An Eye for Business

By Hannah Wallace October 31, 2006

Before he peers into the eye of an 82-year old woman in his Center for Sight operating room, David Shoemaker glances at the monitor, where a sticky note has the woman's name phonetically spelled in large letters. "He never wants to mispronounce a patient's name," says Nancy Cinnater, who's the Center for Sight's full-time medical "narrator."

Using a microphone, Cinnater explains each step of the cataract surgery to the woman's husband, who's in a viewing room behind Shoemaker, looking at an image of the patient's magnified eye. The procedure is videotaped and given to the patient to take home.

It takes about four minutes for Shoemaker to liquefy the cataract, suction it out and replace it with a foldable lens. One of his four assistants holds the woman's hand through the procedure, and when it's over, Shoemaker turns towards the viewing room and gives the thumbs-up sign before moving on to the next patient, who's prepped and ready to go in an adjacent operating room.

The glass separating the viewing room from the operating room becomes opaque at a flip of the switch to protect patients' privacy, an innovation Shoemaker said was inspired by a similar window he saw on a yacht 15 years ago.

Next to the operating rooms, two teams of four nurses and assistants work with patients in the pre- and post-op area, which has the pulse of an emergency room, only calmer.

"It's like a symphony," Shoemaker, 51 says. "Everybody has their role."

Such well-orchestrated precision enables Shoemaker to perform about 150 surgeries in a week, sometimes with as many as 40 in a day. His weekly total is about as many as a typical ophthalmologist may do in a year.

He started the viewing room and taping service 15 years ago, when he says patient trust in medicine was at an all-time low. "The idea was to re-establish trust," Shoemaker says. "It's important to involve patients and significant others in every aspect of care." He says that knowing family is there watching makes a patient more relaxed, and that makes for a better outcome. "You heal better," he says. "Everything we do plays into that."

It's not a conventional way to practice ophthalmology. But then there's not much about Shoemaker that is conventional.

20/20 marketing vision

The Sarasota doctor's eagerness to question accepted practices and adopt promising new ones has made him one of the leading ophthalmologists in the U.S.-and raised a few eyebrows along the way. And many of his innovations are in marketing and business growth. Indeed, unlike many doctors, who are notoriously known for lacking business acumen, Shoemaker has developed the business side of medicine as much as his surgery skills.

The Center for Sight has grown in 20 years to five offices with 170 employees who see about 65,000 patients each year. The Center's modern, $8 million Sarasota office near Sarasota Memorial Hospital includes a surgery center, an eye clinic and a retail optical store. Five vans transport patients who have no other way to get to the facility.

Patients can get eye exams, glasses, treatment for glaucoma and surgery all in the same building. They can also get Botox, a facelift or a hair transplant by one of the Center's plastic surgeons.

"It is very unusual," says Derek Preese, an ophthalmology practice management consultant who lives in Utah. Preese has worked with about 500 ophthalmology practices and says he can't think of any other that offer hair transplants and cosmetic surgery.

"Some specialties may include plastic surgery around the eyes, but that's usually where it ends," says Preese. "Most practices expand by adding more doctors in their specialties."

Shoemaker acknowledges that the services he's added are unusual, but he says that from his perspective, it just made sense.

"It sounds like it shouldn't, I know," says Shoemaker. "But after I do surgery, people are seeing better and the first words out of their mouth are 'what happened to me?' They remember themselves as 10 years younger."

Declining Medicare reimbursements made providing the additional elective services, which are not covered by insurance and are paid in full by the patient, a matter of survival, Shoemaker says. Preese says ophthalmologists have taken a particularly hard hit because most cataract patients are older and covered by Medicare.

That, coupled with technology to make cataract surgery routine, has pressured doctors to do more surgeries and to do them quicker. Although it may go against the grain of what most people consider "good medicine," Preese says, cataract surgery should be done quickly.

"One of the keys to good surgery is to not leave the eye open for long," Preese says. "There's no medical downside to doing it quickly as long as you do it well." Preese has watched Shoemaker's technique at conferences and says he's "one of the best."

"I don't know anybody who does 40 in a day," Preese says. "He could be one of the fastest and busiest in the country."

Shoemaker won't discuss revenue, but a cataract surgery runs about $3,600 to $4,600, which means that in an average week, the Center is billing $540,000 to $690,000 for that procedure alone

The keys to his success, Shoemaker says, are staying on top of the latest technology, bringing in top-notch doctors and being extremely organized.

Those are all lessons he learned as a child growing up in Miami. Shoemaker's father, William Shoemaker, was a dentist and innovator who applied the "Golden Proportion"-an artistic theory about how symmetry relates to beauty-to dentistry. He patented several dental devices before he died in 2000. Shoemaker says his father didn't profit from his inventions the way he should have. "He didn't care about business," he says ruefully. "It was perfecting his craft."

It was a mistake Shoemaker was determined not to make. Shoemaker says it never occurred to him to follow his dad into dentistry. As a child growing up in Miami in the 1960s, he was riveted by the Apollo space program. "I wanted to be an astronaut," he says.

His family supported his decision and took him to an orthopedic surgeon to predict his growth. (In the early days of the space program, you had to be small enough to fit in a space capsule.) The doctor told them David would grow to about six feet, three inches (about two inches taller than he turned out to be), and so Shoemaker had to cross "astronaut" off his career list.

He considered trial law until a friend of the family who was a judge took him to a Miami murder trial. Shoemaker didn't like what he saw and so, he says, he "pursued medicine by default." He attended medical school at University of South Florida and then came home to Miami, unsure where to practice. His parents handed him an AAA Trip Ticket with Sarasota as the destination.

"The map took me to Siesta Key, and that was my market research," Shoemaker says with a smile. After watching a sunset on the beach with his wife, he fell in love with the area.

