunately hasn't happened. So referring doctor's call, knock on the door, excuse me, Dr. Sternberg, there's a call you need to take. Excuse me, you know, I need to take this call. It's a doctor with an emergency. I need to go back in. But if you don't do that, you know, when there's a patient in an office in Provo with a retinal detachment, it's a little, you know, here, they don't, if the Moran person doesn't get back, they go to the private practice. The private practice person doesn't get back, they go to the Moran. I mean, that's the way it works. They want the problem solved. Return those calls. Keep in touch with your referring physicians. Your referring physicians is a specialist. It's a life line. They, you live and breathe or don't buy them. And they are very fickle. They may, they, there's, you're as, there's loyal to you today as they are to you today. They will change. And you need to really get to know them. You need to know how they like to hear from you. Do they want to get a letter? Do they want to get a call, a faxed text? Or do they not want to know? I got, I got a call. I had a referring doctor when I was in Emory. And, you know, I would send him letters every time I would see his patients. He finally called me and he said, Paul, did you know the difference between a referral and a consultation? I said, what do you mean? He said, the consultation is when I send you a patient, I want your opinion and I want the patient back. A referral is a patient that I send you that I don't want to hear anything more about. Okay. That when I send you a patient, there are referrals. I don't send you consultations. Do you understand the difference? Yes, I do. I mean, that's fine with me. Never sent him a letter again. Never called him. Got lots of business from him. I was his doc. He, he, you know, he, he talks to me. He talks to me. I don't want to hear anything more. He wants me to see that patient every six months. If they develop what AMD wants you to take care of he does not want to see that patient again. Maybe if they need a cataract operation I'll send him back. Most, they're probably already pseudophagic, so, you know, he was done. There are some docs, though, that really, you know, they want, you know, if a patient with retinal attachment, patient landed there. They may want to know, you know, that the surgery went well. And ask them, you know, do you want me to phone you? Do you want me to send you a text? How do you want to communicate? Get that down. Keep it in your head. And know that. There are so many ways we can communicate that are really easy these days. And, you know, that quick, you finish the, you finish the, you know, the vit bugle and you just send a text to the doctor saying, surgery done on Mrs. Smith went great. The guy sitting in the clinic sees the text going, all right, move on. It's, you know, that will create loyalty. How long does that take you? It's a thought. You've got to think about it. You've got to have it hardwired in your business. And do the doctors do that here? Are they good about communicating back? It's really important. Patients notice a difference. You know, you guys I know do a lot of stuff with patient satisfaction at University of Utah. The prior Dean, Dr. Lee was one of the, was developed a reputation on this. And, you know, we do a lot of work with patient experience. Actually, in addition to being department chair, I'm the chief patient experience officer. So I oversee all the press scanning surveys across the medical center. And, you know, there are doctors in my department in the medical center that do most of them do really well. But there are outliers and there are reasons for that. Patients do notice. There's just no question. And, you know, you can either respond to what you're doing internally or you can have the patients go on the internet and start posting stuff about you. So, you know, here are, you know, our scores, but, you know, vitals.com also posts stuff. But on your vitals.com, you know, there may be two comments, you know, based on somewhere for four ratings, as opposed to if you have survey, there are going to be hundreds of ratings. And which people are more likely to take the time to initiate a review on vitals.com. The patients that's really happy with you, or the patient that was really unhappy with you. I mean, some of us are regular, you know, are regular on Yelp or whatever and just do it. But most of us will only decide that's with a crappy experience and I'm going to sit down and write about it, right? Isn't that generally how we're motivated? The number of times we go to have a good, we may have a spectacular experience and we'll do a review. But anything that's kind of excellent, very good, we're not going to, we kind of expect it. So, but if it's bad, we're going to write about it. This is what my vitals.com looked like five years ago. You can see that I had four reviews and there was one person who didn't like me. Okay, so look what my overall rating is, 2.5. That's not very good, right? So, if you go, if I'm googled and this bumps up at the top of my Google search, 2.5 stars, you know, I'm not going to get very much business. So, you've got to, first of all, put in some sort of system in your practice or if you're at a, you know, a medical center that will post the scores. So, because it'll get, there's a way to get the search to put the institutional rating higher and then periodically search yourself. We went to transparency publishing, I'm not