20/20 MONEY: The Business of Optometry

Welcome to this episode of 20/20 Money! My guest on today's show is Greg Crabtree, CPA.

Greg is the author of two of my favorite books about running a business and using the numbers of your business to make informed decisions (Simple Numbers, Straight Talk, Big Profits and Simple Numbers 2.0: Rules for Smart Scaling). He's also the Partner in Charge in the Huntsville, AL office of Carr, Riggs, and Ingram and I was excited to chat with him about the concepts he talks about in his book. We talk about cash reserves in your business, the 4 forces on cash flow and the importance of starting with profitability, the lies that business owners tell themselves through their financials, why meal periods are important to him, and why the rolling 12 month financial report is so much more important than YTD.

As a reminder, you can get all the information discussed in today's conversation by visiting our website at integratedpwm.com and clicking on the Learning Center. While there, be sure to subscribe to our newsletter and you can also set up a 20-30min Triage conversation to learn a little bit more about how we help OD practice owners around the country reduce their tax bill, proactively manage cash flow, and make prudent investment decisions to help them live their best life on purpose or check out any number of additional free resources like our eBooks, blog posts, and on-demand webinars.

And with that introduction, I hope you enjoy my conversation with Greg Crabtree.

Have a podcast-related question? Contact our team here!

Resources:

• Books & Benchmarks' 2025 annual report

• Books & Benchmarks

• Book a Triage call with Adam

• Download the Practice Owner's Financial Toolkit

• 20/20 Money Ultimate Financial Success Masterclass

• OD Mastermind Interest Form

• Check out Adam's book: How to Buy an Optometry Practice

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Apple Podcasts

Spotify —————————————————————————————

For past episodes of 20/20 Money with full companion show notes, please check out our episode archive here!

Check out Adam's other podcast!

The Optometry Success Podcast

Subscribe on Apple Podcasts: https://bit.ly/4tttng6

Subscribe on Spotify: https://bit.ly/4tuf0YM

In this episode of 20/20 Money: The Business of Optometry, I'm joined by Nathan Hayes of Books & Benchmarks to go over their recently updated benchmarks analysis and unpack what the latest optometry practice data says about growth, overhead, and profitability. We discuss why a benchmark is a starting point, not a verdict on your practice, and why rising expense ratios may call for a closer look at revenue rather than an immediate round of cuts.

We also talk about the difference between profit and cash you can take home, how equipment purchases affect the balance sheet, and what your numbers may reveal about staffing, patient capacity, and collections. Nathan shares how he uses financial statements alongside an owner's account of what's happening in the practice to identify where attention is needed.

Have a podcast-related question? Contact our team here!

Resources:

• Books & Benchmarks' 2025 annual report

• Books & Benchmarks

• Book a Triage call with Adam

• Download the Practice Owner's Financial Toolkit

• 20/20 Money Ultimate Financial Success Masterclass

• OD Mastermind Interest Form

• Check out Adam's book: How to Buy an Optometry Practice

————————————————————————————— Please rate and subscribe to 20/20 Money on these platforms

Apple Podcasts

Spotify —————————————————————————————

For past episodes of 20/20 Money with full companion show notes, please check out our episode archive here!

Check out Adam's other podcast!

The Optometry Success Podcast

Subscribe on Apple Podcasts: https://bit.ly/4tttng6

Subscribe on Spotify: https://bit.ly/4tuf0YM

The most expensive professional service may not be the one with the highest price—it may be the one you mistakenly thought was a great deal.

In this episode of 20/20 Money: The Business of Optometry, I explore the familiar idea of "good, fast, and cheap: pick two" and applies it to the professional services optometric practice owners rely on every day.

It's easy to compare prices. It's much harder to compare value—especially when you're hiring an attorney, financial advisor, consultant, accountant, IT provider, or other professional precisely because they possess expertise you don't.

That's the paradox: the reason you need the professional may also be the reason you're not qualified to judge the quality of their work.

I discusses why dramatically lower pricing shouldn't automatically be viewed as either a red flag or a great deal, why practice owners should instead ask how the economics of the provider's business model work, and what may be exchanged for a lower price. He also shares practical ways to pressure-test professional advice without becoming an expert yourself, including asking what alternatives were considered, where a recommendation could go wrong, how work is reviewed, and when a second opinion may make sense.

Because price is what shows up on the invoice. Cost is what the decision ultimately takes out of your pocket—and your calendar.

