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How Mindful Living Led to Private Practice Success and Fulfillment with Sogol Pahlavan, MD

Doctors who want to start their own practice are becoming a rare breed.  If you only seek advice from those who only work in academic settings or employed in hospitals, you will get a very skewed vision of what’s possible in your entrepreneurship journey. 

So says Sogol Pahlavan, MD, who was lucky to come from a family of business owners, and credits their support in helping her and her sister build a successful Texas pediatric practice.

Another important component in her success was instituting mindfulness in her life, so much so, that she now teaches this philosophy to other physicians.    There’s so much to digest in this lively discussion, this episode bears repeat listening!

Dr. Sogo Pahlavan’s Links:

https://www.facebook.com/pahlavansogolmd

https://www.instagram.com/drsogol_mindfulliving/

Dr. Sogol’s email: pahlavansogol@gmail.com

Joyful Journaling Webinar on Aug 29:
https://www.drsogol.com/journaling-webinar

Transcript:

Dr. Mike Woo-Ming: Having been surrounded by entrepreneurs for most of my adult life, one common trait that I see with the successful ones is that they also have had exposure to entrepreneurs early in their venture in starting up their own business. For myself, I had resident friends who would talk about their plans to start up their own practice, start up their own urgent care.

Even my dad, although wasn’t successful, his network marketing company that he was involved in and such was the case for my next guest, becoming an employed physician was not in her vocabulary. She had in her family, business owners, people who she could confide in, mentor her steer her in the right direction.

And this has led to herd her sister and building a very successful pediatric practice in Houston, Texas, and on the interview as well, we’ll not only hear about her journey. We’ll also share about why she decided to pay it forward. And now she mentors other physicians in the field of mindfulness and why it’s so important.

My interview with Dr. Sogol Pahlavan on this episode of BootstrapMD.

Hey guys, this is Dr. Mike Woo-Ming. Welcome to another edition of Bootstrap MD I’m super excited that I’m finally releasing this interview to the public. It’s probably one of the biggest delays that we actually had. And it’s mostly it’s my fault because I’ve been having some travel issues and our schedules didn’t work, but I’m so excited to finally get on the call with this physician/mindfulness coach.

Dr. Sogol Pahlavan is a mindful coach. She is trained in pediatrics, went to also exciting that she’s been a practice owner. For over, let’s say they started in 2008, so 13 years. And it’s so awesome to have a practice owner because it seems that we’re a dying breed. And I wanted her to come on, not only teach us about mindfulness and how we incorporate that in our lives, but all the trials and tribulations that come with being a practice owner.

So without further ado, Dr. Sogol. Thank you for joining us on the call today.

Dr. Sogol Pahlavan: Thank you so much. Such a pleasure. And I was like, is this going to happen today?

Dr. Mike Woo-Ming: That’s why we are botj fans of mindfulness. So when we don’t have control of things, one of the things that we do have control is being more mindful of what’s going on in our lives. I gave her a really brief introduction that I don’t think it gives it justice. I would like you to tell us about your journey and, being a physician and then transitioning it to being a practice owner, and then finally a coach.

Dr. Sogol Pahlavan: Yeah. So before I turn it, tell my journey, I just want to give a summary of what I’m going to talk about because there’s two angles that I’m going to come from. Number one, for those physicians that are in residency or med students or finishing residency, if there is any inkling in your body and you little tap, any little sign that you want to be your own owner… you want to be the CEO of your company. You want to be able to have autonomy… it is completely possible to do that. When I started 13, 14 years ago, we didn’t have any of these resources. Like we didn’t have any of the podcasts, Facebook pages… limited social media. I don’t think Facebook was even out or we didn’t use it for that social media.

So get involved, create your networks and just talk talk, and network and connect and do not ignore that. Calling and that urge that you have, so that I want to put out there. Then the second thing I want to put out there, which kind of brings in my mindfulness is if you do choose to go that route.

Okay. And it’s totally possible for every single one of you, doesn’t matter what subspecialty you are in. Then please don’t forget yourself in the journey. And I’m going to take this time to explain what that means. And that basically means in the mindfulness said, it means carving out time for you and regrouping and setting boundaries and doing things that gives your body rest and your mind rest.

And it gives you a piece of a peace of mind instead of just going, which is what I did because I didn’t know any better. So I went, I am from originally, I was born from Iran in Iran which, so that makes me an immigrant. And I came here at the age of 10. So I had all those challenges of being just in a new country with a new language.

I didn’t know “hi, how are you?” But that’s pretty much it like English to have taken a couple of English classes. And my parents were first-generation and I was a first generation immigrant. So lots of challenges during the middle school, high school years. And we came to Houston and I’ve literally stayed in Houston.

I went to college at A&M, which is an hour away. Came back to Baylor, graduated, Baylor, stayed at Texas because they had a great… I’m a pediatrician, and they had a great pediatric program. And I actually was going to do the PICU at fellowship and got admitted to the UCLA program.

And then I had a kid and I decided I cannot move to LA with a kid without any family. With like limited money. And I had my child after I graduated, I had my child, I stayed home with her for three, four months. And then I was like maybe I should get a job after school. And so I literally, I reached out to someone that I knew that I had worked as a med student or resident.

I don’t remember doing a summer internship. And she was a pediatrician and I was like, Hey, do you and my sister and I graduated the same time. We’re only a year apart. So we reached out and we job shared at her place and she was in private practice. So she had a great small practice. We were the second and third physician.

And so she. Taught us a lot, not just like clinically, because it’s your first year out in the learning curve. It’s a lot, but also the administrative side. So we really got to know her nursing manager and her practice administrator. And just asked a lot of questions and was intrigued about how, the way that things right.

And we were going to stay on with her, but we just had differences in like visions. And one of the reasons I went into the private practices because the American dream for us was like, you, like you own your own. Company, whatever that is whatever field you’re in, you need to be owner of that.

