Here’s a question Dr. Cary Herzberg wants every optometrist to ask in the mirror: if you dropped every vision care plan tomorrow, could your practice survive?
For most young ODs, the honest answer is no. Not because they aren’t great clinicians — optometry school made sure of that — but because, as Cary puts it, “they don’t teach you how to make a living.”
Cary has spent 50+ years in myopia management, pioneered modern ortho-k, and mentored countless successful specialty docs. Together we’re mapping out how the modern OD can take back control of how they practice and do business — starting with step one: becoming the decision maker.
What we cover
The squeeze on modern optometry. Vision plans dictating care, patients buying scripts online, private equity buying up practices with “no future,” and new grads saddled with debt who see private practice as a someday-maybe dream. The result: docs stuck in a McDonald’s-like model, seeing a patient every 10–15 minutes.
“But I’m just an associate.” You don’t need to own a practice to be the decision maker. Cary tells the story of Glenda, an OD practicing inside a Walmart who built a thriving independent-style practice — topographer and all — because she refused to be a yes person. If you increase what you bring to the table and management doesn’t notice, that tells you something too: it’s a dead end, and you should move on.
The salesperson problem. “I didn’t go to optometry school to become a salesperson” is the most common objection Cary and I hear. Our reframe: you’re not selling, you’re informing — and with the myopia epidemic, you have a duty to inform. Everybody sells, every day. The docs who make peace with that are the ones who thrive.
The screen time silver platter. Society is drowning in negativity about kids’ screen time — grades, mental health, loneliness — and yet almost nobody outside our circles is talking about what it does to their eyes. When you bring it up, you’re not selling anything; you’re standing up for parents who feel completely alone. Cary has had parents tear up in the chair over it.
The five steps to becoming the decision maker:
Redefine yourself — decide what kind of optometrist you’re going to be
Come to terms with selling (reframe it as informing)
Pick your specialty
Envision what it means for your patients — have a five-year plan for every one of them
Do your homework — bring the ROI case to whoever controls how you practice, fully prepared
What you get in return. Freedom to practice the way you always imagined. Peace of mind — a boat with a rudder instead of drifting with every wind. Practice growth built on loyal patients and referrals instead of plan-shoppers (”vision care patients aren’t really your patients — they’ll move along the day you drop the plan”). And ultimately, your life back: Cary built a patient base so loyal he could take a third of the year off to travel, and they waited for him.
As his mentor told him: “Become a legend.” Irreplaceable. The doc patients beg not to retire.
Chapters
00:00 — Intro: Dr. Cary Herzberg
01:12 — What “practice independence” actually means
02:31 — The forces squeezing optometry (insurance, online sales, the McDonald’s model)
04:34 — The litmus test: could you survive without vision plans?
06:07 — Debt, private equity, and the decline of private practice
08:51 — Becoming the decision maker: optometry’s biggest advantage
12:18 — “I’m just an associate”: the Glenda-at-Walmart story
19:00 — Bringing a prepared plan to whoever’s in charge
22:44 — “I didn’t go to optometry school to be a salesperson”
26:07 — Selling vs. informing
28:17 — A five-year plan for every patient
33:15 — The screen time silver platter
38:17 — The five steps, recapped
40:14 — How to actually find a mentor
43:39 — Advantage #1: Freedom
55:20 — Advantage #2: Peace of mind
1:00:14 — Contracts: price for the worst case, never nickel-and-dime
1:05:13 — Advantage #3: Practice growth — become a legend
1:08:41 — Advantage #4: Live the life you wanted
1:11:07 — How to reach Cary
Have a question for Cary or a topic you want us to tackle in this series?
If this resonated, share it with a colleague who’s feeling stuck in the system. That’s how this profession changes.