publishing, putting on the website our star ratings. Actually, Utah was the first place to do that. They were really doing poorly in their patient satisfaction scores. They started publicly reporting and like magic, the scores got better. The doctors really responded to it. Here is what mine looks like. You can see that I went from 2.5 to 4.9 and that I had 81 ratings, you know, not four. This is from a few years ago and the comments, you know, are positive. So, transparency, here's what happened to us when we started publishing our scores. We were in the 48th percentile, we went to the 70th percentile and we're, I think, in the 80th percentile now. Every institution that has done that is seeing this improvement. Now, obviously, everyone can't be in the 70th percentile. So, it's kind of like what Lake Wobagon, you know, where everyone is above average. But there aren't, every institution is not willing to go public with it. The doctors are resistant and you have to have, I also happen to be the chief medical officer. So, when the chief patient experienced officer wanted to publish it, he went to the chief medical officer. The chief medical officer said this is a really good idea. So, we moved it forward. And it's the obligation of the division chief of the chairman to, when there is a physician that has lower scores, to sit down with that commission and have conversations with him or her, point out that they have lower scores and try to motivate change. And when you have those conversations, I'm not sure if I have the slide in here, what do you think you'll hear from the doctor when you sit down and say, what will you hear in that conversation? I mean, some probably just don't know, you know. Okay. Wow. Thanks for sharing that. I wish that were the response. It's not very often because they do get it. Some of them don't look. Some of them don't open their emails from me. I found a fascinating thing. One of my challenges as chief medical officer is to get information to the faculty. You know, and how do you get them to read your emails? And so, periodically when it's something really important, I would, you know, get it sent from the dean or the CEO instead of me try to elevate it. And so, I have a group that's called the physician console. It's 25 doctors, kind of doctors, doctors. I meet with them once a month to kind of get their insights. And I taught them a communication. And they said, you know, you've got it completely wrong. If you want us to read something, don't move it up the hierarchy. Move it down the hierarchy. I'm much more likely to read something from my division chief than I am from the dean. Shocked me. But I guess it makes sense. The person they see on an everyday basis is their division chief. The rest of us are just kind of talking heads. I told the dean that he wasn't very happy. But, you know, because, you know, we kind of think that we have more influence and power as we get, but we don't. We have more power. We don't have more influence. So what do you think they say when you share with them their scores? I have too many patients. I'm busier. I'm too, I'm so busy, you know, this is why you're making me see too many patients. My practice is busier than the others. That's one. What's another? There are three things I hear. One is I see more patients. Number two, my patients are more complicated. I see all the reops. I see all the patients that are coming in for a third opinion. What's the third? The third is it's not statistically significant. They're not enough surveys. You know, prove this proved to me that there's a statistically significance difference between 51 and 60. So those are the three things you hear. So what is what is your answer? Well, you're busier. You're really busy. But you know, Rachel's busy too. And you're Rachel's scores. Okay, your patients are complicated. Yeah, but you know, Sturmburg sees some pretty tough patients and he does pretty well too. And are you saying that it's okay for complicated patients to be unhappy with you? No, it's not, you know, they deserve the same level of service as others. For statistics, you go, you're right, it may not be, but it's certainly a direction. And I'm not going to argue with you on the statistics of it. But you know, we've got 20 doctors in the department, you're the lowest. And, you know, this is an opportunity for you to do better. So a couple things that can help minimize patient waiting time that what's the best way to minimize patient waiting time show up on time. You know, if your clinic, you know, number of doctors that will, you know, if their clinic starts at eight, they may not show up to 830, 845, if my patients are dilating, they're never ready for me. If I show up, they're not ready. What's the best way to get them ready? Show up. If the techs know you're there, they're gonna, they're gonna be a little more expeditious and working them up. If you're not there, there, what's the rush? Dr. Sturmburg's not there. I don't have to be in a hurry. He never shows up till nine o'clock, becomes a cart and a horse thing. And don't leave clinic, you know, I'm bad about this, you know, if I get caught up in there, and any patients waiting, I may go down to my office and do some emails, do some phone calls. But guess what's happening that 10 minutes and I'm going down there, turns into 20 minutes or 30 minutes by the time they come up, I'm behind. So try not to leave clinic. When when you're there, it's amazing how quickly things move along, they