NBS: Choose one high-consequence professional relationship in your personal or professional life and pressure-test it. Ask what alternatives were considered, what could cause the recommendation to fail, how the work is reviewed, and whether the stakes justify getting a second qualified set of eyes. You don't need to become the expert—you need to become a better buyer of expertise.

Resources:

• Book a Triage call with Adam

• Download the Practice Owner's Financial Toolkit

• 20/20 Money Ultimate Financial Success Masterclass

• OD Mastermind Interest Form

• Check out Adam's book: How to Buy an Optometry Practice

————————————————————————————— Please rate and subscribe to 20/20 Money on these platforms

Apple Podcasts

Spotify —————————————————————————————

For past episodes of 20/20 Money with full companion show notes, please check out our episode archive here!

Check out Adam's other podcast!

The Optometry Success Podcast

Subscribe on Apple Podcasts: https://bit.ly/4tttng6

Subscribe on Spotify: https://bit.ly/4tuf0YM

What does it really take to build and lead a successful multi-location optometry practice? In this episode of 20/20 Money, I'm joined by Dr. Andy Yaryan, Dr. Jeni Kohn, and Dr. Patrick Curran, three experienced practice owners who offer an honest look at what is happening beneath the surface of a growing practice. We discuss the challenges that remain even after achieving visible success, including rising expenses, staffing and culture, shrinking margins, associate recruitment, and the danger of becoming complacent.

We also explore how each owner evaluates investments in the practice, why the desired return is not always financial, and how priorities can shift from maximizing income to creating more time and freedom. Our conversation covers the metrics they watch most closely, from operating profit and staff costs to new-patient growth, retention, and revenue-cycle management, as well as the importance of building strong leaders, delegating effectively, and having difficult conversations before unresolved issues begin affecting the entire team.

Finally, Andy, Jeni, and Patrick share some of the lowest points in their ownership journeys and what helped them move forward. Their experiences are an important reminder that sustainable success rarely looks as effortless from the inside as it does from the outside, and that practice ownership requires continued learning, honest self-evaluation, and the willingness to keep working through difficult seasons.

Have a podcast-related question? Contact our team here!

Resources:

• Book a Triage call with Adam

• Download the Practice Owner's Financial Toolkit

• 20/20 Money Ultimate Financial Success Masterclass

• OD Mastermind Interest Form

• Check out Adam's book: How to Buy an Optometry Practice

• Yaryan Eye Care Center — Dr. Andy Yaryan

• Moses EyeCare Centers — Dr. Jeni Kohn

• Johnson Curran Optometry Centers — Dr. Patrick Curran

• The 7 Habits of Highly Effective People by Stephen R. Covey

• Multiplication by Subtraction by Shannon Waller and Jayne Stymiest

————————————————————————————— Please rate and subscribe to 20/20 Money on these platforms

Apple Podcasts

Spotify —————————————————————————————

For past episodes of 20/20 Money with full companion show notes, please check out our episode archive here!

Check out Adam's other podcast!

The Optometry Success Podcast

Subscribe on Apple Podcasts: https://bit.ly/4tttng6

Subscribe on Spotify: https://bit.ly/4tuf0YM

The most expensive mistake in your practice might be solving a problem you never proved existed.

Dr. Jen Stewart joins me back on the show for a conversation about making better decisions before writing the check. Inspired by Jim Collins' concept of "firing bullets, then cannonballs," we explore why practice owners should test assumptions, gather evidence, and understand what success actually looks like before committing significant money or resources to a decision.

One idea kept resurfacing throughout our conversation: more isn't better; better is better.

Before you hire another employee, buy another piece of equipment, or sign a lease on more space, ask yourself: What am I solving for? In service of what? At the cost of what? And perhaps most importantly: What would it take to get a better result with what I already have?

NBS (Next Best Step): Identify one "cannonball" you're currently considering in your practice. Before committing to it, write down the problem you believe it solves and identify one or two smaller, lower-cost experiments you can run to prove the problem—and the solution—before writing the check.

Have a podcast-related question? Contact our team here!

