From a Physio Bed in His Car to Three Physio Clinics Built on Trust | with Vinay Parmar, BOAC #64

0:00I was a little bit disillusioned in my previous job. I was enjoying still being a physio. I was just felt like I was flatlining a little bit. I wanted to really challenge myself. I left my current job at the time without anything else lined up. I wrote down on it. I want to own my own private practice before the age of 30. You've got to go along that journey from thinking of you being able to control a lot of it to then trusting the systems that you put in place and you having less control. over every decision or every communication or every patient interaction. I opened the doors to the new health club and I was like, this is in two weeks.

0:40And that hit. That was a big moment. I was like, this is a tough one. Even for myself, I remember opening clinic and we took over our lease from a, what was previously a fish store. Yeah. And so you can imagine the humidity coming off of the fish tanks, what that does to the walls, the shop front and everything. But it always comes from being trustworthy. If they don't need another session, you don't tell them they need another session. They know because people are intuitive as well. They know when someone's in their best interests or not. This is your healthcare is a rice cooker, not a microwave.

1:10I think looking ahead, I want the business to be in a place where I'm seeing that patients are having a really good experience with their practitioners. But at the same time, I'm always not a part of that. I'm almost invisible from the outside looking in.

1:33Before we get started, this episode of the Business of a Clinic is sponsored by Virillo. Virillo is the trusted marketplace for clinic owners looking to sell and groups and clinic buyers looking to acquire high-performing clinics. There are very few specialized marketplaces in the UK that focus on this transition for clinic operators. Virillo is one of them. Learn more at virillo.co.uk. Now on to the episode. Hey, everyone. This is Jared, co-founder of Coherent Healthcare. We are back for another episode of The Business of a Clinic. Today's an interesting one because so much of the journey, as far as I understand it, is about the organic pull, the fact that you were focused on the next one and the next one.

2:14So this is a slightly different story than some of the ones we've heard, which sort of went in from day one and thought, here's me at 100 locations. So that's going to be really interesting. But I'm here with Vinay, who's the founder, director, CEO, you can introduce. Exactly. And still the physio. And still the physio, all these things. And I think we're going to dig into the model, which is a little bit different than what we might see in market. And also maybe the personal journey that takes us from your first patient to where you are now, which is well past your first patients. Welcome so much to the show.

2:44Thank you for being here. I have a chance to get to know you a little bit. But for those who don't, could you maybe give us the two minute introduction of your sort of journey arc as I started and here we are now? Yeah, absolutely. First of all, huge thank you for having me on. It's a massive honor to be a part of this. I started 360 Physio myself back in around COVID time, actually. So the journey began. I was a little bit disillusioned in my previous job. I was enjoying the work side of it. I was enjoying still being a physio and things, but I'm someone who values growth and values evolving as not only a practitioner, but into a slightly bigger role.

3:27And I just felt that at the time I was employed and it was, I was just felt like I was flatlining a little bit and I was kind of moving horizontally and I wanted to really challenge myself in a really different way. I've felt like I've always had an inner entrepreneur inside me that was waiting to just burst out and try something new. And alongside that, there was also a creative side of me that when it comes to designing a brand and building the business and putting my own kind of fingerprint on it and my own authority on it, that I just really wanted to get out. And I wanted to tie it in to what I was already doing.

4:07I left my current job at the time without anything else lined up. I was a little bit younger at the time and probably a little bit more gung-ho and go for it sort of thing. And yeah, I just thought, you know what, I'm going to land on my feet. I am going to find something that will keep me going. And I do want to try something new. I do want to try an element of, I do want to try risk. And I thought, you know what, let me just quit this job. and in the spare time that I had whilst I wasn't working I thought let me just tap into the creative side a little bit more let me design a website and let me start doing some home visits and I had a few referrals I had I bought a treatment bed portable treatment bed I had it in the back of the car and I got a few recommendations here and there and a few can you see this person or what you do if I visit here and two three here and there over a few days in the week grew quite quite a lot and then it was growing really well but I knew I wasn't going to continue to improve as a physio just doing that on my own one man band just right I was making good money but I thought I do want to still grow as a physio as well so I got a part-time job in London in central London for a clinic three days a week to do alongside the home visits and I was doing home visits on two days and that was just getting busier and busier and then I did the three days in clinic which I was still enjoying and then those two days on the road was just getting busier and I was just driving north London west London and then I might have an appointment in northeast London and then another one back in I was just all over the place but I was earning good money and things and I thought this is probably a little bit too much and then at the same time I got the opportunity to set up move the home visit business into like a premier health club in North London.