And that was instilled to us with my parents. All my cousins are owners of whatever their field is. My dad, he owns Dairy Queen. So he’s a business, everybody’s a business owner. So a lot of people are like ” how did you get over the fear?” And I was like, I don’t think I thought about it.

I was just like, oh, this is what everybody around me does okay. I’ll do it. And the place that we opened is right by my dad’s Dairy Queen. It’s like a five minute drive. And he had been in that community forever. And so he kept saying there are so many kids that come here, come open and we were like, we don’t know any… we didn’t know anything.

We didn’t know anything about business. I feel like the residents right now, at least know some, because there’s a lot more talk about it. Like I filled out the Medicaid application myself, like it was that and then my cousin gave us, he had a space. So he’s like, ” Hey, I’m going to give you the space for six months, free, open up build it out, open up if it works great.”

If not, you just lose the money on the build-out or whatever. You don’t have to pay me rent. And we opened, and it’s been crazy since because the community needed it. And my office is a little bit different because it’s underserved. It’s an underserved area. More of a Hispanic immigrant underserved area.

And that’s just that I chose that area because I just connect with that population. I had… we had a really good mix in where we started working out of residency and I just bought the Hispanic communities. I just connected with them. So it’s been great. We’ve grown. Just all word of mouth. I don’t know anything about marketing. I don’t know anything about HR. We just literally just made every mistake in the book. And then we learned,

Dr. Mike Woo-Ming: So it sounds like just having this family of entrepreneurs was really the big the big thing that really helped you overcome this. Because as as we talked about at the top, There’s not a lot of practice ownership. Maybe they’re talking about business, but I still see the percentages most chose to work for a hospital.

Nothing is wrong with it, but is it just where there are people who actually own practices or just general businesses?

Dr. Sogol Pahlavan: No. So I think we’re the only physician… so we’ve got dentists that own like dental practices, but they were businesses. But what I will say to that is, that’s why it’s so important.

I don’t think I call that your like “circle of five.” I don’t think the people within that circle necessarily need to be your family. I was lucky enough that I had mentors that were my family members and it was like subliminal kind of in a sense to where I didn’t even question it, but if you don’t have that, but then you have that urge, right?

Like that thought just like passes. Even if it’s one time a year, it passes through your mind. Start to find that circle, start to connect with those people. And connection is so easy and social media now. We’ve got like four pediatrics, we have a Facebook group that’s “pediatric private physicians” or something it’s called PPP.

So if you’re in what dermatology, see if there’s a dermatology group out there or connect with the local, like there has to be one. Local specialist of you out there. That’s in private practice. Usually there’s one private and even in Houston, because it’s so like in pediatrics, it’s so dominated by the two children’s hospitals, you can still find them one cardiologist, one in the crane.

So connect with them, find them because the more, this is what I, this was such like a big question for me, I’m like, why is it that all these residents that come out of residency, just go back and work for their hospital, or for like those outpatient clinics? Like, why don’t they, I don’t understand.

And it’s because they’re circles. their support is like their hospital and all their mentors are academic, which there’s nothing wrong. If you want to do academics, great. Do academics like it doesn’t I’m not saying don’t, but I’m saying if you want to step beyond that, then go find the people that are there.

Don’t ask the people that are not there to give you advice. The people, that’s the biggest thing it’s don’t ask that people in academics like, oh, should I open a private practice? I’m gonna say no, but they don’t know. They don’t have the knowledge. I can ask them what’s great about academics and then go to private practice and say, what’s great about your job, right? So that’s why it’s so important to start building that circle, whether that’s just locally going, reaching out to the private pizza. We loved students. We love residents.

Like we have such a passion about our space where we’re like, yeah, you should totally do this for yourself. And so we’re very open to, I love it when students email me and they’re like, oh, I heard you on this or this, can you help me? I’m like, yeah, I’m going to help you. Yeah, sure.

Because I want to be there as well. And I know it’s a possibility for them.

Dr. Mike Woo-Ming: , So when I talk with medical students or new physicians and they want to own their own practice, but there’s always a “but”. And probably the biggest one is “I’ve got these student loans. They’re getting big. It’s much easier for me to go to work for some somebody else.” What were some issues that you had to get over in terms of like finances? Did you have to get loans? Did you self-fund it?

Dr. Sogol Pahlavan: Yeah. So I will say students loans are huge. So I went to all in state colleges, whatever education, so I think I came out with $120,000. Student loans, which is not much back then, but people are coming out with 300, 400.

So if you’re a med students think about that, like where you are pre-med or something where you want to go. And I think the finances are super important at that stage. Do you go out of state? I you pay four times or do you stay in state and then pay less? So think about that.

And then we, I got our build-out was like $60,000 at that point. So yes, we got a loan of $60,000. But again, like we made it back it’s just like people, I think it’s your mindset. It’s like, oh, Dollars like, oh, that’s so much money. Or oh no, that’s actually an investment. $60,000 in an is an investment for me to create whatever that I want to do this dream or my desire, or have these possibilities.

And within two years, we grew out of our space. It was a shopping center with a dentist in the middle. So we got this space and then we grew out and got this space. And then within three years we bought ourselves the land and an old factory, or like a building or something. So that was another investment.

Again, I wasn’t like, oh my God, I have to take it. It was like half a million dollars. I was a lot. But again, I was like, okay, yeah, we’re going to take out this loan, but at the end of it, I own my land. Don’t don’t think so an instant gratification is so big in this generation, right? I think long-term, I own my land.

I own my building. I’m going to have equity in this. And that comes from the belief that I can do this. This is I know who I am. I know I’m a great clinician. If I don’t know anything about business, I can learn one of the things that I always tell residents. Think of it as you prolonging your residency and other two years, right?

