[upbeat music] - Hello, I'm Nido Qubein.

Welcome to "Side By Side."

My guest today was told, "You can't do this, and it won't work."

That happened when she helped start a full service eyecare management company in 2001.

Her company now has a network of more than 800 local optometry practices in 27 states, and last year, her company saw more than 3 million patients.

Today we'll meet Sue Downes, the CEO of MyEyeDr.

- [Narrator] Funding for "Side by Side with Nido Qubein" is made possible by.

- [Narrator] We started small, just 30 people in a small town in Wisconsin.

75 years later, we employ more Americans than any other furniture brand.

But none of that would've been possible without you.

Ashley.

This is home.

- [Narrator] For 60 years, The Budd Group has been a company of excellence, providing facility services to customers, opportunities for employees, and support to our communities.

The Budd Group.

Great people, smart service.

- [Narrator] Coca-Cola Consolidated is honored to make and serve 300 brands and flavors locally thanks to our teammates.

We're Coca-Cola Consolidated, your local bottle.

[upbeat music] [upbeat music] - Sue Downes, I've been fascinated by your life story.

I mean, you had a sad incident in your life with your dad.

He had cancer.

And that got you going in the whole area, understanding insurance and benefits and all the rest.

And then you started a company.

And that company today has 800 practices across America, in 27 states.

It's called MyEyeDr.

What was that incident that caused you to have such drive and initiative to co-found this business?

- So I've always been in the optical optometry field, right, and had a passion for it, for many reasons.

You know, I think it's very diverse.

So it's not just healthcare and managed care, it's operations, it's retail.

I like variety, and it brings all of those.

But my dad, to go back, did have cancer.

He had a brain tumor, and we knew he was not gonna live long.

And I decided to take the time off to spend with him at the end of his life.

And I was very frustrated because it felt very insensitive that while my father was dealing with the end of his life, that more doctors were focused on, what is he eligible for?

How do we get him approved for this?

You know, at the end of his life, he wanted to actually go home.

He was at the Cleveland Clinic, and he wanted to go home to our small hometown to be with his family and friends.

And even getting an ambulance to transfer him was like an act of God, right?

And so I thought if I take my passion and love for optometry and helping people see better, and I make it so that vision insurance is simple and easy, right?

That when you come in, we can focus more about your eye health and your eye eyecare needs, and your insurance can be more automated.

One interesting fact about vision insurance is it works a little bit differently than our regular payers.

So regular payers, we have high deductibles, we have copayments.

We're always thinking, "Do I need that test?"

Vision insurance is really a prepaid benefit.

So you are paying for your vision care, your glasses and your contacts, out of every paycheck, and if you don't use it, no one gives you a refund check at the end of the year.

- I see.

- And so I wanted to be the experts.

I wanted to help people.

- So you started the company.

First, one store.

- One office.

- One office.

- One office, one patient.

- Where was the office?

- Burke, Virginia.

- In Virginia.

- Yep.

It was right after 9/11 had happened.

And then the sniper attacks had happened in the Washington, DC market too.

- And you opened up this office with one employee, two employees?

- Well, I actually worked clinical care every day.

I had one doctor and two other associates.

So yes, zero marketing dollars.

Spent all of our time.

I spent all my time going to every association meeting.

Anything I could to talk about MyEyeDr and eye care and get people in.

- And you called the first office MyEyeDr.

- [Sue] We did.

- And then how does one go from one office to 800 offices, from one state to 27 states?

- Well, I didn't plan it, to be honest with you, right?

You know, there's another co-founder.

We originally planned on having maybe 40 to 50 offices in the Washington, DC market.

Upon opening the first one, some of the doctors that previously worked with me, I've been in optical for 35 years, so have lots of relationships.

A few of the doctors started calling and saying, "I heard you're opening an office.

If you open near me, I'd love to join you."

And when I first partnered with that local community doctor, who loves providing care, but isn't the best at maybe hiring staff, dealing with managed care claims, you know, accounting, all those things, because we had access to their care and their patient database, it just started growing.

And within six months we had three offices, and we were returning more to the investors than they were making on the market at the time.

- And speaking of six months, something happened in your life six months into the founding of MyEyeDr.

- Yeah.

So MyEyeDr is a very personal journey.

