He Lost 70% of His Revenue. Then This Physio Started Buying Businesses | with Ross Tomkins, BOAC #73

0:00We lost 70 % of our revenue over a short period of time because a lot of our contracts were tied together. They were quite intricate in the way they worked. I'm a physiotherapist, worked very, very briefly in the NHS in the UK. I wanted to spend an hour with a patient and they said I had 20 minutes. I was thinking about the new contract that we'd offered somebody and I was probably only giving my patient 90%. And that was the moment where I went, I need to stop. I need to actually focus on the business. In my mind, AI can do the job of 10 people. So you could get rid of nine. Or you could have 10 people doing the job of 100 people.

0:40This is a multiplication. There are lots of people out there who say they're AI experts. And actually, probably they weren't three months ago. They were doing something else. So they promise the world and then don't deliver. I would be a little more careful about who I partnered with, I think. You're going to spend more time with them than your husband or wife. So we'll go out to dinner. We'll go out in a personal way and have a look at how they interact with the people in the restaurant. But the goal is in five years, we will have 500 million revenue under management. This is pounds, not dollars.

1:23Hey, everyone. This is Jared, co-founder at Coherent Healthcare and host of The Business of a Clinic. Today, we are joined by Ross Tompkins, who has had a very interesting journey that we're going to get into. But as you all know, our sort of three key audiences are, number one, clinician entrepreneurs who are building their own practice. Number two, consolidators, group operators, people who are starting to think about scale. And then group number three, the investor behind some of that consolidation activity. and what's really interesting about the conversation I think we're going to have with Ross is that he has has or is wearing some combination of all three of those hats so this is a very interesting one Ross could you maybe just just start us off by giving us the one minute version two minute version of how you got here to this conversation and then we'll go from there sure yeah I'm not really good at trying to get things in a minute or two but I'll try my best so um so I am your typical accidental entrepreneur.

2:22I'm a physiotherapist. I qualified in the 90s. I worked very, very briefly in the NHS in the UK. I realized I was pretty much unemployable because I wanted to spend an hour with a patient and they said I had 20 minutes. So that wasn't going to work out. Eventually started my own business in 2006. And really, I only started it because I wanted to be the best physiotherapist that I could be. I didn't start with the end in mind. I didn't start with a financial goal. I just wanted to spend an hour with a patient, get to the root cause of the problem and be the best version of myself. That was it. That was plain and simple.

3:04Now, because I was pretty good at my job and people came back, we grew. And we actually grew that business up to 35 members of staff over a few years, completely by accident. Now, throughout that journey, I kind of learned many things about myself and about business as well. At one point, as I thought everything was going great, I'd actually just published my first book, The Business of Health. About a week after that, we lost our biggest client, which was a huge shock but it forced me to think differently and it kind of and you hear this a lot I think especially on podcasts you hear people say and it was a really low moment that forced them to think differently differently and that was it for us we lost 70 % of our revenue over a short period of time because a lot of our contracts were tied together and they were quite intricate in the way they worked.

4:00And it forced us to think differently. So it forced me to look at mergers and acquisitions as a faster way to grow where we weren't relying on a single client anymore. And after we did our first one, something just clicked inside. And I was like, wow, this is a much better way to grow. It might take a while to get there with negotiation, but then all of a sudden you can double in an afternoon. This is wild. So I just focused on that full time. Over the last nine years, we've done 29 deals, including both acquisitions and exits. So we've sat on the other side of the fence as well. And about just under two years ago now, we started our latest vehicle, if you like, for this, which is Balmoral Partners.

4:49You can see on my hat. And in there, we are now a healthcare holding company incorporated in the UAE and rolling up in the UK, the US, and Australia potentially as well. So there's a lot to sort of pick on there. One of the things that I'd love to understand, and I think other people probably have their own version of this, to your point, like the good moments, the bad moments. But I think there's probably the mindset transition. For you, you said it was like, oh, we can double in an afternoon, takes a while to get there. But that I think that kind of thinking is very different probably than why you got into the practice in the first place where you went in as a clinician and you sort of came out as a as an entrepreneur.

