Dr. Daniel Chang on Expanding a Healthcare Brand

Episode Transcript: Dr. Daniel Chang on Expanding a Healthcare Brand

Crawford Ifland: Hello, everybody, and welcome to another episode of The Medical Marketing Podcast.

This week, we’re going to talk about how to successfully grow and expand an existing private practice with someone who’s done just that.

Our guest today is Dr. Daniel Chang, co-owner and refractive surgeon at Empire Eye and Laser Center in Bakersfield, California.

Over the years, he and his staff have grown Empire into a thriving practice serving the Bakersfield community, and he’s leveraged that experience to open up a new sister practice – Parkway Optical Boutique. So we’re excited to learn from his experience and get some pearls on the topic of growing a healthcare practice.

Dr. Chang, welcome to the show!

Dr. Daniel Chang: Thanks Crawford, thank you for having me.

Crawford Ifland: So Dr. Chang, just by way of introduction, tell us a little bit about yourself and your practice.

Dr. Daniel Chang: Sure Crawford. Empire Eye and laser started back in 1998. Actually, the founder of the practice, Jim Shuler, brought my brother on board just a couple years after that, in 2000. So they grew it for several years, and in 2008, Jim Shuler retired and that same year I came into town and joined my brother.

I was a couple of years out of training in practice in Arizona that I came here to Bakersfield to do the family thing. So my brother and I decided to work on this practice together and live together and have our kids grow up together.

Crawford Ifland: How fun. So what made you choose ophthalmology as a specialty to go into?

Dr. Daniel Chang: Well, it’s been an interesting journey. It’s fun, because people have asked for many years, “did your brother and you go in for the same reasons?”

And we kind of had our own sets of reasons, and we both had our own journeys, but one of the new things about the field was I really enjoyed the technology aspect of things, and what we’re able to do, the impact we can make in people’s lives.

The relative cleanliness of the practice in terms of how we interact with people, not needing them to undress and doing other things that putting on gloves for routine exams.

It’s also something where the actual work we do and the quality makes a difference in terms of visual outcomes and qualities – that has a concrete difference, and the care that we take makes a difference.

Beforehand, when I was thinking, it’s like, oh, this is not one of the really busy professions where we’re spending lots of hours, but that’s turned out to be untrue. We always find ways to fill in our days with plenty of work to do, so it’s as busy as you wanna make any other specialty.

Crawford Ifland: So what does a typical day look like in your practice for you on a day-to-day basis? What does that look like?

Dr. Daniel Chang: Well, the nice thing about ophthalmology and about our practice, obviously, is a combination of clinic and surgery.

I see patients certain days, I do surgery on other days, and one thing that I built into as we’ve grown the practices, we have MDs and also optometrists. So I have some dedicated administrative time, which is filled up with meetings and calls and trying to get emails done and things like that, and it’s a good balance and good mix of different things.

We generally start anywhere from 7-8 in the morning, depending on the day, and we’ll run through about 5 o’clock from a patient care standpoint. But the work can continue on, and one of my goals has been to try not to take the work home – make that family time or be able to do the work during the day as much as possible

Crawford Ifland: So you and your brother enter into this existing practice and over the years you seek to grow it even more beyond the way that you found it. What are some of the biggest challenges that you encountered while you were trying to grow the practice over the last decade?

Dr. Daniel Chang: Well, I think in terms of growth, there’s different ways you can look at growth.

Obviously, you can look at your financials and P&L, and that’s something that that you want to go on a steady pace. That’s never really been a specific goal, we’ve never set financial goals in terms of growth.

What we find is, hey, what are the needs within their practice?

Balancing those three has always been the challenge, because we have too much of one and not enough of the other, then you’re not able to maximize your efficiency. Because our goal is really about being efficient – when I have a busy day, a full day, obviously, we need the financials to work, but we want something where you feel like you’re not constantly struggling because your practice is out of balance.

I think the other way we grow is just in quality. Our predecessor was able to retire in late 40s. His goal was to build a very busy and successful financial practice and be able to retire early into move on to other interests, and that hasn’t been our focus.

Our focus has been on bringing in the quality of getting involved in R&D and research, doing things that really pushes the technology and the quality of what we’re able to deliver to our patients.

So I think those are a little bit less concrete from a financial standpoint – you can’t just look at a number and track it about the ability to do publications and presentations, be involved in different advisory boards for industry, helping technologies and shape in the way we think as a field, certainly has growth and reward in it, and that’s something that we’ve chosen to focus on as well.

