DR. LARRY PATTERSON
Focus Through the Generations (FTTG) offers insight from four different generations of the nation's top ophthalmologists. Hear from the experts themselves on their varying life experiences in the industry.
Dr. Larry Patterson is the medical director of Eye Centers of Tennessee and a nationally known leader in the field of cataract and refractive surgery. Among many firsts, Dr. Patterson was the first physician in East Tennessee to perform Refractive Laser-Assisted Cataract Surgery (ReLACS).
hear from dr. larry patterson
Our host, Polly Neely had the pleasure of sitting down with Dr. Larry Patterson for an exclusive discussion regarding his life and industry experiences. Get to know Dr. Patterson a little deeper in this episode of “Focus Through the Generations”. Make sure to check out an episode featuring Dr. Larry Patterson’s son, Dr. Michael Patterson and get to know this father-son duo a little closer.
Polly Neely: Dr. Patterson, thanks for joining us this morning. This is Focus Through the Generations and what we're doing is, we're interviewing four actively practicing ophthalmologists in four generations. It's a unique time that we have four sets of generations that are actively practicing right now. We wanted to capture that time and get everyone's focus on what they think of their careers and what they've thought through what's happened in the last year and just their life in general. So if you'll just introduce yourself to us and tell us a little bit about you and your practice.
Dr. Larry Patterson: Sure. I'm Larry Patterson. I'm an ophthalmologist practicing here in Crossville, Tennessee. I've been here, this is now year 33. I grew up with a father who was a preacher who moved all over the country and ended up in West Tennessee. I went to medical school and residency and Memphis, and then moved here. This was my first practice, hung out my shingle and started it from scratch and grew to where it is today.
Polly Neely: And I was with you back not long after you hung out your shingle, I think.
Dr. Larry Patterson: Yeah, you were probably there close to five to 10 years into it.
Polly Neely: Your son, Michael was playing ball on a ball field. The last time I saw him.
Dr. Larry Patterson: You saw him in T-ball or something.
Polly Neely: Yes, and now he is in your practice as a doctor. We're going to interview him as well. That's so fun. While we're on that subject, what's it like having your son as a partner?
Dr. Larry Patterson: Everyone comes up to you and they go, it must be wonderful having your son as a partner. And it's like, there have been great moments, but man there've been some tough moments and Michael will tell you the same thing. Working with a family member is a totally different dynamic, and it just depends on the person you have. I know some cases where some fathers and daughters work together and it's the most sweet, loving relationship they have, and we're much more confrontational and aggressive, but it's been a very net positive overall.
Polly Neely: Yeah. It's a competitive world between father son teams. I've heard that from a lot of the father-son teams I know right now. I know we have one father daughter team and we're going to interview them as well. So, it'll be a different perspective to see what happens during that. I know overall it's great to have him with you. What do you think is the biggest problem facing our field today, our industry of ophthalmology?
Dr. Larry Patterson: So many things right now, honestly, we don't have near as many problems as people think. On the positive side, there's a limited number of ophthalmologists and far more people who are going to need our service. One of the biggest challenges we're facing is figuring out how to see all the people that need to be seen. I think there are some, probably the biggest problem would be optometric incursion into the surgical area. It was one thing for us to allow optometrists to do medical care and within certain parameters I think that's fine; but you have to draw a line in the sand with surgery. Otherwise there really becomes almost no difference, and there was no reason to go to medical school and residency in ophthalmology. I think that's something ophthalmologists really need to wake up to and be willing to spend their time and money to fight that. I think ophthalmologists, a lot of them, are caught in a catch 22. They know optometrists shouldn't be doing surgery, but on the other hand, they get referrals from optometrists. But if they're not careful they're going to find themselves getting bitten in the butt for not paying attention to what they're allowing to happen.
Polly Neely: I have to say I agree with you quite a bit on that one. And that will be a difficult thing because the referral base, the co-management piece. But the doctor is the doctor, you go to school for that. You learn what to do in those what if moments that you need to have.