see you standing around and the techs are gonna get some patients ready for you. They will. I really feel it's important to have a lead tech recorder back in your clinic, somebody who I respond well to being told what to do. So I really like having somebody tell me injection, you know, this patient is needs, you know, has a ride that's got to go, you know, and they, you know, need to help drive the efficiency, you need to empower them, let them know that they are in charge that it's there. And it's great ways to start with the huddle at the beginning of the day, saying, you know, we've got, you know, 28 patients today. We have six new patients. You know, this, this one patient who's coming in is referred by Trisha Yearwood. So we need to, you know, make sure that they're that they get seen expeditiously. This this one is a trustee. And this this one here is really annoying. I mean, you know, let them know, give them the highlights of so they know they kind of take they'll put up look on the schedule, put some asterisks and they'll know to kind of move things along. And you also have to let empower them to interrupt you, especially with this. There will be patients that take too much of your time. You've all you've all been there, right? They just have more more questions, more questions. So my, my texts know that I rarely spend more than 10 minutes in the room with a patient. So if I get to about 12 minutes, they interrupt me, they'll knock on the door and say, excuse me, Dr. Sturmburt, you know, do you have a second? And that's their way of saying, wrap it up. So you don't get behind. I have a great story about a patient who came to me for a second opinion about a macular hole. She was a corporate lawyer. She had been seen by one of the very good retina people in private practice diagnosed the macular hole told she needed surgery. I went in to see her said, you know, Ms. Adams, you know, you have a macular hole, you know, the other doctor was absolutely correct. He's very skilled. I encourage you to go ahead and have the surgery. She will have a few questions for you and I said, All right. And she took out a legal pad. And she asked me about eight, 10 questions. And then she turned the page. And I said, How many pages of questions do you have? She said five. And I said, you know, I could sit here and answer all five pages of your questions, but it really wouldn't be fair to all the other patients in my clinic. I would really get behind I want to answer all your questions. But here's how much time do you have today? I've got the whole afternoon. Terrific. So here's what we're going to do. You stay in this room, I'm going to go seek three patients. And then we'll come back and do page two. And then I'm going to go and see three more patients and we'll go back and do page three. If you're willing to stay here, I am too. But I'm not going to we're going to have to do it this way. She said that works for me. She stayed there all afternoon. I answered all five pages of the questions. She wanted me to do the surgery. I did it. She donated $2 million to the I Institute. And everyone's happy. Communication is critical. It improve your communication skills are really something you need to develop. And there are better ways, you know, there certainly are some of us who are introverts, doesn't mean you can't develop a very good skill set with your patients. Just like some of us may not be the most technically have great dexterity, we still can become very good surgeons that practice, you know, you've already the books about the importance of practice. And there's no question that the level of communication does affect outcomes. So your clinic should start with a huddle, you need to know your staff, you need to be able to call them by the first name. I really believe in entering clinic through the front door, not through the back door. You know, so many of your clinics, they have the secret back door where the doctor can sneak in and sneak out, right? Do they have that here? Or I mean, I always enter clinic. First of all, I go to the start of the front desk, I greet the receptionist by their first name, and then go into the waiting room. I tell them that I'm here and we're ready to start seeing patients. And then I would greet my staff. I if when things slowed when I get behind, my staff gets behind, I don't get behind. When my staff gets behind, I go I go in the waiting room, and I visit with the patients. They the line my staff uses is Dr. Sturmer works the waiting room like a cocktail party. I will walk around, I'll sit, I'll introduce and I'll talk to them. A practice is is this is your family. These are people you need to know. And over years, you get to know them. And you need to interact with them like they're really important to you, not a chore. When you're in the room with a patient, you know, always sit down. One of my younger doctors, she's outstanding. But she was struggling with her patient satisfaction scores. I said, Can I shadow you in clinic? I just can't. I just don't understand why you aren't getting good scores. You are good doctor, you're incredibly outgoing, affable. Well, she for efficiency, instead of using the computer in the room, she had a laptop and she had it on wheels. You know, like on the in the units, you know, the WOWs, the workstations on wheels, and she would, you know, wheel it between rooms. So she'd come in, and she'd stand there, and she talked to the patient. And she was kind of, you know, typing. And