The Future of Canadian Optometry series on The 20/20 Podcast is a series of 6 interviews with leaders within various organizations in the Canadian optometry landscape.
The first interview in the series is with Dr. Alan Ulsifer, CEO of FYidoctors.
In this interview, you will hear Dr. Ulsifer discuss:
valuable market insights into the four main types of consumers in eyecare
what he sees as threats to the profession
what FYidoctors is doing to support the long-term success of the profession
what the future optometrist's job looks like
The Future of Canadian Optometry series is presented by Aequus Pharmaceuticals.
Stay tuned over the next three weeks to hear and watch all six episodes.
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Listen to the podcast here
Dr. Alan Ulsifer, CEO Of FYidoctors - The Future Of Canadian Optometry
I'm truly grateful that you would take the time to join me here to learn and grow. As always, right off the top, before I get into it, I always ask a quick favor. If you've been getting any value from previous episodes or upcoming episodes, which I am very confident you will, please share it. These next few conversations I'm going to go into are going to be extremely important for us as Canadian optometrists. Please do share this. Send a link to your friends and colleagues. Text it, put it on Instagram posts, LinkedIn posts, whatever you can do.
I promise you I will be truly grateful every time I see that. Our colleagues across the country will be better for it, and be grateful that you have shared this content with them. The next six episodes are going to be part of what I call The Future of Canadian Optometry, presented by Aequus Pharma. The future of Canadian optometry is a series of six conversations with six leaders in the industry.
They are leaders from different organizations within the industry that are going to help us shed light on what is the current state of optometry in Canada. What is the future for optometry and Canada? What do we have to look forward to? What do we have to be careful about? What information can we learn and glean from people who are at the top of these organizations and who are making a lot of the decisions that are essentially determining the direct direction that our profession is going in? That is what The Future of Canadian Optometry series is all about. It's 6 interviews with the following 6 people, which I'm sure once you read the names, you'll understand why these conversations are going to be so important.
There's Dr. Alan Ulsifer, who is the CEO of FYidoctors, Dr. Daryan Angle, who's the VP of Business Development at IRIS, part of the New Look Group, Mr. Bill Moir, who is the GM of Specsavers, Canada, Mr. Rick Gadd, who is the President of Essilor Canada, Mr. Alfonso Cerullo, who's the President of LensCrafters North America, and round off the conversation with Dr. Kerry Salsberg, who is a successful private practice independent optometrist based in Ontario, who truly understands what the sphere of optometry is now and what direction we're going in. He is somebody who is at the cutting edge at the front of the curve here as to what is the leading technology and what we can expect to see in our industry moving forward.
After having these interviews, I am confident that you're going to walk away from each one of these interviews with a different insight, with a different outlook on the profession. Some cases are positive, and some cases maybe not so positive. I'm grateful for the guests who have come on and who have been mostly candid and open to answering the questions that I've asked direct questions that we, as optometrists, should be asking. Most guests have been open to answering these questions head-on. Once in a while, you'll see a guest give a more corporate answer that dances around the question.
Every guest, with all of their answers, will speak for themselves about where they stand and what they think of optometry in Canada. We're going to start with this episode, which is with Dr. Alan Ulsifer, the CEO of FYidoctors. This is a great episode to start with because Al is very candid and open and even says it right off the top. He's not the best at being secretive or sugarcoating or answering in a corporate way.
He likes to be himself and answer very openly, which is fantastic for us, as the rest of the optometrists in Canada, trying to understand what a large entity like FYidoctors is doing and what they see as the future of optometry in the country. Without further ado, here is the first episode of the future of Canadian optometry series presented by Aequus Pharma. This interview is with Dr. Alan Ulsifer, the CEO of FYidoctors. I hope you love it.
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Dr. Alan Ulsifer, thank you so much for joining me here for this special conversation about the future of Canadian optometry. I appreciate you being here.
Thanks so much for the invitation, and I look forward to our chat.
As many of the audience will know, I put out a little bit of a call-out to some of the larger entities and organizations in the industry here in Canada, asking you and others like yourself to come on and share your thoughts on where the profession was heading and some of the changes that are happening now. I do appreciate you taking the time to come in and join this conversation.
I know that that initial call-out may have seemed to feel a little uncomfortable for some people, but I know that you are not afraid to tackle these types of conversations. Thanks for coming on to do that. In quite a unique position, being the CEO, being the head of FYidoctors, this large entity in Canada, I imagine you've seen a lot of change if you haven't been involved in the change yourself directly.
I imagine that you're privy to a lot of conversations that many of us are not. Whether you're able to share some of that information publicly or not, I expect that that unique perspective will be invaluable for the masses. The average optometrist is wondering what's going on in our country and in our profession. I hope you're able to share as much as possible, as much as you're comfortable sharing, and hopefully, we can have a candid conversation about that.
