Human Connection — The 20/20 Podcast

Dr. Daryan Angle, VP of Business Development at Iris Visual Group, has seen many changes in the Canadian optometry landscape. He was heavily involved in many changes in Ontario in the late 2000s when the profession shifted away from the fee-for-service dispensing model. That (plus the fact that he has acted as chairman of the board for Iris and currently oversees much of their expansion) makes Dr. Angle an ideal guest to discuss the direction Canadian optometry is heading.

In this episode, Dr. Angle discusses:

• his thoughts on significant shifts which happened in the past (such as the changes in Ontario and the deregulation in BC caused by Clearly)

• what the current disruptive forces are in the profession

• how to create value in an eye care practice

• what is his organization doing to support optometry

• where the profession is heading

Aequus Pharmaceuticals present the Future of Canadian Optometry series. So stay tuned for all six interviews with guests from different large organizations within Canadian eye care.

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Dr. Daryan Angle, VP At Iris Visual Group - The Future Of Canadian Optometry

As always, I am truly grateful for you taking the time out of your day to join me here to learn and grow, especially for this series of conversations that is going to be invaluable for us as optometrists in Canada, to understand where our profession is going, what we need to know that going well, what we need to be careful of, what we need to change, how we should approach the coming disruption and the changes that are inevitable and are happening.

This interview is the second interview in this series of The Future of Canadian Optometry with Dr. Daryan Angle who is Vice President of Business Development at IRIS, which is part of the larger New Look Group. In the last episode, I interviewed Alan Ulsifer who's the CEO of FYidoctors. We got a good perspective of this large organization, FYidoctors, what their presence is, what their plans are and what Alan being at the top of this organization sees as our profession in the future.

Daryan was no different in that being part of a larger organization, being in the leadership of this larger organization and having a very different perspective of the profession as a whole, where we are going and what IRIS is doing within that profession. Keep in mind that the point of these interviews is not to promote these organizations like FYi, IRIS, Essilor, LensCrafters or anyone else. The point is to ask the leaders within these organizations questions that we don't normally get a chance to ask. We will see a large organization making a move, an acquisition and say, “What was the point of that? What does that mean for me as an optometrist or a profession in the future?”

That is exactly what I'm hoping to achieve with this series of conversations, to have this show as a platform to ask hard and direct questions. What is your organization doing to support optometry? What is your organization doing to make sure the profession thrives and that future optometrists have a strong profession that they are passionate about and want to be part of?

What are you doing about these things that are maybe not so positive? What about this thing that your organization did that didn't seem like it was a step in the right direction? As I'm asking these questions, we are able to draw a lot of valuable insight, especially from guests like Alan in the last interview and Daryan in this interview who are willing to face the questions head-on.

They're not scared to take on those challenging questions. They invite them so we can learn about their perspective on the profession. This interview is with Dr. Daryan Angle and this is the second installment in The Future of Canadian Optometry series presented by Aequus Pharma. I hope you love it. Don't forget to share it. Put it up on Instagram or LinkedIn. Send a text to your friend. Let them know that this conversation is happening so we can all learn and thrive in the future.

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Dr. Daryan Angle, thank you so much for taking the time to join me for this very important and special series of discussions that we're having on the show. I appreciate you being here.

It's my pleasure. Thanks for having me.

As you know, I put this call out through the show to various organizations in the country to invite them on and chat about where we're heading and what the changes are that are happening in the industry. Since your response and others who have responded to me, I've been reaching out to colleagues across the country to get the temperature collectively. Nationally, how are we feeling? What's going on? What's on our minds? There are some obvious things. There are some elephants in the room and subtle things that are under the surface that seem to be very consistent when I'm having these conversations.

A lot of the questions, discussions and topics we're going to cover in this episode are those questions that have come from those conversations that I've had with our colleagues. Daryan, yourself and most of the other guests that we're going to have on for these conversations are in somewhat of a unique position. You're in a position that most of us are not. You're in a leadership position in one of these large organizations.

You've seen, if not been directly involved, in a lot of the change that’s happened in our country and our profession over the last decade or more. I feel like you and our guests that are coming on will have this perspective that the majority of us will not. I hope that we're able to have a candid conversation. You're comfortable with this. I hope you'll be able to share as much information as you can from his perspective that the majority of us do not have. I understand there'll be some things that perhaps you get to hold close to the chest but as much as you're comfortable sharing, we will all appreciate that. Let's start with this. From that perspective, how would you describe the state of optometry in Canada?

Optometry in Canada has never been so strong in terms of each province, the awareness in the public and the market share that's held. In the majority of provinces, optometrists have been very good in terms of entrepreneurs. There may be some exceptions there based on regulatory history but over the last few years especially, there's been a lot of strong leadership in a lot of colleges and associations.

We're seeing the dividends of that hard work. That's to say there aren't some headwinds coming that we have to be aware of but having been in practice for many years, I've seen a lot of change in a few years for the positive. That certainly makes me proud. Optometry is unique in Canada compared to the US and certainly as a profession globally. In Canada, in terms of all those best attributes you could have in a health profession, we're not just fortunate but we have to give ourselves credit for the efforts as a collective that we've done as a profession. To me, we're in a great spot at present time.

I'm glad to hear you have such a positive outlook. From this perspective of a 30,000-foot view that you might have that the majority of us don't have to feel that we're in a positive place is great. We'll talk a little bit more about where we think we're going and will be down the road but before we get there, let's talk about some of the other questions that are on our colleagues' minds. First of all, the common theme is a question about corporate versus private. If you could define for me in your mind, what is private practice optometry? What is corporate optometry? Where do IRIS and New Look as a larger brand fit within that?

I've never liked this binary labeling of private versus corporate. I never understood what corporate practice meant. There are some definitions thereof. Private practice to me is independently owned by an optometrist wearing all hats of all things in the practice whether that's marketing or HR. All are on the shoulders of the owner. That may or may not be affiliated with some buying group but in terms of the actual function of serving the patient, that's all on the individual.