5:58So kind of David Lloyd style health club, quite premium and nice environment and things. And they said, you know what? Do you want to try to set up this thing over here? Take a couple of days, move the home visit stuff into here, do two days and give it a good go. And they said on the condition that eventually we don't want it just to be you. We want it. We want a team. At the time I thought, am I ready for this? Should I go for it? I've got quite a good thing. The home visits is hardware, but it's low risk. I haven't got overheads. But I thought, you know what? This is what I've dreamt of doing when I was quite young.

6:34And I thought, you know what? If I don't take this opportunity now, I know I'm going to look back in 10 years time and think, yeah, exactly that. And then, yeah, it just grew up from there. There's a word that you used in your introduction, which is something, dreamt something. And I'm curious about that dream.

6:57So I don't know that a lot of people get into practice leadership on a dream as much as it is by accident. The number of conversations with people in the MSK space who say, I went to school to be a practitioner because I was interested in health care. And that seemed like an interesting place to start. And then I went to go work for someone else. And it's sort of a series of accidents opposed to a knowing, a forward thinking, an emotion that comes with that dream. can you take us back to that moment in time when you first had that sort of hey this is a version of of my future how old were you where were you what did you eat that day yeah it's strange I so I knew first of all that I wanted to be a physio from really young I was big into football had a lot of injuries and I knew from 14 years old that I wanted to be a physio I picked all my GCSEs around physio I picked all my A-levels around physio I didn't really consider anything else.

7:50I just went for it. And that's all I ever looked at and pursued. And then I knew as well, if I became a physio that one day I wanted my own practice. So that seed was in there from early on. My dad had a business himself and family have, the wider family have businesses. So it was always that inside me that was wanting to come out. And then I think it was in around my mid twenties that it was funny. I had a book, just a notebook that I bought and I wrote down on it. I've still got the notebook at home I wrote down on it I want to own my own private practice before the age of 30 and I completely forgot about what I wrote down completely forgot I even made the note and then it was funny when I moved the business into the lab it was actually on the 3rd of November the day before I turned 30 happy birthday which is yeah and then funnily enough the business was open for one day and then because of covid restrictions bang shut closed doors two weeks closed doors had one booking in that day i was so excited and then shut two weeks i was shut and then i was open again for two weeks later on and then shut again and then it was just all over the place but yeah it was from yeah just had it instilled in me from early on it's interesting I also opened practice in the middle of COVID.

9:12And I remember being very confused about why tailors were allowed to open again before we were. How important we did aesthetics and dermatology. I appreciate it's not necessarily essential health care the same way. But why is it that someone getting their pants measured, their trousers measured, is more of a critical service than a care clinic? That's a temporary conversation. The idea of opening and closing the lockdown. I've been to that movie and it sucks. It was tough. It's really terrible. You have to manage your time, manage your clients. and all the bookings it's interesting to hear that from the age of 14 you had a sense that was the direction of travel and that there was also this personal dna around entrepreneurship and you said okay the question is when is what i'm understanding it was a when yeah are these things gonna come together not this is gonna happen it's just a when is it gonna happen yeah totally is it yeah i don't know if you could say it was written or not but sometimes you don't even know along your journey what's gonna happen but maybe some things are just written and and yeah you just gravitate in that direction without even realizing sometimes because I think back to how the business got launched in the lab and how it grew from there and I wouldn't have had the opportunity to move into there if I didn't already have the home visit business if I didn't really have the website set up and I didn't have everything in place already so it was that thing of when opportunity meets preparation and yeah it just all came together because of the steps I took before so you were saying as as part of the use the word risk which I was very interesting so it was relatively low risk yeah for you to start that way so one thing I'm taking away is there are probably a lot of different clinical disciplines where you can start in a low risk way MSK in your case may have been one of them I don't know how you start low risk dentistry in quite the same way but the idea that you can start relatively low risk i think it'll be really interesting to understand the journey you've been on now going from you and a room in a club how you have thought about managing risk at a business level and that was there's a clinical risk compliance risk whatever but at a business level you've kept eating more of the cake and now it's bigger now it's more now it's the next this idea that as it grows there's also more risk.