I'm comfortable sharing most things. I do have NDAs, but my reputation in the company is my idea of keeping a secret is telling one person at a time.
Let's start with this. From your perspective, how would you describe the state of optometry in Canada nowadays?
From a clinical side, it's a very exciting time with advances in technology and drawing new treatment methodologies. Our importance as a profession in the community is as high or higher than it's ever been. The state of the profession for what we do and how we help people has never been better. If we look at the more industrial approach, the commercial, our profession or industry has been an area of interest to a lot of people outside the immediate community for a long time. I talked early days, years ago when we formed FYidoctors, a lot about consolidation is coming, private equity. I talked about Specsavers at that time and the impact that they had on the market.
I've talked over the years about how other markets have been disrupted. We have a lot of outside people looking at the profession, looking at the industry with lots of money that they want to put into this industry. Not for the sake necessarily of investing in the profession, but more of how they get involved in what they see as a very lucrative opportunity and profession. Money is a key factor, and we're seeing in BC with the injection of cash that Specsavers is making, even the $10 million in advertising for a market that size, no one's ever done that in the history of our profession in that particular area. A lot of entities are looking at this as an opportunity.
What would you say is the opportunity they see in the profession and Canada in particular?
There's an opportunity to, in their mind, make optometry practices more efficient by consolidating a more efficient supply chain in all areas. This was a big part of why we formed FYi in the early days. As independence, you're paying more for everything from a supply chain perspective. Even now, from a marketing social online reputation management, all those things are more and more expensive for an independent. They see utilizing capital to consolidate as an opportunity to drive very high returns.
Independent Optometrist: Consolidations happen in a lot of industries and usually been great for optometry.
You're one of the founders of FYidoctors. It's been well over several years. Some would consider that you have amazing foresight to think that consolidation was important and to come together as a group. Do you feel that consolidation is the only way for the profession to survive? Is private practice still going to be a viable way to practice?
It wasn't about survival. When we formed the company, we had a couple of mantras. One was consolidation is going to happen regardless. It's a reality. Why can't a bunch of doctors do it? That way, define what an eye exam looks like. Create a different narrative in the marketplace around what eye care should be. We have this tagline called, "Doctors defining eyecare." It was much less about consolidation as the savior of the profession, but consolidations happened in a lot of industries, and it hasn't necessarily and usually been all that great for the profession. That's the reality. I'm not talking about optometry. I'm talking about all kinds of healthcare disciplines where in the United States and abroad, everything is being consolidated.
There's more capital on the sidelines than there's ever been in history, and health is seen as a safe haven and a great opportunity to deploy that capital. It was less about saving optometry because we knew there would be consolidators and competitors, but we had an opportunity to drive our destiny. Capital and money are important. By working together and making some compromises, we've been able to do things we wouldn't have been able to do on our own.
What would you say are some of the upsides and downsides of the consolidation? You mentioned that it's not always positive for the profession. What would be some of the negative things that you see potentially happening in optometry or in other industries?
The biggest negative is that people other than optometrists get in the exam room. Did they decide your hours? How many patients do you need to see? What procedures do we do or shouldn't be doing versus procedures that we shouldn't do? What's the feeling around investment in technology? Is that seen as an opportunity? Is it seen as simply standard of care, the right thing to do? Is it financial engineering methodology where if it makes financial sense, we do it, and if it doesn't make financial sense, we don't? Those are the big pros and cons. If the answer to the first part is yes, now we have more capital to invest in those things. Let's face it. It's costly to be state of the art in our industry.
If by getting together, all of those things are aided, then it's a great story. If, on the other hand, that money is not going back into the exam rooms and to technology, and it's about driving the behaviors of the optometrists, then you have some pretty significant negative potential. If we look at even South of the border, some of the optical entities where there are quotas for optometrists in terms of how many patients they have to see an hour, I don't see how that can be good for the profession.
Sometimes when you mix financial people and healthcare practitioners, there is misalignment. That's always the risk that's going to be out there. Whether it's a private equity, a corporation, or even another optical entity, those are the questions we have to ask. Is this helping the profession be better than it was on our own? Is it a way of financially engineering the business for the sake of maximizing profitability? Can it be good? Yes. Can it be bad? Yes, as well.
Would you say you've seen examples of that? You're mentioning down in the states, you've seen specific examples of that type of thing happening where that financial entity is dictating some of the things that are happening within the exam room and the way the doctors are practicing,
Ultimately there's a management team that executes. If it's a majority ownership situation, that management team is set to execute the vision and the strategy of the owners of the business. Sometimes that may misalign with what's best for the patient. I've seen all kinds of examples, and I'm not picking on private equity. There are some fantastic private equity roll-ups in healthcare, whether it is all about high-end clinical care doing the right thing.
