Join host Bob Migliani in this insightful podcast episode as he interviews Dr. Benjamin Chudner, the Chief Medical Officer at AEG Vision. Dr. Chudner shares his journey from being an optometrist to his current role, offering valuable advice and perspectives for optometrists looking to sell their practices or explore career options. Discover how AEG Vision is shaping the future of optometry and empowering practitioners to elevate patient care through strategic planning and collaboration.
Join host Bob Migliani in this insightful podcast episode as he interviews Dr. Benjamin Chudner, the Chief Medical Officer at AEG Vision. Dr. Chudner shares his journey from being an optometrist to his current role, offering valuable advice and perspectives for optometrists looking to sell their practices or explore career options. Discover how AEG Vision is shaping the future of optometry and empowering practitioners to elevate patient care through strategic planning and collaboration.
Bob Miglani:
Hello, hello, hello, everyone. My name is Bob Migliani. Thank you and welcome to our podcast. Our interview today is with Dr. Benjamin Chudner. Dr. Chudner is the chief medical officer at AEG Vision, a private equity fund dedicated to the optometry market. Dr. Chudner, welcome. How are you?
Dr. Benjamin Chudner: Great. Thanks, Bob. Thanks for having me.
Bob Miglani: Of course, of course. So Dr. Chudner, for those who don't know you, please tell us a little bit about yourself and what you do.
Dr. Benjamin Chudner: Sure. So while I'm an optometrist, I'm currently the chief medical officer of AEG Vision, which puts me in responsible for all clinical strategy for the organization. So when we look to what type of optometric services we provide, my team develops the strategy for all of that. I manage all of our vendors and make sure that we're interacting with outside agencies in the right way, I guess. and making sure that we have access to all equipment necessary for doctors.
Bob Miglani: Wonderful. Thank you so much. So how did you get to this job? How do you get to where you are? Tell us a little bit about your journey. How did optometrists end up working with AEG Vision? And how's your journey? Tell us about your journey.
Dr. Benjamin Chudner: Yeah, it's really, I'll try to make it short. It's kind of a long story. But, you know, after I completed my residency at Baskin Palmer, you know, I thought I'm going to be this medical optometrist. That's what I want to be. And so I was able to find a job back in the West Coast. So I'm from the West Coast and I was able to find a job in Washington State working for an ODMD practice. did that for three years and then realized it's really not where I wanted to be and I wanted to be a practice owner. So I left that practice to buy my own practice in a town, a small town outside of Seattle, and did that for 10 years. And while I was there, I started consulting for a lot of companies, which I know a lot of doctors, I get asked all the time, how do I, you know, how do I get into that side of business? Mine happened accidentally. I was introduced to SevaVision at the time, through a group that I joined from the broker that helped facilitate the sale or the purchase of my practice. And I started lecturing for SEBA back then it was on dailies. We were doing a little bit of night and day, but it was mostly on their dailies. That led to lecturing with Bausch & Lomb and then with other, some pharmaceutical companies. I was doing Inspire for a while and also Allergan. Eventually Bausch & Lomb was happy with what I was doing and asked me to come inside. And so, Yeah, so it was kind of weird. I went inside for a hot second. I was going to sell my practice. And it was right when Bausch and Long went private. And that job was eliminated five weeks after I took it. So I went back to practice and did that for a little bit. But it's interesting, once you leave practice, which was a hard thing to do, your mindset changes. And I wasn't happy in practice anymore. And so about a year and a half later, I told Bausch I was ready to come back. in whatever role they had. And they did have a role for me. So sold my practice, moved from Washington to New York, where I was doing learning and development for B&L for a little while. Then eventually, when B&L was purchased by Value Pharmaceuticals, got into professional strategy, which was the original role that they had hired me for a couple of years before. Did that for a little while, and then actually got an opportunity to move to LensCrafters, where I was an eye care director. So I had eye care operations. Did that for a short period of time, about a year, year and a half. And then I was promoted to Luxottica on their center of excellence for their eye care team. And I was overseeing optometric engagement for all 2300 or so locations under the Luxottica banner in North America.
Bob Miglani: Wow.