5:35And somewhere, I guess, somewhere along the way, the identity goes from being clinician entrepreneur to being entrepreneur clinician. And I guess I'm sort of curious, can you, to the extent that you can, so take us back into that transition period where you had those harder conversations? What were the sort of mindset and belief changes that took you from version one of the practice you were building to version two, three, four? How did that change for you? so I think there was a few things over the years that that took me through this change so I remember quite vividly when I first started the business and I was trying to be the best version of myself as I said before you know being the best therapist and clinician that I could be I had this sort of epiphany where I realized that even if I was the best occupational ergonomist in the entire world.

6:33If nobody knew who I was, how on earth was my business going to grow? So this kind of epiphany was maybe I should stop learning about clinical stuff and actually start learning about business and might chose to start learning about sales and marketing. And that was a big moment. And then probably wrestled with my identity for a couple of years where if I had to make it at a barbecue or at the conference and you said, what do you do? I would have said I'm a physiotherapist, quick as anything. And that is my identity. That is who I am. But over a few years, you know, I went down from five days to four days, four days to three days, three days to two days, struggled to let go, you know, and I was still doing a couple of days a week as a clinician because that's who I was.

7:22That's what I identified as, even though I was spending far more of my time on the non-clinical things, the contract review meetings, the offers that we had made to new clinicians. And one day, the thing that really flipped the switch was I came home from work one day and my wife said, how was the day? I said, I've not been the best physiotherapist I can be today. And she said, what do you mean? I said, my patient probably We didn't know. But I was focused elsewhere. I was thinking about the contractually meeting we had coming up. I was thinking about the new contract that we'd offered somebody.

8:05And I was probably only giving my patient 90%. And remember, I'd got into this to give my all, to be the best physiotherapist that I could be. And that was the moment where I went, I need to stop. I need to actually focus on the business. so that was probably at that point quite a quick switch that flicked it went right you are no longer a clinician you're actually a business owner and you've got to take this seriously i know to be so sort of in the emotion about it but i can imagine you know you you've spent your qualification years and early years in the clinic believing that was the that was the mission the mission was to be the best physiotherapist that you could be.

8:52And then it sounds like almost by accident, you called it earlier, like accidental entrepreneur, but like you've sort of, someone has done this, this magic trick to you where suddenly that, that hasn't been the front, front runner. How does that feel? Is there any emotional tension there for you? Is there, is it sort of a step back and, oh, how did we get here? What was the sort of, what was the inner journey that you went on to say, actually, this is my new idea. Now I'm not going to introduce myself as physiotherapist anymore. I'm going to introduce myself as X. And what was X? What was the new introduction when you were no longer introducing yourself as a physiotherapist?

9:28That is a brilliant question, Jared. And it took years for me to get comfortable with that new identity. And it actually took me probably six or seven years until I actually forego and gave up my license to still practice. Because something deep inside said, no, you're still a physiotherapist. What if you need it? What if it all falls down? So I went from, yeah, I'm a physiotherapist who runs a business to I'm a clinician, managing director. And then I was like, I'm a managing director of a physiotherapy company. And then I went to, I'm a business owner. And now I'm the CEO and the founder of a healthcare holding company.

10:16But that took many years to get comfortable saying, because I would say it and I almost wouldn't believe it. Because there'd be part of me inside going, no, you're a physiotherapist. What are you doing? And so it took a while. It's interesting. I, um, we, we work with a lot of clinical leaders and usually when, when we find ourselves getting involved is when they, they start thinking about that transition for themselves, because now they're starting to think about growing the business as opposed to just sort of being in the business. And, and I think what you've just described is very common, which is this idea that, that like the title struggle is like, it's very much an identity thing.

10:56Like I, you know, people have spent X number of months, years qualifying to be a certain thing. And then now suddenly that thing is occupying like 10 % of their time and 90 % of their time is doing this other stuff that maybe they actually like more or they're more interested in, or it's just what is needed at that time. But, but I think that, I think that probably resonates with a lot of people on that journey. Now you're much deeper in that journey. You are well out the other side of the transition. And now you're, you're sort of in like a, it sounds like you're in a building and a growing, you're thinking a bit differently about what comes next.