It's those entities that have seen the value in that brand so that Mayo Clinic and Cleveland Clinic approach healthcare. We'll talk about money at some point a little bit more later. That can be a good story. Are they telling people in their marketing how important healthcare is versus the spray and pray marketing message of cheap eyewear and pretty people wearing glasses? It's all in the messaging, but there is an opportunity to be profitable and high quality. Give the best patient care. Let the doctor do their thing however they want to. There's value in that. Some investors see that, and some don't.
On that value side of things, it's creating the perception of value, at the very least, to the patient. If you have a patient looking to go to a service provider or an optometrist and want an eye exam, how does an optometrist, clinic, or brand create that perception of value? When a patient is selecting a clinic that they want to go to, how would they say, "This one looks like they're going to give me the best eye exam?" How do you think that we would do that?
If discussions about competition lessen, eye care in the Canadian market can become stronger, and developing better doctor training will be much easier.
First of all, it's understanding the consumer. One of the advantages of having a minority partner is they do a ton of market research. We've always done market research, but we've never done more than what we have. I have done a presentation or two on some of the results, and there's some brand new stuff that we got out of Canada. The reality is we need to understand the optical consumer. Out of the studies, we have very different mindsets of the optical consumer. McKinsey broke it down into 4 or 5 categories of consumers. Years ago, Luxottica did research on this as well. It's funny how the categories were pretty similar, with one exception.
If you indulge me, I'll jump into that. That will be a better framing for answering the question about what an optometrist does as an independent to win and survive in the marketplace. First of all, the independent can do well and has done well in markets where even over 50% is a value-driven market. The first thing the research showed us, similar to the Luxottica research of years ago, was they broke it down into four categories. That budget-conscious person who doesn't care about looks, fashion, and as much about eyecare wants the cheapest possible glasses. That's all that drives them. On the other extreme, you have the quality seeker who wants good quality eyecare and a good quality product.
Brands might be important or might not be important. If they are perceived as quality, that's the quality seeker. There's the doctor-loyal patient. That's about 30%. No matter what, they're going to buy from the optometrist and see that optometrist for all services. The other category that McKinsey identified is tied to some of the disruptions that are going on now. They call them the style seeker. This is a person that wants great fashion. They might want to own a couple of pairs, 3, 4, or 5 pairs of glasses even. They like how they look in eyewear but don't want to pay that much, so they're very value-driven. They've identified that it is about 16%, 17%, and 18% of the market.
The purely budget seeker is around 20%, even up to 25%. You've got these different competing segments with value and price being more important than what it was in the old days with the Luxottica study where they said 18% of people was budget price. They didn't have a style seeker component because, if we think about it, it probably didn't exist. We had value, but we didn't have the Warby Parkers. The Bone looks, the Bailey Nelson's, and the Oscar Wylee's that have this cool vibe appeal to the Millennial generation. It's not seen as poor quality. It's seen as good value. A lot of the research is showing that they are gaining traction as much as the story, where sometimes old people will try them, and they always come back. That's not what the data says.
We, as traditional optometrists, somehow aren't capturing that image for the new young consumers. When we go back to how optometrists succeed and do well in markets where over 50% are in the UK and Australia, there are not nearly as many independents. In the UK, the top three biggest chains make up 80% of the market. Look at the United States, where Vision Monday top 50 biggest optical entities. Years ago, if you added the top 50 together, it was about 24% of the market share. Now it's in the low 30%, so there is more consolidation, but North America is still very much dominated by independence, more in the United States where the numbers are in the low 60%. In Canada, it's 50%.
How do you win? Be mindful that you have to execute and invest in your practice. Give amazing service. A lot of these studies talked about loyalty as well. As you can imagine, style seekers and budget-conscious consumer is not loyal compared to optometrist loyal consumer who is loyal. Loyalty is driven more by emotional factors. That's the primary target. You look at other things like price, selection, technology, and all those things.
The one great thing in the Canadian market is that quality eyecare technology and knowledgeable staff are hugely important, more so than the same consumers in the United States. There's hope. Execute well, invest, and be conscious of styles. One thing that was shocking to me in these studies is the difference between that brand-consumer in eyewear and that they want to brand. Study after study both in Canada and in the US show that segment is shrinking dramatically to the extent where I've often felt like optometrists have felt like, "I got all the brands. I'm going to be safe."
That's less of a story, according to the research. Optometrists have to think about having an affordable offering for patients, especially in this world where there's going to be more noise. Like it or not, on TV, radio, and social media, there's going to be more about price. People don't necessarily want to buy inexpensive frames, but they want to know that they're getting good value and have a choice.
Execute, invest in technology, and make sure you're talking about what you're doing so that the patients understand the test you're doing because the category of expert is, in any industry, a huge term to own. Independent optometry has the ability to maybe not own the expert category but certainly be up there. In those markets where it is 80% chains, independents have done very well by sticking to what they're great at and doubling down on being a great doctor and having a great staff and great technology.