Dr. Benjamin Chudner: Yeah. So I was doing that for a while and then eventually was The position came up as a medical director for AEG with the former head of LensCrafters, who is now the CEO at AEG. So I jumped ship. That was in July of 18. And then September of 2020, we created the chief medical officer role and I was promoted. So here I am. A long, long journey, but it got me here.
Bob Miglani: Hey, I hope you have all those business cards.
Dr. Benjamin Chudner: It's funny. I've seen people do that and I don't know that I do, but it would be interesting to watch that progression.
Bob Miglani: Yeah. I mean, I think, you know, people today, you know, stay in roles and then they're like, okay, what's next and how do I do that? And so your journey is actually pretty, pretty interesting. So thank you for, for sharing that with us. And it's really important for optometrists who are audience here today, to be able to know there's a side outside of just one dimension. I mean, yes, of course, owning a practice multidimensional, but there's more to that, to optometry than doing that day in, day out. So it's really.
Dr. Benjamin Chudner: And you have to be willing to take a risk. I mean, it was certainly a risk to sell my practice, moved to New York, you know, not knowing anyone here other than who I was going to work with. And then, Really, you have to be willing to accept opportunities as they come. Otherwise, it's tough to make those transitions.
Bob Miglani: Yeah. So let's talk about that for transitioning and selling to practice for a second here. Just your experience. So when did you decide to sell? How did you make that decision? Because practice owners today are also thinking about that. When do I do it? When's the right time? And so talk to us about your experience of when you decide to do it. And then how do you make that jump?
Dr. Benjamin Chudner: Yeah. So mine's a little unique to be fair. So when I sold was in 2011, there was really only one big, uh, acquirer of practices. And that was my doctor, uh, who had been founded, I think in, you know, one Oh two, and they were still on the East coast. Um, so, uh, but my decision to sell was based on, uh, an opportunity I got. It wasn't a retirement thing. I was young or young-ish. So in 2011, I was, I guess, 41. Um, and so my decision to sell was based on an opportunity to do something different with my career. Uh, and so it's a little bit different than what we're doing now. We're buying practices. Um, and so, um, you know, I had a plan and I, I think, I think that that is the one common thing you, whether you sell to an independent practice, independent, uh, doctor, or to a large private equity group or any other kind of group, some of the larger non-private equity groups, I think you ultimately have to have a plan as to what life looks like after selling your practice. Mine was different. I will tell you, though, and maybe it's not as true for people selling their practice, but staying in their office The hardest part for me was if I was no longer seeing patients or owning a practice, was I still an optometrist? So I don't know that other people have that same psychosis that I had, but once I got over the fact that I'm always an optometrist, I can always go back and see patients. The decision to sell is pretty easy, but I sold to a private doc who was looking to expand in the area.
Bob Miglani: Got it. Got it. All right. So talk to us about, you know, and I love the idea of, you know, this, this, this plan, because they, there's a lot of anxiety that optometrists have today. And so they think about, you know, private equity as dollars, checkbooks, right? And so, you know, and to hear, oh, there's a chief medical officer or like at AG, isn't it all about monies and dollars and cents? So walk us through kind of your role specifically and how, as a chief medical officer, you work with practice owners either before, during, or after. Talk to us a little bit about what you do.