11:28Risk comes with it, but the bad time is hitting really hard now. So how have you thought about building the business around the idea that you're also creating an increased risk profile around the work you're doing? Yeah, it's a challenging one. I think one thing I've learned is that you've got to go along that journey from thinking of you being able to control a lot of it to then trusting the systems that you put in place and you having less control over every decision or every communication or every patient interaction. And then in turn trusting the systems that you put in place and having the procedures there to make sure things stay manageable and managing risk in that way as well.

12:16So for me, it's about having the right kind of structure in the business and having that implemented well to manage risk and making sure there's systems in place to, when something hits hard, that we've got something there to bounce back and we can still move forward and continue to grow. If I can be provocative, do you have an example, not COVID, although I'm sure COVID is one of them, do you have an example of something that has hit hard that you've had to bounce back from with respect to exactly what you're describing? Yeah, I think one thing that did hit pretty hard around the theme of risk was when we did, when the business grew from one site in Muswell Hill, then we moved into Mill Hill.

13:00And then the third one, which was the biggest risk, was moving into the Central London Clinic and opening there just under a year ago now. And that one was the biggest step because we're going into complete new territory. We have no digital footprint there. we have no client base there there's big competitors around all of these sort of things and it was a big risk but it was an opportunity to really grow the practice and take it to that next level and a real challenge point came when we were initially planning I was working off the club's time frames to open and their opening date was initially from way earlier in the year it was always like an open first of september you're gonna get a grace period there with time to build and things there which i took on board the recruitment process started early it started in june july and i wanted everything to just be ready for open and this is the first time going into a new build place a whole new branch all together the other two clubs are like fully established and already running lots of members there that we could here come the builders here come the builders Because yeah, this is a big thing, probably the biggest move in the business and in my own journey as a practice owner.

14:18And I'm here ready, not really knowing what central London is going to bring and what challenges it's going to bring or the challenges of moving into a new practice as well, a whole new building, what that's going to bring. Naively, I'm there planning to start on 1st of September. We're ready. We're going to go in. We're going to hit the ground running and things. And then things go a little bit quiet. and then you're still thinking, are we going to start? And then it's the first September, then gets pushed back to late September and then it's mid-October. And then we're working off mid-October.

14:49I recruited at the time and got two new therapists on board and we managed to delay the start a little bit into mid-October. And then I'm now set on mid-October and I've confirmed the start dates with the two new therapists and everything's in place, all the paperwork's done and all the contracts are signed and things and then I think I went into central London in late September I had a conference to go to and then I thought it was a good time to go in and have a look and see what's going on there and things and had a meeting there with one of the owners and yeah I went in and I opened I still remember the site I opened the doors to the new gym and the health club and I was like

15:36this has not been open in two weeks and that hit that was a big moment I was like this is a tough one because there was stuff everywhere like the whole place was upside down there was like builders you could hardly hear yourself because the drilling and there's all kinds of complications as well which delayed it further and then it wasn't until first of December that club ended up opening. So I had to improvise. I had these two new starters and I made a commitment to them that I wanted to honour that we were still starting then and we had to improvise and make things work around it. What did that look like?

16:11I'm assuming that chapter had closed. What did that look like? So it was a mixture of things really. I thought we have to use this adverse moment to our advantage as well and use it as a real good kind of planning type phase so a lot of it looked like a lot of networking around the local area exploring the local area seeing what opportunities were around there what clubs we could associate with and things and obviously at the same time I needed them to bring in revenue as well to support the commercial side of the business I managed to shift some of their hours into a mixture of clinical in the two established clinics so they could still bring in some revenue and the other half of what they were doing each was then around the marketing and networking, meeting some of our referrers to establish connections and pathways and things like that.