Market research is important. One of the things is that smaller clinics, independents, or the average, don't have access necessarily to that information. Not at their fingertips, at least. To be able to share it and let our colleagues know what types of consumers are out there is very important. Where do you think the price comes into all of that? Let's say I'm executing. I'm being an expert. I'm offering the latest technology, but a patient walks up and sees X number of dollars for an eye exam. Do you think that plays a role in their decision to come in?
It does play a role. The consumer research is very clear that price is important. If we look at the style seekers and the budget-conscious consumer and add those two together, we have something in the 40 percentile where the price is a big factor. Does that mean that they're avoiding the optometrists? It appears that nowadays, no entity has captured that. Eighty-five percent of those people seeking value are seeking it in multiple places. They've not identified a brand or banner that owns that. I do believe that will change and is changing. It will continue where you may have an entity that goes after that to own that. Can they own it from both a budget and a style be seen as both? That remains to be seen.
Independent Optometrist: An optometrist’s loyal consumer go to professionals they trust without thinking about the price of the product.
The opportunity for optometrists is to break the perception of being expensive. It's interesting in the market research for years. Despite FYi, we own our supply chain. We have a private label, two pairs, which are very inexpensive. People still saw us as expensive. We had to tell how we create both that high quality but not also the add-on expense expensive. There are ways to tell the story where you can say, "We can do that too, but here's where we thrive and excel. Here's the difference between a personalized lens and not, and why the measurements are so important."
It's a bit of work to tell that story, but it is a compelling story. If you can get the consumer to think that you're not expensive, that they can get value, but you have different products that others might not be offering, that's how you beat the story. Do people look at that, and if you don't give a different narrative, they're going to assume optometrists are expensive. The research is loud and clear forever on that. Even when in Ontario, where there was a fee for service, by far, optometrists were less expensive than competitive optical because of the fee-for-service model. People still thought they were expensive. It is very much a perception play for the consumer.
That part is more on the product, the glasses, that eyewear type of thing. How about on the service side? An eye exam costs X number of dollars in one clinic plus whatever in another clinic. If a consumer sees an eye exam at $80 versus seeing an eye exam at $150, do you think they perceive one to be better than the other? Do you think they'll say, "They're doing the exact same thing, but this other guy's charging me almost double?" Do you think there are other ways for us to display that?
If we look at the optometrist loyal consumer, which is about 30%, it probably doesn't matter much. They're going to go to optometrists they trust, and they're not thinking about the price. Those who don't have someone they're loyal to might ask questions about that and want to understand the difference. There's a segment of the population when things are less expensive, and that's a deterrent as well. They automatically assume that it's less value. To answer your question, up to 40%-ish of the population is going to be driven by that. Unless they're told otherwise, they're going to assume it's the same.
If the dollar value is material to them, they're going to pick the lower dollar value. The goal is to get a chance to tell them the story. In a lot of cases, we don't necessarily get that chance because they've already made the decision based on that price. If we're lucky enough that they phone and ask, then that's our opportunity to say, "Here's what's included in a comprehensive eye examination."
From your perspective, as an optometrist and an owner of an organization that's optometry first, how much do you think a high-quality, comprehensive eye exam should be in Canada? Give me an average number.
In FYidoctors, our doctors set their fees. I don't think anyone in our organization does it for under $100. Probably the norm is around $150 for a full comprehensive, which probably includes an OCT in that examination is typically what we would see out there.
I know that's an awkward question. Because it's awkward, that's a question we should ask each other. I know we can't exactly say, "This is how much you're supposed to charge." Here's some understanding of the value of the service that we provide. We go to school for these number of years. We get all this training and this expertise in this area. There's got to be some return on that to some degree. If we're offering that for free or at some discounted rate, we're not doing ourselves a service as individuals and as a profession as a whole. I am curious to get the feeling from others when I interview them to understand where they stand on that. I know some may not want to answer that question, so I appreciate you being open to it.
The reality is it's not a bad thing for an optometrist to make a decent income. They deserve it. It's seven years of school. It's not an income that's out of control with other professions. In fact, it's significantly inferior in some ways, for the most part. You will hear a noise out there about optometrists taking advantage of you. There are groups already telling that story to politicians and anyone who will hear the story like, "We're going to save the eyecare industry. People aren't getting their eyes checked off enough because of the expense of it. We have a study to show that." This is the thing that's going to be happening in the marketplace now and be set in a way that we've never experienced.
If you think we've been fighting to make sure that our services aren't devalued, and Ontario certainly is going through the wringer here, that messaging is going to be amplified in a massive way going forward. How do we know that? You look at what's happened in other markets and other areas. You learn about the conversations that are already happening. That's going to be the challenge. We're going to have to justify more why an exam should cost this amount of money.
