The Business of a Clinic (BOAC)

In this episode of The Business of a Clinic, Sally speaks with Stephanie Romeo, practice manager of 740 Park Plastic Surgery, about growing from a front-desk role into practice leadership and maintaining personal service in Manhattan’s competitive aesthetics market.

Stephanie joined the practice at 21. Eighteen years later, she oversees the operations that keep it running alongside Dr. Stafford Broumand. She shares her progression from receptionist to patient coordinator to practice manager, and how each role deepened her understanding of the patient journey.

With one surgeon, one operating room, and a close-knit team, the practice depends on clear communication and continuity. Stephanie discusses the work behind an accredited in-office surgical suite, preparing patients for surgery, sharing knowledge across the team, and making sure someone knows what needs to happen next.

The conversation also explores how the practice has changed. Stephanie describes a shift from a strong reconstructive focus towards a mix of around 90% cosmetic and 10% insurance-based work. Adding an aesthetic nurse and nonsurgical services allowed patients to access more care in a setting they already trusted, while creating new questions about recruitment, skills, and cultural fit.

Sally and Stephanie discuss the balance between booking surgery and giving patients space to decide. Some people are ready after one consultation; others return two years later. Stephanie explains how she approaches price questions, potential dates, and follow-up without making patients feel pressured or overwhelmed.

Discretion is part of that process. A surgical quote can reveal a patient’s intended procedure, identity, and personal spending. They consider how to use gentle reminders and automated communication while remaining thoughtful about the sensitivity of the information being shared.

The discussion turns to Instagram, influencers, and before-and-after images. Stephanie explains why discovering a surgeon online should lead to a closer look at credentials, aesthetic preferences, and whether the patient feels heard during a consultation. They also explore expectations around recovery, including why being able to leave the house is different from feeling ready for work, social plans, or exercise.

Behind the personal service is a longstanding approach to reporting. Stephanie’s spreadsheet contains data going back to 2006. She tracks surgical and injectable activity, looks for changes in demand, and reviews performance with Dr. Broumand each month. Patient feedback adds another perspective, highlighting improvements that numbers alone might miss, from communication to an uncomfortable postoperative garment.

The episode closes with staff loyalty, onboarding, covering absences, and the possibility of expansion into Florida or another Manhattan location. Stephanie reflects on what growth would require and why a higher-volume aesthetics business would need a different operating model to the practice she manages today.

In this episode

• Joining the front desk at 21
• Progressing from receptionist to patient coordinator and practice manager
• Learning the patient journey through different roles
• Running a small practice with one surgeon and one operating room
• Sharing knowledge across a close-knit team
• Supporting an accredited in-office surgical suite
• Preparing patients and coordinating the steps before surgery
• Moving from reconstructive work towards cosmetic care
• Adding an aesthetic nurse and nonsurgical services
• Hiring for skills, judgement, and fit
• Referrals, returning patients, and long-term relationships
• Instagram, influencers, and how patients discover surgeons
• Looking beyond a social media profile
• Credentials, aesthetic preferences, and before-and-after galleries
• Clarifying what patients mean by downtime
• Handling the first inquiry and questions about price
• Giving patients time to decide about surgery
• Following up without creating pressure
• Holding potential dates within a limited surgical diary
• Gentle reminders, automated emails, and discretion
• Recognising the sensitive information within a surgical quote
• Deciding which new treatments to introduce
• Repeat appointments and patient reminders
• Tracking surgical and injectable activity
• Using NextGen, Excel, and monthly performance reviews
• Learning from patient feedback alongside the numbers
• Filler trends, patient education, and seasonal demand
• Staff loyalty, onboarding, and covering absences
• Considering Florida and satellite locations
• Competing with med spas while protecting personal service

Key idea

Stephanie’s experience shows how personal care depends on consistent work behind the scenes. Clear handovers, thoughtful follow-up, trusted staff, and regular reporting help the practice respond to patients without rushing their decisions. As the business considers growth, the challenge is preserving those relationships and the time patients need.

About the show

The Business of a Clinic explores how private healthcare clinics can grow by improving patient relationships, patient engagement, clinic operations, retention, follow-up, commercial systems, and the overall patient experience. 

Eight years ago, a conversation between Rhys Carter and England rugby player Jamie George in a Dubai bar turned into an idea: could they bring some of the healthcare experience available to elite athletes to everyday patients?

That idea became Carter & George.