11:35What does today look like? How do you think about the future for yourself, given where you are right now? Yeah, that's another really good question. So things are different now, and there isn't a part of me that thinks of myself as a physiotherapist, I think, on a day-to-day basis. If I'm in a room full of physiotherapists, I can still, of course, relate and flip back into that, although things have changed and moved on from a medical perspective, you know, in the 10 years since I put my hands on someone. But we employ close to a thousand people now, you know, that should be nearly 1200 by early next year with the acquisitions that we've got going on.

12:13And actually that entity, that business deserves someone at the top, you know, as a leader who is a leader who is a healthcare entrepreneur and not, I don't want to say just a physiotherapist, but not a clinician anymore. Someone that is thinking of the vision of the wider things that have to happen within a business. So I think that's how things have changed and kind of how I see myself now. And to help me get there, what I did is I kind of like flipped another switch in my head, which was what I enjoyed as a physiotherapist was I enjoyed when someone came into the clinic with a bad back and they left and they didn't have a bad back or they came in with a bad knee and after a couple of sessions they didn't have a bad knee anymore like that made me feel warm inside I really enjoyed that and now I don't get to do that so much although I do have a little bit of contact with our men's health clinic in such a way but we as I say we employed lots of people now that are helping everybody on a daily basis.

13:18We own a medical supplies and pharmaceuticals business. We sell thousands of SKUs every single day to doctors and clinicians all over the UK. We own a medical device company that sells microscopy into research establishments that are working on all sorts of pathologies. So the change of mindset was, although I can't help anyone on a daily basis myself, the businesses that we're involved in and that we own through a ripple effect, helping thousands and thousands of people every day, which has to be a move in the right direction. So it sounds like one of the mindset shifts for you was, how do you think about your impact on ultimately patients, people, but the cause and effect or the input and output was maybe much, much closer joined in the days of being a physiotherapist.

14:14People came in feeling one way, they left feeling a different way. Now, I guess the delayed gratification of that impact is much longer, but also the reach is much wider. Do you have any, I'm always hesitant to say any advice, but like what other mindset shifts did you notice in yourself that allowed for that transition to be either effective or challenging either way but what else was was part of that identity reformation i think a really big shift that allowed me to move from clinician to business owner if you like was when i realized that i didn't have to be the best at everything in the business uh because i think early on you know i was trying to be the best clinician that i could be.

15:03And then I was trying to be the best at sales and marketing. And then I was trying to get a handle on finance. And I wanted to know about operate, wanted to know about leadership. And I was kind of trying to be everything to everybody. But when I realized actually that was impossible, nobody could be the best at everything. And I kind of had to get out of the way. And I had to start employing people better than me. And that was quite a switch to make. And all of a sudden, I was surrounding myself with people far more talented than I in certain positions within the business that really allowed me to focus on the things that I was good at and allow them to do what they were best at.

15:40So that was a really big moment, I think, in my transformation, if you like, from clinician to business owner. It makes sense. You mentioned a minute ago, now, I guess, through Belmoral, you have a thousand, soon to be a thousand plus people involved around the organization. Obviously, the impact that they have on patients' lives is many fold. You gave some examples, medical device, diagnostics, you're working across the healthcare continuum. what are you seeing at that sort of nexus point? A lot of people in the space probably see a thin slice of healthcare. Maybe they see provider operations.

16:21Maybe they see health tech innovation. Maybe they see digital. Maybe they see drugs and devices. You're seeing a sort of melting pot of healthcare stuff. What's the through line that you see? What's happening across the sector, showing up in these different portfolio companies that you now own and lead? that's making you think, okay, this is the future of where we're all heading. Like, this is what comes next for the sector. What does that look like for you? I think every single business that we have at the moment, you know, it has different concerns about the technology and the AI that is, you know, coming into our industry.

