Business of Medicine - Rahil Roopani, MD

Haven’t provided an update in a while and that’s simply cause I’ve been trying to juggle work, marriage and fatherhood. All good things. But time for an update: Our practice has grown to two surgeons and two physician assistants and we’ve had significant YoY growth thus far. But our limiting factor is our time. The major issue for scaling/growth is that our surgeons ‘generate’ revenue as evaluating patients and providing treatment recommendations is still only carried out by the surgeon. We’re going to make a slight pivot to expand our service lines in the coming months to include cosmetic dermatology / aesthetics. Root Hair Institute ➡️ Root Hair & Skin I’m excited about this change as I am not going to be a provider of these services and solely will focus on the management side of it. My dermatologist partner and the PAs will serve our patients. Excited to share this journey.

@InvestingDoc Did she participate in the interview?

I interviewed a doctor today. He bought his wife (who is not in medicine) to our first interview with my practice. First time I've ever had someone bring their wife to their interview for a job. Have yall ever had this happen?

@faraz_tx Telfair

@RRoopani 🔥🔥🔥 Where is this?

Sugar Land, TX MOB up and running. First ground up RE development.

When do we get tariffs on hair transplants from Turkey?

Plenty of things in healthcare are antiquated. Doesn’t help that many of the tech platforms (electronic med record, imaging systems, etc) do not have open API to integrate with one another. Plenty of companies exist and charge a good amount of money to carry out records requests still!!

The fact that doctors’ offices and hospitals still share imaging amongst each other using CDs is embarrassing and unacceptable. It’s 2024. People under the age of 20 don’t even know what a CD is. Dare I say, this is more egregious than the fact that the US Postal Service is still in existence, delivering mail at a loss that the US taxpayer has to bear.

@InvestingDoc Yep, but you have something we don’t. Volume. Nonetheless, you’re providing good pt care and doing right from a business fundamentals standpoint. As a peer, I’m telling you, spend your energy not focusing on it. Enjoy time with family instead. You’re going to win either way.

@RRoopani Yeah, we do our best to drown in 5 star reviews. But I'm sure you have these bs reviews too (we all do)...they get under my skin

New patient no showed to their appointment yesterday, claims it was an emergency. We accommodate them with a visit today, 1 day after their no-show. They show up 35 min late today, no paperwork filled out We reschedule again 1 star review for not accommodating them better

@InvestingDoc Ultimately volume of reviews will drown out the negative ones. Easier to do with the volume your group manages.

@RRoopani I usually respond generic bs. BUT This one I flamed & called them out that they didn't show yesterday and showed up 30 minutes late today to try to accommodate them for a new patient visit and I'm sorry this did not meet your expectations. Good luck finding a new doc.

@InvestingDoc Yep doesn’t seem like a good fit anyway.

@RRoopani She demanded half day off to do what she wants and to end her day at 3:40pm, when her contract is work until 5 every day. If we don't meet those demands she quits. The problem solved itself. She put in her notice to my office manager when we essentially laughed in her face

Sometimes an employee relationship turns toxic. One of my new PAs is now telling others that its BS that I get a full day "off" from patient care to run the business without any pt visits. They are demanding = time off to go home and hang out with their dog I wish I was kidding.

Workplace culture is more important than you think even if you have a small team. Implementing structure with roles and responsibilities is a great start… But it needs to be nurtured and the individuals on the team need to be heard when they’re upset. They need to be supported and applauded at other times. Keeping a pulse on that builds up a team that can sustain challenges such as difficult work weeks. The goal should be for them to not hate coming to work on Mondays.

@AlexLathery Promoful Swagify @nnkurji

What's the best company to order custom shirts, hats, and other business swag from?

This past weekend, I used a power washer for the first time to clean the deck. It was a blast and made me feel like a manly man for about 2 hours… Then it became a chore that I would happily pay someone to do lol

@HealthcareREguy Which market is this? $950 seems outrageous unless there’s a heavy ASC component, etc but even then, still high

Working with a physician that built his building for around $9.5M. He now wants to structure a sale leaseback. The problem is it's only 10,000 SF. It cost him $950/SF to build it... In order to break even on a sale, he'll need to pay $75/SF in rent as a tenant (market rent is $30/SF) Unless he's willing to take a major loss, a sale leaseback is now unfeasible. And even if he sells his practice, the best he can hope a tenant to pay him is $30/SF. It'll be a long long time before he'll be able to pay off his current loan. If he ever does. What's unfortunate is all of this could have been avoided if he had worked with a real estate partner from the get go.

@RahilBerani Something called “Spocking”. The person who injected should’ve gone more lateral on both sides of the forehead to prevent that look.

Why is this so bad @RRoopani

Our team is focusing incessantly on growing our brand’s credibility with genuine customer reviews. This past week, we achieved five new 5-star revenues. A new record for our small volume, niche practice. In the beginning, these reviews were very scarce because of two points: 1. Our patients like to stay private. 2. Our treatment strategies take longer to play out. We had to just trust the process, build patient rapport, show success and then strike with a well-timed request. In addition to the above, educating our team on the importance of these reviews (as part of the full scope of marketing) has been essential to spurring them into action to make these requests.

Take care of your team even if it costs your business a little bit more. This past Friday, our clinic’s power went out. Not just us but the whole building. What was supposed to be a busy work day with a good amount of revenue to be made turned out to be a total loss. All good. We can withstand this in our 3rd year of ops. However, the same isn’t true for the hourly members of our team. They need the hours to be able to live their own lives. In general, most clinics say ‘tough luck’…no one wins. Loss of revenue for clinic and frustrated staff. Instead, we came up with a compromise. Everyone gets paid a half day even though we had to close up after 1 hour of operations. Told them all to enjoy the weekend. Hopefully this would soften the blow.

@InvestingDoc Wow - would get your attorneys involved to clawback security deposit and whatever rent you’ve paid.

Amateur investors. Don't own commercial RE and "fake it" Our new office got shut down by the city today bc of no CO. I showed the inspector the CO the landlord gave us. Turns out, landlord photoshopped it, it's fake. Now our location is shut down until we fix it

Four die-hard Houstonians messaged me hating on Houston and calling it a third-world country after this week’s loss of power and infrastructure breakdown post-hurricane. Crazy that this will likely keep getting worse. Crazier that the local and state governments haven’t come up with solutions to help mitigate damage and destruction despite the uptick for years in these natural disasters to the region.