Dr. Benjamin Chudner: Yeah, so let's take a look historically. So when I was the medical director, I was in charge of eye care operations. And the idea was for me to come on and not only be eye care operations, which is the day to day, how do you manage a practice? It's contracting doctors, recruiting and contracting doctors. It's managing the schedules. managing compensation and bonus programs and that sort of stuff. But then there was also this strategic component to it. How do we advance eye care? And really, those two things are hard to do together. And so what we did was we split out eye care operations and put that under our operations team. So I built a team with, at that time, four doctors underneath me that were senior eye care directors that were really there to help the doctors on the day-to-day stuff. That team was moved on to the operations team. We have a vice president, or actually, she's now senior vice president of eye care. And then I took over strategy. And the intent here was, we know what we're really good at. And we are really good at running practices from a general optometry point of view. So see a patient, sell them glasses. And where we saw the opportunity was how we're buying these specialty practices. We have one of the largest myopia management practices in the country. And in fact, as a whole group, we probably are the largest single myopia management practice in the country. We have the largest medically necessary scleral lens practice in the country. We have large vision therapy practices. And the people that were running the businesses don't necessarily know those that side of optometry. So it was important to to build a medical services team that understood simple things like how to bill and code for those things. But also, how do you expand that? How do you take what you learn from a practice in Illinois who's doing half a million dollars a year in myopia management minimum? and bring that to a practice in Pennsylvania that's never done it before. And so what we realized was we can only go so far by maximizing the revenue that comes from patients through selling glasses. We realized that we have to start to elevate the level of care that we provide and start building revenue on the professional services side for a bunch of reasons. The first and most important one to us is better patient care. We can't simply be a refract and refer entity because that's not good for patient care. And if it's not good for patient care, it's not good for us, our business model, because we want doctors to want to partner with us. And then secondly, it's better for business. I mean, at the end of the day, we are an ongoing business concern. But we realized from the outset that the key to success from a business standpoint is being successful on the patient standpoint. And so that's what my team has built. to help develop.
Bob Miglani: That's really important. If a doctor is thinking about selling to a private equity organization, A lot of them, I guess, they stick around, right? They stick around for some number of years.
Dr. Benjamin Chudner: They have to. They have to, right? They have to, right?
Bob Miglani: It's part of the requirement, yeah. Yeah, no, it's part of the contract. So then it's important for them to know that there are opportunities to grow, right? Is that what differentiates, I guess, AEG from other potential PE funds that might acquire?
Dr. Benjamin Chudner: I'd like to think so. I can't speak with a lot of knowledge on the other entities, only from what we hear. I think many of them say you can practice full scope, but really what we hear is that a lot of those entities are focusing really on the retail side. We believe that what differentiates us is we wanna take what made the practice successful and blend it with what makes our group successful. So back office systems, common platforms, and now what we're building is protocols for ocular surface disease management, myopia management, diabetic patients, glaucoma patients, so that we can provide tools for our doctors, again, to elevate patient care. And I'd like to think that's what separates us. And so what doctors have to, I mean, I talk about this when I lecture on it is usually there's three main reasons or motivations to sell. It's financial, professional, and personal. And what I found is the older a doctor is when they retire, financial becomes much more important, obviously, because it's a wealth management strategy. And younger doctors that sell, they care a lot more about the profession of optometry and their specific business and their employees. And it's not to say the older doctors don't care about their employees. But you have this ratio of what's important and financial usually rises to the top as someone's nearing retirement. And to be honest, I don't know that we pay the highest rate for practices. I think that there are other entities that may pay slightly more than us. But what I hear from our doctors, they choose us because it's not always about money. You only need so much. But really, what is the satisfaction you'll get practicing for us for two to three years after sale, because that is what we want the doctors to do, because it's good for patient care and continuity, but also where they want to see their practice go. And our intent is to take a very successful practice and take it to the next level in ways they can never do, because we can put capital and human resources against that growth that they may not have been able to do.
Bob Miglani: Yeah, no, that's very good. Important point, because we talk to practices all day long, you know, and, you know, there's about 140 practices that utilize hoot. And one of the reasons exactly to your point that a lot of doctors join is like, I'm just running my business here, I would love for somebody to kind of help me think put on that myopia hat. and help me execute on that or put on my, I've got all these patients whose kids are suffering from myopia and I just don't have the time if there was only somebody. So, and that's wonderful. And the same thing, and the second thing that I hear about, talk about as to your point is, this is ocular surface disease is so much more interesting to me, Bob. And I want to kind of do more of that. but how do I do it? How do I get into it? What do I have to do? What are the tools? Because I got to deal with, you know, paying Nancy at the front dash, somebody going to maternity leave, somebody's doing this at any other. So to your point, the variety is so important to optometrists today because they've been doing this, you know, primary care for so long. And they're like, I need like a, I need a way to kind of time out and reboot. And that's kind of a very interesting thing. So talk to us a little bit about how you see the future of optometry. What's your view of practices today and where they're headed? And from a recruiting perspective of new docs coming on board to patients, talk to us about a couple of things you see in the future.