Where IRIS sits, if I had to give a name, it would be more of a branded co-ownership model. Being part of a brand that's national and having all the tools that a large group can wield but having that ownership at a local level. Having some entrepreneurial abilities to maneuver in your present market as a local owner but using some of the tools that may be other competitors are only there for the benefit of a large corporate entity.

I feel we sit in the middle between what might be considered corporate. One way to look at corporate would be that the dispensary is 100% owned by a large company and then the optometrists have an exam service-only business either within the walls of that or beside. Under the New Look Group, we certainly have that model in some of our optical banners that are not IRIS. To me, that makes sense based on those two terms but IRIS to me sits firmly in the middle trying to grab the best of both sides.

Optometrists have full autonomy to practice to the full scope and even specialization based on their interests. So long as the brand attributes are maintained, there's some consistency across the network.

The thought here is that with corporate, there's this top-down. All of the directives are coming from the top and then there's a loss of autonomy. Whether that's true or not, that's where the negative connotation comes from. Generally, as we're having these conversations, there is a concern that that's going to be the direction that the profession may be heading to a point where optometrists are losing their autonomy and they're therefore wanting that distinction between what is each entity or corporation's perspective on that?

It depends on how you define autonomy. In our network, our optometrists have full autonomy to practice to the full scope and even specialization based on their interests so long as the brand attributes are maintained and there's some consistency across the network. For us, we've learned. We've been built on an optometrist and started in franchising and built up into a partnership model so we know the strength comes from the professionals that are in the clinics doing the work and treating the patients.

We've learned in the past that a top-down approach is a recipe for finding an organization in danger because the fragility of having to centralized approach is pretty apparent. You can see it in maybe other industries where you see large giants fall pretty easily based on some mistakes made by people that maybe are disconnected from what goes on in the real world and we understand that.

With our partners, we've never been more interactive in terms of hearing from them what it is that works and what doesn't work and getting their feedback and contribution on how we define the way we operate moving forward in our clinic. It's about sharing best practices but having consistent scaffolding. The best practices sometimes are hard to share if the way your clinics run is so different amongst the independent colleagues and things like that.

Yes, you can hear something from a colleague that's working but maybe your clinic isn't set up that way. With our network, that consistency makes it easy for us to grab a best practice and then roll out or share it with everybody. All the base things are similar so any innovations are easy to scale up. I was in DC meeting with our VC partners. I'll be also in Alberta and Ontario. That's exactly what our meetings are about.

It's looking at consistent information about the practices because that's the thing. Having tools that can gather data that may be an independent practitioner may not have or you may have the data but how do you crunch the data? How do you use the data to guide where you're going? How do you ask questions? How do you take information with conclusions you think you might have and get feedback from some of the smartest brains that there are in the profession?

Those are the ways that you build strength. To go center top down, any of us who is on Rogers can have an example of how being top-down centralized might put yourself in a much more fragile position than being able to reach into the minds of people that are practitioners who are skilled at what they do and see the effects of everything that you can bring to the table daily with each patient.

There are some consistencies or standardization. I imagine there has to be a model like that. What types of things are we looking at there that would be standardized? Only a few of them, if you want, off the top of your head.

We're on the same EMR model that we've designed ourselves on an iPad base. We have a seamless nine-stage patient experience where all the information gathered from each patient and every touch point is shared on the common platform so that a patient's never having to say more than once what their problem is. Once you intake them, they say, “I'm having trouble in the distance.” They're not going to get asked that same question five times. That information seamlessly flows from intake pretests to optometrists so that patient feels heard. “They heard me. They're a team working for me.”

That platform allows for that seamless communication. In the end, it's trying to increase the perceived value of the experience that a patient has. That's one of the consistencies we have to have because ultimately, that's the promise that our brand is offering to the public. When it comes down to location and the name of the location, we try to keep some consistency there.

There are variations based on whether we've acquired a practice that looks beautiful and we don't want to touch a beautifully renovated practice. Maybe we change some of the display items that are minor and the product mix. Although we do adapt the product mix somewhat to the markets, certainly, there are more consistencies across. Ultimately, what that comes down to is to a patient or a customer, consistency is more valuable even than excellence.

We strive for excellence. That's in our DNA. Most optometrists are overachievers, in general, but it's very interesting to learn that consistency is something more powerful in a market than it is in excellence. That can be shown by a lot of brands that are successful and other industries that you’re like, “This place is crappy,” but you go there because you know what it's like. You expect it. It's comforting to you and humans like certainty. I practice in my partnership location out of Waterloo two days a week, in addition to my leadership roles. I see people migrate from all over the country to my location. They're from BC or Alberta and they moved to Ontario. They wander into a location and it's because they're comfortable there.

That to us is the power of our network. Do you give up some of the minutiae of variation? Yes, and some of the things there. You don't control everything as a partner but certainly, you control the quality of care you provide and how you provide that in terms of optometric clinical skillset and focus. That platform gives you so much more power to we're not worried necessarily about even HR, payroll, POS, inventory and some of the things that are not so much. Some people might find it fun. I don't find fun. I like patient contact and that one-on-one experience with each patient and making sure that you're doing an outstanding job.

One of the things that's on a lot of people's minds and I've heard you speak about this on perhaps another show or something, is consolidation. That's something that's been going on for a long time but it seems to be more prominent perhaps as the groups that are consolidating more and getting bigger. In your mind, being part of one of these groups, do you feel consolidation is necessarily inevitable? I suppose we can say it's inevitable. It's happening already but is it necessary for optometry in Canada to remain strong? Is it only necessary from a business standpoint? What is your perspective on that?

The pressures and economic forces are pushing us towards more consolidation. It's ramping up as challenges are out there. Other organizations are looking for expansion. We're a very attractive industry from a pure business standpoint. You look at the margins that I have. People in the financial or general business salivate because these are some good margins. They don't always understand what goes into getting those margins from a service standpoint but it's a very attractive industry for return on invested capital. There's that. With that competitive landscape, it becomes harder to do it on your own.