Today, the group operates 20 clinics across the UK, employs more than 80 people and sees around 65,000 patients a year. Its next target is 50 sites by 2030. But Rhys's story is as much about what went wrong as what went right. 

In the early days, he remembers paying payroll and discovering he had only £70 left in the overdraft. Later, rapid growth outpaced the group's management infrastructure and cost the business good people.  

In this conversation with Jared Aron, Rhys explains what he has learned about scaling a healthcare business without losing the culture, people and patient experience that made it successful in the first place.

They get into the 300% growth of Carter & George's first acquisition, why talented physios need genuine career progression, the decision to remove receptionists from clinics and centralise patient support, why patient experience needs to remain consistent from Google search to post-treatment follow-up, where AI belongs in healthcare operations, and why retail, hospitality and veterinary groups may have more to teach MSK operators than other physio clinics do.

Rhys also shares the question now sitting behind Carter & George's next phase of growth: once you have the infrastructure to run 20 clinics, does going from 20 to 50 actually become easier than going from 10 to 12?

 In this episode of The Business of a Clinic, Jared speaks with Frederik Mueller, co-founder and CEO of Third Way Health, about building a healthcare business in a market captivated by AI, and why people remain central to his approach.

Third Way Health combines dedicated teams with technology to manage front-office operations, including patient calls, scheduling, referrals, prior authorizations, and document management. Frederik says the company handles around 15 million patient interactions a year across approximately 2,000 providers and 16 specialties.

The conversation explores the gap between answering a call and helping a patient. Frederik describes the operational work behind seemingly straightforward requests, from understanding a clinician’s booking preferences to keeping track of leave, cover, and changing instructions. Across Third Way’s providers, he says there are roughly 1,000 operational changes every week. Technology needs a reliable way to keep up with those changes.

Jared and Frederik also question how automation is measured. A call marked as resolved may leave the patient with another number to ring and the same problem to solve. Similarly, automating 20% of calls does not necessarily mean a practice needs 20% fewer staff. The remaining workload, staffing structure, and responsibilities still need to be understood.

Online booking offers another example. Frederik explains how unwritten rules and individual clinical preferences can make scheduling difficult to standardise, even when the software is available. He discusses the trust, clear processes, and ongoing maintenance needed to turn a technical capability into a service that works consistently.

Patient choice is another central theme. Some people want a quick digital interaction, while others need help with a complicated situation. Frederik reflects on the importance of preserving access to human support and how a poor automated experience can damage trust long after the technology itself improves.

The conversation also covers the staffing pressures behind the interest in automation. In Third Way Health’s survey of 200 healthcare executives, 86% said their organisations were not sustainably staffed. Frederik argues that automating part of the workload still leaves recruitment, training, and turnover to address. He shares how he stays focused on client results while competing with heavily funded companies promising AI-led alternatives.

Looking back, Frederik identifies an early assumption he had to reconsider: that improving healthcare administration was primarily a technology problem. Experience showed him how much depends on processes, clear responsibility, and keeping systems current. Jared and Frederik discuss underused software features, the work involved in maintaining integrations, and the need for a fallback when something stops working.

The episode closes with the choice between managing these operations internally and working with a specialist, followed by a comparison of UK and US healthcare. Drawing on experience in both markets, Frederik discusses payer complexity, fragmented technology, and approaches to innovation. He considers what each system could learn from the other about simpler administration and trying new ways of delivering care.

In this episode

• Building Third Way Health around people and technology
• Managing around 15 million patient interactions a year
• Supporting approximately 2,000 providers across 16 specialties
• Patient calls, scheduling, referrals, and prior authorizations
• Why healthcare administration problems recur across markets
• Clinician autonomy and the need for consistent operations
• Hidden booking rules and changing instructions
• Why online scheduling can be harder than it appears
• Keeping up with roughly 1,000 operational changes a week
• The difference between answering a call and helping a patient
• Questioning what a resolved call actually means
• Why fewer calls do not automatically mean fewer staff
• Understanding the workload left after automation
• Giving patients a choice of digital and human support
• The lasting effect of a poor patient experience
• Competing with heavily funded AI companies
• Staying focused on client results amid technology hype
• Third Way Health’s survey of healthcare staffing pressures
• Recruitment, training, and turnover after automation
• Learning that healthcare admin requires more than technology
• Assigning responsibility for processes and keeping them current
• Evaluating tools, integrations, and fallback plans
• Making better use of existing software
• Finding time to maintain what a practice implements
• Managing operations internally or choosing a specialist partner
• UK and US differences in payers and technology
• Simplifying administration and creating room for innovation

Key idea

Answering the phone is one step in a much larger patient journey. Frederik’s approach centres on combining technology with people who understand the work, clear processes, and ongoing updates. The measure of success is whether patients receive the help they need and the practice can deliver that service reliably.

