#159: How He Scaled to a Multi-Surgeon Clinic in 3 Years With Dr. Sepehr Lajevardi Owner and Principle Surgeon of Cosmex

PODCAST TRANSCRIPT

Practice expansion strategies and operational systems facilitate clinical growth via specialized care and integrated team workflows.

Early Career Growth Strategy

Specializing in breast and body procedures established a recognizable reputation and facilitated rapid practice development. High quality patient care and selective case management built trust during initial operations.

Scaling Multi Surgeon Operations

Standard operating procedures and concierge teams manage patient journeys while supporting surgeon specific niches. This structure enables consistent, high volume lead management and collaborative multi disciplinary care.

Marketing and Infrastructure Systems

Foundational backend processes must precede paid marketing to ensure effective lead conversion. Strategic investment in specialized managers and AI tools sustains operational productivity across expanding clinic locations.

Next steps

• [Sepehr Lajevardi] Identify Collaboration: Determine potential areas for collaboration with Huyen Truong. Explore established experience to find suitable partnership opportunities.

Details

• Initial Meeting Setup and Introduction: The initial conversation focused on setting up the meeting logistics, including the sound check and ensuring the speaker was spotlighted. Huyen Truong introduced the show, noting their postcard show has over 6,000 subscribers, primarily doctors and surgeons in the cosmetic surgery, hair transplant, and self-referring patient sectors, expressing excitement to share Dr. Sepehr Lajevardi's story about scaling their practice.
• Guest Introduction and Practice Overview: Dr. Sepehr Lajevardi, a specialist plastic surgeon and founder of Cosmics Clinic in Sydney, Australia, was introduced for achieving the remarkable feat of scaling their private practice into a thriving multi-doctor clinic in just three years. The discussion was set to cover their journey as a young surgeon entering a competitive market, how they achieved patient trust, and their rapid growth strategies, noting they had been attempting to secure the interview for seven months.
• Starting the Journey During COVID-19: Dr. Lajevardi began their private practice journey right when COVID-19 started, which was a difficult time due to lockdowns and hospital closures. They initially worked at a hospital where they completed their fellowship but faced challenges securing operating lists.
• Early Career Strategy: Mentorship and Overflow Work: To gain experience and build their list, Dr. Lajevardi joined a group practice, primarily assisting senior surgeons and handling their overflow patients, establishing a mentor-mentee relationship. This supportive environment allowed them to book cases at the end of the mentors' lists, who would then assist them, providing confidence as they built their patient base and secured referrals.
• Challenges of Securing Operating Time and Expanding: Starting out in private practice involved difficulties securing regular operating theater time, assistants, and anesthetists. Dr. Lajevardi's early focus was on building these basic essentials and they expanded their workload by joining multiple clinics offering overflow work, often taking any opportunity offered, even if it was just two days a month.
• The Challenge of Multiple Locations and Long Hours: At one point, Dr. Lajevardi was working across seven different practices in seven locations, which was physically demanding due to the size of Sydney. This challenging period involved starting as early as 5:00 AM to perform rounds at multiple hospitals, sometimes spending two to three hours on the road before the start of their day. Their advice to new surgeons is to be open and say yes to every opportunity, regardless of distance or frequency.
• Specialization in Aesthetic Surgery: Early on, a key distinguishing factor was Dr. Lajevardi’s decision to focus on a very narrow area of aesthetics: breast and body surgery. This specialization allowed them to concentrate their fellowships and training, giving patients confidence that they only performed those procedures. Dr. Lajevardi embraced traveling and taking any opportunity to build their case portfolio, recognizing the value of the specialized approach in a competitive market.
• Building Trust and Reputation through Specialization: Focusing exclusively on breast and body aesthetics meant that all their work across multiple practices was consistent, enabling them to build their before-and-after gallery and establish community trust. This specialization was essential for establishing their name, positioning them as an expert in a prospective patient's mind, and generating word-of-mouth referrals.
• Overcoming Early Hurdles: Gaining Patient Trust: The biggest hurdle in the early days was gaining patient trust since they lacked before-and-after photos, reviews, or an established name. Dr. Lajevardi focused on delivering excellent, high-quality patient care and being highly selective with patient cases. They strictly avoided challenging or revision cases to ensure they delivered quality results based on their training and experience, thus protecting their burgeoning reputation.
• Importance of Conservative Patient Selection: Dr. Lajevardi resisted the temptation to take on every patient, especially those rejected by other surgeons, emphasizing the necessity of operating within their abilities and being honest about achievable results. They would openly tell patients if they could not achieve the desired results and would recommend seeking other opinions from mentors or colleagues. This selective and honest approach helped them build their practice faster and establish their name for specific procedures.
• Differentiation Through High-Standard Patient Care: To differentiate themself in a crowded market, Dr. Lajevardi prioritized providing a very high standard of patient care. This involved giving patients ample time during un-rushed consultations, providing extensive pre-surgical information, daily post-operative rounding, and regular follow-ups. They believe that excellent patient care, from consultation through aftercare, is what truly resonates with patients and influences their choice.