I'm not saying that the whole landscape will consolidate into a major group or brand. There's always room for very entrepreneurial and strong, independent optometry but there is certainly a lot more consolidation to come. It will certainly hit a plateau. I don't know what that will be but I don't think that it's always going to be 100%. You've got to be a part of one group or another. There'll be a significant chunk of the market like that. Also, for the strong entrepreneurial optometrists, they'll do fine but you'll have to be strong. There's no resting on your laurels. You're going to have to be a pretty smart business person, as well as a professional.

That's not always a hat that someone can switch up based on what you're trained in school. Maybe even how we determine who makes a good optometrist entering school. Is that the skillset that we're recruiting for? You can be very good in school and 90% in your classes but are you entrepreneurial? Can you take the pain of losing money for 3 or 4 years? Can you grind out for hours as you've never ground up before and do things you've maybe never done before, learn as you go and take the failure until you get the success?

That requires a special kind of grit that maybe doesn't even come from school. Maybe it comes from how you were raised or what. If you want to remain separate from a larger banner, that's the skillset that you have to have. More power to anyone who's got that because you'll make a pretty strong business for yourself. You have to love it, love every part of it and do it well.

That strong entrepreneurial person who's built a strong business can survive. What happens to everybody else? They either get taken up, fold or close the doors.

If you've got an existing practice, you've got lots of exit opportunities, whether that's with us or others. The exit strategy for existing practices is pretty robust. You've got lots of choices there. It all depends on how you want your legacy to look when you go, how that transition will look and what the timeframe of that is. A lot of new ODs are not necessarily looking for ownership right away. They want to have an environment where they've got a team or they're around people that can help mentor them. They may find themselves working in different environments to find what they like and go from there. That may be joining a strong entrepreneurial independent practice or joining us and going from an independent contractor into the co-ownership model.

If you're new to the profession, you got to work in a lot of different places to figure out where you like to be and you'll find it. There are always going to be different market segments served by different groups. To be independent, you have to find your niche and be a strong entrepreneur but those independent practices may be quite big and have a lot of associate doctors as well. It's an interesting demographic challenge as the Baby Boomers move towards retirement and we have the Millennials and Gen Zs come up and what that's going to look like. That's why we try to grab the best of both worlds. Lifestyle is also very important to a lot of people and hard to be an entrepreneur to have a balanced lifestyle.

It's not a balanced lifestyle thing if you're a strong, independent entrepreneur. That's where we come in and try to bridge the gap. To build some equity and some long-term value for yourself or retirement or for just having an asset that serves you over time with cashflow and resells value but also gives you a lifestyle so that you don't have to do everything all the time. That's where we tried to bridge that gap.

Being top-down and centralized might put you in a much more fragile position than being able to reach into the minds of practitioners who are skilled at what they do and see.

With this consolidation, I supposed one of the big concerns is that you have entities that are so large that they can affect change themselves. Is that something that you see as potential with some of the consolidation with the organizations that we have in Canada of creating change whether it's legislative or other forms that can affect the future of the profession or the direction that we're heading?

It's always a threat. No matter what, you can't rest on your laurels. We've worked very hard as a profession and in most provinces being independent contractors and always being self-employed. Never being an employee. I don't think there's any province that allows you to be an employee of a corporation. It's pretty clear in most regulations that it's a go-zone for everybody. That's important to maintain. To me, that is why Canadian optometry is awesome. Even if you're in a corporate setting for a year, you're self-employed. You got the tax benefits and write-offs of that. You get that extra bit of freedom and income that comes from that. You don't want that to change.

We need to always be vigilant about the regulations that over the last few years have been put in place in each province and make sure that we have a voice in government and at the table. Also, we're all aligned as much as possible. Ontario is a great example. When I moved to Ontario in '06, it was a mess but slowly over time, the leadership that has risen into the association of college and association with our coordinated action to renegotiate OHIP is outstanding.

We have 95% to 96% participation in the job action unheard of for many years. No one even thought it could happen. That’s aligned with everybody. All the bigger groups were like, “This is healthy for optometrists to do this,” but that's the kind of coordination we need to have to keep the momentum going in the right direction. We all have to be vigilant and get better at how we strategize those things. The Ontario examples are very good ones.

There's always going to be forced to change, especially when you've got bigger groups that have a benefit. We have to be better in that regard, whether that's through associations, colleges or even individual groups using their resources to make sure that we're defending the status quo from a structural professional regulation standpoint but allowing for evolution in the ways that we want through scope expansion and all that. That's critical.

I was looking at that. You're quite involved in those earlier changes that happened back in '06, '08 or '09.

We've made a challenge to some of the regs in Ontario. We responded to being taken to task for our business model in '07 and come to a settlement in '08 but then the regulations wound up changing on the books in '14 kicking off that revolution of regulatory change. 2014 in Ontario was a pretty big year to change and it created a lot of catch-ups.

If you look at markets that may be fertile ground for groups coming from outside of Canada to come in and scoop up market share, there is some risk in Ontario because optometry having been on a dispensing fee, no profit model for eyewear has shifted into either these side-by-side models or private practice, which required your eye exam fees to be sustaining income levels.

As a result, optometry doesn't own necessarily eyewear. There are a lot of independent optical chains that own eyewear. Eyewear, we're talking $3.2 billion a year in business Canada, which my estimate would be 4 to 5 times what your service revenue is in the country. That is the powerhouse. Having a piece of that is what allows you to determine your influence in a country and a province. That's where Ontario in 2014 changed but a lot of catching up has to be done for optometry to grab market share before somebody else comes in and takes it. That's where things get steered.

