The Business of a Clinic (BOAC)

Joëlle Rotsaert, founder of Injectual, joins us to talk about what it really takes to build a modern aesthetics brand.

We cover Joëlle’s journey from fashion into aesthetics, the personal experiences that shaped her view of the industry, and why she believed there was room for a more focused, more design-led, more culturally relevant injectables brand. We also discuss why many clinics weaken themselves by offering too much, how Injectual built around a clear specialty, and why Joëlle sees injectables as something that can be safe, premium, and still feel accessible.

The conversation also goes deep on clinic growth: bookings, sales, front of house, aftercare, memberships, operational strain, HR, and what starts to break when a founder-led clinic becomes a multi-site business. Joëlle also shares her longer-term vision for international growth and for building a dedicated offering around gender-affirming care.

In this episode:

•  Joëlle’s route from fashion into aesthetics 
•  Lessons from Harley Academy and Cavendish Clinic 
•  Why focus matters in clinic branding 
•  Building Injectual around injectables 
•  “Approachable luxury” and hospitality-led healthcare 
•  Organic content, influencers, memes, and authenticity 
•  Why front of house is not the same as sales 
•  Specialist bookings and conversion systems 
•  Scaling pains: memberships, systems, inventory, and HR 
•  Growing internationally without losing the brand’s DNA 
•  The long-term vision behind Transect

What do private equity-backed clinic groups understand about growth that many clinician-led practices miss?

In Episode 28 of The Business of a Clinic, Jared breaks down why PE-backed operators and non-clinician leaders often grasp Coherent’s value faster. The answer is not that they care less about care. It is that they are trained to think in terms of store-level efficiency, organic revenue growth, patient economics, and asset appreciation. 

The conversation explores how patient leakage affects site-level productivity and clinic value, why many of the biggest growth opportunities are hidden inside the patient journey, and why head office teams often cannot see leakage clearly from the P&L alone. Jared also explains the questions buyers and operators should be asking if they want to understand the real performance of a clinic beyond surface-level revenue numbers. 

This episode covers:

•  Why PE-backed groups focus so heavily on organic revenue growth 
•  The difference between clinician-led thinking and operator-led thinking 
•  How patient leakage impacts margin, productivity, and asset value 
•  Why “cost per lead” is not enough to understand clinic performance 
•  The one simple question that often reveals whether a clinic has a leakage problem 
•  How fixing leakage can increase asset value without increasing marketing spend 

If you run, acquire, or scale clinics, this episode is a useful lens on what really drives appreciation at site level and why better follow-up, retention, and conversion are not just operational details. They are value creation levers. 

In this episode of The Business of a Clinic, Jared sits down with Michael Schumacher, co-founder of HMDG, to talk about what is actually changing in private healthcare — and what still is not. They get into why healthcare remains slow to innovate, why so many clinics struggle to adopt technology well, and why AI tools like receptionists or voice agents often sound more impressive than they perform once they hit real clinic workflows. 

Michael shares his view on the Private Practice Barometer, what it reveals about clinic margins and benchmarking, why many clinic owners still undercharge, and why pricing is often one of the fastest ways to improve profitability. The conversation also explores the difference between lead volume and lead quality, how poor follow-up distorts marketing performance, why some clinics are hard to buy or scale, and what private equity often misunderstands about the realities of healthcare operations. 

The episode then opens up into a broader conversation about the future of healthcare businesses: patient trust, experience design, brand, gamification, recurring revenue, Neko Health, and why healthcare still has a long way to go in building consumer-grade experiences that actually keep patients engaged. From “bad leads” to Botox clubs, this one covers a lot of ground. 

In this episode, we cover:

•  Why healthcare is still behind on innovation and digital transformation 
•  The real problem with AI receptionists and autonomous front desk tools 
•  Why implementation matters more than the software demo 
•  What the Private Practice Barometer reveals about clinic performance 
•  Why many clinic owners underprice their services 
•  Why follow-up pricing matters more than most clinics think 
•  The difference between lead quantity and lead quality
•  Why clinic marketing often breaks after the lead comes in 
•  Why buyers and investors often misunderstand clinic value 
•  What clinics can learn from Neko Health, gamification, and membership-style models 

About Michael Schumacher
Michael Schumacher is the co-founder of HMDG, a marketing agency originally focused on MSK clinic owners and now working more broadly across healthcare. In this conversation, he brings a commercial and operational lens to clinic growth, pricing, marketing, and the future of healthcare delivery.