17:02So yeah, they had to be adaptable and we had to think on our feet a little bit to make it work. But we managed to do that kind of hybrid role for them over the next kind of six weeks or so till they did find the open. Now a quick break to tell you a little bit about Coherent Healthcare, the company behind the business of a clinic. Coherent helps fast-growing healthcare providers engage, support, retain, and nurture their patients from intake to discharge. As you get bigger, your patient body grows enormously, and it becomes much more than just another hire, just another front office team member.

17:36It's no longer a people problem. You need technology that can scale with you. Coherent helps you do that by keeping every patient on track. In short, we're the agentic CRM and patient support platform for outpatient hands-on healthcare. To learn more, visit us at coherenthq.com. Now back to the episode. I think we've probably had 10 conversations on the business of a clinic about people coming head-to-head with construction. Yeah. Yes. I think the biggest lesson learned, more often than not, is how to manage construction and challenges that come with construction. Even for myself, I remember opening clinic and we took over our lease from what was previously a fish store.

18:20And so you can imagine the humidity coming off of the fish tanks, what that does to the walls, the shop front and everything. So also like you, I can't DIY anything at all, even in my personal life. So trying to figure out how to manage that reality, it's a totally different language. It's a totally different way of doing things. So I think the idea that people, that you had to recover from construction challenges, delays, etc. Yeah, yeah, exactly. And so much of it is out of your control as well. You can plan and you can strategize and aim for this day, but so much of it is out of your control, which is difficult to navigate.

18:56You have to be ready to change plans quite quickly and you have to be ready to improvise to manage the best interests of your business and your team as well, right? as you know yourself it's not an easy place to be and especially having never done it before and it being a new whole new chapter for the business it was really that was a time where you're not eating properly or sleeps just all over the place you just mind's just in the pit of it then how do you get out of the pit i think a lot of people they go through that early journey the curve looks like yeah looks like that we're just speaking to an msk practice i think he's got three or four sites now not long ago and he was talking about the bad days yeah and how those bad days are it's very it's a very real thing yeah it's like climbing out of a pile of sand meanwhile there's a truck that's just double more on top of you it's a good analogy climbing how do you get out of you're trying to establish yeah the practice now the group yeah how do you get over that first threshold i guess that first threshold is from a financial perspective paying yourself yeah not worrying about end of month and then at some point paying someone that's not yourself and trying to do the same thing but at a certain point yeah you cross the chasm where you can say okay now i've got the basics of business economics are making sense now how did you climb at or are you still in it i don't want to make any assumptions but it's out of that kind of rough phase period so how do you get through that rough period i think it's an element of trusting the process as well we I just take it all back to basics I on a personal level I was like I said I wasn't sleeping well I wasn't and it was just all consuming but for me it was just trusting the process and I took it back to basics I was making sure I was firstly looking after myself that was a really important first step because if you're trying to climb out of it and think the things and you're not in a good headspace it was just you're not going to make good decisions You're not going to make the right decisions and you're going to be constantly on the go.

21:00So I had to make sure I was doing the things that put me in a good place first of all. And the basis of that come for me from doing my meditation, making sure I still do my exercise, my runs, my workouts, and just having a good support network around me to make sure that I was still looking after myself, importantly. And then in terms of on a more practical level and a business level, it was really just trusting the systems that you put in place and trusting the process still doing the basics really well. What do those look? I think probably hugely variable based on what you're trying to do. But I'm always interested when you think about the basics.

21:37There's the, I'll put it in quotes, the obvious, which is serving the patient that's right there for sure. I am curious about how you would define the basics aside from that, because obviously great clinical provision is part of what you do. But when you think about the basics from not necessarily a clinical perspective, from a business perspective, what are those things? Yeah, it was. So we tried a lot of different things like reach outs and emails and cold emails and things like that. But it was I didn't find that was really doing the organic work. And for me and for the company, that looked like just really using our own ecosystem and better and really tapping into that a little bit more.

