68 MMP | They're Living Rent-Free in Your Practice

Optometrists haven’t gotten a real raise in 20 to 30 years. Vision care plans are paying a fraction of what exams are worth — and the doctor is covering the overhead, the staff time, the insurance admin, and the billing. The plans cover none of it. They are, as Dr. Cary Herzberg puts it, living rent-free in your practice. Become a subscriber on our substack = full episodes + newsletter + bonus content: https://myopiamindset.substack.com/ This week, I sat down with my father — Dr. Cary Herzberg, 40+ years in specialty optometry, myopia management pioneer, and one of the people who has been trying to solve this problem since before most of us were paying attention — to have a conversation about the biggest threat facing the profession right now. We talk about why the burnout epidemic is structural, not personal. Why the best residents are doing the math and reconsidering. And what it actually looks like — practically, step by step — to build a specialty practice that doesn’t depend on being a human assembly line. This isn’t a theoretical conversation. Cary lived it. He dropped insurance, lost 80% of his patients overnight, and rebuilt around specialty care. What he found on the other side is what this episode is about. In this episode: — Why vision care plans made sense in 1985 and are a trap in 2025 — The 80/20 revelation: less than 20% of the practice was generating 80% of revenue — How to grow a specialty practice alongside your current patient base — without pulling the band-aid off — Why your specialty day has to be a sacred space (and what happens when it isn’t) — The future of optometry: board certification, OD-to-OD referrals, and the 50–100% scope expansion nobody’s talking about