16:58A lot of the operators and certainly the newer companies within the business that are potentially a little bit more experienced, a little bit older, are worried. and a lot of the sort of younger operators and the people we've had in the business for a while are more excited about it. But it's certainly, you know, it's very pervasive. It's going through every area, I think, of healthcare. And no one's really sure what's going to happen yet, how it's going to be affected, but it's definitely on everybody's mind. Now a quick break to tell you a little bit about Coherent Healthcare, the company behind the business of a clinic.

17:33Coherent 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. It'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 health care. To learn more, visit us at coherenthq.com. Now back to the episode. What is the, I guess, if you take us into the micro, where are you seeing that show up in your in Balmoral's ecosystem?

18:17Is it showing up on the back office side, the front office side, patient facing side? Where are you seeing some of those changes, good or bad, start to come out? and certainly at back office stage across all of our businesses you know we're starting to see some real savings being made in terms of time and the way we're kind of choosing to look at ai is in my mind ai can do the job of 10 people so you could get rid of nine or it could or you could have 10 people doing the job of 100 people you know so so the way we're choosing is there is This isn't a taking away thing. This is a multiplication.

19:00So, you know, we don't want people to be fearful of this. So, you know, we are seeing the back office is starting to improve and we're starting to see some savings being made across the board. From a marketing perspective, we haven't yet identified a way that AI works well. We have had a number of people look at it. And what I found is there are lots of people out there who say they're AI experts. and actually probably they weren't three months ago. They were doing something else. And so they promised the world and then don't deliver. So that's where I'm at on the marketing side, although I am convinced it can work.

19:36And then from a day-to-day perspective, I guess it hasn't really affected the patient contact yet, although I certainly think it's got the ability to. I think we're probably very close, even if it's not happening already, to AI interpreting radiology reports far better than a surgeon or a consultant can because they don't get tired and they can look across thousands and thousands of images in a second or probably less than a second. So I think that is quite exciting, the benefits that will come to a patient that way. A friend of mine actually just 25 minutes ago got in touch to say they just got diagnosed with colon cancer.

20:21And we wonder whether that would have been picked up sooner, you know, had there been an AI robot surgeon or consultant looking at that, you know, and looking at the images. So that's quite exciting. And I think it's coming in. We've got within the organization, there's an interesting conversation saying, will AI ever touch patient care? and there's we're probably falling on to the 70 % of the company saying no you know a robot will never replace a carer in somebody's home because of the sort of the empathy side but then there's a there are people in the organization going actually no that's not right you know and and give it maybe another I don't know it's advancing really quickly five ten years there'll probably be robots in people's home you know we're really sophisticated ai that are just as good as a human at interacting with someone caring for them and actually being empathetic through a algorithmic way um so yeah that's across the board kind of what we're seeing interesting i i think it's uh it's interesting also because you're you're you're now sort of i guess one layer removed or maybe multiple layers removed from the operational front line of doing that you know sort of patient hand-to-hand combat, probably a strong word for healthcare, but you're not seeing patients in the same way as you were many, many years ago.

21:47AI obviously is a now shift. It's a thing that's happening in the last 24 months to the sector. People are starting to come to terms with what this might mean. Do you remember other sort of pinch moments, linchpin moments, pivot moments in the industry from the days that you were, I guess, a physio first and foremost, to later parts of the journey where actually there were these very marked moments in time where we said, ah, this is a change moment and we're changing in this way or we're changing in that way. I guess I'm trying to understand, you know, in some ways, AI is new, wonderful, exotic and hugely capable.

22:23And in other ways, it's just a faster typewriter. So what were the other sort of moments in your journey in healthcare where that sort of change dynamic was really afoot, really, really visible to you, either as a practitioner or a business owner? Yes. So, you know, the first 15, if you go back to when I was a student, probably the first 20 years of me being a physiotherapist, all of our notes were written on paper. So, you know, you'd see a patient and then you'd write your notes. It took between maybe five and 20 minutes if you had to write to a consultant afterwards. And I remember distinctly when all of a sudden the first patient management tools came out that you didn't need to write it down anymore.