I said, I think it's because you're standing when you're talking to the patients. I think that they, you know, it's putting you in this, this power position, this, you know, you need to be try sitting down. You know, I understand bringing in the, you know, the efficiency of it, but I think you need to sit down, be at the patient's level and look at them in the eye. And, and she changed that and it made a dramatic difference. I always start. The other thing for efficiency is I always start by asking the patient what they want out of the visit. What are your questions today? And then I try to answer them. It's much more efficient than doing your exam, giving your spiel and then asking them, what questions do you have? Because then it takes off as you may have been completely off track in terms of what you're doing. The fewer questions the patient asks, the more efficient your clinic visit is going to be. Now you don't want to stifle their questions. But you, you want to minimize them. Otherwise, you'll get behind. And when you do finish the visit, and you're asking if they have any questions, there are two ways to do that. You know, one way is to finish your, your computer, turn to the patient, do you have any questions? And the other one is, if you're going to stand up, have your hand on the door and go, do you have any questions? Two very different messages. And the number of docs who ask you have any questions, all they're on the way out the door, if you're saying, I really don't want to answer any of your questions versus the ones that make it clear there are listening, but hopefully you've answered their questions. And they say, no, doc, thank you very much. And you're out of there. So that little things make a big difference. Optimized technology, something that us older doctors may not be as good at. But, you know, you guys have Epic. It is an incredible tool. We have no idea what actually is inside that there are, I mean, there are a lot of stuff it can do that if you know it, you can figure it out. There's special tools for effective correspondence, you can often auto referral letters, you can you can have a set up so that you don't that every referring doctor gets a referral letter without you having to craft it. So there are things that you can do and you need to take advantage of them. Your website is really important. The number of patients these days who pick their doctors based on the website is just continuing to increase. It's only going to increase. And quite honestly, when medical students look at residency programs, the website important, I mean, didn't you guys didn't you all look at the website? You know, you interview 25 places, 20, whatever it is, you can't know everything about everyone. So when you're on the plane, you're in the airport before your next visit, what do you do? You go to the website. And you go, wow, there's a good website tells me a lot about the department. This is a crap. And until you make a judgment about it, just like your tour guide tour guides affable, you like the place if your tour guide is, you know, solid, you're not, it's nothing to do with the place just to do but that's what you take away. And teaching aids can be helpful as well. Always strive to improve. I really think shadowing is important, especially at any stage. And if there's someone who you've heard is a really good runs a great practice, ask if you can spend a day following her, you know, see how she runs her practice. And if there's someone that you trust, you know, ask if they wouldn't mind shadowing you and seeing how you run your clinic and give you pointers. My administrator will do that a lot, because she's not a doctor. And so but she's very committed to the efficiency of our practice. So she I encourage her to shadow the doctors. And it's also a nice way for her to build a relationship with them. And, and she learns a lot about best practices by doing that. If you look at the biggest driver for positive patient experience in most clinics, it's about informing patients about delays and waiting time. It's kind of part of my working the waiting room, letting them know where we are, what's going on. One of the biggest changes in the airline industry came about 10 years ago, when they decided that it was better for them to tell the patient, tell the customers when they were delays. And it's much information about why there's a delay than when they didn't. When you were just sitting there, waiting and didn't know anything. But as they try really hard to say, I'm sorry, we're delayed, there's been weather in Chicago, the plane's going to be there. That didn't happen until about 10 years ago. We don't do that very well here. Dr. Sternberg is running behind. He had a couple add on new patients that were unanticipated. You know, he'll get, you know, 10 or 15 minutes behind. We're going to actually put monitors in the clinic. We're going to have, we're putting up a board like in the airlines. You know, when you check in, you'll see Sternberg 15 minutes behind, you know, Patel on time, Kim hour behind. It's going to be transparency. I love it. It's going to drive efficient. It'll work. And we do a lot of, do you do lean management here? You guys know what, you know, it's just a way to identify workflow improvement opportunities. One of the things I think is really critical is this one, be selective in your use of testing. I think that we over test. And I also think that we often have patients ping ponging back and