When the big dollars of eyewear are being captured by entities that can wield that resource in a way that maybe is not favorable to the profession, that's where the race is on. Other provinces have their challenges. BC is more of an open regulatory environment there. The best defense is an offense in terms of getting a stronger presence, being competitive and making it about eye care first. For instance, if you look at Quebec, they're protected by language but optometry has a significant portion of the majority of the eyewear market there. They do steer the ship and keep everybody out but they've got some advantages that a lot of us don't have from a language perspective.

Are you saying we should all start speaking French?

Maybe but there would have to be rules around companies.

You mentioned BC and some of the regulatory changes here. In that period when you were involved in those changes in Ontario, in that case, it was IRIS getting called out for the way that IRIS was behaving in that market that they were not supposed to but it worked out to the benefit of optometry. IRIS was doing something that generally was going to help optometry but a similar type of thing happened in BC where a corporation was doing something. They were getting called out for doing whatever or acting a certain way that wasn't according to regulations.

They took that to court and unfortunately, that's where the deregulation happened. It was performing in a way that they were not supposed to and they ended up getting the regulations to change. For someone who's practiced their whole career in BC, that's where my concern would lie if I'm going to make this a bit more personal. It is in the corporation where they come in and say, “These regulations are not working to my benefit.” The changes that they want to make are not to the benefit of the profession as a whole.

How difficult would it be to stop a large organization from making those changes? That was early in my career so I didn't see the inner workings of it but from what I saw, it seemed like a steamroll. There wasn't a whole lot of stopping that. How do we fortify ourselves? You mentioned the best defense is offense or however you said it but what do optometrists need to do to batten down the hatches and be prepared for potential regulatory changes like that in the future?

In BC, it was interesting and we could probably do a whole episode on it and dissect it but it was a political coup d’état. When you start to track the people, the players and where they were, they were in positions of political influence. There was a plan. It was not that they just came in there, went all willy-nilly and expected to win at the courthouse. They had their political ducks lined up. That's something the profession has to do as well. It's important to get yourself in those rooms and conversations connected to the right political people in various ways to be able to be there to effect change. I could tell you in Ontario, what happened is exactly that.

We were on our own in some ways because there wasn't necessarily the same push to allow optometrists to work with opticians and sell for retail in the colleges and maybe a bit more the associations at the time. Our strategy was very diverse in the sense that I had a lobbyist that I was working with who got me in to meet with some of the bureaucrats because sometimes, the politicians change but the bureaucrats stayed the same. They often hold the power of a file. You need to get to know these people, more than necessary, the politician in some respects. I don't want to speak ill of government bureaucrats but they like to be spoon-fed with information. They don't want to have to work for it.

You don’t go into government because you're a hard-working entrepreneur. You want an easy schedule. Both of my parents were civil servants so I can say that. If they have a file, they want someone to spoon-feed them in the framework in which they're working. If they've got a mandate, you've got to deliver the information that aligns with their mandate to make them look smart when they're talking to the politician or whoever's in their department. There's that aspect. Different regulatory arms are always gathering reports. You got to get in there, get those connections and deliver that.

It was a different media landscape when we were doing all this but we had a proactive PR strategy that was very effective at the time. The media is different now than it was back then. When we start to get into conflict, we were able to leverage the media to our favor and that's a particular skillset. It takes a lot of plans, coaching and the right thing. Also, through the legal aspect. The legal aspect is certainly the most costly. I have in my office volumes of our charter challenge litigation lined up. It's a point of pride.

It was a year of my life where you were researching down to building this legal case under the charter of rights. The legal landscape may have changed as well since that time. The bottom line is you need multiple strategies in the halls of power to even keep things how you've made them. If other forces are coming in, you got to get there. It's hard because the profession is not necessarily huge in terms of dollars to collect, this and that but also with the larger groups like myself and others, working collaboratively together in some aspect is important too.

In Quebec, they are more organized in that way, in which a lot of the major eye care groups are competitors in the marketplace but they're like, “We got to make sure that they don't go too crazy and make it hard for us to operate our businesses. Let's all get together and have some common things that we want to make sure that the government is not going to hammer us or surprise us with.” That's a model that we should be looking at in other provinces too if we want to be more effective. The government also likes alignment. They don't like an anti-competitive activity necessarily. In the eye care industry, it'd be like, “All of us want the same thing here. This is what we want. We're all aligned. We have all this mobilization.”

It’s like with the Ontario Association doing their OHIP negotiation. “We're all aligned. We can't divide these people. We're done. We can’t do anything. We're going to have to go to the table. We can't split them up and make that person want something different and upset.” That alignment is very powerful and that's going to be incumbent on us to set differences aside based on our different models if we want to keep eye care as it is, which I believe is in a very healthy place on the regulatory level.

Build value that far exceeds the dollar and reap the rewards.

With potential forces entering the market and looking to make those kinds of regulatory changes, it is one thing to look at the large entity but then I'm always curious about the optometrists that choose to work with those entities. I'm not picking on anybody here but speaking about us being collective as a profession, wanting to strengthen our profession and do what's best for the long-term for our profession, what would you say to someone if you were talking to somebody who was working at one of these places? It’s all theoretical, Daryan.

I certainly don't judge anyone based on where they choose to practice. You always got to go where your values are aligned. You need to look inside yourself and say, “What values do I have? Also, what long-term future do I see for myself? Is where I'm at contributing to that potential future?” Certainly, if the future puts you less in charge of your life, less self-employed and maybe an employee working not with your autonomy or the scope of the practice you want to, then you got to think about the long-term. What is going to support that level of autonomy and practice? Decide what environment you want to be in that does that.

It's tough because you come out of school with lots of debt. You got a lot of bills to pay and not necessarily looking to go further in the hole to start a business. Not everybody. Some people do and more power to them. It's about aligning yourself based on values. To me, that pretty much gives you the answer. If your values are short-term, I'm going to earn a lot and the profession is damned. It doesn't matter what five years will bring for me. I'm going to make hay while the sun shines. If you do that, you may reap the results of that. We all have to think long-term. It's one thing for us to be in a great place but we want to be in many years in a better place or at the very least the same if it's great now.