23:10You had to type in, and then it was verbal, and you could speak into something. And I was actually the last person in our organisation to address that and to take it on board. All of our physios were saying, this is amazing, I love it, it's faster, and I was the last one to switch. And I found it the most difficult, which is interesting. I did get there in the end, but by then I was working a day a week, two days a week. So it wasn't as problematic for the business. But what's interesting is I was the one that was resistant to that. But that was a big change at the time. And now, obviously, with AI, that's got even faster, even better.

23:49And now we can write the consultant letters off the notes that are happening during the consultation. So it's quite incredible how things have moved in such a short space of time. Is there a, it's an interesting one, I guess, now probably wearing more your business hat rather than clinician hat. There's a, I think for us, the thing we always wrestle with is oftentimes we find that healthcare innovation really focuses on minutes, especially in AI world. We keep seeing the conversation come back to minutes saved. And I guess there's an inferred downstream P &L level impact of minutes saved or satisfaction that comes with minutes saved.

24:35And yet we have not yet seen, when I say we, I mean coherent, has not yet seen or had a conversation with a clinician or even a practice owner who has said, we've adopted certain technologies and or tools. We've put in place an AI receptionist. We've put in place this thing. And suddenly we've had 10x productivity from the team, or we've suddenly been able to reduce our team if that's the direction that you move in. What we often find is there's this adoption and there's an incremental uplift. This sort of people are a bit happier because they don't have to write their notes. We've saved 10 minutes per practitioner per day.

25:12But where do those minutes, like how do those minutes actually show up when you're thinking across your portfolio of companies? You're thinking about modernization, about AI. How do you think about the ROI story? Is it just are we talking about minutes and smiles? Is there a more rigorous way to actually hold, you know, you mentioned about your marketing experience. You said people haven't really delivered on the goods yet. Where should the bar be for a health care operator when they think about adopting new technology? What is good enough? How do you draw the line on what clears the bar for, yeah, this is worth doing?

25:50I think for us, what we were really concerned about was the feeling that the patient or the client gets during the interaction. And the minutes saved in writing the notes, speaking to a consultant, doing all those things, are minutes that you can spend with the patient, with the client. And that means that they get a better experience. You know, maybe the physiotherapist or the clinician, you know, gets to spend an extra five minutes because they're not thinking, I've got to get them to leave because I've got to write my notes. So, you know, patient satisfaction questionnaires and things that we've carried out throughout the years.

26:34Certainly we saw an improvement when the patient software changed and we moved, like I say, to typed instead of written and then to sort of verbal. and that's what we expect to see as well across AI. So we're less, as I said, we don't want to get rid of anybody certainly. I would love to see the bottom line improve with some of these things but ultimately as long as our clients are benefiting, I think it's worthwhile the investment. But it's interesting, you sort of take it, it sounds like you're taking it back to if the patient experience improves, everything else sort of works itself out better patient experience means business is going to do better ultimately that's that's what's on the pizza box is patient experience yeah exactly retention gets better you know people they're going to come back more often they're going to talk to more people and word of mouth improves and i don't quite know how to measure all of that yet but that's my my thinking got it so so i guess maybe as a i'm trying to think about what what framework is there in that?

27:39Because I know one of the conversations we often have with practice leaders, especially those that are scaling, is how do I know where to put my innovation dollars? How do I know, do I put money behind this initiative? Do I put money behind that initiative? And oftentimes what we find ourselves saying to practice leaders is, what is the number one thing in your clinic or in your organization? What's the number one priority? And sometimes the answer is bottom line. It's like, great, well, AI dollars is probably not going to be the thing that shows up on the bottom line tomorrow in quite the same way.

28:15You should just go fire a bunch of people and bottom line will get better. Or you should go spend a lot more on marketing. I think it's a ruthless way to say, if P &L is number one priority, there are ways to address that that are not necessarily AI. Whereas it sounds like what saying is actually number one priority is patient experience. Everything else is downstream of that. And if AI is a thing that serves that patient experience objective, then it's worth investing in. Is that sort of the right mental model? 100%, yeah. Okay, got it. Where does that show up now, forward-looking? So I know you're in the US right now.