In Episode 26 of The Business of a Clinic, Sean sits down with Dr Arnold Gangaidzo, founder of Lancashire Smiles, to talk about the real journey behind building a private dental practice from the ground up. 

Arnold shares his path from Zimbabwe to the UK, why missing out on medical school turned out to be a blessing in disguise, and how dentistry became the right path for someone who wanted both healthcare and entrepreneurship. 

They get into what clinic ownership actually looks like when the Instagram version ends: builders missing deadlines, CQC timing, rent-free periods disappearing, loan repayments starting before revenue is stable, and the shock of cash flow once the doors finally open. 

Arnold speaks candidly about the pressure of making it work, taking little to no income from the business in the early months, and learning that profitability on paper is very different from real money in the bank. 

The conversation also explores one of the biggest mistakes ambitious clinic owners make: expanding capacity too early. Arnold explains why opening a second treatment room before fully maximizing the first created more white space, more cost, and more complexity than expected. 

From there, the discussion moves into retention, recurring revenue, lifetime value, and why growth-minded owners need to focus on strengthening the first bucket before building the next. 

They also talk about building a personal brand on LinkedIn, using systems like Asana to stay accountable, and why Arnold is building Lancashire Smiles with the long-term vision of a regional multi-site group. 

His philosophy is simple: build with the intention to sell, even if the real goal is to create something strong enough to keep and pass on to the next generation. 

This episode is for clinic owners, operators, and aspiring founders who want a more honest view of practice ownership: the risk, the pressure, the discipline, and the thinking required to build something real.

What kind of healthcare will AI actually transform first?

In this episode, Jared and Sean unpack one of the most important distinctions in modern healthcare: hands-on care vs cognitive care. Hands-on care requires the patient to physically be there — dentistry, physiotherapy, chiropractic, dermatology, aesthetics — while cognitive care can often be delivered remotely through diagnosis, advice, or telehealth. That difference matters because it shapes how AI will be adopted, where it will create leverage, and why the future of in-person care will still be deeply human for a long time. 

They explore why the real challenge in hands-on healthcare is not only what happens in the treatment room, but everything around it: logistics, movement, scheduling, follow-up, and getting patients to actually take the next step. In Jared’s view, that “next step” is 90% of the battle in many clinics, and it is where so much patient leakage begins. 

The conversation then shifts into the mindset of clinic owners versus multi-site group operators. Jared explains why group leaders think in terms of lifetime value, appointment density, ROI, and margin, while many smaller clinic owners still move too slowly or make only incremental changes. They discuss how the best operators build clinics scientifically rather than artistically, and why systems, efficiency, and reduced founder dependence matter so much if you want to grow or eventually sell. 

They also get into one of the episode’s sharpest ideas: cost per consultation matters more than cost per lead. A clinic can feel good about lead numbers while quietly losing huge value between enquiry and consultation. Jared shares an example of a clinic with roughly 100 high-intent inbound enquiries in a month, but only around a third converted into consultations, while many others sat in the dangerous “still in process” category. That invisible gap is where profitability often dies. 

Along the way, they talk about failed Salesforce implementations, why AI reception often disappoints, how “set and forget” workflows create hidden losses, why archived patients are often a goldmine nobody understands, and the simple test every clinic owner should take: go on holiday and see whether the business still runs without you.  

In this episode, they discuss:

• The difference between hands-on care and cognitive care
• Why AI doctors are more relevant to telehealth than in-person treatment
• Why hands-on healthcare is really a logistics problem
• How patient leakage happens in the gaps between steps
• The mindset difference between clinic owners and group operators
• Why group leaders think in appointment density and lifetime value
• How acquisition-minded clinics are built differently
• Why technology only works when there is ownership behind it
• The hidden cost of bad software implementation
• Why AI reception often creates more tasks instead of solving them
• How edge cases are the norm in healthcare
• Why archived patients may represent lost revenue sitting in plain sight
• Why most follow-up sequences are based on guesswork, not evidence
• Why cost per consultation is a better metric than cost per lead
• How plugging leakage can create a clinic’s best month ever
• Why founder dependence weakens clinic value and exit potential

Timestamps

00:00 – Hands-on care vs cognitive care
 02:10 – The hype around AI doctors
 03:00 – Why AI can assist but not replace hands-on practitioners
 04:00 – Neko Health and the persistent human layer
 05:08 – Why Coherent focuses on logistics, not clinical decision-making
 06:37 – The real challenge: getting patients to take the next step
 08:20 – How multi-site clinic groups think differently
 10:20 – Why clinic leaders need to shif

Healthcare often focuses on clinical outcomes — but the operational reality behind delivering care is far more complex.