22:17I just thought if we keep reaching out externally far wide and tapping into all these kind of new avenues, it's not coming from a trusted place. And I think back to the core of the business, how it all started, it all built on building an element of trust within our community. And I thought the best way is we tap into that trust of our community and we keep, we engage with them a bit more to grow it from there. so that meant yeah using more kind of marketing within our ecosystem within our mail list within our you know environment so leveraging own network so we've heard this a few times and actually i'm thinking about a practice leader that we had on quite a few months ago back end of last year who said that they had invested initially very heavily in the the usual yeah in paid marketing yeah and it worked yeah but it hit a ceiling yeah very quickly then they came to realize that actually there is only so much juice in that orange there is juice but there is only so much juice in that orange absolutely yeah i'm very curious in the business that you've built how many patients do you see now per month for whatever it might be so at per week on average we're around 100 120 in that ballpark so you're doing 120 patients a week so some percent of them 10 15 are new starters yeah so you're looking at bringing in 50-ish new starters per month yeah finger in the air yeah yeah all right so we do that we spend a lot of time so 50 new pages a month which means you probably have let's say that you convert i'm making numbers up 50 of your inbound interest so let's say that you've got 2x that of inquiries you get 100 to 150 new inquiries per month ballpark yeah probably no probably in that ballpark how did you think about building to that number that obviously is going to support that new patient flow that blood flow into the clinic yeah it can't all come from one place so network yeah the what's immediately accessible felt like one place to really yeah drive the outcome where else did you how else did you think about building the book of business the the patient relationships outside of the traditional yeah from a new practitioner opening shop today yeah the obvious the easy place to go is i'm going to pay for that attention i'm going to pay for that interest yeah how did you play that what was your journey into growing the book yeah it was jamin sorry jamin within our current the patient book you have now is however big you've seen 52 pages a month 100 ish a week you probably have a few thousand patients that are many thousands of patients yeah where did they come from how did you go out and build that almost that nucleus beginning of that book from zero effectively yeah a lot of it in all honesty a lot of it came organically my philosophy in growing the business has always been always will be growing it organically and growing it with a good moral compass and always having the patient's best interests at heart that will always be paramount in anyone or higher my my own work is well i'll never become a company that will over treat or over diagnose and over sell and this and that because i've just found personally that if we treat our patients that we have well and as if we would our own friend or family that will do the work for you that will do the networking for you because there's so many patients now that I see their whole family I see their brother their sister I see their family I see their parents or whoever it is that was one big strong element that kind of continues to be but it always comes from being trustworthy if they don't need another session you don't tell them they need another session they know because people are intuitive as well they know what's when someone's in their best interest or not and I think if you always work with that moral compass that will do a lot of the hard networking work for you.

26:13So that was one element of it from patient care perspective. Now will always be the kind of core of how we work. And then the other part of it is working with external specialists and consultants that, again, trust our work as well. And nurturing those connections as well and maintaining those connections and keep doing good work, being reliable. And there's some consultants that we work with that are very selective about who they refer to and things and referred to us for years, just purely out of trust. So I would say it's all just come from organic. Yeah, organic network. It's interesting. Actually, Sean has a saying that he will often rely on.

26:55He says, yeah, health care is a rice pot, not a rice cooker, not a microwave. Yeah. There are some industries where you can show up. Yeah. put on two minutes and pop out comes the magic but health care is not yeah necessarily one of those places you need to cook and let it sit and let it cook and let it sit and let that trust compound exactly what you're saying those relationships take a long time yeah to actively build yeah no definitely i'm probably earlier in that journey and where we're at and for me what's worked to get it to where it is now is just building that trust and building that that community and that ecosystem around us yeah and that's just always like i said i've tried other things before and this has always just been that that number one core of what we do it seems to work so far it's interesting some of the bigger groups that we speak with 20 sites 30 sites yeah one of the things that they say is that their origin story when they were more connected to the the the patient work yeah and more connected to i think importantly the patient voice yeah they had a sense of where the patients were coming from yeah and as a result what to do to nurture and really open those floodgates yeah it's become harder and harder for the decision makers you can look at it in the data yeah but the data doesn't always tell you what's happening in the conversation definitely i'm gonna show up as a google ad interest in but but actually it's the friend's brother's sister.