Shoemaker started out with two established Venice ophthalmologists; then, after three years, he struck out on his own. "I was young and had all these ideas," he says. "I was at a different place in my career."

He established his first practice in Venice and soon added a surgery center. It was the mid-'80s and the accepted procedure for getting rid of cataracts was to cut a large incision in the eye, remove the cataract, put in a lens and then stitch it.

"It was very irritating" to the eye, Shoemaker explains. A revolutionary device had recently come on the market, making the stitches unnecessary. He learned how to use it and says he was one of three doctors in the United States to popularize the new, no-stitch method.

That set the precedent for his pursuit of new technologies. Today Shoemaker serves on a Food and Drug Administration panel to investigate new ophthalmic devices. He speaks at national and international ophthalmology conferences and patented the Shoemaker Intraocular Lens Forceps, an instrument used to replace lenses.

Being bold in medicine and in business hasn't always won Shoemaker friends. While billboards and television ads today hawk everything from anti-depressants to cardiac surgery, reputable doctors just didn't advertise 20 years ago. Shoemaker didn't let that stop him.

"Old-timers would say, 'What are you doing?'" Shoemaker recalls. "But I watched in Miami as fabulous surgeons sat around with nothing to do because incompetent ones were advertising."

That wasn't all that ruffled feathers in his profession. When Shoemaker decided to build a surgery center in Venice near the Venice hospital, he says other doctors saw it as a threat. "People stopped talking to my wife," he says. "And I didn't get invited to too many parties."

As the Center's surgeon, marketing guy, CEO and technology filter, Shoemaker worked 15-hour days, seven days a week. About four years ago, he brought in a partner, Bill Lahners, another leader in ophthalmology, to help him.

Lahners is now responsible for new technology and is the Lasik surgeon at Center for Sight. He is also a clinical assistant professor at the University of South Florida and on an FDA advisory committee.

Other specialties at the center, such as retinal surgery and hair implant surgery, evolved as the demand grew, Shoemaker says. "Patients don't want to go from one office to the next," he says. "It made sense to keep adding specialties."

Growth in sight

The Center for Sight opened regional offices in Englewood and North Port and on Osprey Avenue in Sarasota. Then, in 2000, it opened its 21,000-square-foot Center for Sight on South Tamiami Trail in Sarasota. That's now the only place where surgeries are performed.

"The focus of our practice is rejuvenation," says Shoemaker. "It's the feel-good place."

He's made these disparate services come together through his knack for marketing. The videotape memento patients take home begins with promos for the Center's other services. It's just one of Shoemaker's many marketing touches.

Shoemaker came up with marketing tag lines to tie his doctors to their services: There's Lasik by Lahners; Faces by Fezzy, Hairlines by Greco and Cataract Solutions by Shoemaker. They all operate under the Center for Sight umbrella, which despite the taglines, he admits has been a marketing challenge.

"It's confusing to have a face lift at the Center for Sight," Shoemaker says. "Eventually we'll have to do the Center for Skin Care and Cosmetic Surgery."

On the other hand, Shoemaker's reputation as a surgeon has helped bring in patients for the other specialties. "There's a trust factor that helps us in what would otherwise be confusing," he says.

A fit, attractive man who looks more like a college athlete than a 51-year-old doctor, Shoemaker recently added his photo to Center for Sight billboards around town. "Now people think they know me," says Shoemaker, who is divorced with two twentysomething children.

He jokes that the billboards haven't helped him get dates. "Do you see my phone ringing?" he says with a laugh.

Actually, Shoemaker's single status has brought him more attention than he'd like. After his divorce a few years ago, he threw a Playboy mansion-themed party at his Siesta Key house. The party attracted a socially prominent crowd, and Shoemaker appeared in photos in SARASOTA Magazine surrounded by scantily clad women.

"Do we have to talk about that?" Shoemaker asks. "It was probably one of the dumbest things I've done."

Shoemaker says it was a welcome-home party after his wife vacated the house they once shared and he moved back in. His friends said it should be a themed party; someone suggested the Playboy Mansion, and Shoemaker went with it. He invited the photographer, but when the photos appeared in the magazine, Shoemaker says he started getting flak.

"Who wants to think of their doctor as up partying all night?" Shoemaker says.

Shoemaker says he actually lives a quiet life, spending his spare time with his children: Kristine, 21, studies history at Tufts University in Massachusetts, and Austin, 23, is pursuing a Master's degree in computer science at Stanford University, where he also won a national rowing championship last year. Both are frequent visitors to Shoemaker's waterfront home, where their father enjoys sculling, flatfishing and his new passion, wine. He selects it, collects it and drinks some of it. It's done well as an investment, Shoemaker says. He declined to say what his inventory is worth.

"It's one of life's great pleasures," Shoemaker says. "You can drink it, sell it, it's all good."

Shoemaker's single status has also given him a perspective on the challenges of dating, and now he's planning to do something about that, too. He's launching Soulsearch, an Internet dating service, to cater to "high net-worth" singles. "It's been in start-up status for a long time," says Shoemaker, who won't say much else about the venture. "We're making progress."

Shoemaker says he may next open an office in Manatee County. He plans to continue adapting new technologies and looking for specialties to add.

"We're right in the middle of it all, and it's where I want to be," Shoemaker says.


Center for Sight statistics

Founded in 1986

5 offices in Sarasota

170 employees

6 medical doctors

7 optometrists

1 hair transplant specialist

1 licensed aesthetician

65,000 patients annually

120 cataract surgeries a week

Services outside ophthalmology: laser skin rejuvenation, facelifts, quick mini lifts, eyelid tucks, browlifts, Botox, facial implants, hair transplants, skin care, permanent cosmetics, mesotherapy 


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