In this episode of Business of a Clinic, Jared Aron sits down with Dr. John Chinegwundoh, consultant physician and Chief Medical Officer at Coherent Healthcare, to explore what actually happens behind the scenes of modern medical practice.

Drawing on more than two decades of experience across the NHS and private healthcare, John shares his perspective on how healthcare systems really function — not just clinically, but operationally.

The conversation explores the growing gap between clinical expertise and operational execution, and why so many clinics struggle to maintain consistent patient engagement over time.

They discuss the hidden challenges of managing patient journeys, the structural reasons patients quietly fall out of care, and how emerging technologies like AI may reshape how clinics stay connected with patients long after their first appointment.

This episode is a thoughtful look at the business and operational side of medicine — and why solving these problems may be just as important as the clinical work itself.

• Why running a clinic is far more operationally complex than most people realise
• The hidden administrative load behind patient care
• Why clinics often lose track of patients over time
• The concept of patient leakage across the healthcare journey
• Differences between NHS and private healthcare systems
• Why technology has struggled to solve operational problems in clinics
• How AI may transform patient communication and follow-up
• The future of patient relationship management in healthcare

00:00 Introduction
 01:03 Meet Dr. John Chinegwundoh
 03:45 The operational reality of running a clinic
 06:18 Why healthcare administration is so complex
 08:47 Managing patient relationships at scale
 11:10 Why patients quietly drop off over time
 14:36 Understanding patient leakage in healthcare
 18:05 Technology and the limits of current systems
 21:12 AI and the future of patient engagement
 24:50 NHS vs private healthcare systems
 28:32 Operational challenges facing modern clinics
 32:10 The future of patient-centred care
 35:40 Closing thoughts

Business of a Clinic explores the operational, financial, and technological challenges of running modern healthcare practices.

Hosted by Jared Aron, founder of Coherent Healthcare, the podcast features conversations with clinicians, operators, and healthcare leaders about what it really takes to build and run successful clinics.

Learn more about Coherent Healthcare:
 https://coherenthq.com

Follow Coherent on LinkedIn:
 https://www.linkedin.com/company/coherent-healthcare

Most healthcare providers believe they already “do follow-up.”

They call twice.
 They send an email.
 They assume patients will come back when they need care.

But when you open the practice management system and ask one simple question —

How many patients currently have no next appointment booked?

— the answer is often uncomfortable.

In this episode, we unpack the structural patient drift problem inside private healthcare clinics:

• Why up to 50% of patients who start care never complete it
 • Why “we already follow up” rarely means what people think it means
 • Why thousands (sometimes tens of thousands) of patients sit in systems with no discharge status
 • Why 30%+ of patients miss essential annual reviews
 • Why AI receptionists solve only a tiny fraction of the real issue

We explore the concept of the “Office of the MD” vs the “Office of the COO.”

Clinics are full of highly trained practitioners delivering world-class care.

But commercially?

There is usually:

• No retention team
• No sales team
• No operational strategy
• No structured follow-up infrastructure
• No ownership of the full patient journey

The result isn’t bad care.

It’s operational failure.

We also discuss:

• The difference between automation and true workflow ownership
 • Why interoperability between PMS, CRM, and marketing tools usually breaks down
 • The myth of “autonomous front office AI”
 • Why healthcare is fundamentally an edge-case environment
 • Why empathy still matters in high-value treatment decisions
 • What “superhuman follow-up” actually means
 • Why “eyes on, hands off” is the future of healthcare operations

Healthcare is not e-commerce.

You cannot afford to miss the 20% edge cases — because in healthcare, the edge case is the case.

If your clinic has:

• Thousands of patients with no next appointment
• Treatment plans that stall
• Annual reviews that go uncompleted
• Leads that never convert
• Cancellations that never rebook

Then this episode will challenge how you think about patient management — and what real operational transformation looks like.