Dr. Larry Patterson: We've encouraged people to do what we've done. Our model has been instead of having a massive referral base, just to create, purchase, and own the referral base. We have many different satellite locations that we own, the optometrists work for us. We do get some referrals outside, but the vast majority of our referrals are within our owned business, and that reduces so many other referral issues that people are having.
Polly Neely: Yes, because you can lose that really fast.
Dr. Larry Patterson: Yes, overnight.
Polly Neely: That's a great strategy. I like that. Who or what has influenced your life the most?
Dr. Larry Patterson: I'm always hearing stories, people get asked that question and there was always that one person, and I never had that one person. I had so many people, teachers, parents. Probably professionally though the person who influenced me the most was our administrator, a guy named Ray Mayes, who you've met, and Ray's ex-marine. They're just a different breed of people. I think before Ray came on; I had a practice. I had my small little practice. When Ray came, he started seeing it more as a business. That's not to demean the part we do as doctors but understand that growing it from just a practice into an actual business to where that if you do go away for a week on vacation, the thing just keeps chugging along. We do now have a business that has great worth, and we don't have any interest in selling to private equity, although we've been offered great sums for our business. We didn't have a practice, they're not interested in buying practices, they're looking for businesses. When we saw the value outside groups we're placing on our business, we realized we had truly achieved that, we had something of great value way beyond just a practice.
Polly Neely: I agree with you. As I watched Ray build that, I think he's pretty darn amazing. I remember the first time I met him, he’s a little scary, but really amazing.
Dr. Larry Patterson: Yeah, he's a large guy, he's tall, very muscular, the kind of guy that could bench press most of us, and he doesn't smile a lot and he's a fairly serious guy.
Polly Neely: He's really a sweetheart though. I've worked with him; I like him a lot. Let me ask you a question. What lesson have you learned from COVID in your practice that you will take forward with you post-COVID, if we ever achieve post-COVID?
Dr. Larry Patterson: Yes, and interestingly in Ophthalmology Management, this last issue, Ray actually wrote an editorial about that. One of the biggest things is just don't run so lean, have some cash on hand. Have a substantial amount of cash on hand. Maybe you have it invested, whatever you may have it, but make sure you have access to capital. Cash is one thing and also lines of credit, things like that, have stuff available because this sort of thing is going to happen again. It may not be COVID, but something's going to happen. We were fortunate to live in a state, Tennessee, that while they locked down surgery for about six weeks, elective surgery, they considered eye care an essential business because people need to see. We voluntarily shut down for about two and a half weeks and realized two and a half weeks into it this is a mistake. This is a bad idea. This is not helping anyone and so we reopened. We've certainly had our share of people in the office who've gotten COVID. I think the pandemic is real, I think it's serious, I think it needs to be given its due respect, but I think wholesale shutdowns of economies and businesses is a bad idea. I think we've hurt far more people doing that than had we just taken certain precautions and know that it's going to affect a certain number of people. We've lost people. People in our family have passed away, so we take it with all its due respect. But I think you just have to keep on keeping on. We did not do much Telehealth. I just am not a big fan of Telehealth. I know so many people that were calling glaucoma patients and getting a Telehealth fee for making sure they were taking their drops, but I don't know, that just doesn't seem to make any sense to me. We just pretty much kept on wearing masks. used certain precautions, lots of cleaning and that sort of thing, and just kept on going.
Polly Neely: I like that. I've talked to a lot of people who actually like Telehealth you either do, or you don't and there is an art to it to do it correctly and not just do it, but do it correctly.