forth too many times between different, different things. And if you can minimize the number of times that you see a patient. So if a new patient comes in. And patient, the staff looks at them as if Dr. Sternberg, this patient is being referred for a melanoma. You know, would you like me to get an ultrasound before you see the patient? You know, yeah, get an ultrasound in photos. Make that rather than me, staff seeing the patient, me seeing the patient, sending them for the image, coming back, you know, try to minimize that stream like here. This is really important also. Don't sit in your office. You need to round, round in your own office, round in your building, visit community physicians, 10 hospital staff meetings. You need to be visible. You need to be seen. And the especially if you're new to a community, you really need to get out and introduce yourself and just be persistent. When people, you know, I will have residents who want to go back to Los Angeles and they'll say, I can't know, but nobody's looking for anyone to hire in Los Angeles. And what do I do? And I basically say, well, how important is for you to live in Los Angeles? My family's there. I really would like to live in Los Angeles. I said, set up a practice. How am I going to do that? I said, you know, how quickly do you need, how much money do you need to make? How quickly? Because if you're willing to wait, you'll be successful. Communities are growing. Doctors are retiring. You're, you're good. As long as you're willing to wait, you know, you don't have to do, you know, you're willing to not do eight cataracts a week, your first year. If you're willing to do, you know, a couple of months and then gradually build it. Almost wherever you go, you'll be successful if you're willing to kind. Now the challenges these days, you know, getting on insurance plans can be difficult. But if you're, if you're, use that free time to your benefit. If you're not busy, get in your car, go visit people. Make yourself, go out, you know, whether it's physicians, whether it's nursing homes, whether it's bridge clubs, you know, what, you know, there are, where are patients going to be and, you know, potential patients and, and you get your name out and they'll, they'll, I mean, early on in my practice, I realized that I was, one day I was leaving the practice going home. It's about six o'clock at night, 6 30. And there's a little old lady sitting in the waiting room. And I said, excuse me, ma'am, are you waiting to be seen? No, no, I'm finished being seen. I said, well, are you waiting for someone to pick you up? She said, well, yes, the shuttle from, you know, my, you know, nursing home is, is going to pick me up. And I said, well, what time was it supposed to pick you up? It was supposed to pick me up at six o'clock. I said, well, it's 6 30. She said, oh, I said, where do you, which nursing home is it? I said, I'll take you home. My business from that nursing home went through the roof. There's a doctor that'll give you a ride home if you miss the shuttle. So I would always at the end of the day, I'd round in the waiting room. Anybody still there? Anybody need a ride home? I think it's important you get engaged, not only in the medical community, but in the non-medical community, that, that you can build your practice as much by people who are non-physicians getting to know you and think that you're a good person, and if they are physicians. I think it's important for you to volunteer, but be selective. Your time is valuable. Make sure that it is work that's meaningful to you and interesting. Don't do something just because it seems like it's a high-profile group, but if there's something that's meaningful to you, you shouldn't get involved. And for people who ask, you know, how did I become president of the academy? I didn't one day somebody said, well, you know, you should be president of the academy. It started with, you know, me being active at being the junior guy in the state society, and then being the program director for the state society, and then being the loser who decided to become president of the state society, because it's a thankless job, but taking it seriously, and then getting regional, and then getting national. It's really working your way up. I have people call me who say, you know, Dr. Sturberry, I've been on all these academy committees, and I've never been elevated to a secretary position. You know, why is that? You know, what can I feel like I've really been a very important volunteer? And I said, well, something's happening in those committees that's making them not decide to make you chair the committee. You know, that you've got to find out what you're not doing, because I'm not in the room, but when, you know, just being on the committee is not enough. That they pick the people that they really think are going to perform well and are good team players and good leaders. They're now more and more our young physician groups, and I think these are really great. The young ophthalmology group for the academy is fantastic, but they also exist in sub-special organizations now. They exist in the local ophthalmology, local medical societies. And then I do believe in engaging the non-medical community. My interest was always the visual arts. So over the years, I started out in Atlanta on a, I love photography. There was a little group called Photo Forum that I joined and started to meet people and then got very active in the art museum that way. Met a lot