If you do internal medicine, let’s say and that’s three years and then you want to go and then your mind is okay, in three years, I’m going to make, I don’t know, I’m just throwing something out there. I don’t know. Number $200,000. And that’s my salary because once your mindset is set and you have a certain salary, then your lifestyle starts.

Competing with that salary. Then I can buy a house. I can buy a car, private school, whatever. So just tell yourself, okay, I’m going to graduate in three years, but I’ve got two years where I’m going to build my practice. So my salary is going to stay at whatever 40,000. I don’t know how much residents my salary is going to stay at $40,000 for the next few years.

Then you allow your mind to open up a little bit more to the possibility of oh, Maybe this, there is another route, right? So a lot of it is just your mindset. Moving forward. Part of it is like the mentoring and connecting and then part of it is. What mindset are you looking at? Looking from if you’ve got like half a million dollars worth of loans to do a little bit of planning on that day, or if you have a partner, then the partner, like if you’ve got money coming in from the partner, then you’ve got to get the partner on board and say, Hey, I know, Salary would have counted in three years, but no, it’s going to count in five years.

So allow me those two years, we’re still going to live in this apartment with our, I don’t know, like Honda or whatever car that we have, and our kids are gonna go to public school, or we’re not gonna have extravagant things, but it’s about prioritizing. That’s why I said it starts with your why and how much you wanted and if there’s a want there, and there’s an inkling there.

Then don’t keep numbing it out and don’t kid keep, burning it up, like really go for it.

Dr. Mike Woo-Ming: I love this really strong belief in investing in yourself, because you have to decide, do you know what you want to do? What your goals are in terms of money, at least now.

As opposed to, back in 2008, when the rescue of that financial crisis, I talk with new owners and they’re like, it is so easy getting an SBA loan with these rates that they’re giving. They’re almost basically giving money away to do this. And if you have something that you want to do, and of course I’m a big proponent of becoming your own boss and it’s really.

I don’t even if in my opinion, if it’s a half a million in loans, you can always work with a financial planner. I’m not a financial planner, but there’s always a way there’s always a way if you have, if you feel that you have to do it. Yeah. It might make you want to work somewhere else. As you’re growing your business and never tell people to like, if you’ve got guaranteed income, you can work 10 to 20 hours or work some locums or something, like that while you’re building your dream. But as we sit here now is you’re a practice owner and maybe you can give the listeners about, what your schedule is now in terms of like your clinical time versus administrative itself.

Dr. Sogol Pahlavan: Yeah. So I am I right now, we’re in year 13. And I have dropped down to two clinical days a week in the middle of COVID. I was like two and a half. I picked up some like sick shifts because of the craziness of COVID. And then I’ll pro I say, I want to stay with them five years. I went down to four days a week and maybe every five years I kept going down. So maybe within 10 years I was down to three days a week and then twice.

And now I’m sitting at twice a day. But even when I was full-time of five days a week and this is, what’s so beautiful from private practice, I was able to, I was able to do whatever I wanted with my schedule. So like I was able to come in at nine o’clock because my kid had something at eight o’clock.

I had another one for physician female mother physicians up there. . I had two kids under the age of five when I started, when we broke ground and then I was pregnant within six months of breaking ground. So I essentially had three kids under the age of six by the first year into my practice.

So it wasn’t like. I held off on having or whatever. Now I just kinda did it all together. So it is totally possible to do it. There’s a right way of doing it for me. I think I made a lot of mistakes and a lot of that, those mistakes were just like, not understanding what my personal needs was. Not delegating.

It’s huge for decisions. I didn’t delegate anything. I was like, oh, I’m going to do everything right. Don’t do that boundaries. I let a lot of people run all over me as far as staffing. Okay. I learned not to do that, but that’s all the growing pains. Like you learn, right? These are all, I don’t look at it like, oh, I was walked over.

I would look at it as like a learning opportunity. Wow. Look at all the tools that I have in my belt. Now that I’ve gone through this journey. So it’s totally possible. I have some major money mindset issues. Half a million go for it. My brain read all, but yeah but that’s just my brain,

But yeah, but my schedule back then, or I would come in at nine and work through lunch, but I didn’t take a lunch break. Like it was totally what I wanted. That’s the autonomy. I think it’s important, especially when you have kids or I would blog. I did not. My last patient, I think from when we even started, my last patient was at four o’clock.

I was out of the clinic by 4:30. Like I never stayed because our clinic is far. So the traffic is a little bit and I never wanted to stay in that in that traffic. But I was super efficient with my time. I know operational management. I’m very good with drawing boundaries with patient. Like those kinds of things.

I worked to my advantage to be able to see patient efficiently and make it out the door. And then some of the other things like, okay, we have before COVID we had scribes in our clinics. So if I have was working for someone, I would have to go through 20 layers of administration to try to persuade them, to get ascribed, strike, scribe, any like literally there’s four people in our admin team. And so I joke cause most of the. I’m in practice with my sister. So she’s a pediatrician and where the two managing partners. So literally our decisions were made over texts at 11:00 PM. Like when we were, after the kids were at bed, like it was just so easy.

There was no, like I set up this meeting and let’s have blah, blah, blah. So those are some of the great advantages during COVID. We paid everyone. We took a hit personally, but we thought that was the right thing to do. We didn’t let any staff go. Some of them physicians that wanted to go down a day, a week because of the kids at home, we just accommodated everyone and stuff.

So though, where everybody else that was working with other big financial, organizations were just, The messages reporting on Facebook. My institution did this. I got laid off. There’s so many mid-levels that are now in primary care. There are so many mid-levels that are now replacing pediatricians and internists.

And I dunno, like dermatology, like crazy easy stuff. So I feel like this time is even more. Have a time to be able to go out on your own, like more of a recent, because you’ve got, so I don’t think medicine’s the same. I think it’s much harder than it was when we were, when we had trained like your job security. There is no job security in medicine, and COVID told us that, and there’s so many changes and transitions that the system is going through as a whole. So why not just dip what you want and do things your way.