About the show

The Business of a Clinic explores how private healthcare clinics can grow by improving patient relationships, patient engagement, clinic operations, retention, follow-up, commercial systems, and the overall patient experience. 

 In this episode of The Business of a Clinic, Jared from Coherent Healthcare speaks with Dr. Jeremy Krell, managing partner at Revere Partners, about building dental practices, backing healthcare technology, and helping clinic owners make better decisions about the tools they use.

Jeremy brings the perspective of a dentist, startup operator, and investor. After building, scaling, and exiting ten dental practices, he worked at Oscar Health, Quip, and Simplifeye before establishing Revere Partners to invest globally in dental-related software, fintech, and medical technology.

He recalls how investors repeatedly dismissed dental technology as too small or too specialised. Quip was viewed as a beauty product, while Simplifeye’s fundraising story centred on fintech. Those experiences helped shape his decision to build specialist investment support for an industry whose problems he understood firsthand.

The conversation moves from founders seeking investment to clinicians choosing software. Jeremy says an average private dental practice may use around 25 pieces of software, often without the time or resources to assess each one thoroughly. At Revere, he describes receiving more than 1,200 applications a year, tracking 120 structured data fields per company, and investing in no more than eight to ten companies annually.

For clinic owners, Jeremy recommends starting with the patient journey. From the first inquiry through to treatment, where are patients being lost, what does the schedule prioritise, and can the team see reliable performance data? His rocks, pebbles, sand, and water analogy explores how different procedures fit together and why a full appointment book does not necessarily mean the practice is operating efficiently.

Jared and Jeremy also examine how trust influences technology purchases. A recommendation from a friend or adoption by a large dental group does not establish whether a product will suit another clinic’s workflows. They discuss looking beyond the demo, understanding how a tool works, testing assumptions, and moving on when the fit is wrong.

On AI, Jeremy argues that effective adoption can give practices a competitive advantage, while emphasising human judgement, context, and repeated evaluation as the technology changes. He shares how his own fund uses AI while keeping people responsible for the process.

The discussion also covers rising staffing and operating costs, pressure on reimbursement, and the need to rethink practice finances. Jeremy explores automating routine work, connecting systems, and building a stable financial foundation as prevention becomes a larger part of dental care.

Asked to name his most important growth priority, Jeremy returns to the team. He argues for consistent associate training, helping clinicians become effective and productive, and tracking performance so an owner can step back while retaining visibility. Throughout the conversation, technology sits alongside the people, processes, and clinical work it needs to support.

In this episode

• Building, scaling, and exiting ten dental practices
• Moving from clinical practice into technology and investment
• Jeremy’s experience at Oscar Health, Quip, and Simplifeye
• Establishing Revere Partners
• Why investors dismissed dental technology as too niche
• Building specialist investment support for dental businesses
• Assessing more than 1,200 company applications a year
• Using structured data to evaluate investment opportunities
• The complexity of managing multiple software tools in a practice
• Starting technology decisions with the patient journey
• Finding gaps between inquiry and treatment
• Understanding what the appointment book prioritises
• Rocks, pebbles, sand, and water as a scheduling analogy
• Why a full schedule is not automatically an efficient one
• Looking beyond software demonstrations
• Testing recommendations against the clinic’s own workflows
• Why adoption by a large dental group does not prove fit
• Recognising a poor technology choice and moving on
• AI adoption and competitive advantage
• Keeping human judgement and context in the process
• Reassessing tools as their capabilities change
• Consolidation and changing practice ownership
• Rising costs and pressure on practice margins
• Automating routine tasks and refocusing staff on patients
• Connecting systems and improving access to performance data
• Rethinking finances as prevention becomes more prominent
• First-visit economics and hygiene revenue
• Building a stable base for growth
• Making associate training a priority
• Tracking performance so the owner can step back
• Keeping people central as technology develops

Key idea

Jeremy’s approach starts with understanding how the practice works: its patient journey, schedule, team, and finances. Technology decisions become more useful when owners can identify a specific problem, assess whether a tool fits, and measure what changes. His strongest growth priority remains developing the clinicians who deliver the care.