In some of those markets, the cost of an eye exam starts at two for certain optometrists who went to that high tech and invested in their clinics. There are consumers that will pay that for value. It's just there is going to be potentially a larger group than there is now that's more price conscious because of how much noise is going to be made in the market. Let's face it. There's already been lots of noise about prices in the Canadian market going on for a long time, and we've weathered the storm. I do believe that's going to continue and continue to put pressure on our fees.
The eyecare industry has an opportunity to utilize technology to create a better experience for patients while keeping the importance of the doctor.
This is the message that I've been hoping to share with a lot of our colleagues. Not putting names on this. There's another low-cost budget player in the market. It's all good. The trouble is there are entities that have the ability to lobby in government or to go to insurance companies and show you don't need to be reimbursing this much for an eye exam and lowering our compensation, whether it's through our MSP or through what the third-party insurance providers are giving us.
That's where, in my opinion, some of the bigger concern is because that affects us broadly. It's not another competitor down the street. We're getting paid less overall. I'll step off my soap box. I don't know if you agree with that, Al. I feel like you did already say some of that. It's a matter of us all getting together to understand the importance of making our profession stronger.
You mentioned sharing the market research, and I'm happy to share the market research with anyone because it makes us all better and helps us understand. We've never looked at buying groups or independent optometrists as competitors. That's never been a philosophy of our organization. It comes down to what are the things that are important that competitors can agree on. What's important to the patient is the most important thing. It would be interesting if we talked less as competitors and tried to outdo each other on price and everything else, but how do we make eye care in the Canadian market stronger and better? How do we better train our doctors? What are the things that we should be doing from a scope of practice perspective?
There are lots of things that we can all agree on out there that are good for the patient, but our industry classically hasn't behaved that way. It's, "Our company's the best, and we're going to do it our way and not talk to anybody." Maybe those days are possibly changing now, but we have a very noble profession that cares for its patients and wants to do the right thing. We do tests and procedures that don't make any money because we want to look after patients. That's important to us. How do we make that better? How do we make that better for optometrists when it comes to doing those things? That is important.
How would you define a private practice versus a corporate one? How would you define those two things? Where would you say FYi generally falls into that? Is it its own separate category?
The word corporate optometry is funny. I've always been scratching my head on it. Most of us have professional corporations. I had five partners in my practice before FYi. It was a corporation that had five people under it. What is corporate? When you get to more than ten, is it corporate? What actually is it? I've always looked at corporate optometry as tax planning. There are partnerships. We have space-sharing arrangements in optometry through partnerships.
If there's going to be a definition of corporate versus not, it comes down to who's in control of the patient care experience. For us, it's always been critical that even though I'm an optometrist, if I dared to suggest somebody should see another patient that day or something like that or suggested how they could be more efficient in their examination process, that would be blasphemy. We have the biggest practice in Canada by volume. It's considered taboo in our organization.
I've coined the word independent optometry. Corporate optometry or controlled optometry where the doctor isn't in control sounds corny, but in FYi, I call it dependent optometry. We're dependent on each other, our size, and our scale. We wouldn't be able to do the things that we do without all working together. You make some compromises. In our organization, we have a board that's more financial and budgets and that thing. The group that decides what happens in our organization is our advisory committee, which is anywhere from 14 to 18 optometrists where, "What are the things that we can do together? Why do we want to do that? What's the advantage of doing it?"
From a day-to-day operational perspective, it's those doctors that are weighing in on what we do and what we don't do. Management not from a patient care perspective, but from an operations perspective, we'll have all ideas. That's our sounding board and decision-making board to say, "We make a case for why this makes sense to do it." It's doctors that decide if we're doing it or not. They're speaking on behalf of the other doctors in the organization. When I look at, "Are you big? Are you small? Are you a corporate or not?" it's more around governance, "What's the governance of the organization? How are decisions made with respect to the practice of optometry, the operation of the organization, to investments that the company makes?" To me, that's what defines the difference.
As independents, you get to do whatever the heck you want. The disadvantage is pricing, and it's getting harder and harder to run a practice. Let's face it. I didn't have to worry about online reputation management, digital marketing, Google reviews, and all these things back when I practiced. Now, these are all things that are an extra burden to the optometrist. By making some compromises and doing some things the same, I won't call it standardization, but maybe that's as good a word as any. We do have some standardization on backend systems, even electronic medical records.
By standardizing, you can automate. That's a lot of what we're trying to do. It is to create the systems, automation, and investments that enable the doctor to execute patient care and feel proud of their practice. They still think of it as their practice. They're making the decisions around. We support HR, but they pick who they want to work with. They pick the hours they want to do, pick the procedures they want to do, but they have support in a whole bunch of areas that they wouldn't have as independent. Corny or not, it's dependent optometry within FYi.