And I don't know if it would be as successful as it is, first of all, if I didn't have all the great associates and doctors that I have.

Like, they make it, right?

But on opening my third office at that six months, my husband at the time, the father of my two children, committed suicide on the night of opening that office.

And so, you know, it took it from being a career into being a calling, long term.

In the beginning, it was truly just surviving.

I had taken everything I had and put into the company.

I had agreed to take a very low salary from the investors so that more of my compensation was put towards equity, right?

And I didn't have any family near me, so it was sink or swim.

- Wow.

- Yeah.

- It's a perfect story of from adversity can emerge abundance.

First of all, you are the American dream.

You are an entrepreneurial episode if one ever heard of one.

How does one find these investors?

How did you get people to invest in an idea that you had to start the first office?

- So they're all optometrists, right?

They're doctors.

And in fairness, we had a previous business.

The other co-founder did.

And so we had success on doing this, right, at a very small scale.

And so understanding where my strengths were and my position in the managed vision care industry and so forth, it was easy to get them to agree.

But in the beginning, I had a different percentage of ownership in every single office.

So you know the administrative challenges that would make.

Yeah.

- So now you have 800 offices.

You've moved your home from Washington, DC to the Tar Heel state.

You've now built a nice home in Raleigh, North Carolina.

And we're glad to have you down in North Carolina.

Let me ask you this: What is the biggest challenge that you face today in running an organization with 800 offices in 27 states?

- You know, that's probably the biggest question I get, what keeps me up at night.

It's the culture, right?

It's making sure that every associate, every doctor understands the purpose of MyEyeDr and helping patients really see and live their best lives and making sure that they communicate.

That we don't get an eye exam on a regular basis, right?

We should get an eye exam every 12 months.

And so coming to our office is a little bit like going to Disney, right?

And we want you to have an incredible experience.

We want you to be educated about it.

We want you to see your best.

And so keeping that culture alive so that our associates and doctors can execute that is my number one challenge.

- So when you say culture, do you mean being kind and nice and excellent service and caring about patients?

How do you define culture?

- All those things.

I think being experts in the eyecare industry, making sure that they're really educated on the solutions for our patients.

Being passionate about what they're doing, right?

Not just being a mechanical job of going through the process, but actually connecting with a customer, with a patient, and making them feel special being at MyEyeDr.

And feeling that it's not, you know, this eyecare has been a traditional service for many, many years.

Making it feel like it's more of a journey, we actually have something called My Vision Wellness Journey.

So making sure that we connect all of those spots of the visit together to make patients feel special.

- And as America ages and we have more needs, more healthcare needs, and so on, where does optometry comes into all of this?

Is it a growing field?

Is it a field that competes?

Who would be your competition?

Is it hospitals?

Is it other organization, other networks of optometry offices?

- Well, I think, just because I want us to be the best, that everybody's a competitor, right?

And we talk about that.

But really it's a growing need.

So there's less ophthalmologists in this country than there was.

There's less graduating.

So therefore and- - An ophthalmologist is a surgeon?

- Is a surgeon.

Yes.

So we are continuing to expand our scope of practice, and we are doing more services around eye infections and eye diseases to help patients.

And MyEyeDr really is positioned well to have the most credentialed doctors to do that.

- And optometrists can do those services.

- They can do a lot of services.

Yes.

Especially in North Carolina.

- And how is an optometrist certified?

- So they have eight years of education.

They have an undergrad, and then they go to four years of optometry school.

They do residencies as well, or internships, at different practices through their optometry school.

- How many optometry schools are there in the country?

- Oh, you're gonna catch me off guard.

I don't know that answer anyhow.

- Yeah.

And why isn't one in North Carolina?

- I think there's one coming in North Carolina.

- Yeah, maybe.

Yes.

- I heard a rumor.

Yeah.

- Yeah.

So I'm intrigued by the whole notion that you can run a network of offices in 27 states in a healthcare environment that is confusing to so many of us, you know, patients and regular citizens.

What is on the horizon for healthcare as you see it?

And what are some of the obstacles that patients ought to be aware of?

- Yeah, so, you know, when you talk specifically about our field, there are some growing concerns because of climate changes and because of the digital age that we're living in.