00:00 – Discovery calls and confusion about what we actually do
 01:00 – The “spaghetti” patient journey
 02:00 – Why less than half of patients complete care
 04:10 – Lead conversion, post-consultation follow-up, recall
 06:20 – The 30% missed annual check-up problem
 07:40 – What is the real drop-off rate?
 09:00 – Recurring care in MSK, physio, dentistry
 10:10 – Thousands of patients with no status
 11:10 – The missing Office of the COO
 13:00 – Why AI receptionists are only 1% of the problem
 14:20 – Interoperability, PMS limitations, and software overload
 15:40 – Autonomous front desk vs augmentation
 16:20 – Healthcare as a living organism
 17:40 – Why healthcare is the edge case
 18:10 – Empathy, treatment blockers, and feedback loops

Most clinics believe retention is strong.

The diary looks full.
 Revenue is up.
 Marketing is working.

But beneath the surface, patients are quietly falling off track.

In this episode of Business of a Clinic, Sean and Jared unpack one of the most misunderstood problems in healthcare operations: invisible patient leakage.

This is the silent drop-off that happens at every stage of the journey:

• New inquiries that never get followed up
• Consultations that don’t convert
• Cancellations that aren’t rebooked
• Patients discharged without continuity
• Thousands of active patients with no next appointment

And because it’s not measured properly, it feels like everything is fine.

What You’ll Learn in This Episode

1️⃣ Why “80% retention” is misleading

When you multiply 80% across multiple visits, it’s not 80%. It compounds downward. What looks healthy on paper often masks cumulative disengagement.

2️⃣ The difference between a System of Record and a System of Action

EMRs, PMS platforms, CRMs, RCM tools — they store information.
 But they don’t necessarily take action.

Owning software is not the same as owning outcomes.

Most clinics have tools.
 Very few have execution.

3️⃣ Why white space isn’t a marketing problem

Empty slots in your calendar are terrifying. The instinct is to spend more on ads.

But often the problem isn’t lack of demand.

It’s:

• Unmanaged inquiries
• No follow-through on consultations
• No structured recall
• No cancellation recovery

The revenue is already inside the business.

4️⃣ Clinical follow-up vs service-based follow-up

Clinical follow-up is table stakes. It’s your duty of care.

But service-based follow-up is what separates good clinics from great ones.

The five-star hospitality mindset doesn’t stop at fixing the issue. It extends beyond the visit.

Healthcare rarely does this well — not because providers don’t care, but because systems aren’t designed to support it at scale.

5️⃣ Why hiring more coordinators doesn’t solve scaling

Every clinic has a ceiling.

You only have so many treatment rooms.
 You can’t multiply revenue infinitely with more headcount.

As your historical patient base grows, the math breaks:

• 1,000 patients becomes 2,000
• Then 5,000
• Then 10,000

But your physical capacity doesn’t grow at the same rate.

At some point, adding people stops solving the problem.

Operational leverage matters more than headcount.

6️⃣ Revenue vs EBITDA: what really drives valuation

Healthcare businesses are not SaaS companies.

They aren’t valued primarily on revenue multiples.

They’re valued on profitability.

If top-line revenue grows while bottom-line stagnates, the gap between the two is where invisible leakage lives.

Fixing leakage is often more powerful than chasing growth.

The Core Question

How many patients in your clinic right now do not have a next appointment booked?

If you can’t answer that with a precise number — in real time — you’re not measuring leakage.

And if you’re not measuring it, you can’t fix it.

This Episode Is For You If:

• You run a single-site clinic
• You manage a multi-site group
• You lead operations
• You’re responsible for revenue performance
• You’re thinking about scaling
• You’re considering an exit in the future

This conversation challenges the default belief that “more marketing” is the solution.

Sometimes the biggest growth opportunity is not outside the business.

It’s inside.

🎧 Listen in to rethink retention, rethink follow-up, and rethink what true operational excellence looks like in healthcare.

What actually makes a clinic valuable? In this episode, Sean and Jared unpack the uncomfortable truth: great clinicians aren’t enough — the business is won or lost in the operational “plumbing” around care. They explore patient retention as an asset, the gap between “booked” and “completed” care, and why many clinics look healthy on the surface but fall apart under diligence.

From there, the conversation turns to AI: AI receptionists, AI scribes, and the hyped “AI doctor.” The key question isn’t capability — it’s responsibility. Who checks the work? Who holds the risk? And what happens when AI introduces a “verification tax” that forces humans to double-check everything anyway?

If you’re building, scaling, or preparing for an exit, this one is a practical lens on what matters: brand, systems, accountability, and the patient journey — not just technology for technology’s sake.

Key themes and takeaways

1) Clinic value is operational, not just clinical

A clinic becomes investable when outcomes don’t depend on one hero operator. They break down the shift from “principal-led” to “process-led”: consistent delivery, repeatability, and a patient journey that doesn’t leak revenue through missed follow-ups and drop-offs.