Independent Optometrist: Automated systems and investments allow optometrists to execute patient care flawlessly and feel proud of their practice.
The concern with the word corporate, or at least the interpretation of it, is a top-down structure where essentially all of the mandates come from above, and that's what everybody has to follow the marching orders. At least that used to be the way it is. Now, perhaps there are versions of it or evolution of that.
There is a top-down. Look at the new world of business. The goal is to be flat or that word servant leadership or stewardship. If you have a team that thinks that way, that's very different from a traditional hierarchical organization where the decisions are made top-down, and management is like, "This is what we want to do, and go make it happen." That exists in all industries. That exists in ours. The hierarchical institution is still alive and strong, but all of the best management gurus are how you create a servant leadership culture where we don't use the word head office. We use the word home office.
We have a patient pathway, which is something we have worked on for years. Here's the ideal patient experience. It's every touch point in the whole journey we've defined and have a training program on. We also have a home office pathway because of the people in the lab and Calgary that aren't in clinics. What's our pathway? How do we create that great experience for our doctors and their staff? We have that spelled out, and it's a training program that has to be renewed every eighteen months. We have a job to do in supporting the clinics and having them see the value. The big question to ask anybody in any of these settings and that I would challenge new doctors people thinking of selling your practice or whatever is ask what's it like. I'm always shocked by how people will sign contracts without asking questions.
We give a list of all of our doctors. "Do you want to see what it's like in FYi? Phone anyone you want. I'm sure somebody and they're going to tell you the good, the bad, whether it was a good decision or not." We don't do that. That's the best way for a person to figure it out. Ask those hard questions of any organization. For new entrants, what's it like? How do optometrists work in those other settings? There are lots of answers out there. We just have to ask the right people the right questions.
If there's any overarching theme here other than supporting our profession and making sure it stays strong is asking questions, that's something that we're going to get to. When we talk about new grads and students and that type of thing, asking questions is something we don't do enough of. It's something that I'm getting better at because I have a show, and I need to ask questions, but we don't ask enough questions.
We're uncomfortable. We don't want to make the other person uncomfortable. We don't want to look bad or whatever it might be, or we don't want to look stupid because maybe there's a stupid question, but there are no stupid questions. Whatever endeavor you're embarking on, whether buying a business, selling a business, or a new grad, you need to ask the questions. Don't be afraid to make someone uncomfortable by asking the right questions.
Speaking of an uncomfortable question, here's another one. You mentioned FYi owns a supply chain, and I know there have been some pretty significant acquisitions over the last little while. If I'm not mistaken, there was a frame line or manufacturer. For somebody who's not part of FYi, how do you think that is perceived? Is that perceived as you as the new Luxottica Essilor in Canada? How should people see that?
We're doing deals, and we'll continue to do deals. We're well capitalized. A quote I use in about all of my presentations is, "The only way to predict the future is to have the power to shape it." We will continue to be bold in our actions. When FYi first started, we were the evil empire, a bunch of old guys that we're going to sell out and cash out. Many years later, what have we done to the market? Have we gone to predatory advertising? Have we ever spoken poorly about independent practice? Have we not supported the school? We're making acquisitions, but we're also making the Waterloo Institute happen by giving them millions of dollars. We are doing the same thing in the School of Montreal in terms of the innovation lab.
We are using technology and investing in that to train better students. You did ask what are some of the things that we've done. We supported the schools unlike no other organization out there. What have we done in the profession? We have OCTs in all of our locations. We will have wide-field imaging in all locations by the end of 2022. We're investing in protocols. We build the dry eye protocols. We built a turnkey operation. We often see in private practice where we buy a machine, and we don't know how to implement it to make it work for the patient and train our staff. We're investing in all of those things, like dry myopia control protocols. We're getting stronger.
There's no question we're growing, but is that good for the profession or bad for the profession? Since we've done marketing and market research, we are trying to tell the story about how important patient care is. We're telling our database. We're talking about things that others aren't talking about. I believe that we've elevated the quality of eyecare in Canada by making these aggressive investments and that others are doing the same because that's now becoming the standard of care.
Sure, we're growing. No, we're not quite as big as Luxottica Essilor. We're a tiny little mouse compared to the size of that organization, but we will do smart things to benefit our practices and make us more competitive. To be able to afford technology, the economics sometimes isn't there from what you're able to charge the patients to be able to continue to do that because we've made other smarter investments.
Money will play a major role in the evolution of optometry, whether money is taken out to profit takers or reinvested.
I honestly don't believe that it's been to the negative of the profession. It's the opposite. Have we supported independents? Will we continue to support independents? I'll be honest. In the early days of FYi, we would have regular meetings with the two of the big buying groups. I tried to say, "Here's an opportunity for us to truly do something together." We offered the buying groups to have ownership in our laboratory, which was fledgling at that point in time. It was not in the interests of the buying groups at that point in time to do anything with FYi or with each other. I like to think there's still hope that we can talk about the things that matter. We've created an organization that can be very helpful to independents if they have an open mindset to it.