• Personalized Care and Honest Expectations: Dr. Lajevardi stressed that differentiation comes from giving patients personalized care, paying close attention to their specific needs and goals, and maintaining honesty about achievable outcomes. If patient expectations are unrealistic, it is important to be upfront, stating they cannot meet those expectations, but when results are achievable, they are committed to helping the patient through the entire surgical journey.
• Scaling Cosmics Clinic into a Multi-Doctor Practice: Dr. Lajevardi took over a single-doctor practice from one of their retiring mentors three years ago and scaled it into Cosmics Clinic. The practice has grown significantly from two staff members to nine surgeons, including five plastic surgeons, specializing in vascular, breast, bariatrics, and offering multi-disciplinary services like weight loss, implant checks, skin cancer checks, and hair transplants. The goal is to be a "one-stop shop" for comprehensive, head-to-toe care where surgeons maintain subspecialty focus.
• Value-Added Services and Comprehensive Care: The clinic focuses on providing extra value to patients through complimentary services, such as post-operative lymphatic massage, LED treatments, scar care products, and skin care products. A dermotherapist sees every patient to provide individualized advice, sometimes including treatments like Morpheus8 or needling. This comprehensive care approach and patient-first perspective help differentiate the clinic and contribute to their success.
• Team Building and Associate Integration: Scaling the clinic has required significant work on the business side, particularly building a team of over 15 staff members and developing standard operating procedures (SOPs). A key to having associates join and succeed has been ensuring they are given attention and support, with some having a full day of consults on their first day back from fellowship.
• The Importance of Associate Specialization: Unlike the traditional model where retiring surgeons pass unwanted work to associates, Cosmics focuses on what the associates want to do. They inquire about the associate's specialization—for example, if they only want to do deep plane facelifts—and build their practice around that specific procedure. This approach leverages the clinic's reputation and patient base to build the associate's portfolio in their desired niche, which is critical for successful collaboration and colleague motivation.
• Transferring Associate Experience to SOPs: Dr. Lajevardi structured their approach based on their own experiences as an associate in seven different practices, focusing on the needs they would have wanted met. The clinic maintains regular monthly meetings with the business development and practice managers to review associates' numbers and adjust plans to help them grow their practice.
• Benefits of a Collegial Multi-Surgeon Practice: Working in a larger clinic fosters a collegiality mentality, offering a sense of being part of a supportive team. Surgeons can consult each other on complex cases, refer for second opinions, and cover each other’s patients when on leave, which is a major advantage over a solo practice.
• Standard Operating Procedures (SOPs) for Patient Journey: To manage the multi-disciplinary clinic, strong internal protocols and SOPs are maintained and regularly updated based on experience. A dedicated Concierge Team manages leads and has their own manager who monitors KPIs, ensuring specific training is provided for new associates, including sitting down with specialty surgeons to understand procedures like vascular or hair transplant procedures.
• Lead Management and Patient Experience: The training ensures that staff, such as the Concierge Team, understand the procedures they are discussing with potential patients, which is vital for initial conversations. When patients arrive for a consultation, dedicated patient coordinators greet them, explain the consult process, and look after their care throughout the entire journey, including follow-up by nurses.
• Internal Call Center Operations and KPIs: Cosmics maintains its own dedicated internal staff to manage incoming calls, with specific training provided for different procedure inquiries, such as injectables versus facelifts. They do not set conversion rate KPIs due to the high variability between different procedures (e.g., vascular vs. facelift leads). Instead, KPIs focus on crucial metrics like response times and timely follow-up, ensuring patients are contacted when promised.
• Aggressive Lead Response Time Strategy: The clinic aims to respond to the majority of leads within five minutes, which is achieved through a system of stacked start times and different shifts, including those covering evening hours. A call-routing protocol in their CRM ensures that if a patient coordinator is busy, the call is routed sequentially to other staff (patient coordinators, reception, and eventually managers) until someone answers, providing a quick, personalized touchpoint.
• Conversion and Touchpoints: Leads from referrals, such as friends or family of existing patients, often book appointments immediately because trust is already established. Conversely, fresh leads who are researching or comparing multiple clinics require more effort and a greater number of touchpoints, sometimes taking months to convert. The patient journey involves three formal consults before commitment: initial interactions with the Concierge Team, a pre-consult with the nurse coordinator, and two face-to-face consults with the surgeon, with only the first surgeon consult being charged.
• TGA Compliance and Digital Strategy: To remain compliant with the strictest regulations, the clinic focuses on creating educational videos, discussing their experience and training, and highlighting conferences they attend. They emphasize the importance of standardized, clinical before-and-after photos, maintaining a dedicated photo studio for consistent results.