About the show

The Business of a Clinic explores how private healthcare clinics can grow by improving patient relationships, patient engagement, clinic operations, retention, follow-up, commercial systems, and the overall patient experience. 

In this episode of The Business of a Clinic, Sally from Coherent Healthcare speaks with her longtime chiropractor, Dr. Chris Anselmi, about building an independent practice, navigating financial pressure, and delivering the care he believes in as the economics of healthcare change.

Chris started his practice in 2000, gradually bringing together chiropractic, physical therapy, massage, and acupuncture. He shares how the team developed around complementary skills, alongside his own experience of learning to run a business while treating patients.

His career includes 15 years affiliated with the Hospital for Special Surgery and treating New York Knicks players. Chris recalls a year-long interview process, writing a scope-of-practice document for a role the hospital had not previously had, and learning alongside other musculoskeletal specialists. He reflects on how those relationships shaped his development and opened new opportunities.

The conversation also covers disruption. Chris experienced 9/11 early in his practice journey, then faced a different set of challenges during COVID. The clinic closed for almost eight weeks while financial obligations continued. He describes using relief loans and savings, reopening gradually, and rebuilding in a city where remote work had changed commuting patterns and patient demand.

A move to larger premises created an opportunity to sublet space, but keeping the clinical team busy required further decisions. After years of working primarily out of network or on a fee-for-service basis, Chris began accepting selected health insurance plans. He explains how that helped rebuild activity, but says low reimbursement and restrictions on covered services have since pushed the practice towards a volume model he does not want.

Sally and Chris discuss the risks of changing that model, including his consideration of a gradual move away from some insurance participation. They also explore rising patient acquisition costs and his decision to reduce Google Ads spending after more than a decade as competition made attracting patients increasingly expensive.

Patient relationships offer another area to examine. They distinguish general newsletters from personal check-ins about someone’s care and discuss how follow-up could help the practice understand why patients do not return. The conversation considers what happens after a care plan is presented, particularly when a patient declines or leaves without explaining their concerns.

Chris also shares how a seven-week programme and an immersive weekend in Chicago changed his approach to discussing money. He describes learning to explain the value of care through the activities patients want to regain and taking more responsibility for making fees and financial expectations clear.

On hiring, Chris recalls choosing to trust his own judgement despite a former employer’s warning about a candidate who became a longstanding team member. The episode closes with his experience researching and renting a SoftWave device before buying it, introducing a service outside insurance, and becoming more confident in explaining its price. He shares his own observations and patient experiences along the way.

In this episode

• Starting an independent practice in 2000
• Bringing chiropractic, physical therapy, massage, and acupuncture together
• Building a team with complementary clinical skills
• Joining the Hospital for Special Surgery
• A year-long interview process and defining a new role
• Learning alongside musculoskeletal specialists
• Treating New York Knicks players and other athletes
• Maintaining patient relationships over decades
• Early entrepreneurial experience through a landscaping business
• Experiencing 9/11 as a young practice owner
• Managing the many responsibilities of an early-stage clinic
• Moving to larger premises and subletting space
• Closing for almost eight weeks during COVID
• Relief loans, savings, and the cost of reopening
• Remote work and changes in the patient base
• Accepting selected insurance plans to rebuild demand
• Low reimbursement and pressure towards higher patient volume
• Considering a gradual change in insurance participation
• Trusting personal judgement when hiring
• Personality, teamwork, and finding the right people
• Learning to discuss value, benefits, and fees
• Connecting care plans to activities patients want to regain
• Taking responsibility for the financial conversation
• Reducing Google Ads spending as acquisition costs rise
• Personal follow-up versus general newsletters
• Understanding why patients do not return
• Responding when a patient declines a care plan
• Imaging and patient communication
• Researching and renting a SoftWave device before buying
• Introducing a paid service outside insurance
• First-visit pricing and explaining fees with confidence

Key idea

Chris’s practice is at a point where keeping the team busy and delivering his preferred model of care are becoming harder to reconcile. His experience explores how insurance participation, acquisition costs, patient follow-up, and clearer financial conversations all influence whether an independent clinic can sustain the care it wants to provide.

About the show

The Business of a Clinic explores how private healthcare clinics can grow by improving patient relationships, patient engagement, clinic operations, retention, follow-up, commercial systems, and the overall patient experience.

In this episode of The Business of a Clinic, Jared from Coherent Healthcare speaks with Charlie, co-founder of Generations Cryovault, about building an independent fertility storage business, challenging industry pricing, and making patient affordability part of the business model.