28:52You're thinking about expanding your group activity. Can you give us a look into the future, what's getting you excited? Where do you think the next chapter for Balmoral is? So we're looking at a couple of things over in the US in particular. One is psychedelic clinics, psychiatric clinics. I think that's a really interesting space. We spoke a little bit before we jumped on. So that's got a lot of our time and attention at the moment. And it'll be really interesting to see how we can use AI there to measure patient outcomes, because the outcomes that can happen in that particular industry are enormous.

29:32You know, you can take someone from treatment-resistant depression to feeling fine, you know, in a couple of sessions. So, you know, how that's measured at the moment, it will be really interesting, and then to see if we can improve those outcomes utilizing these technologies. Interesting. And is talking about that as sort of like a growth area for your work, What does that, let's say you end up doing work there, what does that live alongside? So you mentioned again, UK consolidation, you have some provider operations. What else is in the bag for Balmoral right now? What are the different things that are sort of occupying that holding company?

30:14So at the moment, we have 10 different investments, different niches, different industries that we're involved in. The big three, I would say, are elderly care, My CFO and my business partner was 10 years at HC1. HC1 were the largest independently held elderly care company, healthcare company in the UK. And they were just sold for 6 billion pounds in a deal with Barchester. And he spent 10 years there, did about 500 million in transactions with them until he had that little bit of an entrepreneurial itch and wanted to do something for himself. So I'm really pleased that he joined me almost two years ago now.

30:58So Elderly Care, it really is his experience, his background. So it's fantastic. He's bought lots of Balmol. And we've then got mobility. So we've done three acquisitions in the UK at the moment in the mobility vertical. So that's wheelchairs, walking sticks, powered chairs, excuse me, and modifying vehicles so people can utilize those. And that area, I think it's kind of taken off faster than anything else within Balmoral at the moment. And we think it'll continue to do so. Again, similar to the clinics, it's quite fragmented. It's an area that's only growing. You know, we are all getting older, living longer, having more chronic diseases.

31:42So there's not going to be a downturn, I think, in that particular industry. And then the third thing that we're really excited about is that psychedelic roll-up. looking across the ketamine phenic space in the US. The other verticals are smaller. I think we'll grow a little slower. We did place a few venture investments last year in some quite exciting startups. So they're more hands off. They're there, of course. We're just waiting to see what's happening with them, support the founders where we can. But I think those three that I mentioned are where most of our time will be seen, utilised over the next couple of years.

32:21When you think about the things you've learned on the journey, being in these different pockets of healthcare, if you had to sort of wrap all those things up and take them back to the beginning of your journey, where you first started, what would you have done differently? What would the, you know, now with the wisdom, of course, what would you go back to day one and do differently based on the experience you've had since on the M &A side, on the in-clinic provider operations and outside of it? What would be the sort of one or two pieces of gold that would have maybe changed the trajectory? Obviously not necessarily better or worse, but just changed it.

33:02What would you take back with you? um i would be a little more careful about who i partnered with i think um i it's very easy as an entrepreneur when everyone who owns a business you know whether they're a clinician or a business owner they're clearly entrepreneurial otherwise they wouldn't have done it but one of the dangers i think of being an entrepreneur is we all get we all like shiny things. So, you know, the next opportunity looks fantastic. And the next opportunity looks fantastic. And it's easy, I think, to get sucked into those. And I've done that a few times over the years and probably not done enough due diligence on the people that I was getting into business with.

33:47And you've got to be really careful here because for certainly for a period of time, you're going to spend more time with them than your husband or wife. You know, you're going to be speaking to them every day and over a long period of time. And in the beginning, it's great, you know, because everyone's pulling in the same direction. It's all exciting. Everything's shiny. But what happens when it's not shiny? What happens when that business takes a bit of a downturn? What happens if somebody's not very well? You know, all of a sudden there's more onus on somebody else within that relationship.

34:16And you've got to, I think, really think things think things through. So over time, and I'll spend a lot more time and care and attention on choosing the people that we do work with. And I think that's one thing I definitely would have done differently. And a couple of the deals that I've been involved with over the years probably wouldn't have happened if I'd taken that approach. And is that, I guess, for the people who are maybe early in the journey, specifically, I'm thinking about the clinic operators, many of the folks that we interact with, I think what you've just described is probably shared experience.