Dr. Benjamin Chudner: So I think the, where doctors run into trouble is they always get the what and the why. So they know that myopia is a huge issue and we need to do something about it. We know that ocular surface disease is a huge issue. We need to do something about it. So they get all that. It is the how, it's exactly what you stated. do we start to do those sort of things? And how do I do it in my practice when I'm focusing on private primary care? And so one of the things that we're looking to do is we don't have to put myopia management in every practice. what initially, and we can build referral centers throughout our network. So a doctor can start to refer for certain things that they can't do in their practice. And as they build up a patient base that they're referring out, now they're big enough to have their own center. And if there's anything I see for the future of optometry is we need to do a better job working together. And, you know, as an example, when we recruit doctors, the number one question I get is, do you have an OCT at the practice? I can't practice without an OCT. You know, I graduated in 97, there were no OCTs. I can assure you this without an OCT. The question though is not can you practice because I think you can. The answer is should you? And the answer is no, you should not practice without an OCT, but it isn't that you need an OCT in your location. What you need is you need access to an OCT. And I have a lot of practices that don't have a large enough glaucoma population or macular degeneration population or any really retinal disease population to justify an OCT at the cost that they are for the reimbursement. I mean, if the reimbursement is horrible, but I can be sure to give access to an OCT to every one of my practices. Now, most of our practices, to be fair, have an OCT because we acquire them with that. But the reality is what I'd like to see optometry get better at is start to utilize their colleagues more. Do a lot of glaucoma management in my practice. Maybe I shouldn't manage all the glaucoma, but I certainly shouldn't be referring to a glaucoma specialist. And can I be doing the annual eye exams and maybe even the three month visits or four month visits to monitor pressure. But when I need an OCT or visual field, maybe I go and send it to a doctor who does more OCTs and is better in interpreting those. And I'm not to suggest that we shouldn't have OCTs everywhere, but in some practices that can't justify equipment like that, it doesn't make sense. So that's a harder example for people to get behind because everybody wants an OCT in a visual field. So let's extrapolate that to ocular surface disease. you can't afford to have devices like LipaFlow or IPL or radio frequency devices in all of our locations. So what we can start to do is build these referral centers in demographic areas, what we call DMAs. And so if I have a patient that needs an IPL, I can refer to that center. Now, for the record, I can go follow that patient. I can build a half day a month or a half day every other week, whatever it is. And I do nothing but IPLs at that location. But that way I can start to leverage the scale where we have access to devices without having to place these expensive devices in every location. And that's where I think the future of optometry is. I think this idea that a practice should do everything for every patient and especially try to do it on every day, is an old antiquated idea back when optometry couldn't do that much. And so we need to take advantage of networks of optometry. And I think that's where these consolidators have an advantage. And I get asked all the time, is private equity bad for optometry? And I don't have a crystal ball. I don't know what 10 or 20 years looks like, but in the short term, every one of the large consolidators has someone like me who is an optometrist leading these sorts of initiatives. And I think you can actually be very good for optometry because we can provide resources to practices that wouldn't normally have them to elevate the patient, the level of patient care.
Bob Miglani: Yeah, no, I think it's actually excellent. Excellent point. There is a, there is power in the network. And when you have a child with myopia that you're seeing, little Johnny comes in, he's got myopia and you're not set up for it. And you're like, and then the mom and dad go home with glasses, you know, it's gnawing at you. You're like, ah, I really should be in a myopia program. I don't do it. I know the expertise, blah, blah, blah, you know, et cetera, to educate and all that. But and then you don't refer out because you think you're going to lose them to a sale, the optical sale. The other doctor is going to keep them. And the other doctor is not reaching out to you because they're afraid to reach out, et cetera. So it's really you're 100 percent right. The patient outcomes are worse. in that case, right? So the child goes continues without myopia, and we're not doing our job as you know, and to give them the best care possible. And now your scenario is, you've got a referral center, I love the idea of a referral center, it's there is a power in networking here. And so you get a chance to do good. And also the revenues, in fact, stay within the system, right? That's kind of the point as well. So that's really powerful. And I think the more and more people realize that we have to refer out. And it's just, and also just, I guess the question is like, I guess then you just have on the backend, I mean, this is a technical thing, but on the backend, you have kind of a way to monetize the system. Oh, this person referred by this person. And then that credit, I suppose, goes back. So that's why that.