Charlie’s background spans technology, finance, and cord blood banking. He explains how that experience led him into fertility cryostorage, where preserving specimens goes hand in hand with carefully tracking their identity and custody.

The conversation explores the challenges of competing in a consolidating market. Charlie argues that independent providers can struggle to gain access while patients face limited practical choices. He describes how the emotional urgency of trying to have a baby can mean storage arrangements receive less attention than treatment decisions, even when those arrangements carry ongoing costs.

Jared challenges Charlie on the benefits of scale, including better equipment, service, and convenience. Charlie acknowledges that investment can improve the patient experience. Their discussion centres on how those efficiencies are used, who benefits, and where commercial incentives can conflict with affordability.

Charlie explains Generations Cryovault’s pricing promise: he says the company caps its margin at 15% and gives clients visibility into its costs through their portal. As the business grows, he expects fixed costs to be spread across more clients, creating the potential for lower prices. He also makes clear that rising costs can still lead to price increases.

Lower pricing brings its own challenge: helping patients understand that affordability does not automatically mean lower standards. Charlie discusses the company’s ISO 9001 certification, independent audits, security measures, and published disaster recovery and business continuity plan as ways to make its processes visible.

The conversation also examines the information patients need to make decisions about storage. Charlie describes people who understand their fertility treatment in detail but know much less about storing or transferring their specimens. He recounts helping a prospective client understand a transfer quote of more than $1,000, after which she negotiated a lower charge with her clinic.

Jared and Charlie explore how AI may influence those decisions. Charlie shares the example of a customer who used ChatGPT to choose a storage provider, alongside a discussion of at-home sperm collection and work supporting military personnel. They question whether the information available online helps patients understand what a service should cost or simply reflects what providers already charge.

Charlie also discusses the barriers he has encountered when approaching employer fertility-benefit programmes. He says Generations Cryovault has not yet been accepted into the programmes he has approached despite its lower-priced storage, while acknowledging that he does not know the mechanisms behind those decisions.

The episode closes with what Charlie wishes he had done differently. Rather than initially following the industry’s existing commercial model, he would have built around patient affordability from the beginning. His ambition is to show that an independent business can make a credible commitment to lower costs while maintaining the processes and service patients rely on.

In this episode

• Charlie’s journey through technology, finance, and cord blood banking
• Moving into fertility cryostorage
• Preserving specimens and tracking identity and custody
• Co-founding Generations Cryovault
• Competing as an independent provider in a consolidating market
• The benefits and trade-offs of scale in healthcare
• Investment, efficiency, and who receives the benefits
• Why fertility decisions carry particular emotional urgency
• The attention patients give to treatment versus storage
• Annual storage charges and Charlie’s estimates of underlying costs
• Transfer fees, contracts, and practical barriers to switching
• Generations Cryovault’s stated 15% margin cap
• Giving clients visibility into the company’s cost structure
• How growth could spread fixed costs and support lower prices
• Why a pricing promise does not rule out future increases
• Building confidence in a lower-priced service
• ISO 9001 certification, independent audits, and security
• Disaster recovery and business continuity planning
• Helping patients understand a transfer quote above $1,000
• The difference between access to information and useful context
• At-home sperm collection and support for military personnel
• A customer choosing a provider through ChatGPT
• What online information reveals about price and cost
• Patient vulnerability and commercial decisions
• Barriers to entering employer fertility-benefit programmes
• The operational work behind promises to patients
• Building affordability into a business from the beginning

Key idea

Charlie’s approach puts patient affordability into the company’s pricing promise and makes its costs and processes more visible. His story explores whether an independent provider can earn trust, compete with larger organisations, and pass the benefits of growth on to patients while sustaining the business.

About the show

The Business of a Clinic explores how private healthcare clinics can grow by improving patient relationships, patient engagement, clinic operations, retention, follow-up, commercial systems, and the overall patient experience.

In this episode of The Business of a Clinic, Jared, co-founder of Coherent Healthcare, speaks with Trevor Maurer about helping oral surgery practices grow by improving scheduling, answering more calls, and making the patient journey easier.

Trevor works with 54 surgeons across nine US states through OMS360. He shares his journey from small-town Saskatchewan and college football to healthcare sales, multi-site management, and supporting surgeons in running their practices.