34:53You hire a new practitioner, you bring someone on who has complementary skills. How do you pressure test that now? So you're saying, I think a bit more carefully about it. I'm going to approach differently. Do you have a sort of, how does rubber hit the road? How do you stress test whether or not said person is a person you want to do business with is a person you want to give that trust to what what are you looking for in that so i spend more time with everybody now and in different situations so we'll go out to dinner you know we'll go out in a personal way and have a look at how they interact with the people in the restaurant we'll maybe go and have a game of golf or we'll go to an event together and just spend more time understanding how they see the world and i think where how they react to different situations because how we react in everyday life, I think, is a really good indicator to how we react in business as well.

35:53So I think I just take a little bit more time to get to know them outside of the business before making a decision. Makes sense. I want to be respectful of your time. You've been very generous with it so far. I want to, if it's all right, I want to go back to the sort of start of your healthcare journey where you're building, running, growing, acquiring healthcare clinics. I think that that journey, it was where you started, whether it did establish the foundation for everything that's come afterwards or not. But it is very much where you started your journey as a practitioner, and then ultimately into a group operator, a group leader.

36:31How are you seeing healthcare provider operations today as compared to the landscape when you were last involved. So as an example, the UK, you said you practice in the UK, we're seeing a lot of consolidation, particularly in MSK. Right now, there are a lot of new players coming in starting to buy and build and all the rest of it, trying to consolidate. What are you seeing from your vantage point, from a healthcare provider operations perspective, specifically, I don't know the extent to which that's in your portfolio as well. But when you think about your typical main street clinic, you know, be it physio, be it dental, be a dermatologist, what is going on there that you think is sort of new and or interesting or has your mind share right now?

37:16I definitely agree with you that there is a lot more consolidation happening now within those clinics, which I think is really exciting. I think it's a really great opportunity for the clinicians to ultimately either bring on board a partner that can help them scale or to help them have a far more exciting and potentially life-changing exit. Our first exit from our physio clinic, where we had four clinics, was a mindset shift again. It was our first exit. My wife retired off the back of that. But it wasn't life-changing. I couldn't have never worked ever again off the back of that. but I think now there's an opportunity you know to probably take that from a you know a three to six times multiple which all of a sudden gets interesting you know and I think could potentially be very life-changing for clinicians that are out there so they don't have to go and shift gears and buy other you know buy medical supplies and buy home care and they can just do what they love grow a significant clinic and potentially that means you know never do anything ever again so I think it's exciting.

38:23I think it's a really good opportunity. I appreciate that. Thank you for sharing. So for those who are thinking about anything in the sense that there may be relevance, I'm sure that they'd be more than welcome to reach out to you. These are my words, not yours. So obviously, ignore them if you need to. But I'm sure you'd love to hear from them. I guess any parting thoughts on your side? Where does this conversation go if we were to sit together in five years? And we were to say, what was the journey from when we were last together to Balmoral today, what would you like to be able to say? What's the sort of forward-looking press release?

38:59Wow, I love that great question. And just before I answer that, I would say we would love to speak to anyone and everyone. So if you are looking to exit your clinic or your healthcare business, definitely get in touch. If you're looking for operational expertise for assistance with capital raising and growth, again, there It could be a partnership. And if you're an LP as well, you know, if you're looking for somebody to partner with on a particular niche or a particular vertical. And we're currently we're just talking to a company about investing together. They're putting in 25 million to a deal over in the US.

39:35So anyone throughout that journey, I would love to have a conversation with. But the goal, and hopefully we'll come back and we could talk about this in a few years, is in five years we will have 500 million revenue under management. Whereas the end of this, we're currently sitting at 42. This is pounds, not dollars. And by the end of our second year, which we're racing towards, hopefully that will be finished on around 70. So we've got an ambitious and lofty goal, but I'm confident in the team. And we'll get there. Thanks so much, Ross. Ross, thank you for joining. Thank you, everyone else, for joining.

40:12We look forward to seeing you again for another episode of Business of a Clinic, and have a great afternoon. Thank you. 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.