Dr. Benjamin Chudner: Yeah. That's tougher. We are working through that, but there's there's, you know, how much do you give for the referring doctor versus the one that's actually doing the treatment? But I will tell you, my ultimate goal, so let's take a doctor who's doing no myopia, they see little Johnny and they know that they need something. So they refer to one of their colleagues in their area that does it. My goal is, as that doctor starts to refer more and more, they start to build a myopia management practice, and then they're doing it in their practice. I think the end game for me is not to have, to limit what my doctors do, so in a hub and spoke model, It's not really to limit what my spokes do. It's to allow my spokes, so to speak, who are interested in myopia management, as an example, an opportunity to get involved in it without any major risk to the practice, because they could start to refer in work with that doctor, excuse me, that they're referring to. with the idea that if they want to build a myopia management practice in their own practice, they can. I would love to have three or four myopia management practices in one geographic area. I'll have as many as the doctors who are willing to do it. What I can't do is just say, okay, now you're in myopia management practice. Here's your axial length. here's your corneal topography. It's a lot of capital expense and they may not be able to build their business. But once they start to refer, build that business and have repeat customers coming in and they start to build it, I'm more than happy to spend capital to build out their myopia management business. And now they're one less referral source, which is fine. And maybe they're getting referrals from other network doctors. I mean, I think it gives you the best of both worlds. Those doctors who are interested in elevating the type of care that they can provide, and some doctors are very interested in myopia management, some are not. Some are very interested in ocular surface disease, some are not. And that's great. I think there's a space for all of them. But this type of model allows me to start to build a practice, a base of patients in that practice without risk to the business and gets the doctor the ability to start practicing at that level with support from their colleagues, eventually to a point where they can do it in their own practice and they're off.
Bob Miglani: Yeah, no, that's actually a great example of how to help people grow, just teaching them to fish, you know, that idea. So as we kind of wrap up with a couple more questions for Dr. Chodner, so day one, is this the kind of conversation that optometrists can expect when they join and they sell to an AEG vision? I mean, in the sense of like, when do we, you know, when did they get to talk to Dr. Chodner? Like, when is that going to happen? If you day one, you join, you know, you're part of a GeoVision, you know, when can they have these strategic kind of conversations with Dr. Chardon?
Dr. Benjamin Chudner: Yeah, day one is very anti-climatic. Literally, you get a check as a savvy. You get your check. And for your staff, their payroll comes from a different payroll company with a different name on the check. And then really, we have a saying, you have to go slow to go fast. There's a lot of emotion around and turmoil around an acquisition. There are employees that are uncomfortable. They don't know what it's going to be like. The doctors don't know what it's going to be like. You have selling doctors and associate doctors, associate doctors that thought they were going to buy in there or not. So there's a lot of emotion. There's a lot of turmoil. We want that to settle down. We want really everything to run smoothly for a while. So none of those conversations can happen until they start getting placed on our systems. So we have to put them on our common EHR and our common point of sale system, which gets them into our our network and our data warehouse, we have all access to information that's coming out of their practices. That can take 90 to 120 days. So we really want things to settle down before we go crazy. And the reality is, we have access to legacy systems, but it's not easy for us to do that. Certain people in our organization obviously have access. Our Treasury Department and our Corp Debt Integration Department all have access. But the day-to-day operators and the people on my team, we don't have access to legacy systems. So we won't even know what they're doing until their systems. So I would say it's a minimum of 120 days. And we really like to wait six months before we start having conversations because you want to get through all the hiccups that are inevitably going to happen with a transition into after acquisition.