Dr. Larry Patterson: Yes, you either have to do it or not. Where we've done Telehealth for example, we had already done this before this started, but we quit seeing cataract patients after surgery on the first day post-op. After many years of doing that, and I realize it's sort of the standard of care, but we realized we were not really gaining a lot for most people. I knew some other doctors had done that in the past for years. So, we just call the patient and make sure they're doing okay. We've had virtually no problems with that. We've been doing that for about three or four years now. We're beginning to do Telehealth for YAG capsulotomy post-ops, just calling people a week later or a few days later and say, how are you doing, is your vision better? If they're happy, I've never seen a more worthless visit than a YAG capsulotomy post-op visit. They are almost always seeing better, they're happy and if they're not, we'll have them come in. These are visits for which you're not getting reimbursed anyway. So it's just a matter of calling someone, making a note in the chart and we'll see you at your next visit. So, trial and error, we'll figure it out and we'll get a new standard of care as time goes on.
Polly Neely: We will, I agree. I have one last question for you. How have you seen the technology in ophthalmology transition since your career started and what do you foresee the technology becoming in the next 15 years?
Dr. Larry Patterson: You know, technology is a two-edged sword on one hand. It's really cool. I mean, I'm an anterior segment surgeon, but I don't know how we could do without OCT. In fact, any time a cataract post-op comes through and they're not seeing as well as they should, I don't know what we would do without the OCT. In fact, our tech just does an OCT, we won't charge for it, but if the OCT is normal, we know okay, they're not having cystoid macular edema. In our rural practices, we do a whole lot of retina injections, so for there, it's just a mainstay. On the flip side, it is getting where even in our small satellite practices where there's just an optometrist seeing routine eye exams, they kind of need an OCT too cause they’re seeing a lot of diabetic patients that may have retinopathy. The other side of the sword is these things are expensive. Some technology has gone down in press, but it's pretty easy to spend $65 to $70,000 for a new OCT, and for a small optometric practice that's really hard to recoup, you may never recoup it. So that's the problem, it's the cost and sometimes it's the space, we're constantly remodeling our office looking for new places to put stuff. You build a practice, or you build out a facility and you're just not really thinking about stuff that hasn't been invented yet. I mean, when I built this particular facility 18 or 19 years ago, nobody had an OCT, so all of a sudden you have technology that requires a room. We're realizing that over the next 10, 20, 30 years more OCT type things will come about, we just don't even know what they are yet, but they're going to happen. So that both cost and places to put it I think are the challenges over the next 15 years.
Polly Neely: That’s great, I agree. Are there any words of wisdom you want to give to the new generation, like Michael, coming up in this business?
Dr. Larry Patterson: We just hired a new ophthalmologist; his name is Andrew Johnson. In the last issue of Ophthalmology Management he wrote a really neat article that talked about that. I think if I was going to boil it down to one thing, be willing to work. I mean, if you want to get out of residency and just get a salary position for the rest of your life and show up for work and see the patients and then spend the rest of your time with your family and friends, that's fine, there's nothing wrong with that. But don't anticipate having those upper echelons of salary. If you want to have a really good salary, if you want to make what some of the top ophthalmologists are making; you're going to have to work. You're going to have to become a part of a business and eventually hopefully buy in and have some skin in the game even though you may not have to work quite as hard as the original guy did who built the practice. But as an example, in my practice, these are not words of wisdom to Michael, he just figured out on his own. He now works twice as hard as I do. I'm 61, I'm not planning on retiring, but I only work three days a week. I have a four-day weekend every week and that, by the way is my advice to older guys, slow down. I see people my age and older that are working five and a half to six days a week still.
Man, there are so many other things you can do in life, you don't have to just be an ophthalmologist. There are other really cool things, for me, it's flying. I got my pilot certificate about 12 years ago and I'm here in East Tennessee and just this weekend, I flew to see my folks and my sister in Dallas, I flew my own plane there. I fly all the time and just have so much fun doing that, but find what you like besides just ophthalmology, it'll make you a better person, it'll make you a happier person. I love ophthalmology, I love the practice, the patients, my staff, the surgery, but there's more to life than just ophthalmology.
Polly Neely: I agree. Thank you so much, Dr. Patterson for joining us today, and we look forward to talking with you again.
Dr. Larry Patterson: Thank you, Polly, it’s good to see you again.
Focus Through the Generations is supported by Bruder Healthcare Company.
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