Dr. Mike Woo-Ming: Not only is it changed, but to do this, obviously your skill sets has changed being in not only just being a commission, but being an administrator, what do you think was the turning point for your clinic in terms of okay, this is working, this is a success.

Dr. Sogol Pahlavan: I don’t think I ever thought it was literally, I will say location. Location, like 20 times. And we didn’t do a lot of research. A lot of it, I feel like I don’t know someone up there, the universe, whatever you believe in was just looking out for us. We didn’t do a lot of the research as to what, where hire people.

We, my dad was like, Hey, there’s a lot of kids here. And we’re like, okay, here’s a shopping center. Let’s open up, like literally, but we opened the doors. Then they flipped. Yeah, there was no, and I don’t remember when we took, like how long did it take us to take a salary? I don’t remember, but I will say from the current pediatricians that are in the Facebook group that we talk to.

12 to 18 months is usually what they say. It’s not like 2, 3, 4, 5 years or anything like that. It’s not, especially, I will say with the way that patients are getting treated in larger systems where they’re very disconnected and losing that connection with the physician or getting really frustrated with the front office.

I will say that a lot more people are looking for that that relationship that’s been lost. And if you’re in solo, what we went into medicine for is just connecting and having relationships and helping people. And so it is totally possible. And I think people are yearning that craving that relationship.

And so are physicians and so our families and. Yearning that family physician relationship. Yeah. But no, there, there’s no way that it won’t work. I’ve never heard of the pediatrician. That’s opened up a practice that it hasn’t worked. Like I haven’t, and I’m very much into all these different places that pediatricians are AAP, blah, blah, blah, all that kind of thing.

Dr. Mike Woo-Ming: One, one area that I see where a lot of people have, the biggest issues is obviously your biggest expenses, usually salary. And usually it comes winter, hire a, another physician or another mid-level. What was your experience with that? You said you have eight providers now

Dr. Sogol Pahlavan: yeah. We’re still trying to figure that out.

Yes, we have, I will say, you know what I have, I will say, I’ll say each provider is different and their needs are different, right? Just like all humans are different. So instead of having something that’s very like concrete, this is what I offer. Ask them what would you like. That’s what’s beautiful about private practice, right?

I don’t have to go by any particular set contract that came from up there somewhere. Three levels higher. I can sit down and be like, Hey, do you like telemedicine? Would you like to do half of your like visits from home telemedicine? How would you does money? Is that something that drives you or do you want more PTO or do you want to be home at four o’clock with your what do you want?

And then work backwards from there, right? Because there’s no, because each individual is different and each individual has different needs depending on where they are in their life. And so just ask them,

Dr. Mike Woo-Ming: I love like focusing on when I’m working with employees… “Tell me what you’re good at.

What are your strengths? What do you feel you want to do? Or are there things that you want to do, but maybe you don’t need the support.” Maybe you want, we can help you with the education for this. Is that something that you want to pursue where it goes wrong is when you’re having them do something that they’re not interested in doing? They don’t want it.

Dr. Sogol Pahlavan: That was awful. I did that for a long time. And then I was like, why did they keep leaving? I’m just trying to teach them stuff. And then I was like, oh, I don’t think they want to be taught. I just think they want to be like, some employees just want to stay and do the same thing. And they’re totally cool with that.

And personally, I’m not cool with that, but I’ve learned that, Hey, that’s their choice and it’s okay. And there’s nothing wrong with that. That’s a great point.

Dr. Mike Woo-Ming: Yeah. And our staff, at least I have a staff, not as large as yours. I think we have 12 employees now, but we’ve had a longevity, whether they’re loyal and they have, with the office manager, who’s got four daughters, she gets to go home early. Cause she, her softball practice. That’s her thing in her life. And so she stayed on because she didn’t enable to move her hours. So whatever that is for your employee, again, it’s an art, it’s not something that you read in a book, but you know what I found that just focusing on what they’re good at and it’s, we’re all there because we want the best outcomes for our patients.

And that’s going to happen with people who want to be there and they see the same vision that you do.

I just want to ask one last question. We could do another episode on this, but I wanted to focus on the mindfulness coach and why you decided to become a coach.

Dr. Sogol Pahlavan: Okay. I describe myself as an Energizer bunny and a locomotive.

I go at 120 miles per hour without a break. And I did that for 40 years. And then my body said we’re not going to do it anymore. And it, the way that it manifested with me is I was tired. Like posts called tired all the time. It didn’t happen. What I ate, if I exercise, if I slept and sleep, if I, and I started cutting back on work hours, didn’t matter.

Didn’t matter. Didn’t matter. I went through the whole like workup of like fatigue, whatever, this and that. Then I thought it was like mid-life. And so I struggled with it from like 40 to like I’m 45 now still to like for four years. And then I started reading a lot of books, like self-help books.

And so what I. The conclusion I came to is that I was emotionally exhausted. And the reason I was emotionally exhausted is because I had not ever stop and pause and listen to my body and listen to it. You need to take a break, you need to take a vacation, you need to delegate. You need to not pack your schedule with so many patients like those messages.

And I kept just kept pushing through it. And you run out of gas. And I think on top of that, we, as physicians are such givers and th we have to take a lot of art. We have to listen to a lot of our patients and with. My patients are getting to be that age of like teenagers and there’s a lot of more problems and social problems and mental problems.

And I was taking all that money and I was just like internalizing all of it. And it wasn’t a good combination. So I was carrying my own emotional baggage and then taking it from my patients. And so I had turned into this really angry, frustrated, trying to control everything. And that just like tired me out.

And what was so surprising is I D I would never considered myself like being depressed or anxious when I didn’t have a family history of it. So I didn’t even look there. I was like, this absolutely doesn’t make any sense. So then in some of the groups that I’ve been in, the physicians.