- You say climate change.

Are you talking about economic climate, or?

- No, I'm talking about climate change is seasonal, right?

We're experiencing allergies right now.

- Oh, I see.

- So people are having more dry eyes, right?

And if you haven't had dry eyes, it's a very uncomfortable experience, and it's lasting, right?

I personally have dry eyes myself.

I take drops every day.

I have different services to treat them, et cetera.

But more importantly, myopia management is a growing concern.

And by the- - Myopia.

What is myopia?

- That's nearsightedness.

So you would see people who have like, the thicker glasses, right?

And so that is because they're on, you know, you and I grew up, and we were outside more, right?

We weren't staying inside.

We weren't on a computer or a video game.

And today our children are more in that environment.

- Yeah, that's a big concern, is it not?

- [Sue] Correct.

- Hours and hours in elementary school and high school and college, at work.

Some people are literally in front of a computer eight hours a day.

- Correct.

And so what's happening is that myopia is growing at an alarming rate.

So children are having more severe myopia, more nearsightedness.

And what we're gonna see long term, they're saying by 2040 it'll be a global epidemic.

And what we will see is we'll see more retinal detachments, more macular degeneration, other eye diseases and conditions that will continue to grow.

So that links into a little bit of your question, right?

But I think, overall, you know, personally, I think our healthcare system needs to be cleaned up a little bit.

There needs to be more uniformity.

You mentioned we practice in 27 states.

Do you know that I have different licenses in every single state, right?

Doctors can do different things in every single state.

You know, we are very committed at MyEyeDr on compliance, and we spend an enormous amount of time and money on it.

But just making sure that we're current on everything, and that we can protect our patients the best, and really think about their future, is a key initiative for us.

- What happens to people who can't afford to go see an optometrist or ophthalmologist, or to even care about, you know, their eyes?

And how much education do we do in America vis-a-vis good healthcare about your eyesight?

- Yeah, so first I think there's a confusion about eyesight and eyecare.

I think that people think too much about, "I need a new prescription.

I can't see as well, so I need a new prescription for my glasses or contacts."

when, in fact, your eyes are this entry point of your overall health.

So we can detect things like heart disease, high blood pressure, right?

- You can study my eyes and know that that relates to heart disease and other issues.

- Correct, we can detect that you have other issues going on- - Really?

- not to mention cataracts, glaucoma, you know, things that preserve your vision, right?

I mean, imagine- - Like diabetes, for example, affects eyesight, right?

- Yes.

Correct.

Right.

I mean, imagine living your life without having your vision, right?

And then when you think...

Sorry, I lost, what was your second part of that question?

- Yeah, the whole education piece about, you know, are we educating.

- Oh, and about access to the care?

Yeah.

- Yes, yes.

Access and education.

- So hopefully people who can't afford eyecare are into our Medicaid, our state programs, right?

But that is becoming a growing compound problem as well, because one, people aren't educated to understand.

They don't have the information to know that they can participate in it.

Right now, through COVID, it was laxed in the re-enrollment, but starting April 1st, which is right around the corner, the Medicaid members in most states have to re-enroll.

And if they don't, they're not gonna be eligible for that.

So we're concerned that we're gonna see a drop-off in those.

The other thing is, you know, through COVID, a lot of doctors have a challenging time getting staff, paying wage labor.

And so what we've seen in a lot of communities is doctors not associated with MyEyeDr, they're not able to take Medicaid.

And so there's a lack of resources available for these patients to actually be seen.

- I'm interested in the way the business is structured.

So if you have an office, how big is an office size-wise, typically?

- Like, on a square footage size?

- Yes.

- It depends on the state really that you're in.

So in Washington, DC, my average footprint's around 1,600 square feet.

Where we're sitting in North Carolina, it's more like 4,500 square feet.

- Really?

- Yes.

- That's a big space, 4,500 square feet.

- Correct, but this is a state where we can do more services, right.

There's a need for it.

There's isn't as many ophthalmologists.

So in some of these rural areas, we're really being the triage, providing the eyecare services for our patients.

And there's a need, there's a demand.

- I see.

How do you know if an office is successful?

- Well, you know, we look overall first with the NPS scores, right?

Like, you've gotta provide great service.

Your patients have to be happy.