of people in the community. And then when we moved to Nashville, the people from Atlanta called the people from Nashville and said there's this guy who moved here who was very active in the arts community and you need to get him involved. And before I knew it, I was on the board of the Art Museum there and the number of people you meet on these boards that are movers and shakers in the community is really amazing. So whether it's a charity or a cultural organization or your place of worship, you know, these are very important that can be impactful. And guess what? They will help you build your practice. You'll meet people there that don't want you to be their eye doctor. Oh, you're an eye doctor. I've been looking for an eye doctor. Or my mother's not happy with who she's seeing when you see her. Before you know it, word of mouth spreads. In the last few minutes, we're going to talk a little bit about management and leadership skills. So we're moving a little bit away from building practice. So before we do that, are there any questions about the different things I talked about? So to be an effective manage manager and leader, these are the four things that I think are critical. Very organized because your professional, your practice, your lab and your teaching are all very time consuming. If you're going to layer administrative skills on top of that, you really have to be organized in order to do that. You need to delegate. You need to be willing to let other people do things for you. You need to trust them. We'll talk about that. Work-life balance, you guys are the one, your generation is the one that reminded us about it. But it's very important. And I am a strong believer in mentorship. So if I were to have reflect on one of the two most critical keys to my success, it's these, that I'm organized and I delegate. I am, I do not waste time. I am disciplined in terms of getting things done. No matter how many hundreds of emails I get, they are all finished by the end of the day. Phone calls are all returned. My messages in basket and epic are all caught up. My tasks are all completed. Once you get behind, you get further and further behind. You can't do it. You've got to keep up. And part of the way to do that is to delegate. So you need to have, empower colleagues and staff to do stuff for you. The, my retina division at Emory was set up so that each day one of the doctors was in the OR and one of the doctors took all the walk-ins. Generally the doctor in the OR on Tuesday was the one that took the walk-ins on Monday. So anything that came in on Monday that needed surgery, they'd add on Tuesday. The Tuesday guy, Wednesday, the Wednesday woman, Thursday. And then that way, and then the person that operated on Monday got everything that came in over the weekend. But it made it so that when you were not that person, I didn't, I operated on Tuesdays and I wouldn't operate any other days because I knew my partners would take those cases on those days. So one of my patients came in with a recurrent detachment. It happened once in 20 years. That was a joke. If they came in on a Wednesday, I knew that Tom would see it and operate on Thursday. He sent me a message that this patient came in, but I knew it would get taken care of. And we didn't have a culture, like I inherited at Vanderbilt, where if Paul's patient came in on Wednesday, Paul would see them and operate on them on Wednesday night or add them on Thursday. My practice was my practice and your practice is your practice. If you want to do other stuff, you can't do it that way. You have to help each other and you have to trust each other. You bring a junior person on, you have to trust and to take care of your rehabs. If you don't, you shouldn't have brought them on. Will they be as good as you? Absolutely not. How could they possibly be as good as you? You've been doing it for 20 years. They've been doing it for 20 minutes. The only way they're going to get good is if you trust them and let them do it. And they will do the case and the patient, maybe you have 85% success and they'll have 81% success, but they're still going to be pretty good and you have to trust them because they won't grow otherwise. And it's the same thing with your assistant and with the people in your lab and if they aren't doing it, then replace them. But you've got to empower them and give them the opportunity to grow. And you know all the stuff about when they do screw up how to manage that. You've got to manage them up and not manage them down. But ultimately it will grow your team and it will grow you. I think that there are a few keys to leading. First, I think this is the most important. I truly believe that integrity and transparency are absolutely critical. And if someone, you know, I had someone that I, you know, when I recruit someone and I learn something about them in the process that they didn't share with me that's negative, I'm done. You know, tell me, tell me what, if there's a problem in your history, tell me about it. Let's have a discussion if we can work it out great. But don't try to hide it. I believe in transparency, our compensation plan is completely open book. My chairman at Emory was wonderful and I learned a lot from him. But he believed in what I call the black box, you know, which meant that you had a salary. And then at the end of the year, he would open up the black box and, you know, you get bonuses. You didn't really know where it came from and how. And I said, I am not