The conversation starts with the patient’s experience. People arriving for oral surgery may be anxious, in pain, and trying to fit treatment around work and family. Trevor explains why excellent surgery can still be overshadowed by repeated forms, waiting, unanswered calls, or uncertainty about what happens next. Protecting the patient’s time, he argues, deserves the same attention as protecting the practice’s time.

Same-day surgery is one example. Trevor describes how preparation before the appointment can allow suitable patients to have a consultation and procedure in one visit. In the figures he shares, operatory time falls from around 100 minutes across two days to 58 minutes in a single visit. He also discusses a gap in follow-through: depending on the practice, up to 30% of patients who attend a consultation never return for surgery.

Jared and Trevor explore how AI can help practices respond without losing human connection. OMS360’s calls roll over to an AI service on the fifth ring, giving the team the first opportunity to answer. They discuss where automation can support communication, insurance verification, and efficiency, while preserving access to a person when patients need reassurance.

Referring dentists need that attention too. Trevor explains why clear notes, access to the surgeon, and confidence in the patient’s experience matter to referral relationships. He describes how referral development managers review shared cases and uncover concerns that might otherwise cause referrals to disappear without explanation. The conversation also covers surgeons calling after treatment, Google reviews, and why silence should not be mistaken for satisfaction.

When a practice asks for more patients, Trevor begins with the surgeon’s ideal day and the schedule needed to support it. He reports finding unanswered-call rates as high as 28–30%, with opportunities to improve through phone systems, staff training, and AI overflow. In the practices he describes, improving existing operations can provide two or three years of growth opportunities while referral marketing continues.

Trevor also shares the story of a surgeon who visited an established facility, reconsidered his approach to same-day surgery, and later reported doubling his productivity. He makes clear that clinical decisions remain with the surgeons, while teams can learn from how other practices organise care.

The episode closes with evaluating technology without overwhelming the people delivering treatment. Trevor discusses his test-and-learn background at Procter & Gamble, his preference for being a fast follower, and how Shore Capital Partners supports shared AI evaluation across its portfolio.

In this episode

• Trevor’s journey from Saskatchewan and college football to healthcare
• Supporting 54 surgeons across nine US states
• Why surgeons value direct answers and evidence
• Understanding patients who arrive anxious or in pain
• Protecting the patient’s time alongside the practice’s time
• Repeated forms, waiting, and unclear next steps
• Preparing suitable patients for same-day surgery
• Reducing repeat trips and time away from work
• Why some patients never return after a consultation
• Fear, pricing, and everyday barriers to treatment
• AI phone overflow on the fifth ring
• Preserving human reassurance when patients need it
• Automation, insurance verification, and communication
• What referring dentists need from an oral surgery practice
• Clear treatment notes and access to the surgeon
• Finding concerns before referrals disappear
• Referral development managers and shared case reviews
• Post-surgery calls, patient feedback, and Google reviews
• Why patient silence does not always mean satisfaction
• Starting with the surgeon’s ideal working day
• Building a consistent scheduling template
• Unanswered calls and patient demand already reaching the practice
• Understanding whether growth needs more demand or more capacity
• Improving operations while continuing referral marketing
• Learning from a surgeon’s reported productivity gains
• Maintaining clinical autonomy when introducing change
• Testing technology without distracting clinical teams
• Shared AI evaluation through Shore Capital Partners

Key idea

Growth can begin with the patients already trying to reach the practice. Trevor’s approach is to understand the schedule, answer incoming calls, strengthen referral relationships, and remove obstacles between consultation and treatment. Improving those everyday operations can create room for growth while making care more accessible and less disruptive for patients.

About the show

The Business of a Clinic explores how private healthcare clinics can grow by improving patient relationships, patient engagement, clinic operations, retention, follow-up, commercial systems, and the overall patient experience. 

In this episode of The Business of a Clinic, Sally from Coherent Healthcare speaks with Dr. Diane Madfes about growing a dermatology practice while protecting patient relationships, maintaining clinical standards, and learning to share responsibility across a team.

Recorded in New York, the conversation draws on Diane’s around 30 years in dermatology and her experience building Madfes Dermatology and Aesthetics Group across New York, Greenwich, and Florida. She started her practice hoping for more flexibility as a mother, but found herself on call around the clock.

What began with one doctor, an office manager, and a medical assistant grew into a team of six physicians and around 20 support staff. Diane discusses the work behind that growth: accommodating patients after hours, hiring, training, delegating, and learning to run a business alongside delivering care.