Crawford Ifland: So ultimately providing all of those services, providing a wonderful patient experience, but also trying to remain in balance and see what are those areas that really need a little bit of help or need more investment to try to bolster those, if you will…

Dr. Daniel Chang: For sure, and one thing that we realized in the past few years, and actually our staff came to us with this is  the importance of our staff.

I think a lot of us as physicians think, “patients first.” We always put the patients first, but really to achieve that in a lot of companies, the Disney company is shown to put your customers first is really by putting your employees first.

And that’s not just in terms of your entry-level employees and what you pay them, but it’s about developing them. Obviously paying them well, developing managers, training them, having people who are good at that, developing a whole network and structure.

As an organization, the medical practice, surgery center, and our management group, we’re approaching 80 FTEs. And so to be able to run that as a mom moms and pop office, we can’t do that anymore.

So we haven’t brought in specific professional managers, but what we’ve done is we’ve identified people from within who have management skills and trying to build them up in order to have layers of management within our practice.

So really investing in our people, and that’s really the funnest part, is investing in people and seeing them grow as somebody who may come in as maybe an optician or front office person growing to where they’re really running the whole practice and doing a good job of it.

Crawford Ifland: That’s great. And I talk to a lot of doctors who would say the same thing or something very similar about patients, “Hey, we don’t just look at this one issue that the patient’s having, we try to view it in a more holistic way, to view the person as the whole…”

And it sounds like you’re trying to do the same thing with your employees: to enrich them over time, to help them develop those leadership skills. So it’s not just, “Well, here’s our budget, here are all the salaries we’re paying,” but how are these people really doing? How are we both leading them and helping them develop and grow in those skills over time as well?

Dr. Daniel Chang: Exactly. We spend more time with our work family sometimes than our home family at least more waking hours, and what a waste it would be if all that meant was a paycheck…

If we can grow, and I like tell my staff this and whenever I interview somebody – we try to help people grow professionally in terms of your skills and your knowledge, and obviously your pay as your responsibility.

And we help people grow relationally – so much of what we do is interaction and being able to improve those skills at work helps us bring that home with our families and others, kids, friends, etc.

And then finally in areas of spiritual – if someone is interested in that and you want to learn and to grow in that area and see how you incorporate faith into life and work, we share only are open to figuring out how to do that through the workplace.

So it’s a great opportunity.

And at the end of the day, as Steve Jobs said, “I don’t want to die as the richest guy in the graveyard.”

He wanted to do great things with smart people, and we wanna do some really cool things with some great people and really invest in the people that we work with… That brings a significance beyond just the next patient, the next patient, next cataract, the next whatever, we’re taking care of.

Crawford Ifland: That’s awesome. So at some point though, you’re looking at your employees, you’re looking at your practice and where you can grow and also looking at the needs of your community there in Bakersfield as well. So at some point, you decide to expand the practice even further into a “sister practice” of sorts, which is Parkway Optical Boutique.

So what brought about the decision to open up that business?

Dr. Daniel Chang: Well, Parkway Optical has been an interesting development.

So our practice was in a typical comprehensive practice: it was started, we saw comprehensive patients, we have optometry and we sell glasses, we did medical surgery, we actually do a lot of aesthetics as well, and then as our facility space grew we had the opportunity to move to a building right next door.

And then we were asking the question of, “Do we wanted to create space for optical within our building?” And a few issues came up.

Number one is, we were kind of running out a space before you had moved into the new building in terms of how we want to use it, and instead of moving out of our old office, we decided to stay there. So we decided that optical, obviously, takes a lot of space and we thought about ways of integrating that with the reception area/waiting room.

And then one thing that was important to us is our relationship with our referring optometrists in the community. A lot of our tomes make their living off selling glasses. As we provide that service for patients, because we have a lot of patients who want that, but a surgeon primarily, we make our living off doing surgery and seeing medical patients.

So we decided, hey, we wanted to create an environment where optometrists could refer their patients and they come to our office and not be exposed to our glasses inventory and say, hey, I wanna come over here.

Whereas, they come to me for surgery, we do the surgical care, send him back from the routine, comprehensive care with the referring doctor.

So it was kind of a natural break both from a space standpoint and from a community need standpoint to have that as a separate business. So we decided just to change the name, keep the location slightly different so that it’s not a place where patients would come stumbling into when they’re trying to come to our office.

And we told our community referral doctors is like, hey, we’re calling it this, and we’re not trying to sneak one on them, but just let them know these are for our existing patients who are seeing us for retina exams and glasses as a part of our comprehensive practice, but we do have a separate surgical practice, which is the part that will take the care of your patients.

And it’s worked out pretty well.

Crawford Ifland: Talk about some of the challenges of expanding from one practice into two.