- What is an NPS?

What is that?

- Our net promoter score.

So how our patients evaluate us, right?

- I see.

Yeah.

- How they score us.

And we look at our online reviews.

That's the first metric for us, right?

- Whether or not your patients are happy with what you're doing.

- Correct.

Then we look at a lot of key metrics.

And we call them key patient indicators, right?

So how far out are we booked, right?

Are appointment books staying full?

What's the frequency of how our patients return?

- Like, a dentist books, you know, every six months.

You come back, and you clean your teeth, and so on.

What does MyEyeDr do?

Six months, a year, what?

- We want you to come back a year, but the dentist is a good example.

People are more compliant with getting their teeth clean than they are with getting their eyes checked.

And yet there's a solution if your teeth fall out, right?

But if you lose your sight, there is no solution.

And then we do look, obviously, at the financial success of the practice, right?

We need to make sure that we have profitability so that we can continue to invest in research, in our patient experience, our associate experience.

- Mm-hmm.

And you're growing at what rate per annum?

- So, you know, overall, if you look at our organic sales, we're growing on average about 4 to 6% per year.

- That's a lot.

- It's a lot.

- That's 40 or so offices.

- Yeah.

We grew a lot during COVID, right?

We started COVID with 575 offices, and we're sitting at almost 872 offices right now.

- Oh my.

- Right?

- And how many do you close in a year?

- Oh.

Well, typically we merge offices.

So a lot of times because we buy another optometrist or partner with another optometrist in the community, they might be close to another location.

- Like banks do with branches and so on.

- Right.

So then we evaluate the real estate.

Do we combine the two together and build a state-of-the-art facility, or do we use one of the centers, depending on capacity, to do it?

But we do have a few that we close every year, right?

- MyEyeDr is a private company?

- It is a private company.

- And what are your long-term plans?

- [laughs] Well, I'm not done yet, right?

I'm still young.

I love working, right?

I've been very blessed to have this amazing journey.

And so for me, as long as I have the continued team and the support of our investors, then I wanna continue this journey of helping people.

You know, I wanna accomplish two things: I wanna increase consumer awareness so people truly understand the importance of an eye exam, and I wanna protect the profession and help it continue to grow.

- And do we have enough of optometrists in America?

- No, no.

- And who suffers the most?

Rural areas like they do in almost every other healthcare?

- Yeah, I think COVID's added the complexity, right?

- Why?

How did COVID add the complexity?

- I think a lot of young people wanna live in more trendier areas, more populated areas.

They're not excited to go to where they grew up, right?

Whether it's Reedsville, North Carolina, or Eden, right?

- We're talking about optometrists now and other professionals.

- Yes.

So we have to continue to figure out how to get these new grads to go into these rural communities and set up a lifestyle for themselves.

- And what does MyEyeDr do to make that happen?

You're involved in the industry, obviously, and there are other companies out there who do optometry.

What are the one or two or three major concerns besides what you already told me, which is 27 states have different regulations, different standards, different certification elements, and so on?

Besides that, what is it that can disrupt the industry, moving forward?

- Well, I think we're getting, I think because there's a lack of education, there's things like online glasses or online contact lenses, right?

And so, you know, if you look at those, almost 50% of those online glasses are actually returned, because there is a technique of fitting them and measuring them and making sure that they actually fit you.

And so there's disruption like that.

- That's e-commerce we're talking about.

- That's e-commerce.

- Yeah.

You're not in e-commerce.

- Today we're not in it.

We will be continuing that journey.

We will be helping our contact lens patients with their subscription program this year, as well as patients.

So if you're in Chicago or DC today, and you lose your glasses, we'll be able to service you online- - Oh, I see.

Yes.

- if you're an existing patient of ours.

- I see.

Yes.

And so what else?

So disruption with e-commerce, that's true of so many different sectors in business and industry.

What else?

- Well, I think along the lines of e-commerce, there's also gonna be an online refraction, right?

So you can get a new prescription from your home, as the FDA continues to evaluate that.

But I think because there's a lack of education, that scares me.

It scares our group of optometrists, right?

Because it doesn't mean that you don't have glaucoma or cataracts or the beginning of macular degeneration.

Like, all that helps you do is give you an updated prescription.