Bob Miglani: Got it. Got it. Understood. Okay, great. No, that's very helpful. And actually, it's good to know and you recognize that there's that little bit of change management in the first several months. It's a lot of emotion, 100%. I think you said it right. I've worked in a lot of company, and whenever there's day one, there's a lot of chaos. And, you know, merging companies and organizations, it's very challenging. And so, all right, so let me ask you sort of the last question, I guess, is that, and actually, thank you for your time. I appreciate it. Just what, what is the advice you have for optometrists today, based on your career, you know, and your perch you're in right now? What would you say to somebody who's an optometrist running their own practice, They're thinking they're not like 65-ish, but maybe they're younger and they're thinking about selling, thinking about career options. What do you say to them? What do you say?
Dr. Benjamin Chudner: Yeah, I think the most important thing is to have a plan and have a roadmap. try to figure out where you want to be in five to 10 years and have a roadmap. And, you know, in full transparency, my original position at Baoshan Law was a director level positions, director of professional relations that I had for five weeks and then went back to my practice. When I came back, I was a senior manager. And when you go, even going from business owner to working for corporate. At first, there was a pay cut. And then when you go down another level, as you know, Bob, in corporate, it's about levels, right? It's titles. So senior manager was a significant decrease in income. Couple that with moving from Washington state with no state income tax to New York with one of the highest state income taxes. So I took a huge risk moving my family. My wife had to leave her job that she had in Washington state, had to work remotely. And that doesn't work out very well. But I had a plan. I knew that I wanted to get to some sort of position like this. And so without having that plan, you can't take advantage of opportunities as they come. So I think the most important thing is, if you're looking, so if you're retirement age, the plan's pretty simple. I'm going to retire, I'm going to work for a couple of years, or I'm going to sell, I'm going to work for a couple of years, and I'm going to retire. I think those that sell earlier, it's important to really have an idea of where you want to end up in the next five to 10 years. And I don't think that's unique advice, but if you have an idea of where you want to be, what you want your career to be, and then you can figure out that roadmap. And there may be bumps on the road, there's going to be setbacks, there certainly was for me. But if you have this vision of where you expect to be in a certain period of time, You just keep working towards that and you take opportunities as they come and pass on ones that don't follow with your plan. And I think that's the most important thing. The last thing, the most important, what I say, especially to younger doctors, is your first job is almost never going to be your last job. And where you think you want to be in optometry may not be where you end up. I always thought I was going to be a private practice doctor, never thought I would, I would leave the lane until other things were open up, opened up to me. So be open, be receptive to, you know, new thought, new ideas, new thoughts about what, what you can do with an optometry. And I think that, um, I love optometry has been great to me. I love this profession. I think, I think everyone has a role to play within this profession and you Some role may be just taking great care of patients and advancing the profession in that way. Others may be to move into industry and advance the profession from an outsider view in. Then roles like mine where we're directly shaping how private equity approaches optometric practices. My sole intent, Within this role, my soul but my, my, my greatest desire is to make sure that optometry is well represented that we always have a seat at the table, so that decisions are made with an optometrist involved, as opposed to boardroom members. And our company has been very good at making, I sit on the executive team, I report directly to CEO. AEG certainly understands the importance of optometry having a voice and how we approach acquiring practices and then running them. And I think that optometrists, I think all of us play a very important role, we just do it in different ways.
Bob Miglani: Yeah, no, thank you. I love the idea that you put forward here is that when you think about have a plan, and it might be setbacks back and forth. So life is never linear, right? There's always I mean, this is ups and downs left and right. It's very chaotic. But have the plan, have the vision of where you want to be and make those short term sacrifices. You know, and like you said, you might have to. I've done plenty of times taking pay cuts. And I think, you know, it's OK. It's it's suck it up. It's OK. Titles don't matter. It's the long term where you want to go. And it actually makes you better, faster, stronger when you get to eventually that point, because you've done the, or you've made the sacrifices, you've swept the floors, you've done all those kinds of things. And then you're like, okay, I can take it. I got this. And so I love, love the plan. I love life is not linear. I love what you guys are doing in AG vision, having the voice of optometry, which is the patient voice, right? It's the patient voice and having that in there. So with that, I will say, thank you, Dr. Chunder. for your time, your thoughtful engagement, and really some great advice for our community. I really appreciate you having you on this episode. Thank you so much.
Dr. Benjamin Chudner: No, my pleasure. Thank you. I really appreciate it. This is great.
Bob Miglani: Wonderful. Thank you.