I know they’re not the same businesses, but obviously you work very closely together, share some of the space and obviously share a lot of the same leadership, so how do you navigate the challenge of running two separate businesses, so to speak?

Dr. Daniel Chang: I think in some ways, it’s like having a satellite office. You can run it as together or separate as you want.

Corporately, we’re still on corporation, so we can do the books. We do track a separate items with the two entities, if you were to have a separate location – we used to actually have a satellite location, we could combine a move facilities – you can run them in as together and separates you want.

And when it comes to doing financials is when you break out line items is look at what information is just gonna tell me? What actual information will that provide? Because you can break things down as much as you want and it may not be useful, it’s just busy work. But in this case, is understanding how the financials are working on that side versus the main office.

The toughest part has been leadership. It’s always about people – it’s about having people who can physically be at the place working with the staff to get them to do what needs to be done.

And having enough good leaders in good positions is always a challenge, so working through that… You can supervise your area where you’re physically at and can you go over to the other area, so that’s been some of the challenges that we’re navigating through from a staffing perspective.

Crawford Ifland: And beyond just the two practices, you have a non-profit as well. Can you talk about some of the work you’re doing there?

Dr. Daniel Chang: Yes, so about 10 years ago, we also started Advanced Center for Eyecare. So it’s a non-profit here in Kern County in Central California, that’s meant to serve those who don’t have access to traditional insurance as their uninsured or under-insured.

A lot of times people have MediCal, is what we call it,  or some sort of managed care where you have an insurance card, but there are very few doctors who can actually see who actually see you, particularly in a timely fashion.

We were taking some of these patients within our primary practice, and then we realized it requires really a different set of care. Now there’s a certain baseline set of “standard of car”e that we want to provide everybody, but these aren’t people who are gonna be interested in aesthetic procedures or LASIK or presbyopia-correcting technologies, but they are people who still need good eyesore: they need glasses, they need cataracts taken out, they need their glaucoma managed, etc.

So we started a non-profit, and that provides a number of opportunities.

Number one is when you have a non-profit, you get to work with your community. There’s charitable support, both from individuals and through organizations, because really the finances are much harder on that side. We do have a separate facility and we have an Executive Director who’s now the CEO of the non-profit, he’s really taken the approach of, “This is not some low-end place.”

At times the equipment, even the facilities at my non-profit were better than my prior practice, really talent me to continue providing a better level of experience for my patients.

So it’s been a neat journey, we have a number of optometrists just employed through there, a number of surgeons operate through there, and for about five years, I was donating my services to a non-profit, and now, I do sure you there for a very discounted fee, and a lot of times I just waive that fee.

So it’s a neat opportunity to reach a different segment of the population, and the need is always there. But to do it in an efficient way that allows an organization to continue survive is always the challenge.

And the big secret to a non-profit, it doesn’t mean you don’t make money or charge money, it just means that you’re not taking any money home – all the money stays within the organization. But you still have to run positive, ’cause no organization can continually run negative and still survive.

Crawford Ifland: But you get to do some good along the way, and help re-invest in your community, especially for those patients who otherwise wouldn’t have received either the same level of care or care in the same time frame as they would need it.

Dr. Daniel Chang: Exactly. And one of the big things that we’ve been doing of late is working with schools to have school-based clinics where our optometrists will go to the clinics in the different districts and provide glasses for kids. And that’s key – if you can’t see, you can’t do well in school and you fall through the educational cracks.

That’s just the lost opportunity and I really lost life, so to speak, so just partnerships with that, which really through the nonprofit platform allows us to be able to do and provide services.

Crawford Ifland: What have you found to be most effective in managing your employees between the two practices and your non-profit as well, and how do you keep everybody aligned?

Dr. Daniel Chang: I think the most important thing in terms of managing employees is really having the right managers. It’s having the right people in place who are able to know what’s needed, who can communicate what’s needed, and to be able to lead.

And I feel as our businesses and organization grows here, my ability to identify and to groom and develop leaders is as important as any other skill that I have.

There are people who are very good employees. And we’ve had employees who are super-techs or super-front office people are super whatever they do, and when we promote him to a leadership role, maybe they didn’t do so good – they were really weren’t leaders, they were just really good at their role.

And the challenge is to be able to get them back into that role and continue doing it well while “saving face,” so to speak. Because there’s a natural assumption that there’s a progression towards management, but that’s not the case for everybody. Some people, they aren’t built for that and not interested in that, so it doesn’t mean that they have to do that to be able to progress.