going to let that happen. I want everyone to know exactly if you do this work, you're going to get paid this much. And if you do this much work, you'll get that much more. And if you don't like it, let's talk about the plan and what are the criteria for the bonuses. But there's going to be no secrets. Respect is important. And obviously that leads to your credibility. You need to surround yourself with good people. And when you find them, you need to listen to them. You need to delegate to them. You need to empower them. Support them both when they succeed and when they make mistakes. Give them credit. Elevate them. You know, if someone else did the work, don't take credit for it. That person will know that you took credit for their work. And the incredible bonus you get from telling, you know, the Dean said, Paul, you know, I love the way you organize that meeting. And you go, thank you, Dean, as opposed to saying, you know, I appreciate it. But this was Brian, you know, this would not have happened without Brian. And if you don't know him, you need to get to know him because he's one of the gems in this organization. What a win, you know, you look good in front of the Dean still doesn't think any less of you because Brian made it happen. He thinks more of you because while you're not you're being modest, you're not taking credit for it. You've pointed out to somebody else who's going in the organization, that person now is has been elevated in front of the team. We have fire drill. Is that what that is? And then if there's people you can't rely on, let them go. Just a drill. I think vision is important. You know, you're fortunate here, your your chairman here is one of the most visionary people I've ever met. He knows where he wants to take this organization. I used to be a big believer in strategic plans. You know, I modified that we, we have advantage, but we have now we call a strategic compass. We talk about directions we want to move as opposed to some, you know, 200 page document that sits on a shelf that you create after a retreat. So we're evolving this. Identifying important problems is a quote from someone that I respect living a successful and satisfying life depends in good measure on early on distinguishing between things which matter much and things which matter little. And I think that is really important data, you know, data, data, data accurate relevant real time. You know, when folks know the facts, they might not like it, but it will work to help correct the problems. And I think if you can give them the data and whether, you know, I have a situation now where I have an older general ophthalmologist and, and we're trying to talk about whether he should stop operating or not. Well, we, we look every six months at the rate of, of vitreous loss or, or at least, you know, capsular rupture. And I was able to sit down with him and say, you know, you're, you're only at 5%. But two years ago you were at 0%. And last year you were 2%. And this year at 5%, when do we stop? You know, as if you want to be one of those guys who waits too long. I said, is it still fun operating? What's, what's our timeline? He's going to stop operating in July 1. And I think seeing the data really helped him make the decision. And so data, they might not, he didn't like seeing it, but it really helped him come to that decision to stop operating. I wasn't asking him to retire. I was just telling him to stop operating. Originally I said, you know, how about the end of the year? Well, this was in November, we had the conversation. He said, next month, he said, no, no, no, June, you know, June, I can do June. June will work. So you have to have those conversations. Persistence is important. You know, nothing happens quickly. Reflect back on that conversation about building your practice. You know, if you want to set up your own practice, you have to be persistent. Trust your vision, your instincts, but you'll make it work if you, if you stick with it. And teams are critical. The days where we could work by ourselves and be successful are over. Even if you're in solo practice, you still need a team. You still need someone to answer the phone and someone to make sure the bills go out correctly and someone to help market your practice and someone to help you see the patients. You need to know when, oh, this is work life balance. I truly believe in this. It's more than an overused phrase. You can't have a busy practice. You can provide quality, tough care and have time for your family. I trained at a place where we fought to see who would be the last person to leave. That was the Wilmer Eye Institute. You know, you wanted to be the last one there and you wanted to be the first one there. Otherwise, you were weak. You know, you were a loser. You know, I, you know, when I see people that are in the office on Sundays, I go guys, you know, get a life. You know, I don't want to hear all the time. You know, if you're organized, if you're delegated, if you're efficient, you don't need to come in every, you don't need to stay there to eight or nine o'clock at night. You are your own worst enemy. You know, if you're not on call, refer the patient to your associate. It's nine o'clock so we can, you don't need an MBA to be successful, but it helps. And I believe in mentorship. Those are my two main members, Robert Lachimer and Tom. So there are some books that I can share with you, but I think we're, we're not at eight o'clock. So thank you for your attention.