You touched on it a little bit in there. As far as supporting the schools, there are only two Canadian schools for anybody who's reading from outside Canada. There's Waterloo, the English-speaking school in Montreal. The University of Montreal, the French-speaking. I imagine that will change at some point in the future. A cynical person might say that these contributions, as significant as they are, may not be entirely altruistic. The presence that FYi will have in the schools will lead to the potential of these students choosing that as their career path. How would you respond to that?
Is it the driving force for why we're doing it? No. Has it made a bit of a difference with respect to some students thinking differently about FYi than they would? Probably, but we're talking $7 million to $8 million in pledges between the doctor's personal pledges, my personal pledge, and the company itself. The scale is, if you did the math on it, it's not very good math. There's a sense of pride in our organization about that. We were lucky enough to be able to get together for our AGM, which we typically do every year. We have the directors of the school stand up and be so thankful and recognize people getting out of their own pockets significant amounts of money because they believed in the profession that got them to where they were. They want to give back.
Do we get some people that join us because of it? Absolutely. That's great. I don't make any apologies for that. This is about giving back and doing the right thing. That is the primary reason that all the individuals and the company itself had given. If you think I didn't have to do some convincing at the board level to spend that money, that would be an understatement even to the advisory committee. We did it because we care about the profession. The innovation labs we funded in Montreal and Waterloo were game-changers in the education of optometrists in Canada.
Staying on the note of the students and new grads, I've never seen in my career the demand that doctors are in now, especially new grads coming out of school. Some organizations, including yours, are offering various incentives for these new grads to join, whether there are large sums of money, big salaries or signing bonuses, or whatever things that might be happening or forgivable loans.
Do you feel that these new grads are in an advantageous position, a position of leverage and power? Are they perhaps being taken advantage of because they're in debt? I heard the amount of debt students are in these days is incredible. On this one, I'm going to give you my personal opinion now. It potentially can blind or obscure the path that a new grad takes and perhaps gets tied to a mode of practice that is not in the long-term beneficial, maybe for the individual or the profession as a whole.
We launched our incentive, but sadly that's what the market is becoming. There is going to be more competition. There is more competition, and dollars are going to be thrown around. Dollars are important. A lot of people coming out how they practice is also pretty important. For us, we didn't want to be ruled out because of an incentive. We frankly are in a position where we can do that. We have the capability. I feel bad about it because most independent optometrists aren't going to be in that same position, or it will be a bigger stretch for them to be able to do that. I do feel bad about that.
Having said that, I also feel bad about more commercial entities where the control of the doctor isn't in question, grabbing up new graduates. It comes down to asking the right questions. To all new grads, ask the hard questions of everyone. Validate the answers to those questions. Talk to people that have been in the situation.
Fortunately for them, there may be a financial tipping point. When all things are created equally, and there's a financial advantage, probably they're going to go to the financial advantage, but new graduates want to do the best they can for their patients. This is a wild new world for us in Canada. It's pretty new for us. It would be interesting to have this conversation a year from now when we have some data, and we can see the actual behaviors of the new optometrists. Is this making a difference? Where are they going? The answer to those questions is still unknown.
Speaking of thinking forward, imagine, if you haven't already, FYi develops a pair of glasses that lets you look into the future, Al. In the future, what do you see for optometry in Canada? Imagine an optometrist going to work. Assuming the optometrist is still doing the eye exams, what does their job look like?
With the sheer numbers, optometrists are probably going to do more delegation. It's an amazing profession. Those new graduates coming out, good for them. It's an amazing profession where you can make such a difference in people's lives. Technology is probably going to change some things. One thing we know is patients don't like the experience of booking an appointment, getting their eyes checked, or picking out glasses.
Independent Optometrist: The quality of eyecare in Canada has been elevated because of aggressive investments. This is becoming the standard of care.
It's a highly stressful experience that people generally don't like. We have an opportunity to utilize technology to create a better experience. Delegation is going to be important, whether that delegation is through staff or some remote technology. That's going to be a reality of our profession in the future, but that doesn't take away the importance of the doctor.
We have to think of ourselves more as healthcare providers than refractionists or test-doers. With limited numbers of optometrists, there is a supply and demand. It's either going to be we keep doing things the same way, and there's going to be more and more schools and graduates, or we find ways to be like, "How can we utilize technology to allow us to focus on what we're good at? What's important to the consumer that can't be replicated by another person or another technology?" The future is bright. It depends on a few things, such as who's playing and where the money goes. I hate to say it, but money is going to play a major role in the evolution of our profession.