Resources:

• 20/20 Money: The Business of Optometry Episode: Optical Isn't Dead, but The Way You Are Running It Is with Dr. Jennifer Stewart

• 20/20 Money: The Business of Optometry Episode: Edging In-House vs Outsourcing: The Economics, Trade-Offs, and Data An Optometric Practice Needs to Measure with Drs. Jennifer Stewart, OD & Sam Hornberger, OD

• 20/20 Money: The Business of Optometry Episode: Why some dry eye practices thrive-and others quietly fail with Dr. Chris Wolfe

• 20/20 Money: The Business of Optometry Episode: Improving your practice by tracking the right KPIs (and ignoring the wrong ones) with Nathan Hayes

• 20/20 Money: The Business of Optometry Episode: Why focusing on "profit" in your optometry practice might not be the most effective owner metric to measure (and which ones you SHOULD focus on) with Nathan Hayes of Books & Benchmarks

• 20/20 Money: The Business of Optometry Episode: Making sense of your practice financials (profit/loss, balance sheet, and cash flow statement) with Nathan Hayes of IDOC

• Book a Triage call with Adam

• Download the Practice Owner's Financial Toolkit

• 20/20 Money Ultimate Financial Success Masterclass

• OD Mastermind Interest Form

• Check out Adam's new book: How to Buy an Optometry Practice

————————————————————————————— Please rate and subscribe to 20/20 Money on these platforms

Apple Podcasts

Spotify —————————————————————————————

For past episodes of 20/20 Money with full companion show notes, please check out our episode archive here!

Check out Adam's other podcast!

The Optometry Success Podcast

Subscribe on Apple Podcasts: https://bit.ly/4tttng6

Subscribe on Spotify: https://bit.ly/4tuf0YM

The investments you own may be perfectly reasonable—and still be completely wrong for you.

In this episode of 20/20 Money: The Business of Optometry, I'm joined again by Peter Lazaroff, Chief Investment Officer at Plancorp and author of The Perfect Portfolio: A Proven Guide to Smart Investing for Long-Term Success, for a conversation about what actually makes an investment portfolio "perfect."

We discuss why portfolio construction has to begin with the investor rather than the investments, why simplicity is valuable but shouldn't become an ideology, and how to evaluate whether added complexity is actually solving an important problem. Peter shares a four-question framework for evaluating new investments, explains the difference between owning an index and following an indexing philosophy, and walks through why rules-based investing can look very different from simply buying an S&P 500 fund or target-date fund.

We also revisit direct indexing and the role tax-loss harvesting can play for business owners, particularly those who may eventually realize a significant capital gain from the sale of their practice. From there, we explore stocks versus bonds, the different ways investors should think about risk, and why reducing short-term volatility can sometimes introduce a different kind of long-term risk.

Most importantly for optometric practice owners, we discuss why your investment portfolio cannot be evaluated in isolation. Your practice is an asset on your personal balance sheet. Its cash flow, value, concentration risk, liquidity, insurance needs, and eventual sale should all influence how you think about the rest of your wealth.

Peter's central point throughout the conversation is a useful one: there may not be a universally perfect portfolio, but there can be a portfolio that is appropriate for you, your goals, your behavior, and the entirety of your financial life.

NBS (Next Best Step): Look beyond your brokerage and retirement accounts and create a complete picture of your personal balance sheet. Include the value of your practice, cash, real estate, retirement accounts, taxable investments, and other meaningful assets. Then ask yourself whether those pieces are working together intentionally—or whether you've been making investment decisions one account at a time.

Have a podcast-related question? Contact our team here!

Resources:

• Book a Triage call with Adam

• Download the Practice Owner's Financial Toolkit

• 20/20 Money Ultimate Financial Success Masterclass

• OD Mastermind Interest Form

• Check out Adam's book: How to Buy an Optometry Practice

————————————————————————————— Please rate and subscribe to 20/20 Money on these platforms

Apple Podcasts

Spotify —————————————————————————————

For past episodes of 20/20 Money with full companion show notes, please check out our episode archive here!

Check out Adam's other podcast!

The Optometry Success Podcast

Subscribe on Apple Podcasts: https://bit.ly/4tttng6

Subscribe on Spotify: https://bit.ly/4tuf0YM

You may feel diversified while quietly becoming more dependent on the exact same sources of wealth.

In this episode of 20/20 Money: The Business of Optometry, I explore concentration risk from two angles that practice owners often don't connect: what's happening inside an investment portfolio and what's happening on their personal balance sheet as their practice becomes more valuable.

We start with the S&P 500. Because the index is market-cap weighted, the companies that perform best naturally become larger portions of the index. Today, the largest companies represent a significantly greater share of the S&P 500 than they have historically. That doesn't make the S&P 500 a bad investment, but it does challenge the idea that simply owning VOO means you've built a complete, diversified portfolio.