When I was young, I came out on my own. I didn't know anything. I was like, “I want to learn the business.” I practiced in so many different environments to find out what I liked to be. Finding a mentor that would fill a gap that was left with school and by sampling different places, I landed where I wanted to be and that evolved too. In my experience, I was like, “This is a pretty cool environment. I like these people.” I found a mentor in Francis Jean, the Founder. I played it cool for a while and practiced not full-time.

I got inspired and learned more about where I was. My career took a trajectory that was natural, exciting and felt like fun more than it did work. The key here is to get on these journeys but think about the long-term. “What's going to give me the best opportunity long-term? What's going to put me in the best position of autonomy long-term?” To do that, you're not alone because there are lots of market forces and groups coming in. What situations are going to make me happy in this situation? I'd hope that it would be in the one where you have some freedom to practice.

That question was off the cuff. I had questions related to that for later in the conversation but since we're on the topic and I derailed myself, I'm going to move on to the same topic. With new grads, you mentioned coming out of school with a lot of debt. That's nothing new. The debt may be a little higher now than it used to be but that's always been the case.

One thing that's different to me anyways and maybe you can confirm or deny this is there's a lot more demand for ODs with the growing organizations, the consolidation or whatever it might be. Also, the salaries that they're being offered or the signing bonuses. There are forgivable loans that are being offered as incentives to try to draw primarily new grads in but even other ODs. They try to sequester these ODs so they can have the manpower to run these businesses.

There are 2nd and 3rd-order effects on other businesses and practices when that thing is happening but specifically with these new grads, do you think that they're in a place of power and leverage because they're getting all this money thrown at them? Do you think that they're perhaps being influenced, almost blinded or at least obscured a little bit by the money and their path maybe potentially be negatively affected by what they're being offered? They're not seeing past that because of the simple math of, “I have debt and I need money,” and that thing happening.

It is tough when it's a mix of both because there's a lot of demand in remote areas. If somebody wants to live or practice in a major urban center, there's no shortage of other optometrists. The market is more saturated. As soon as you go outside the city, the demand is huge because those populations are usually underserved and it’s harder to get optometrists to be there. In those two remote areas, there's more demand than there is supply. That is a power position for a new grad or young optometrist.

When it comes to all the bonuses and things like that, it's getting pretty tough out there for that. We've certainly kept competitive in the market when it comes to some of those things but I like it. For us, it's always about culture, fit and values. It starts to make us feel uncomfortable when we start to lose or an optometrist takes another position because they got a bigger signing bonus or something like that. We're like, “We could pay for that or try to bid outbid but what kind of person are we getting that this is the start of our relationship?” It's a bidding war to get you into our relationship.

We've always been about, “Do you feel that there's a fit with our culture? Do you share our values and passion? Do you like this environment or this family feel that we have? Is that something that you're going to feel good about in 5 or 10 years?” We want that alignment. It sucks when you're out there with all those money being thrown around and we're like, “It doesn't even feel that great as an investment.” If you put yourself as a person who's like, “I'm going to the highest bidder,” then how long are you going to stay until someone else throws some flashes of money?

In the end, how long does that last? Maybe the dynamics change and suddenly, you've taken a couple of great exciting bonuses and forgivable loans but then maybe the dynamic changes in the market and suddenly, you’re like, “Who is going to be in a position to have a good spot?” It's somebody loyal, fits with the values of the practice and hasn't taken a silly advantage of this point in time.

Now is one thing but what do 5 to 10 years look like? Money doesn't necessarily buy happiness. It looks great in the beginning but ultimately, you've got to feel like when you get up and go to work every day that you're not even working but having fun. That's sustainable. Being paid a large sum of money, not being happy and being miserable is never a good trade.

That was a question that I was asking myself. I was like, “How long will this last?” It seems to have happened very quickly. I wonder how long this little blip will last and then what it's going to look like on the other side for ODs and the market in general when all this money has been thrown around and people are put in positions that perhaps they're not happy. I wonder if there's a correction, what that looks like. I guess we'll have to wait and see. Unless you have some foresight on that, I'm happy to hear it.

I wish I did honestly but it's like anything. It's going to have to correct at some point because it's not sustainable. Nobody can keep paying these things out indefinitely. Ultimately, there will be a return to maybe, “I shouldn't be going to the highest bidder or going into the environment that I want to practice in.”

The pendulum always swings. Perhaps, it's on one side and maybe it'll go the other way when people are not looking for money. I don't know if that's realistic but they're looking for an enjoyable workplace setting. It'd be interesting to see how far it swings back.

Our strategy has always been the same in terms of creating an environment and values that are clear so that somebody knows what they're getting into or feels a particular way in our locations and is in alignment or not. That was always put in there from the beginning. The pendulum swings all the time and the market does crazy things. If you're not consistent, you can get yourself tangled up. We've always tried to keep this straight and narrow. We've got to sometimes remind ourselves, “This is our identity and who we are,” so that there's not that variation and we attract those that have that similar DNA or depth.

You mentioned the perceived value of the services that we all provide. It's one thing if a patient is in the office already and you've got your pathways all set. You know that you have great service and that kind of thing. The patient feels that value as they're going through the process but what about a patient who's not yet in the office and still choosing where to go? To the public in general, how does that person in the public determine the value that this optometrist will perhaps provide? How does the optometrist try to show the public that they're going to provide the most value?

Perceived value is always where the customer or the patient feels they've received more than they've paid for. You need to always deliver more than what the dollar sign at the end of the day shows and that's increasing perceived value. We were like, “Maybe that was expensive but that was amazing.” You don't feel bad about it. You're like, “I felt like they treated me well. This was great. My doctor spent time with me and answered my questions. They have great equipment. They listened and solved my needs. They got great pair of glasses. I'm happy. The dollars didn't matter because they over-delivered what I expected.”