Whether that money is taken out will have one negative role to profit takers, or if it's reinvested, that would have another outcome. You're going to probably have entities that do both, and that's going to be a big driver of the future. With the scope of practice, other specialties, other treatments, not just the same eye exam we've been doing all these years, there's an evolution that's going to happen much quicker than what has happened over the years.
What advice would you give to someone staying on the student track here and considering going to optometry school? Not yet in optometry, but maybe someone considering optometry as one of their professions? Be brutally honest here. Would you encourage them to follow this path? What would you say to them? If you encourage them, what caveats or other disclaimers would you give them?
I love the profession, but we got some strange stuff going on now. I don't mean to end on a negative. We have an opportunity for people that come from other countries where they've been fresh out of school and done a three-year program in optometry and challenge examinations and have the same privileges and title as an optometrist who's taken a minimum of seven years of training.
That's a reality and a threat now. If I'm a young optometrist, I'd be pretty concerned about that if I'm a recent graduate or someone in Waterloo or Montreal, and I'm finding out people can be brought over from the UK or Australia on a three-year program. I don't know. To invest seven years and go into all that debt when in such an unfair situation.
I would get students to make a lot of noise about that. Maybe that's not the answer you were looking for, but it's probably one of the most unfair and scary things in our profession now. I'm hoping that the right thing will be done, and invariably in that arena, I'm not confident, but I'm hopeful. Having said that, assuming we continue to grow our scope, the opportunities are great, and our ability to help people and fix problems almost instantly in a lot of cases is unprecedented in healthcare.
It's a rewarding future. A lot's going to be determined by their decisions. What do you choose? Are you asking the right questions? What's important to you? That's the beauty of the people going in. They're going to be the ones shaping the future and having the power and ability to do that. That can be in a negative or a very positive way, depending on the stand they take, the questions they ask, and the choices they make.
I wasn't expecting anything specific. I appreciate the honest answer. If it's negative, it's negative, but at the end of the day, the point of this series of conversations is for us to be as candid and open as possible to understand where we are and where we're heading. If something needs to change, if we need to change course a little bit, the only way it's going to happen is if we are aware of it. Thanks for giving that answer versus some other sugarcoated potential answer you could have given. I'll give you a chance to take a minute if there's anything else you'd like to share regarding this particular topic, where we are, what we're doing in optometry and our profession in the country.
First of all, thanks for the invitation to speak my mind. I know I'm a big advocate of having hardcore conversations. I love it when people ask me tough questions because it shows courage and respect that they would do that. I very much appreciate the opportunity. We have to ask hard questions of each other. We need to be careful about the sugarcoating and the storytelling and trust our gut. Remember that if something sounds too good to be true, it usually is. We have some challenges ahead of us, and we need to have frank conversations. I applaud you for putting this together. I'm interested to see all of the episodes. Thanks for the opportunity to give my point of view.
Thank you so much for taking the time to come on. I'm excited to see how it all turns out for all these different perspectives that we're going to bring together here. If you're reading, don't forget to share this. Throw it up in your Instagram Stories, and share it on LinkedIn, wherever you can. Tell a friend. Let them know that we're having these hard conversations about the future of our profession, and make sure you stay tuned for the next episode. Thanks again. Take care.
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That's the first episode of The Future of Canadian Optometry Series presented by Aequus Pharma. I hope you found that as insightful as I did. There are so many things I took away from that conversation with Al that helped me change my perspective of where we are with optometry, where we're going, and some of the things that I'm going to need to think about. We should all be thinking about moving forward.
I hope you found it useful. I hope you share this with our colleagues across the country so we can all understand where we're heading and share these same insights that we all took away from reading this episode. Remember, there's going to be a new episode, a new interview that's part of the future of the Canadian Optometry Series presented by Aequus Pharma. I'll see you in the next episode. Take care.
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About Dr. Alan Ulsifer
Dr. Ulsifer graduated from the University of Waterloo as an optometrist in 1990, where he was acknowledged for several awards in clinical achievement, including the Ontario Association of Optometrists Award for Excellence in Patient Management.
After graduating, Dr. Ulsifer became one of the founders and the managing partner of Northern Vision Centre, which developed into one of Canada’s largest independent optometric practices. Dr. Ulsifer has also been involved at the executive level with various not for profit Boards including: Alberta Optometric Association, Rotary, Optometry Giving Sight, the Alberta Freestyle Ski Association and the Grande Prairie Chamber of Commerce.
In 2008, Dr. Ulsifer oversaw the creation of FYidoctors, which still stands as the largest business merger in Canadian history in terms of the number of companies involved. He was awarded the Ernst and Young Emerging Entrepreneur Award for Western Canada in 2008 and the Top Canadian Entrepreneur Award in 2012. Dr. Alan Ulsifer has served on many Boards over the years and has an ICD.d designation. He currently serves as CEO & Chair of the FYidoctors Board of Directors.