The need for more space became impossible to ignore when patients were being asked to wait in the park because the waiting room was too small. Later, looking to expand on Fifth Avenue, Diane knocked on a neighbour’s door to ask whether he might consider retiring sooner. Other locations followed changes in patients’ lives, with the Greenwich office responding to moves out of New York after 9/11 and a Florida satellite supporting patients spending winters there.

Sally and Diane explore how a growing practice keeps listening to patients. Diane describes emergency appointment slots, secret callers who test staff knowledge, and doctor huddles to review treatments. She also explains the months of training needed to prepare staff and why a person still answers the phone.

On AI, Diane sees opportunities to organise information and identify patterns, but highlights the importance of context. A patient mentioning an old infection is different from someone reporting a current problem. They discuss where technology can help and where human judgement, reassurance, and conversation remain essential.

The same questions apply to patient messaging. Reminders, review requests, and thank-you texts can become noise. Sally and Diane consider what makes communication useful, when a phone call is more appropriate, and how practices can uncover complaints or gaps in follow-up.

Diane also shares her experience helping launch Garnier skincare in the US and working on product formulation. The conversation covers changing ingredients, reformulations, and helping patients navigate a crowded skincare market. Women’s health is another central theme, including menopause training, her involvement with Women’s Health Access Matters, and the connections between skin, hair, hormones, and care across specialties.

When patients request treatments they have seen online, Diane describes weighing individual needs, age, evidence, and uncertainty. She discusses saying no, offering second opinions within the team, and evaluating emerging treatments. The episode closes with professional networks, teaching at Mount Sinai, and her decision to remain independent despite frequent approaches from private equity.

In this episode

• Starting a practice for more flexibility as a mother
• Finding herself on call around the clock
• Growing from a three-person operation to a larger clinical team
• Building through word of mouth and patient relationships
• Recognising when the practice needs more space
• Asking patients to wait in the park
• Approaching a neighbour about expanding on Fifth Avenue
• Opening in Greenwich after patients moved following 9/11
• Supporting patients spending winters in Florida
• Maintaining continuity across locations
• Hiring, delegation, and learning to run a business
• Why staff training takes months
• Using secret callers to identify knowledge gaps
• Doctor huddles and reviewing treatments together
• Keeping emergency appointments available
• Why a human still answers the phone
• Where AI can help and where it can misread context
• Choosing between calls, texts, and automated messages
• Text fatigue and communication patients actually value
• Finding complaints and gaps in follow-up
• Working with Garnier and developing skincare formulations
• Helping patients understand changing products and ingredients
• Menopause training and women’s health research advocacy
• Connecting dermatology with care across specialties
• Responding to online beauty trends and treatment requests
• Saying no and offering a second opinion
• Hiring physicians with shared values
• Evaluating technology, evidence, and long-term outcomes
• Teaching at Mount Sinai and learning through professional networks
• Choosing independence in the face of private-equity interest

Key idea

Growing a practice requires deliberate attention to the relationships and clinical judgement that patients rely on. Diane’s experience shows how training, delegation, thoughtful communication, and shared values can help a larger team maintain personal care across multiple locations.

About the show

The Business of a Clinic explores how private healthcare clinics can grow by improving patient relationships, patient engagement, clinic operations, retention, follow-up, commercial systems, and the overall patient experience. 

In this episode of The Business of a Clinic, Jared speaks with Vinay, founder of 360 Physio and a practising physiotherapist, about growing a clinic through home visits, health clubs, patient trust, and referrals.

Vinay started with a website and a portable treatment bed in the back of his car. Today, 360 Physio operates across three sites, seeing around 100–120 patients a week. He shares how he balanced home visits with a part-time clinic role, building his own patient base while continuing to develop his clinical skills.

His ambition began early. Football injuries sparked an interest in physiotherapy at 14, and a family background in business helped shape his goal of owning a practice. In his mid-20s, he wrote in a notebook that he wanted to open before turning 30. He opened the day before his 30th birthday. After one day and one booking, COVID restrictions closed the doors.

A premium North London health club later offered an opportunity to grow, with the expectation that Vinay would build a team. Expansion took the practice from Muswell Hill to Mill Hill and then Central London, where he faced an unfamiliar market without an established local patient base or digital footprint.

The third site brought particular pressure. The planned opening moved from September to October and eventually December, but Vinay had already recruited two therapists and committed to their start dates. He describes walking into a building site, realising how far the premises were from being ready, and finding ways to honour those commitments through clinical work at existing sites, local networking, and meetings with referrers.