They were talking about coaches. And I was like, oh, maybe I need to cut. I need something. I’ve no idea what it is, but it’s something to make you feel better. And so I hired a coach and so that allowed me to really understand everything that I was carrying as what’s here. The load was more here than it was on the outside and it’s the mindset and how I looked at things.

And when I started looking at things from a different lens, first changing my mindset. And then the second component is actually looking inside your body and saying Hey, I can feel like you’re allowed to feel like you’re allowed to be angry and that’s okay. Or you’re allowed to be sad and that’s okay.

You don’t have to keep putting up this armor and being like, oh, I’m just going to save everyone. Which is what I had been doing for so long. It’s like a mother, a wife, a physician and administrator, like entrepreneur oh, all those responsibilities. And I had just lost. And what that was.

And so I went through coaching and it completely changed the way that I looked at everything. I always say it changed me. It didn’t shit. Like my kids are the same. My husband’s the same, the jobs, like nothing on that outside change. I was the one that changed. It needed changing and needed. And I reconnected with my mind.

I reconnected with my body. And then I loved it so much that I got certified as a coach. And I picked mindfulness because for the past five years, I’ve just been following the big teachers in mindful teaching and meditation and yoga and a lot of that. And so it just, and a lot of that. Weaves in with coaching.

So it was a great fit and I’m actually using it on like my team patients that come into the clinic, I’m using it with the staff, I’m using it with my kids using it, like towards my it’s like every relationship that you can think of, it’s made a positive impact because of what I have learned. And because of just like making that tiny shift in that mindset and like really.

Empowering yourself and like really going through your emotions and not just hiding from them or for me, we, emotions where we, I don’t feel because if I feel I’m weak and then I can’t get stuff done when I’m weak, I had a crazy grade. So that was like my thought that was like, my limiting thought is that we don’t feel because when we feel like you have to pause and then when you pause, then you’re going to fall.

I don’t know behind what, but you’re going fall behind. And so that’s a lot of the work that I had to do for myself. And it’s made a huge deal.

Dr. Mike Woo-Ming: I’m a big fan of mindful it’s I try to incorporate it every day. And maybe I’m going to put you on the spot a little bit here for someone who is new to this whole mindfulness, they’ve heard the word.

They’d not sure exactly what it is. Is there something that you could maybe teach them right now that they can do to maybe get an introduction?

Dr. Sogol Pahlavan: Listen to that. It’s an amazing question because literally, like I would read all these it didn’t click for me. I was reading for three years and this is what mindfulness was.

I’ll give you an example. I would drop, I cut back hours. I would drop off the kids for carpool. I would come and sit in my couch in my room and I’d sit there and I’d be like, okay. I am present. And then I was like, okay, now what? I didn’t get it. I was like, I don’t get it. Like I get, when they talk about live in the moment live, now, I’d be like, okay, I’m living now in the moment.

If something’s supposed to happen now, but the way I explain it, mindfulness is two things for me, mindfulness. Your thoughts and your feelings, your thoughts live in your head. 85% of what we think inside our head, that mental chatter, that noise is completely unconscious. You don’t know what’s going on in your head because you’re so much on autopilot.

So understanding what those thoughts that your brain is telling you and thoughts are not truth. Thoughts are facts. Okay, so important to understand. So your thought in your brain keeps telling you feelings are weakness and you can’t feel because then I don’t know, you fall behind on whatever be like, oh, maybe I should like, why am I thinking that? Be curious, ask yourself why and then feelings you feel in your body. So like when you, but the first step, isn’t understanding your thought because when you start understanding your thought, when you start thinking about it and making that shift, then you’re not mind chatter that noise that a lot of my clients say I’m tired of the noise.

I’m tired of the clutter. I’m tired of the mess. Like when that gets quiet, then you can drop down to your body. And, oh my God, when you do. Like it literally talks to you and then you can be like, oh my, my body was palpitations. I had chronic palpitations. And I was like, if this continues, I’m going to have arrhythmia by the time I’m 50.

So when you dropped down and I was like, every time now, when I have palpitations, I pause and I’m like, okay, we’re having palpitations. Let’s regroup. What’s going on. Where do we need to look what’s happening? What happened last week? Instead of just like driving through all these speed bumps and not having anything to do. So thoughts and feelings, that’s fine.

Dr. Mike Woo-Ming: That’s awesome. I think that’s been very helpful. So you showed a lot of great information. I think there’s a lot of good stuff that the listeners, what will get a lot out of, for those who want to pursue, I’m going to get to know you a little bit more, maybe learn more about your coaching practice.

What’s the best way to get a hold of you?

Dr. Sogol Pahlavan: So I am working on my website because I have this limiting thought that tech sucks. So it’s coming out in August. It’s going to be drsogol.com. So that’ll be that, but I am on Instagram, under @drsogol_mindful living and on Facebook, Mindful Living with Doctors SoCal.

And I have my podcasts Mindful Living with Dr. Sogol. If you’re interested in understanding what this like mindfulness stuff is, I break it down to I’m a pediatrician. So I talked to. It’s so I literally break it down. Like I’m talking to a kid and I explained to you what it is, and I give away all my coaching tips on my podcast.

So if you listened to my podcast and it really resonates with you, and then you want to work with me further, there’s a bunch of links on the podcast that you can click on or email me or DME, or like Facebook.

Dr. Mike Woo-Ming: I’m so glad we finally were able to do this. It was a great episode. I enjoyed it. Any last minute thoughts before we end the interview today,

Dr. Sogol Pahlavan: Y’all believe in yourself, whatever you have. Of reality. I promise it starts with your belief in yourself and then building your circle of five that has that belief aligned with your values and then just going for it and going for it means just doing it and falling and doing it and failing and doing it and falling and failing and learning until you get to your goal.