We had some people go through and go “back” to their original roles and still thrive, so sometimes there’s some trial and error…

Unfortunately, sometimes when people don’t make it a management, they just don’t feel right in the organization and they leave. But being careful to build that structure.

So that number one, there’s good organization within the organization.

Number two is, if I’m gone on vacation or otherwise, the organization continues to go.

Crawford Ifland: You really have to find the best role for everybody who’s contributing to your practice. And everybody’s talents and gifts and abilities might look a little bit different, so there is really our right role for everybody, and you just have to figure what that is over time.

Dr. Daniel Chang: Exactly, exactly.

And seeing that, and particularly people with different personalities approach things differently, and each manager has their own personality and I have my personality, and I kind of see certain things, but it’s to value the differences we have, and getting the right people on the bus, so to speak, and getting the right people in the right seat to get them working well together.

Crawford Ifland: And obviously, you can’t build a thriving practice or a second practice or a non-profit for that matter, without an outstanding team to surround you and support you. So what do you look for personally when you’re bringing someone new on to your team?

Dr. Daniel Chang: There’s a good book called The Ideal Team Player by Pat Lencioni. And he talks about three aspects that you look for.

Oobviously there’s the CV and experience and all that stuff that they use.

But the three things that helps you find the ideal team player is…

So humble means basically someone who’s able to take correction. And that’s probably the hardest thing to assess in an interview situation, because people on their best behavior, but to know: are they willing to learn? Do they realize they still have stuff to learn?

We’ve had people, we’ve hired them, they seem to know everything. They had a great experience, and when they come in, it’s like, they already know everything. It’s hard to teach them anything.

The second being is hunger – really wanting to do more, really wanting to grow – whether to get more certification as a technician or more administrative training to grow the business, to grow the practice, to grow themselves.

And then people-smart. And that’s probably the easiest one to get a feel for in an interview, as if someone that you like, they’re very personable, they interact well.

Those are the three components that when you have that, you have that “ideal team player.”

So trying to get somebody that fits, and sometimes it’s a lot of interview as you go through a lot of people, when you say, “Oh, this person has experience, they fit the role, and you look at the CV it’s great.” But then they don’t have the drive or they already know everything, or they just don’t interact well of people and they just don’t fit the organization…

So we try to hire based on potential and qualities more than necessarily experience. Because you can always gain experience, you can always teach knowledge, but it’s really hard to change somebody’s attitude and how the interact with people…

Crawford Ifland: And it is important to take your time and spend that time and effort to really get it right, because once you’ve made that commitment and you hired somebody, if they’re not a good fit for your organization – or likewise, if your organization isn’t really a good fit for them – there are costs to that.

So if I’m hearing you correctly, is it really does matter if you take the time and the effort to get that right and get your team right, even if it takes a little bit longer.

Dr. Daniel Chang: I agree – and it’s not just the interview, right?

When they come on board, is having the on-boarding process, having quick evaluations, even within the first 90 days, having them trained and seeing if they fit.

And if they don’t fit, you go ahead and go your separate ways.

And and I tell people at the interview process, I’m like, “Hey, you probably want this job, you’re going to say what you can to get this job, but as an employer or my job is to find a good fit, because it’s really easier for both of us if you do fit…”

Because if you don’t fit and you fake it and you come in, now you get work for a few weeks, but you’re just not gonna fit, you’re not gonna be happy. And we’re not gonna be happy.

So it’s kind of hard to see it from an applicant’s side. Imagine you want a job, but from an employer’s side, you’re really about finding the best long-term fit.

And the key is not saying, “Okay, let’s go, I hope it works” – it’s to make it work.

And then if they don’t work, and we have that review process where you give them verbal feedback, give written feedback, and if need be, you terminate them, but the goals is to not have to do that because you’ve picked the right person, you brought them to the process.

So it’s not about just interview in the interviews, on the first step is really getting them incorporated…

Crawford Ifland: Gotcha. And an interview, a CV, it’s kind of like first date – everybody looks good.But then once you get people into the organization, see how you relate to each other and how you work together, that’s where you really find out…

Dr. Daniel Chang: Right, and there’s a lot of people who don’t look good, so that’s pretty easy to find out. But a lot of people do look good…

You would be surprised at how people show up for interviews and it’s a pretty easy decision.

And I never feel bad cutting interview short. Thankfully, now I’m mostly doing second and third interviews instead of the first interview, but it’s like… No, let’s not waste each other’s time. It’s 5-10 minutes, okay, you’re good.

Crawford Ifland: So you obviously work very closely with your brother at Empire Eye and Laser, and I know many physicians have to navigate that partner relationship carefully, but I imagine it gets more interesting when your partner isn’t just a partner, but he’s also family…

So what does that relationship look like, and what have you learned from it over the years?