And that's even subjective, right?

So, you know, we feel that getting it in the office right now is the best resource.

We feel that that technology can help continue to make sure you're seeing the best.

And so using it in the right way.

- But, you know, telemedicine now has grown remarkably, right?

You get on Zoom.

Again, it's a byproduct of COVID, I think, to a great extent.

People get on Zoom and talk to their doctor.

- Yep, so we do that, right, for follow-up visits in certain conditions.

We also do something that is a little bit different than telemedicine.

It's called teleoptometry, or we call it video-assisted eye exams.

So in some of these rural communities where we don't have a doctor, right, we have technology that you go into the office, and your doctor is virtual.

And you get a physician's assistant or a qualified tech.

- I see.

But you still have to have access to the equipment and the apparatus.

- You still have to have access.

Yeah, yeah.

But we're able to give you the same-quality eye exam in a remote environment.

- Yes, because as long as you have the machinery there, that, you know, someone who knows how to read it, I can see how that happens.

So Sue Downes, your life has been truly the American dream.

I mean, you've come along the way.

You've had adversity along the way with your dad's cancer, with your husband's death, and you continue to succeed and grow.

If we're talking to people who want to start a business or do something, what are the two or three pieces of advice you'd give an enterprising person who wants to also build the American dream in their own way?

- Yeah.

So I would say take risk, right?

- Calculated risks.

- Calculated risks.

Don't be afraid to make mistakes, right?

I made more mistakes than you can imagine.

And I learned more from those than from the few successes that I've had.

- Just don't repeat the same mistakes over and over and over.

- Yeah.

People, right?

It's all about people.

As much as I'm in the eyecare business, I'm in the people business.

So surrounding yourself with really good talent and making sure you take great care of your people.

And that goes back to the culture.

Making sure that they truly are connected to your purpose.

If it is just a job for them, I don't want them.

I want people who want a career, that they have the same owner mindset that I have, right?

So that would be a big part of it as well.

- Yeah, so communication, connecting, relational capital.

- And learning, right?

Like, when I first started the business, I didn't know anything about real estate.

I hadn't done an acquisition, right?

I hadn't done any M&A activity.

And while I hired great consultants and professionals to help me, I continued to learn about it.

I wanted to understand it, right?

I can read a P&L, you know, as well as my chief financial officer.

Like, I understand where there's issues in my business when I see them.

- Yeah.

School is never out for the pro.

- [Sue] No.

In fact, every person I've ever met who's successful in their endeavors, continually, they're on a journey of learning, discovery, expanding their horizons.

That's what it's all about.

And that's where the challenge lies, but that's also where the reward lies.

- And you can't wait for somebody to deliver it to you, right.

You have to invest in it yourself.

- Yes.

So how do you train and educate your associates?

- Well, I think that's an ongoing process, but really having an associate journey experience.

And we have a lot of work, to be honest, to continue to do that.

One of the things we do is really look at career journey and career planning.

So understanding how they develop within the organization.

And then we have an amazing talent acquisition, as well as a talent learning development team that really puts together, you know, great training programs to help, or to help our associates succeed.

- Select them right, train them and develop them, resource them.

Make sure they're learning, they're growing.

Make sure they understand the philosophy of the company and the care that they must give to patients, and all good things happen.

So thank you for being with me on "Side by Side."

It's fascinating to our viewers to always be exposed to people who had an idea, and in spite of all the difficulties, managed to climb the mountaintop.

You've done that.

Thank you for all your service.

And we're so glad you moved to North Carolina.

- Thank you, Nido.

[upbeat music] [upbeat music continues] - [Narrator] Funding for "Side by Side with Nido Qubein" is made possible by.

- [Narrator] We started small, just 30 people in a small town in Wisconsin.

75 years later, we employ more Americans than any other furniture brand.

But none of that would've been possible without you.

Ashley.

This is home.

- [Narrator] For 60 years, The Budd Group has been a company of excellence, providing facility services to customers, opportunities for employees, and support to our communities.

The Budd Group.

Great people, smart service.

- [Narrator] Coca-Cola Consolidated is honored to make and serve 300 brands and flavors locally thanks to our teammates.

We're Coca-Cola Consolidated, your local bottle.

[upbeat music]