Literally, that’s what I did. And I’m still, and it doesn’t stop like failing and falling.

Dr. Mike Woo-Ming: That’s right at the end, it’s about doing something, whatever you have to do to get you there. You will always have that voice in our head. As you mentioned till I guess. No, but that’s part of being human.

That’s part of a protection. It’s difficult to get us out of our comfort zone, but you probably wouldn’t be where you are. If you weren’t able to. To get that practice up, get that coaching practice up and just keep moving forward. So thank you so much, Dr. Sogol. Thanks again. Check out the links to your blog.

Filed Under: Articles, Practice Growth

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7 Success Metrics Every Physician Entrepreneur Should Know

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“If you can measure it, you can improve it”.

I learned early on as an entrepreneur, to do well in marketing you need to know a little math, and there are specific indicators to track what’s working and what’s not.

If you have 100 people  land on your website, do you know what percentage actually buys your product? , I want to share seven success measures to determine the health of your business using the example of my cash-based medical practice.

And as an added bonus, I also share four things I look at to determine the  effectiveness of a new online ad campaign.  Whether you have an online business, a local practice, or just getting started, these are the measures you’ll want to know to save you time and money.

LINK MENTIONED:

http://www.callrail.com – software to track your phone call leads

TRANSCRIPT

If you want to get more sales, you want to get more customers, you have to measure it. So I use certain metrics in my business to determine if I’m losing money or if I’m making money. The metrics that I want to share with you guys I think can be used to apply to almost any type of business out there. I use it for my medical practice, for my online businesses.

Hey, guys, this is Dr. Mike Woo-Ming. Welcome to another edition of BootstrapMD, the podcast for physician and healthcare entrepreneurs. If this is your first time, welcome, and if you’ve listened to me before, welcome back. Today, I’m going to be talking about metrics. Sounds like a pretty boring topic, but it’s something every entrepreneur needs to know. There is a quote that I like to use. The quote says, “If you can’t measure it, you can’t improve on it.” For me, as someone who is introverted and likes to see numbers, this works perfectly for me. I learned early on that to do well in marketing you just need to know a little bit about math.

Take your website. You’ve got a website. You’re selling some type of widget. When you have your website, you want to know analytics. For example, if 100 people come to my website, what percentage actually buys my product? Now, the average is about 1%, 0.5%. Are there things that I can do to improve that percentage? There may be different variables to test on my website. Maybe I’ll have a blue background versus a red background. Is there a difference between people who buy the blue website versus the red website? Maybe I introduce a video versus a still picture. Maybe I add testimonial A versus testimonial B. These are all things that you can measure. An example that we would use is from, let’s say, my online business. Maybe I’ll buy a Google ad. The ad allows you to show a blue background website versus a red background website. Then, you can measure it to see if we send 100 people this versus 100 people on the other site, is there going to be a difference in percentages?

Another adage that we use in marketing is, “If it’s not working, test, test, test,” with the idea that you’re split testing it, and you’re using just basic mathematics to determine which site is better. Once you’ve got a website that is doing well, you then have your control. Then, maybe you’ll add another variable. That way, you can incrementally increase the success of your website, increase more sales.

What I’m going to cover today are these success metrics that I use to determine where I am in my business, just as you would a patient. You would be checking the vital signs to determine if this is someone who’s going to be ill or is this someone who is going to be healthy. You’re going to be looking at the labs. Well, you do the same thing in a small business. I want to share these success metrics that I use. For an example, I’m going to be using my cash-based medical practice. Some of you who are new, I own or co-own a number of different practices that are cash based. They don’t take any insurances. In our practice, we do aesthetics. We do medical weight loss.

Again, we don’t have insurance companies to refer us patients, so I have to have a marketing budget each month. I need to know the dollars that I used, I set aside for marketing, and what isn’t marketing, getting it into the right place. It also determines what I need to improve on, just a general assessment, how we’re doing. So these success metrics indicators just give you a snapshot of your business so you can see where you stand. It’s something that, if I can’t get to it every month, at least every quarter. That way, I know where my marketing budget goes, if I need to promote something, or if I need to take something out of my practice. These are all things that an entrepreneur needs to be aware. Now, again, I’m using my medical practice as an example, but if you have an online business, you can use these same success indicators.

So without further ado, here are the seven success metrics that every physician entrepreneur should know. Number one, customer acquisition cost, or CAC. Plainly speaking, how much money is it going to cost you to acquire a customer? let’s say you spend $1000 on a Facebook ad campaign and you get one customer. Customer acquisition cost is $1000. So I and a business partner, we agreed to put this big banner, pay for this banner, in a shopping mall that was near our weight loss clinic. We got a good deal, but when it came time to re-up it, we didn’t really know if it was making money or not. This one cost thousands of dollars to apply, very similar to I’ve seen practices advertise on billboards. Sure, that Jaime may get thousands of cars every day, but is it targeted traffic, and how do you know that it’s actually worth it? You don’t. In that line of thinking, sure, you might want to get the most traffic as possible. Why don’t you buy a Super Bowl commercial? You have to have something that you can measure.

Now, I do understand that there are some businesses, it’s all about branding. Coca Cola, they have the budgets to have this big media advertising, but not if you’re, in my case, a small local medical clinic. I’ve got a very limited marketing budget. I’m not all about branding, but I want to be sure that your marketing dollar goes farther. Now, one simple way of determining what’s the best strategy for your customer acquisition costs, and most people do this, most businesses do this, is the simple “How did you hear from us?”

Let’s say you decided to do a health talk at a local community group, and maybe it costs you $50 a year to be a member. You find out that you got 10 new patients from that talk that you did. Maybe you should do more of that versus paying $3,000 for a billboard that maybe gets you two patients. That’s just one way of having some type of understanding of what it is. I’m so surprised that more people don’t realize, when they say to me, “Hey, I think it’s working, it sounds like it is,” but they have no real grasp of it.