"VOO and chill" is an implementation strategy. It isn't an investment philosophy.

The same phenomenon can happen with a successful optometry practice. You may never intentionally decide to put the majority of your net worth into one business. You simply grow a great practice. But over time, your income, distributions, enterprise value, and perhaps even your real estate can all become dependent on the same economic engine.

Having a high net worth isn't necessarily the same thing as having diversified wealth.

The solution isn't to stop growing the practice or abandon the S&P 500. It's to broaden the sources of your wealth. That means consistently harvesting excess cash flow from the practice and investing it outside the business while building a portfolio that captures more than just one segment of the market.

We also discuss why this matters enormously when it comes time to sell your practice. The more financial independence you've created outside of the business, the less dependent you become on receiving a specific number or specific terms from the eventual sale—and the more optionality you have when navigating that transition.

The Next Best Step: look underneath both sides of your balance sheet. Ask yourself how diversified your investment portfolio really is, what percentage of your family's net worth depends on the success of your practice, and whether you're intentionally becoming more diversified over time—or simply becoming more concentrated in whatever has worked recently.

Have a podcast-related question? Contact our team here!

Resources:

• Podcast: Are you building wealth, or just feeding the machine

• Book a Triage call with Adam

• Download the Practice Owner's Financial Toolkit

• 20/20 Money Ultimate Financial Success Masterclass

• OD Mastermind Interest Form

• Check out Adam's book: How to Buy an Optometry Practice

————————————————————————————— Please rate and subscribe to 20/20 Money on these platforms

Apple Podcasts

Spotify —————————————————————————————

For past episodes of 20/20 Money with full companion show notes, please check out our episode archive here!

What if one of the most familiar parts of your optometry practice is also one of the things most overdue for a rethink?

This week's episode of 20/20 Money: The Business of Optometry is a little different. After a few updates on what's ahead for the podcast—including upcoming guests, a potential optometry-owner ski meetup at Copper Mountain before IDOC Connection 2027, and an opening in the OD Masterminds Founders Club—I'm sharing an episode from another project that some listeners may not yet have discovered: The Optometry Success Podcast.

The Optometry Success Podcast is the show I co-host with Dr. Chad Fleming, partner at Wichita Optometry. Each week, we combine my perspective from working with optometric practice owners across the country with Chad's boots-on-the-ground experience as a practicing OD, owner, and operator. The goal is simple: short, actionable conversations about ideas you can actually implement to build a more successful practice.

And today's conversation is a great example.

We tackle a deceptively simple question: Does an optometry practice even need a traditional front desk anymore?

As technology changes the way patients schedule, check in, communicate, complete paperwork, and interact with your team, it's worth questioning whether the front desk should continue functioning the way it always has—or whether those valuable team members and payroll dollars could be deployed differently.

This conversation is also timely because a follow-up to this discussion is coming Wednesday on The Optometry Success Podcast. If you enjoy today's episode, subscribe there as well so you can catch part two.

Have a podcast-related question? Contact our team here!

Calls to Action:

• Interested in the OD Ski Trip? Message us!!

• Learn more about OD Masterminds

• The Optometry Success Podcast

Resources:

• Book a Triage call with Adam

• Download the Practice Owner's Financial Toolkit

• 20/20 Money Ultimate Financial Success Masterclass

• OD Mastermind Interest Form

• Check out Adam's book: How to Buy an Optometry Practice

————————————————————————————— Please rate and subscribe to 20/20 Money on these platforms

Apple Podcasts

Spotify —————————————————————————————

For past episodes of 20/20 Money with full companion show notes, please check out our episode archive here!

If your practice has been using the same retirement plan for years simply because "it works," you may be leaving valuable planning opportunities on the table.

On this episode of 20/20 Money: The Business of Optometry, I'm joined by Jared Porter, co-founder of 401GO, for a practical conversation about how much the qualified retirement plan landscape has changed—and why optometric practice owners should periodically reevaluate whether their current plan still fits their business.

We discuss why SIMPLE IRAs may no longer be as "simple" or advantageous as many owners assume, how technology has reduced much of the administrative burden historically associated with 401(k) plans, and why payroll integration should be one of the most important considerations when evaluating a provider.