2) Retention is the hidden asset on your balance sheet

They frame patient history and “off-track” patients as a recoverable asset — not a marketing problem. The clinic that wins isn’t the one that generates the most leads; it’s the one that reliably converts intent into completed treatment.

3) Due diligence exposes the truth

You can run a clinic on adrenaline and spreadsheets — until someone tries to buy it. They talk through why deals fail: messy data, unclear ownership, inconsistent processes, and a gap between what leaders think happens vs what actually happens at the front desk.

4) AI isn’t free — it can create a “verification tax”

AI may book patients or draft notes, but if staff must re-check everything to avoid mistakes, the promised efficiency collapses. The conversation sharpens around “humans-in-the-loop” and the difference between automation that removes work vs automation that adds oversight.

5) AI doctors raise the hard question: who carries liability?

The future of AI in healthcare isn’t just a product question — it’s an underwriting question. If an AI system influences diagnosis or care decisions, who is accountable, and how do you build guardrails that preserve patient safety and trust?

6) Healthcare is logistics wrapped around care

They argue the bottleneck is rarely the clinical moment — it’s the scheduling, follow-up, payments, coordination, and operational reliability that gets a patient to the right room at the right time with the right context.

Chapters:

00:00 Intro — the big ideas: clinic value, retention, AI risk
 02:10 Practitioner → founder: building beyond the principal
 04:10 Retention as an asset: patient “stickiness” and leakage
 06:30 Why diligence kills deals: data, process, ownership gaps
 08:40 Brand and clinic DNA: what makes you meaningfully different
 10:40 The operational skeleton: “plumbing” that creates reliability
 13:10 AI in clinic ops: what’s real vs what’s hype
 15:20 The verification tax: when automation adds oversight
 18:20 Healthcare as logistics: admin lifecycle vs clinical moment
 21:10 AI doctors: liability, underwriting, supervision, safety
 25:30 Guardrails, accountability, and humans-in-the-loop
 29:10 What to do now: practical steps for operators building value
 33:00 Closing — empathy, trust, and sustainable scale

Every clinic starts with a simple promise: give great care to the patient in front of you. But scale changes everything.

In Episode 20, Jared unpacks a core paradox: your clinic has finite capacity (rooms, hours, staff) — but your patient history grows forever. That mismatch creates “leaks” across the journey: leads that aren’t worked, consults that don’t convert, cancellations, DNAs, recalls, and quiet drop-offs. Most clinics respond by spending more on acquisition… while the bucket keeps leaking.

He then breaks down why PMS/EMR systems weren’t built to own conversion, why generic CRMs often turn into tool-sprawl when interoperability is weak, and why the real lever is a true Sales Desk function — one team (or system) accountable for utilization and eliminating calendar white space.

Finally, he introduces Project Alpha: an experiment in giving patients 1:1 coordinator support outside the clinic — before and after appointments — covering follow-up, rebooking, payments, and escalation. The goal: reduce pressure on the front office while improving continuity of care and patient confidence.

Chapters

00:00 Clinical ambition vs the reality of scale
 01:20 The “personal WhatsApp” concierge—and why it breaks
 02:40 Finite capacity, infinite patient accumulation (the first 1,000 vanish)
 06:10 Why PMS/EMR is built for process, not revenue
 07:20 The ownership gap: nobody “owns conversion”
 08:50 You need a different engine to stop the leaking
 09:50 Conversion isn’t art—it’s a data science playbook
 11:10 Tech + technique + team (the 3-part system)
 17:30 Stop funding acquisition while the bucket leaks
 20:00 CRM vs PMS: the ~£1m inflection point and tool sprawl
 21:30 Pipedrive/Klaviyo/HubSpot: order vs optimization
 26:10 APIs, integration, and why healthcare stacks don’t talk
 29:40 Project Alpha: 1:1 patient support outside the clinic, at scale
 31:10 Follow-up reveals problems patients don’t verbalize
 32:30 “Four Seasons” care: bringing outside signals into the clinic
 36:20 Why it’s called Sales Desk, not Front Desk
37:00 White space economics, waitlists, and “110% utilization”
40:20 Case example: 81 appointments booked in ~2.5 weeks
41:00 The psychographics of top-performing clinic owners
46:50 Valuation, EBITDA multiples, and building leverage early
49:00 Closing thoughts: retention and optimization before exit