Dr. Daniel Chang:  I asked that question when I decided to come here and it’s just defining the relationship from a business standpoint. We’re pretty good as guys, I think men more than women are good at compartmentalizing. So when we’re in social situations, and we’ve learned that in those situations is we just try to stay away from business talk. When we’re at work, we talk about business.

But I think with any partners that the toughest part is having the same vision and goals for the practice.

For my brother and me, we know we both love each other, we want look out for each other’s best interests. The difficult part is the way we think we achieve that is very different. So we have different perspectives on what we think we should do for the business on how we think we should run things, so that gives us any kind of partner disagreement or dispute.

So it’s not easy. And from a family standpoint, the stakes are higher, because obviously that could potentially go outside of the business and affect the relationship, but I think we’ve been good at trying to compartmentalize that and say, hey, businesses, business there, and then we’re in family time with our kids, that’s family time for the kids.

Crawford Ifland: And what a rewarding and enriching experience to have a good relationship and to be able to expand that beyond just, here’s business for us, but to use both both facets of your life to have a good business relationship and a good personal relationship with your family…that sounds like a real blessing.

Dr. Daniel Chang: Sometimes we have our arguments, and I know you work with family as well, which is great. And I think the perspective is that I would rather have an argument with my brother than not know my brother…

When I was living in a different state, we hanging off or vacation, we talk on the phone every now and then, we’d go on vacation, maybe every year or something. But here we see each other regularly, and even if sometimes we’re disagreeing, or arguing in in a board meeting is at least I know him and I get to spend time with him.

So that’s the important thing, in any relationship sometimes that the closest ones are the hardest ones, but that’s where we grow, if everything was easy, then we wouldn’t have any space for growth.

Crawford Ifland: Yeah, no, that’s a really great perspective. So for listeners who may either be thinking about starting their own practice some day or perhaps expanding an existing practice, they’ve bought into, what advice would you give them as someone who’s done this before, who’s lived it for over a decade? What does that look like, and what advice would you give them?

Dr. Daniel Chang: You know it’s funny, I never really wanted to be in business owner, I never went into it doing this, and I’ve had just increasing responsibilities through the years…

I think it’s about having your priorities straight. If you want to say, I want make money, and that’s my goal, then that’s your goal, and you can do that.

I think it’s a lot more rewarding as a career to say, I want to build an organization where we have great people who come together and we do great things.

Because at the end of the day, that’s what matters. On your proverbial death bed, you’re not gonna care about how many cataract you did or how much money you made, it’s about the people whose lives you made a difference in.

So find the best people you can, and also finding when there’s somebody good, try to say is there a space within the organization where this person could be plugged in?

Now, there’s been many instances where we had friends or people in the community here that need a job or they need something, and it’s like, well, we do have anything here? Let’s plug you in.

And trying to get good people as opposed to, oh, here’s a spot, let’s find somebody. That’s the way you want to grow.

And that goes for anywhere from staff to the toughest recruits, obviously are your physicians, your providers – they need to really fit within the culture of the organization as well.

Crawford Ifland: And of course, marketing does have to be part of starting a new practice, because people have to know you exist after all. If you had one marketing pearl to offer to physicians who want to start their own practice some day, what advice would you give them? What would you say?

Dr. Daniel Chang: Marketing starts internally and then it expands externally.

So having your staff on board, understanding what’s going on, knowing what you do, having things in your reception area inside your office, where were patients come in, they can be educated before you start pushing…

It doesn’t necessary have to be before, but needs to be concurrent with when you push things out.

If you say, I’m gonna put a website up or put some ads up, and then patients show up and you’re not what you’ve advertised, there’s an inconsistency in the message there.

So really developing that from the core, starting from really who you are as an owner into what you’re making this practice, because your practice really takes your personality or the personality of the owners to educating the staff, to pushing that out, it’s really just being consistent from the inside out.

Crawford Ifland: Well, Daniel, thanks so much for joining us on the podcast today. Lots of valuable advice here, and I think our listeners can get a lot out of it, if any of our listeners, I wanna learn more about you or your practice or connect… Where can they find you?

Dr. Daniel Chang: My practice is, Empire Eye and Laser Center, the website empireeyeandlaser.com. We have a Facebook and Instagram social media presence as well. And of course, my email is just dchang@empireeyeandlaser.com.

Crawford Ifland: Wonderful. Well, Dr. Chang, thanks so much for joining us on the podcast – I appreciate it.

Dr. Daniel Chang: Thank you for having me and thanks for having this resource for physicians. It’s been a pleasure!