One thing that I do, if you’re going to do something like a print ad or a billboard, is to have certain tracking phone numbers that forwards to your main clinic number. When I’m doing some online marketing for my medical practice, I’ll have a different tracking number on my Facebook ad versus, let’s say, my Google ads and another number for a print ad that we’re doing, or a direct mail ad. That way I know which one is bringing in more phone calls. That’s a way that I can track. In that way, I know I can put more money in this one because it’s working, and this one is not. I use a system called CallRail. Callrail.com is what I use. I know if you use Google system, they do have their own Google tracking that’s free, that comes if you use the Google ads platform. But at very least, it’s one way that I can track more effectively what’s working and what’s not.

Next is customer lifetime value or CLV. Simply put, it’s a metrics that indicates what is the total amount of revenue that a business can reasonably expect from just one single customer. If you’re doing this, you are ahead of 95 to 99% of all business owners, yours truly. I have a general idea about my CLV, but it’s not something that I compute regularly. Simple example, I went to Starbucks this morning, got my vente for $6.50, but my customer lifetime value isn’t $6.50 cents to Starbucks because I go there a few times a week and I’ve been doing this since it’s opened. My customer lifetime value, over all the coffees that I’ve drunk, is a lot higher.

Simply put, in your business, are they just buying like one $27 ebook and you’re done, or are you offering additional services? Are you offering services that are more expensive, more lucrative for you as the business owner? Are you offering a webinar experience that may be a few hundred dollars more or coaching? That way, the average customer lifetime value increases. In my example, we have, let’s say, a special on Botox, but they don’t just come in for Botox. They come in every three months. We’ll add complimentary services to a skincare line, supplements, dermal fillers that all increase the customer lifetime value, just a measure of retaining as well as a measure of satisfaction. Are they just here one and done, or are they here for life? I’ve had patients here ever since I’ve been opening.

That’s something that you need to track, and again, most business owners don’t do that. The one measure, just as an aside, there’s a ratio called the CLV to CAC ratio, so customer lifetime value over their customer acquisition cost. Some businesses use that with the sense that you want to be able to increase your CLV and then decrease your CAC. You want to increase the customer lifetime value and then decrease your customer acquisition costs, so the higher the number is, obviously, the better. So that’s one way that you can combine those two measures.

Number three is return on investment. We cover that in the first part. I gave you an example of the different types of online ads. Am I getting a return on investment on my Facebook ad versus my print ad? What’s actually working? I might turn off my print ad when I find that, my return on investment, it’s just not where I need to be. Then, I could put my marketing dollar in a better place that actually is converting.

But again, it always surprised me, in using the understanding of return on investment, how many businesses, at least in my space, in the medical spa space, where they’ll just throw money at it. If they’re business is hemorrhaging, they’ll say, “Well, I’ll just buy this laser because it’s a high priced item. I can get $6,000,” but not measuring what is the customer lifetime value, not measuring what the customer acquisition costs. Then, that laser becomes a coat rack after a few years, until the laser rep remind you of the new best upgrade that’s going to be coming out that you need to have. When you’re looking at return on an investment, don’t just trust what the salespeople are going to say. You want to trust and actually, if you’re going to introduce some type of new procedure or treatment, ask around, “What is return on investment on it?” You want to hear from the business owners. They’ll tell you, not the salespeople because they have an ulterior motive.

So if you’re new to marketing, the first two or three might be a little bit difficult to explain conceptually, but I think the next couple are pretty easy to understand. Number four is how many customers do I have each month, or with Mike it’s, how many patients do I have each month? I also look at breakdown. Are they new? Are they recurring? I’ll also look at appointments. What are the type of procedures that are occurring? How does it compare to 12 months ago? How does it compare it to from two years, from that data point? What do I need to do? What’s changed? I also look at things like seasonal components. That’s why, for example, around December, in weight loss, it’s really slow because people are going to holidays. They want to eat a lot with family and friends, so I might be promoting something different. I might be promoting some skin lines during the winter season to make up for the decreased amount of visits.

Number five is just looking at monthly revenue. What’s the revenue that’s coming in? Again, taking to all the things that I just talked about. One interesting component, too, is do you have recurring revenue? See the thing with a cash-based clinic, it’s based upon how many people are actually going to show up? That determines what the amount of dollars you can be bringing in that day. With recurring revenue, you don’t have to worry about those ups and downs. That’s why the gyms love memberships. They know that, when they joined on the first or 15th or whatever the date is and it automatically re-bills, they’re going to be getting that set amount of income whether the customers show up or not. We don’t have a membership in our clinic, but it’s something that we’re strongly looking at because it does save you, that you know that you’re going to get this recurring revenue that’s coming in, that can help pay the bills when things might be dire.

Number six, website traffic. Obviously not something I look at every single day, but owning a marketing company that did local search engine optimization, it’s important. You want to make sure that you are being ranked for the keywords that will bring in more customers and will bring in more patients. Where do you stand versus your competitors? You want to make sure that you have your Google analytics, you’re bringing in more traffic to your website, the targeted traffic that’s coming in, and if it’s not, what you need to do to improve that.

Number seven, reviews. This is especially important for local businesses. We’re on Yelp, so we want to make sure that we’ve got an excellent reputation on Yelp. We’ll look at the number of reviews. We’ll look at the average amount of stars that we get. These all play a role to it, like it or not. Study by Bright Local, just giving some stats, 82% of consumers will first read up on what other people have to say about a local business. I know I do that myself. Other thing, too, is, as a local business, you always want to be bringing in more reviews. Another stat I’ll throw at you is that 84% believe that reviews that are older than three months are no longer relevant, so you always want to give an opportunity for your customers to say nice things about you for reviews.