Execution in your location with the idea of that person must feel like they received more than they've paid is critical. It's better to do that by increasing what you deliver instead of decreasing what they pay because that'll get you in some pretty tight spots although that is a segment that doesn't require some lower costs options. In terms of getting out there, word of mouth is still number one. You could spend infinite amounts of money on marketing. There is no shortage of places where you can blow money in marketing. Focus on what you're doing every day in your location first because that person will talk about what their experience is. If it's great, then that person will bring more people in.

That's critical. If you want to keep your finances tight, don't overspend on marketing. Make sure you have an amazing outcome for every one of your patients. Naturally, things like Google Reviews and stuff will flow from that. Focus on the patient. Give that patient an amazing experience. Secondary to that, it becomes a game of how you get exposure out there in a noisy place with devices disrupting attention. It is tough. One of the reasons why we aligned around a brand is that brands are simpler when you build them up. They're addictive. They cut through the noise.

Once they've developed a trust level in the perception of the market, it becomes easier because people are like, “I know this place. I'm going there.” We're bombarded with all these things. Other than that, I don't have the recipe when it comes to marketing. We're still working through and it changes. The landscape has changed in the last few years where you could put millions of dollars and when it's going to yield. We're constantly revising strategies all the time because it's not always certain what's going to work and different markets have different things that work for them.

Humans need to feel they're cared for or listened to, trusted, and not judged. That's the key to building a long-term relationship with a patient or anybody.

Getting out there is tough. I don't think it's any easier if you're in a large group. You've got more money but you could waste that money easily if you're not smart about it. The core always comes back to word of mouth. It is always the most effective advertising that you can have. The rest of it is a learning process and I wish I had the secret sauce because that would make my life easier too.

Let’s say in a place where potentially there's going to be a lot of talk about lower costs of eye exams. A potential patient is standing there looking, “This place is charging me $50 for an eye exam. This place is charging me $150.” How do you think that patient's going to make that decision? Is it going to be based on technology? Is it going to be more so on word of mouth? Is it going to be certain patient going to say, “I don't have more than $50. I have to go to this place?” Is this going to be a mix of all of those things?”

It is going to be a mix of all those things and it depends on what population your practice is positioned to serve. If you are positioned to serve a lower-income population, you're going to have to get competitive on your pricing because that's one of the biggest determinations of what some people have in terms of what their ability to pay is. That's the reality.

If you're positioned for trying to get somebody who's maybe a little more after a client or someone that at least is desiring a good experience, then it comes down to the game of word of mouth and the game of reputation. One of the advantages an independent has too is you can get out in the community and meet a lot of people. You can be a social butterfly in your community and raise yourself to a pretty well-known presence there. That's also very helpful.

People see you around and you're committed to local community stuff. That's always great, for sure but it's tough. If somebody only has a price at which to make their decision, they may start at the lower price point before they realized, “I didn't feel very good. They didn't spend very much time with me. These glasses are crappy. They're falling apart.” It does initially when you get a wave of low-cost options. There are a lot of people that try it out and it may hurt short-term for some people.

Some of the patients or customers say, “I didn't like that experience. I’m going to go back to where I'm used to. I know why I pay more there.” You've got to justify it. That's the thing. That's why I come back to the experience that you give in your practice because if you are charging $150 and that patient didn't feel like you listened to them, that you explained everything or that they got good value for that $150, then you're at risk to lose that person for a $50 exam.

They're like, “I'm not paying $150. This was a terrible experience. I didn't feel important at all. I’m out. I'm going to try a cheaper next time.” I'm not trying to critique anybody but I dare say there are probably practices where the $150 exam is like a $50 experience. Yes, you and that practice are at risk. You got to up your level of experience and the location so that people know what they're paying for. Short-term, there's always disruption when a big player with lower pricing maybe comes in, people get curious and then they go out there. It's coming upon us to tighten up our ship and do better.

With your vast experience here across the country, how much do you think a high-quality and high-service eye exam should cost?

That's a difficult question because there are a lot of regional differences. Our pricing is different per province. The dollar sign doesn't matter. It is the value that you can deliver that exceeds that dollar sign and that's not an exact science. That is like, “What is it that we're able to do for each of our patients and customers? If we charge X, do they still feel that’s worth it?” There's a bit of calibrating that happens there. You introduced some new equipment into your practice and charged for it 100%.

Since the beginning of my career, you charge for what you're worth. You invest in equipment and in yourself to be at the top of your game clinically. Your time and expertise are worth something. You charge. Don't ever discount the services you provide but you got to explain that value to the patient in a way they get it. You got to be a good communicator and figure out how to take your brain from optometry school level science into lay-person. Maybe cuss words if you're working in a stressful environment.

It is about adjusting your communication style with your patients and the way they connect to you. It's a tough question for me to answer because it's like, “If you can deliver a $300 perceived value and only charge $200, then your exam should be $200.” How do you deliver that value? That's the ultimate challenge and the journey that you're on. If you want to keep your prices healthy and high, you got to go, “We've got to deliver more than that.”

All of us go on vacations. If you pick a luxury hotel or resort, there are little things that they do that may not cost them very much that you're like, “They treat me like a queen or king. “ You're like, “This is awesome.” The per night charge is not low at all but because they've been able to give you this experience, you're okay with it. There are many examples in many industries like that where little things here and there build value that far exceed the dollar and they reap the rewards.

We can all learn from that. I believe it's a strength and not a weakness. Optometry has got a lot of private revenue into it. To me, that's exciting because you have a green field in terms of what you can do to increase perceived value and revenue coming into your location. While if you're always having to ask the government for fees, it's tough to evolve.

This is a part of the reason why I wanted to do these things recorded one at a time and not put them all out. This is one of those questions that makes everyone uncomfortable. Let's say you read one of the episodes and you’re like, “He answered like that. I got a better answer.” I don't know if that would happen but that was part of the reason why I did that.