• Strategies for Patient Loyalty and Referrals: Key strategies for loyalty include delivering excellent surgical results, providing exceptional care, and offering unexpected added value through complimentary services like lymphatic massage, LED treatments, and scar/skincare products. Building strong rapport with the surgeon, nursing, and administrative teams is also critical, as word-of-mouth remains the best referral source.
• Comprehensive Aftercare Package: The aftercare process is highly structured; patients receive a bag of products and garments at their pre-op appointment. Post-operative appointments include complimentary sessions with a dermotherapist, LED treatment, and access to devices like the LPG machine for lymphatic massage. This comprehensive approach, which includes scar assessment, products, and energy devices to address issues, keeps the patient care entirely within the practice, reducing the need for external services.
• Reasons Patients Choose Competitors: Dr. Lajevardi identified a few reasons why patients do not proceed after a consult: lack of rapport with the surgeon, the patient not being ready for surgery (e.g., needing to lose weight), or price being an issue. Having a dedicated weight loss clinic with bariatric surgeons and exercise physiology helps address suitability issues. The availability of multiple surgeons can address scheduling conflicts, as one surgeon may fit the patient in quicker if they have time pressure.
• Rewards and Future Vision: The most rewarding part of their job is patient feedback and satisfaction, particularly the changes in quality of life after procedures like breast reductions or post-weight loss surgeries. Working as part of a trusted team that feels like a family provides great satisfaction. The clinic's vision is to continue providing comprehensive, high-quality care, maintaining its status as a one-stop shop, and potentially expanding to different locations across Sydney to address travel difficulties.
• Scaling Logistics and Consistency: The key to successful multi-location expansion is establishing very good SOPs and consistent, replicable procedures. Consistency will be maintained by having dedicated managers for each team (e.g., marketing, patient concierge) who handle the recruitment, training, and KPI monitoring for new staff at the second location.
• Importance of Specialized Managers: Dr. Lajevardi emphasized the importance of having the right manager for each domain (e.g., business development, operations, clinic). The clinic manager, for example, has extensive experience running multiple clinics in another industry and is focused on staff management, not marketing. Selecting experienced individuals good at their specific roles, training them, and growing their teams is essential for building the clinic.
• Digital Marketing Strategy Timing: Paid digital marketing is viewed as one of the last steps in the practice's growth strategy. Dr. Lajevardi stated that a strong backend, which includes smooth office processes, bespoke aftercare, and a well-trained patient concierge team, must be established first. Starting paid advertising without these foundational elements is seen as a waste of resources because the clinic would be unable to effectively handle or convert incoming leads.
• Marketing Strategies and Systemization: Sepehr Lajevardi noted that in addition to organic growth, they utilize a dedicated marketing team, including full-time social media managers, and offer complimentary support to their associates by building their digital profiles like Instagrams and web pages. Huyen Truong emphasized that a common mistake is focusing heavily on lead generation without having the necessary back-end systems in place to manage inquiries, resulting in a fractured patient journey.
• Leveraging AI in Clinic Operations and Marketing: Sepehr Lajevardi confirmed that their teams utilize AI to boost productivity across various areas, including the use of AI dictation software in the clinic for saving time on letters, and AI programs assisting with after-hours calls. They also mentioned that teams use AI for content generation and social media marketing.
• Customizing the Marketing Budget Allocation: When discussing marketing budgets for young clinics, Sepehr Lajevardi stated they do not use a fixed percentage of revenue, but rather customize the strategy and budget allocation based on the specific stream of services. They explained that services like hair transplants require a different advertising approach and margin consideration, stressing the need to individualize resource allocation based on the expected return for the clinic.
• Marketing Strategy for Limited Budgets: For a clinic with a limited marketing budget, Sepehr Lajevardi suggested conducting test runs for different procedures to determine the return on investment. They explained that it might be more beneficial to focus resources on lower-priced, high-volume procedures, like an upper blepharoplasty, which yield many leads at a low price, rather than highly lucrative but expensive-to-convert procedures like a "mommy makeover".
• Advice for Starting a Private Practice: Sepehr Lajevardi shared that key advice they would give their younger self is to select and master a subspecialty area early in their career. Other foundational advice included ensuring patient satisfaction to build trust and generate word-of-mouth referrals, and focusing on building a strong, supportive team by placing good people in the right positions.
• Structuring Time for Management and Work-Life Balance: When asked how they structure their week, Sepehr Lajevardi, who works in a public hospital and has academic commitments, highlighted that they have dedicated admin days, such as the current day, to focus on meetings, performance review, business tasks, research, and writing papers. They emphasized the difficulty of balancing family life, practice, and other commitments as a surgeon, making dedicated time for administration essential for meaningful work.
• Clinic Expansion and Future Collaboration: Sepehr Lajevardi revealed that their practice currently has three locations in Sydney, and additional locations in Melbourne, Adelaide, Perth, and New Zealand, with a new branch recently started in Indonesia. They expressed an interest in future collaboration with Huyen Truong, suggesting that despite having many in-house resources, they are looking to find areas where external experience can be leveraged.