Jared and Vinay also discuss the personal strain of that period: stress, poor sleep, and the difficulty of making decisions under pressure. Vinay explains how meditation, exercise, and support helped him get into a better position to deal with the challenges.

The conversation returns to where patients come from. For Vinay, growth has been closely tied to existing relationships: treating whole families, earning recommendations, and maintaining trust with selective consultants. He reflects on why cold outreach did not provide the same foundation and what marketing data can miss about how people choose a practitioner.

That approach includes a clear boundary around treatment. If a patient does not need another session, Vinay does not want the business encouraging one. As the practice grows, the challenge is helping a team deliver that same standard consistently. He discusses early hiring mistakes, assuming others would work as he did, and recognising that expectations need to be supported by clear processes and core values.

The episode closes with Vinay’s ambition to become less visible in the business. He wants patients to receive exceptional care, recommend the practice, and praise their practitioners without everything depending on him. The next stage is building a team and operation that can deliver the practice’s promise with less reliance on its founder.

In this episode

• Discovering physiotherapy through football injuries
• Setting a goal to open a practice before turning 30
• Starting with a website, a portable bed, and home visits
• Balancing employment with a growing patient base
• Continuing to develop as a clinician while building a business
• Opening the day before his 30th birthday
• Closing after one day because of COVID restrictions
• Finding an opportunity within a premium health club
• Moving from a solo service to a team
• Expanding through Muswell Hill, Mill Hill, and Central London
• Entering a market without an established local patient base
• Recruiting before the new premises were ready
• Managing repeated construction delays
• Honouring commitments to two new therapists
• Combining clinical work with networking and referral development
• Stress, poor sleep, and decision-making under pressure
• Meditation, exercise, and seeking support
• Growing through the community around the practice
• Treating families and earning patient recommendations
• Building relationships with trusted consultants
• Why cold outreach did not offer the same foundation
• What marketing data can miss about patient trust
• Growing without overselling treatment
• Learning from early hiring mistakes
• Making expectations, processes, and core values explicit
• Delivering a consistent patient experience across a team
• Building a practice that depends less on its founder

Key idea

Trust has helped Vinay build the practice, but its next stage depends on making his standards clear and repeatable across a team. His story explores how patient relationships, appropriate care, shared values, and practical processes can support growth while reducing the business’s dependence on its founder.

About the show

The Business of a Clinic explores how private healthcare clinics can grow by improving patient relationships, patient engagement, clinic operations, retention, follow-up, commercial systems, and the overall patient experience.

AI can answer calls, send messages, automate workflows and increasingly perform tasks that once required a person.

But that doesn't necessarily mean the clinic of the future has no front-office team.

In this episode of The Business of a Clinic, Jared Aron and Sean discuss what AI adoption could actually mean for private healthcare operators.

Jared argues that the more useful question isn't how to take a 20-person team to zero. It's how technology might allow a clinic to operate with a smaller, more capable team while maintaining or improving the patient experience. That makes AI as much a talent strategy as a technology strategy.

They explore the growing premium placed on human service, why AI receptionists only solve certain parts of the patient journey, and why patient-facing technology needs a different standard of reliability from software built for internal use.

The conversation also looks at the challenge of maintaining patient insight as clinics scale. When the founder no longer sees patients personally, how does leadership hear what patients are actually experiencing? Jared argues that everyday patient conversations can expose operational problems that dashboards and feedback forms often miss.

Then they turn to healthcare's technology stack.

Why do clinics repeatedly migrate from one PMS to another expecting transformation? Why are practice management systems excellent at managing the clinical event but often poorly suited to managing the broader patient relationship? And why should clinic leaders stop starting with features and instead define the specific business outcome they are trying to achieve?

Jared also reflects on changing practice management systems three times in two years while running his own clinic, only to find that the fundamental business performance didn't change.

The episode covers AI receptionists, human-supervised AI, patient experience, multi-site operations, patient voice, PMS migration, healthcare software and the importance of choosing technology around the job that actually needs doing.

Key timestamps: 01:51 AI and the human layer · 04:22 AI receptionists · 10:10 Build vs buy · 15:22 Hiring technology for a job · 20:00 Patient voice at scale · 29:46 PMS vs patient relationship tools · 37:29 Why “AI first” isn't a business objective · 38:18 Why clinics keep changing PMS.

Sponsored by Verillo. Learn more at verillo.co.uk.