With this one, I'm not exactly looking for a number, to be honest with you. You said it yourself and I love that you said it. In your own words, you said, “It's about us as the service providers making sure we value our services and charge accordingly for them.” If somebody is coming in and deliberately lowering the cost of their eye exams, it's not only de-valuing the service of that particular provider but of the entire profession and all other providers by saying, “We are technically providing an eye exam and charging half of what the other people are charging.” Every hotel is giving you a bed to sleep in but the experience of that hotel resort is different. It leaves you feeling like a king or a queen and they charge accordingly. That's how we should look at our services too.

Thank you for answering that. Whether you put a dollar number on it or not is not important. Here’s one of the direct questions that I wanted to ask everybody and I put that call out into the world with IRIS, FYi or whoever. I see that you are providing opportunities to optometrists or new graduates. You are opening these doors of consolidation but what is IRIS doing to make the profession better in the long-term?

We've always been about raising perceived value in eye care services specifically. It's interesting because we talk about a divergence between optometrists and business people. Since the very beginning of IRIS, I've always been encouraging our optometrists to charge more. You're worth more. It's usually optometrists that don’t necessarily want to go there, at least historically.

For us always, we've promoted quality eye care and always been about ensuring that the public knows that that's worth something. It's worth paying for a quality eye care experience, quality technology and product. We are messaging in a way that is always educational and about assigning a high value to your vision and eye care.

In terms of the impact on the market, you can even see it historically. When I came to BC in '01, 60% of ophthalmic lenses sold were uncoated or something like that. It was a high number. We went to fully-coated lenses. That was our thing. On a very odd occasion, we would sell uncoated lenses but we went crazy in terms of 100% fully-coated and reflection coating is better for vision.

We hit that message hard and did it in our locations. We have a significant presence in BC. A few years later, overall in the industry, it was easier for everyone to sell reflection coating and it raised the penetration of that significantly. As you know, as an owner of a practice, coated lens, the price point is more and you do better with it.

Maybe some people reading this are like, “Uncoated lenses, what are talking about? What is an uncoated lens? Why would you sell them uncoated lenses?” Back in the day, you did and we pushed it. We’re fine. We brought the industry up because we were like, “We'll always be willing to push if it benefits our patients. We’ll put our machinery behind it and everyone will benefit.” We'd rather have the general value of eye care go up in quality because it makes it easier for us too. That's always been what we've done.

In terms of equipment too, we like to be scaling up on our equipment. We're rolling out our OCT program. We're doing innovations like teleoptometry in underserved areas. On a technology level, we've been involved in some AI projects as well. We take our resources not only in terms of improving the perception in the marketplace but even on the technology side. We've got some relationships with some schools that we'll be announcing coming up.

Human connection is always going to be priority number one.

We're giving back to education and the technology research side that benefits everybody, ultimately. That's good. We'd rather have everybody doing better than us to have a divergence in the market where people are pulled in different ways. Perceived value is everything. The public will always look at you differently if they see you as, “That person is an optometrist. They help people see better. My eyewear and my eyes are so important. That is worth something.”

When you charge for your services, people respect you and your profession. It all spills over into all these different elements including what we talked about in terms of being politically active and things like that. If the politicians or the bureaucrats who are members of the public perceive the profession highly, then when they meet with you, they're like, “I meet with an optometrist. This is good. This is somebody I should listen to.”

With IRIS being part of a larger group, do you feel that the same mentality and progress are going to maintain over the long-term? Is there a chance that being part of a larger entity will change the course of the way that IRIS is placed within the profession?

No, I don't think so because we occupy a pretty interesting niche in the Canadian landscape. We are unique globally. What we do has been well-recognized in other countries. It is pretty outstanding, even when it came to things like the fully-coated lenses. We moved to that model where we were pretty much 99% or 99.5% fully-coated. That resonated globally. They are like, “This group is doing what?” For us, that's the attractiveness of our group. We've always been this forward-thinking fusion of business and optometry.

We're known in terms of the financial community as strong operators. As long as we can continue to cultivate good leadership and partnerships in our group which is the perfect fusion of optometry and business, we will continue on that path because that is what we are. Changing what we're doing doesn't make any sense because it's always been somewhat looked at globally as a leader position. It would be very weird for someone to say, “They're doing all these things that no one's doing. Let's change it.” It doesn't make any sense.

In terms of our financial ownership structure, it's all financial. It's nothing to do with the operation. The consensus in the larger business world is, “If I'm a pension fund and I want to invest in a good business, I don't know anything about this. They're good. Let them do their thing.” That's what we've always done and that's part of also being decentralized as partners too. It's a bit of insurance because if ever something crazy happened on a central level, partners could be like, “I'm not doing that.”

You have an ownership stake in a local corporation with rights. It’s pretty tough to go against that if something crazy was happening. All these things are decentralized. The whole company could collapse under bankruptcy and our partners will be fine because that company is insulated from everything. They would wind up owning 100% of the practice for cents on the dollar if something were to happen. That's why I like our system because it is anti-fragile and decentralized. For those of you who follow the financial markets, those are things that a lot of businesses talk about because we've seen the impact when you're fragile and centralized a lot and it's not good.

The overarching concern there is a large organization perhaps deciding that they want to change not a business model but perhaps the market's not quite working the way they want it to. They want to change something about it. It's not aligning with the profession. It’s the concern that maybe I'm trying to express with you hear. On a local level, it's great that the optometrist can do what they want to do but it's that larger entity with the potential power to change things in the industry that is more the concern. What do you think IRIS or New Look looks like a few years from now?

We certainly will have a more significant presence in each province in the country. With IRIS, it's about gathering partnerships with optometrists and opticians through mergers and acquisitions. The other banner is the same but more on the market segments that they service. We will certainly have significant growth.

As we get bigger into a market and more financially benefiting, some of the things you and I talked about are things that we want to do like more political activity to ensure we keep the industry and profession strong because we believe it is strong. That's why everything has been built on this strength. We cannot see that go down and we do talk a lot about how would we ensure the future long-term. We also look out for the demography of things and how we service populations.