28:23Definitely. And actually that's the thing. It drove me that the Google ads and I accidental click at 11 p.m. on a Thursday. That doesn't make any difference. So I'm curious about that patient voice, hearing the good, the bad, the otherwise. Yeah. How have you as the principal been able to keep the ear in that conversation without losing the texture of what's happening in the room? How have you done that? It feels like that generosity of spirit toward the patient is a big part of what's anchoring the business. So how do you train for that? What does that look like? What's that approach? It's been a bit of a learning curve for me to learn that, essentially.

29:07So I think in the early days with my first hire, I practiced in a way that I naively automatically assumed anyone coming into the business would. And you don't realize, but not all people will care about it to the same level as you would. And you're quite naive in your thinking early on, but you seem to realize that that's just the reality of how it is. And that's not any reflection on them or anything. It's just how the human mind works naturally. I created this thing, so I'm naturally going to have more investment emotionally to it. And then when I first hired, had one or two people come in and then leave.

29:44And then I realized that there was no process. They didn't know what the philosophy of how I wanted the business to feel was. There was no system there for that. There was no, yeah, we didn't have core values. I didn't really instill that in them, in the way of working. And so, of course, in hindsight now, of course, they're not going to communicate effectively and reflect the tone of the business that I wanted and work in the same or a similar type of way that I did. and then I soon learned that we've got to instill this culture and this mindset from early on from much earlier in the process so that people are engaged and people know what 360 Physio is about and how we work and who we are and what we stand for and who we are as a company so you're at you're in four side sale three sides three side sale yeah seeing hundreds of patients per month yeah a very different story to you in your car.

30:38Yeah. Life has changed. Yeah. For the better, I would imagine. Yeah. Life has changed. If we were to sit down in two years, have this conversation again, and I said, how are things going? And this is one of the things I always love to ask as wrapping the time is, it's all happened organically. Yeah. Now you have maybe a sense of what the future holds. So it's going to be a combination of the organic pull that the day will take forward for you, but there's probably also a little bit of inorganic push. Let's get there now. Where, if you had to say, this is where I think the business will be in two years, five years, one year, whatever the amount of time, your choice, what is going to change for the business?

31:19Where will you be with 360? Yeah, I think on reflection, I think looking ahead a little bit, I would like the business to be, I want the business to be in a place where I'm seeing that patients are having exceptional care journeys. They're raving about us. They're leaving us really good reviews and they are having a really good experience with their practitioners. But at the same time, I'm almost not a part of that. I'm almost invisible from the outside looking in. That for me, looking ahead will be an indicator or a sign that this is running well. and don't get me wrong they are having good experiences and things first but at the moment a lot of it is with me pulling the strings around it and looking ahead a little bit I want it to be less reliant on me to pull those you know what I mean yeah absolutely it's a very interesting change because I think for a lot of practice leaders that we speak with there's always these sort of markers in time these chapters where you get to that threshold and now there's a new set of challenges and you get to that threshold and it feels like the threshold that you're describing the next chasm is yeah maintaining the vision yeah but maybe starting to see a little bit more separation yeah between the vision and the day-to-day which is a very challenging thing to go through and i'm sure will bring its own yeah risks back to the party definitely yeah it feels like each time you grow a little bit you go through different phases and it feels like we're going into another phase now where we will need a new level of operational support to handle the growth and the expansion a little bit.

33:00So that's the next challenge in the journey. I hope we do part two. Yeah. I want to thank you for sharing your time and a bit about the journey. The transition from solo practitioner in a car to three sites is not a straightforward one. So congratulations. Thank you. For what's been achieved. And for those who I think going on a journey of the gradual step up from you seeing everyone doing everything to other people seeing people and doing some things to now those people doing a lot of things and you doing less and less will be really interesting. So it'll be exciting to hear how that goes. Yeah, absolutely.

33:34Huge thank you to you for having me on and for the opportunity. I really enjoyed it. Absolutely. Thank you so much for joining us on this episode of The Business of a Clinic. We hope you had a good time. We hope it was helpful. If you can think of anyone who should join the conversation, feel free to nominate them, send them our way. We'd love to invite them to participate. If you like what you saw, give us a like, share, comment. We hope we'll see you again next time. Thanks so much.