We also unpack some of the planning opportunities created by recent retirement-plan legislation, including startup and auto-enrollment tax credits, increased contribution opportunities, plan-design flexibility, and the ability to use profit-sharing contributions as part of a broader tax and cash-flow strategy.

Jared and I also dig into an increasingly popular strategy: the mega backdoor Roth.

While it can be valuable in the right circumstances, we explain why after-tax contributions aren't automatically available—or advantageous—for every practice owner and how required nondiscrimination testing can quickly change the math.

This episode isn't about convincing every practice owner that they need a 401(k). It's about understanding the options available today so you can make an educated and informed decision about whether your current retirement plan is still the right tool for your practice, your employees, and your own financial independence.

Some of the topics we cover include:

1. Why SIMPLE IRAs can become limiting as a practice grows

2. How modern 401(k)s differ from the plans many owners remember from years ago

3. Payroll integration and what "360-degree integration" actually means

4. Auto-enrollment requirements and recent retirement-plan legislation

5. Tax credits that may offset the cost of establishing and operating a plan

6. Matching versus safe-harbor non-elective contributions

7. Using profit sharing as part of a practice owner's tax strategy

8. Why plan design should begin with the end in mind

9. Roth 401(k)s, after-tax contributions, and the mega backdoor Roth

10. The testing requirements that can derail an after-tax contribution strategy

NBS (Next Best Step): Pull out the details of your current retirement plan and ask your advisor to evaluate it based on today's rules—not the assumptions that were true when the plan was originally established. Specifically, review your contribution limits, employer contribution structure, payroll integration, investment flexibility, administrative costs, available tax credits, and whether profit sharing could improve your overall tax and retirement strategy.

Have a podcast-related question? Contact our team here!

Resources:

401GO

Link: 5 reasons why I hate the SIMPLE IRA

Book a Triage call with Adam

Download the Practice Owner's Financial Toolkit

20/20 Money Ultimate Financial Success Masterclass

OD Mastermind Interest Form

Check out Adam's book: How to Buy an Optometry Practice

————————————————————————————— Please rate and subscribe to 20/20 Money on these platforms

Apple Podcasts

Spotify —————————————————————————————

For past episodes of 20/20 Money with full companion show notes, please check out our episode archive here!

Your next patient may already be looking for an optometrist—and choosing someone else before you ever know they existed.

On this episode of 20/20 Money: The Business of Optometry, I'm joined by Jeremy Bono, Director of Optometry Marketing Services at IDOC, for a wide-ranging conversation about what effective marketing actually looks like inside an optometry practice.

We start with a bigger question: does the public really understand what an optometrist does—and, more importantly, why they should regularly see one? From there, Jeremy and I explore why simply saying that you provide "exceptional eye care" isn't enough to differentiate a practice, how storytelling can make your marketing more memorable, and why practice owners need clarity around their ideal patient before deciding where to spend marketing dollars.

We then get much more tactical. Jeremy explains why Google Ads can be one of the fastest ways to generate new patient demand, how practice owners should think about marketing as an investment rather than simply another expense, and why measuring leads without tracking how many actually become patients can create a misleading picture of ROI.

We also discuss some of the seemingly small things that can quietly sabotage otherwise good marketing: making patients call instead of allowing online scheduling, forcing them to interact with your practice the way you prefer rather than the way they prefer, ignoring existing patients while constantly chasing new ones, and failing to maintain the digital presence that Google increasingly uses to determine which practices deserve visibility.

The larger lesson is that marketing isn't one campaign, one social post, or one advertising budget. It's the entire journey from someone discovering your practice to deciding you're the right place for them—and then making it incredibly easy for them to become a patient and stay one.

NBS: Set aside an hour this week and define your ideal patient avatar—your "IPA." Write down who they are, what they value, what problems they're trying to solve, how they search for care, and how they prefer to interact with a business. Then look at your current marketing through their eyes and identify one point of friction you can eliminate.

Have a podcast-related question? Contact our team here!

Resources:

IDOC Marketing Service

Book a Triage call with Adam

Download the Practice Owner's Financial Toolkit

20/20 Money Ultimate Financial Success Masterclass

OD Mastermind Interest Form

Check out Adam's book: How to Buy an Optometry Practice

————————————————————————————— Please rate and subscribe to 20/20 Money on these platforms

Apple Podcasts

Spotify —————————————————————————————

For past episodes of 20/20 Money with full companion show notes, please check out our episode archive here!