As we get bigger, we'll have more resources to do more things and we are optometrist-centered. That is the core of what we are and we need to always do things to strengthen the profession. Your track record is there. When I challenged the regulations in Ontario, it was not an inexpensive endeavor. We spent a lot of money to do that and it benefited everybody. That has always been the ethos of the organization. Otherwise, our business model doesn't work any other way.

A cynical person might say that it benefited IRIS so it made sense. IRIS had the power and the funding or money to do something like that whereas others who might've wanted to do the same couldn't do it. It's wonderful that it benefited the profession as a whole and that's always what we want to see but the concern going back to what we talked about is if those goals don't align with the profession and that individual entities don't align, that's where things could get a little bit scary and where we need to be more cautious.

I'll get you out of here on this Daryan. I've taken up a lot of your time and you've been very generous with answering all these questions. You've told me what IRIS was going to look like years from now. What do you think the individual optometrist's job is going to look like years from now? Is it going to be the same walking in, doing refraction, doing a health check, going outside and buying glasses or is it going to be remote in some capacity? Is there going to be some other technology you see down the pipeline that's going to change the way we practice dramatically? Feel free to be as dramatic as you want. What do you think that looks like?

I do think that there's certainly going to be a lot of delegation, whether that be to technicians or AI in some ways too. Ultimately, you'll wind up an optometrist breeding a lot of data being processed by artificial intelligence to deliver you a probability of something. It's up to us to make our judgment call based on these data inputs. It's going to be like that. It's all ready when you look at an OCT, especially over a couple of visits in history.

You are looking at trends, graphs and things like that. As AI is able to reach into more data sets and compare, it'll make it very interesting because we'll look at all this information. We'll have to draw our conclusions and communicate that to the patient. We may be less in terms of our physical like doing the exam and more about reading the inputs from all of these scans and different instruments that we'll be using.

Teleoptometry will be much bigger because there are a lot of underserved communities and it's tough to get people out there. There should be a strategy amongst schools to recruit optometrists from remote communities so that they return to them because that ultimately is better. One of the other aspects of what optometrists should be doing is a more expanded scope of medical things. You may find yourself doing a lot of emergency or more medically-based treatment as well. You need to have some physical presence in these locations and being remote isn't going to cover all the bases yet.

Maybe they'll have some robotic arms that you can use through the metaverse to be able to pull up foreign bodies or do some invasive procedure. The demand for our medical side is going to be continuing to expand because there is less ophthalmology. Like you’re doing Oklahoma with being able to do YAG caps and things like that, it's the natural evolution of what we'll be doing. It's pretty exciting as a profession that there are all these interfaces with technology and things that will move forward. That’s the way I see it.

I feel like the human connection is always going to be to me priority number one and that's what all optometrists should realize. They need to be able to listen to a person, explain complex things to them, put them into context and address their needs. The communication and the psychology in that aspect of things are going to be probably even more important as you're able to use technology to do some of the diagnostic. You need to be able to break it all down, be a human and build that connection with people. No matter what, humans are humans. They need to feel like they're cared for, listened to, trusted and not judged. That's the key to building a long-term relationship with a patient or anybody.

Thank you very much. Any final words before we wrap up?

No. We've covered a lot of territories. Thank you for having me. I certainly had a lot of fun.

Thank you, Dr. Daryan Angle. Thank you so much for being here, answering these questions and being part of this conversation, which is going to be an important big conversation across the country. Thank you to everybody who has been reading this series, The Future of Canadian Optometry on the show. I will see you again in the next episode. Take care.

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That was the second installment and interview in The Future of Canadian Optometry series presented by Aequus Pharma here on the show. I hope you're able to take away a lot of insights like I was from Dr. Daryan Angle here who was very open to answering a lot of these questions and facing them head-on. Don't forget to share these insights, videos or audio with your friends and colleagues across the country. This is a conversation all of us Canadian optometrists need to be part of.

Take a screenshot, throw it up on Instagram, put a post on LinkedIn or send a text to your friend. Maybe, more importantly, send the link over so they can read it or watch it on YouTube. Don't forget to send me your feedback. If there are other questions that you want me to follow up with or other questions that we should be asking, I'd love to hear them so we can continue to challenge the status quo and make sure that we are all involved in the direction that our profession is heading in. Remember, we will be releasing new interviews and episodes that are part of The Future of Canadian Optometry series presented by Aequus Pharma. I'll see you in the next episode.

Important Links

About Dr. Daryan Angle

Dr. Daryan Angle was born and raised in Edmonton, Alberta, and graduated from the University of Waterloo School of Optometry in 2001. He joined IRIS in British Columbia in 2002 practicing as an independent contractor, which eventually lead to co-ownership in 2 Vancouver area locations.

In 2006 he relocated to Ontario to serve as Vice President of Professional Relations (2006-2013) during which time he successfully led a political and legal challenge to the regulations governing the business practices of optometry in Ontario. The challenge eventually led to changes to allow open collaboration with Opticians and corporations, as well as the freedom to brand, advertise, and dispense eyewear at retail pricing.

Following that appointment his role became national as Executive Vice President and Chairman of the Board from 2014 to 2017, concluding with the sale of IRIS to New Look Vision Group Inc. Dr. Angle is an active, practicing Optometrist and co-owner of an IRIS location in Uptown Waterloo (since 2007).

Currently he serves as Vice President Business Development and Partner Relations at IRIS the Visual group (a division of New Look Vison Group). In this role he uses his extensive management experience in store operations, regulatory/legal jurisprudence and in mergers/acquisitions to grow the network of IRIS locations, while ensuring current and new partners are engaged and successful in their practices.

Dr. Angle currently resides in Kitchener, Ontario with his wife Jill and 2 young children. He enjoys Les mills fitness classes, stand-up paddle boarding and watching multi-season TV series such as Peaky Blinders and Ozark.