Now, as someone who owns an online business, Yelp may not be very important to you, but the same principles apply. What’s coming up on your name or your product on the search engine? Is it positive or negative? Just like you want to respond to any bad reviews that you would get in a business, you want to respond to some bad reviews on an online testimonial that you may or may not see. Again, reviews is very important in this transparent society that we live in today.

So those are my seven success measure indicators. As a bonus, I want to give you some indicators that I use when I am doing some online marketing. These are things that I look at when I am doing online advertising. Now, you may not be someone who wants to do your own online marketing. You may want to outsource it to a company. These are some things that you need to be asking these medical marketing companies or any kind of marketing companies. If they’re putting out these online ads, these are the indicators that they should be telling you because these are the indicators that can determine the effectiveness of the online ads.

We’re going to again use the example of my clinic. We have online advertising vendors going, where we’re trying to attract cold craft, people who have never heard of us before. The way that we do it, in this scenario, is we use a coupon. We have an ad that goes out where they get a coupon for a Botox at a discounted price. They get a special. Now, we were putting out an around, and let’s say we’re using Google or Facebook. The ad goes in, and if they click on the ad, they’re going to be taken to a coupon where they’re going to get this discount, this discount on Botox.

On the ads, we want to know what is the click through rate. So of people who see my ad, how many actually click through to actually see the coupon? That’s your click through rate. So of those, taking 100 clicks on the initial ad, how many will actually go and click on the advertisement and see that coupon? We want to know what that is. The second thing is we want to look at their opt-in rate. Now, this may not be used for every single ad. You might have, let’s say, a click through that just goes to your website. There’s nothing to opt in. We like to have an indicator.

So for people who decide to take the coupon, we want them to jump hoops a little bit and opt to answer. They have to give us their email address or their phone number to actually get the coupon. That allows us to track and also determines that they’re more serious versus someone who just could be a competitor or just clicking on the advertising. But if you’re just sending them straight to your website, you won’t need to have it. So the number two indicator is the opt-in rate. So of those 100 people, let’s say 20 people, or 20%, actually clicked on and got exposed to the coupon. Now, if they actually get the coupon, of those 20 people, how many actually gave us their email address or their phone number? It could be five out of 20, so that’s our opt-in rate.

Now, taking that further, number three is of those people who’ve got the coupon, how many actually made a phone call? We want to know, from the people who initially clicked on the ad, how many people actually took us up on our offer, got the coupon and then called us to make an appointment. How do we figure that out? You probably guessed it. I have a special tracking phone number, so I can determine who are the people who saw the ad, got the coupon, and I know how many calls that I’m getting. That way, I know whether a campaign is working, or if it’s not.

Again, these are indicators that you need to know, you need to be able to ask your marketing company, whoever you’re going to be using. Now, I told you, there were four. Three are related to the actual online marketing of the ad. The fourth one is related to how well you are at hiring your staff. The fourth one is the conversion rate. How many of those people who take the phone calls, what percentage actually make an appointment? If you find out that one person is getting 95% and you find out maybe another person is getting 25 or 50%, you may need to talk to that person because they’re not doing a good job in actually converting that phone call and inquiry into an appointment.

What I like about it, with these indicators, you can actually break down to see if there is an issue with your online ad campaign. You can actually see where the breakdown is. Let’s say you have a low click through rate. You’ve got your ad, but not a lot of people are clicking on that ad. That means that your ad needs to be improved. There’s something that is not resonating. Let’s say you got a pretty good click through rate. People are clicking through, but they’re not giving you their email address or their phone number. Well, there’s something on that website that is stopping them. Maybe it looks too spammy. Maybe they’re not comfortable giving you their email address, or you’re asking them for their cell phone number. So what’s on the website? Are you having testimonials that enlist trust, that, “Okay, this looks legitimate?” You need to be looking at that.

Then, let’s say people are getting the coupon, but they are not converting those into appointments. We had that issue, and we needed some reminders that they had this coupon. That’s what we found out. That’s where we found our breakdown. Once we improved that, then we started getting incredible amount of appointments. Then, if they’re calling in and it’s not converting into appointments, you’re getting the phone calls, it’s not converting to appointments, what is your front desk person saying? Maybe they’re saying something that’s turning people off. Maybe you’re so busy. You can’t get appointments, and you have to be seen for a few weeks or months. These are all areas that you can look at and investigate and analyze.

So those are the measures that we’re using when we’re doing our online ad campaigns. You notice I didn’t say anything about how many Facebook comments I’m getting or Facebook likes or views. Those all may be important, but in determining your campaign actually being effective, the four ones I gave you are much more important. I have a marketing friend who says, “I can’t deposit likes into a bank.” So if you just stick with the four that I gave you, it’s going to be well worth your time and money.

As an aside, I have a marketing team that we work with that will help you with those four indicators. At least at the time of this recording, they are open to take a couple more clients. So if that’s something that you may be interested, they’re specifically working with med spas and cash-based medical clinics. The guy who owns it I’ve known for over 10, 15 years. If that’s something that you’re interested in, I’m not going to put out their information publicly, but if you are interested in that marketing company, just go to bootstrapmd.com. At the top right is a contact us. Just put in [inaudible 00:24:56] marketing team and maybe a little bit about your business. Again, they’re just working primarily with med spas, cash-based medical practices, and be happy to share with you that information.

I hope you found that helpful. These success measures can really make or break a business and not a lot of entrepreneurs are actively doing it. It’s all about teaching you guys to be more proactive with your business. Find out what’s actually going on with your business before it’s too late. With these indicators, these are the things that are going to help your business, keep moving you forward.

You’ve just listened to the BootstrapMD podcast. For more valuable resources, as well as past recordings of our show, check out our website at bootstrapmd.com. Now let’s get to work.

Filed Under: Articles, Entrepreneurship, Online Business, Practice Growth Tagged With: medical practice metrics, online business, physician entrepreneur

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