#81: How to successfully scale a medical practice nationwide?

PODCAST TRANSCRIPT

Steven Tait:

Welcome to the OMD TV & Podcast show. Thank you for tuning in. 

Through this show, we like to give our audiences a chance to learn some new tips and strategies on how they can grow their practices or clinics. And sometimes we have the opportunity to have special guests on the show who can bring their own valuable insights into how they've successfully grown and scaled their practice. 

Huyen Truong:  

And today we have a special guest on our show, Dr Geoff Cashion, the owner, and also the main surgeon, of Vasectomy Australia. 

And the topic that we're going to discuss about today is how to successfully scale a medical centre nationwide. And Dr Cashion has been running Vasectomy Australia for a number of years now, with operations in most major cities in Australia. 

And we're very excited to hear from you today and learn from your experience of how to run a scale and a medical centre nationwide.  So, this is part of our Covid Special Success Stories series, where we've been featuring interviews with clinics who have successfully pivoted and thrived through tough times like the recent COVID-19 pandemic. Welcome to the show, Dr Cashion. 

Geoff Cashion:

Thanks, great to be here. 

Steven Tait:

Yeah. Thanks for joining us.  

Now, I mean, for our audience here, who may not know you that well, could you just tell us a little bit about yourself and your practice? 

Geoff Cashion:

Sure. So, I've been a doctor for about 18 years now.  

My first 10 years was spent in emergency medicine. And then about eight years ago, I switched over to general practice and was working as a GP for about five to six years. About three or four years ago, I transitioned again from general practice and started doing vasectomies and I was doing vasectomies and general practice side by side. And then about two or three years ago, I then left general practice and elected to do vasectomies 100% full-time. And that's what I do now.   

I have Vasectomy Australia, which is essentially a, vasectomy practice, which is comprising of me. And we have clinics in Sydney, Melbourne, Adelaide, and then a few cities around Sydney as well, and a couple of clinics, one clinic in central Queensland and another in Canberra. 

Steven Tait:

Great. And so, what inspired you to specifically focus on just vasectomies? 

Geoff Cashion:

Well, I'd be a GP, as I said, and I'd been, I'd actually run clinics and set up clinics. 

So, I had four clinics up in central Queensland. We had 18 doctors, obviously that's quite a big operation to run, but I just decided that once I, well, I actually exited those businesses, I sold those to a corporate. And that gave me the opportunity to just to really think about where I wanted to go.  

And at that time, I had just, as I said, I'd just started doing vasectomies around that time I'd been doing them for about a year or so. And it was something I was really enjoying. So, I thought: "Look, now that I've got a chance to do something different."  I looked at doing, I decided that I wanted to do vasectomies full time. And of course, it took a little while for that to build up, but I was quite happy that I'd made that decision, and three or four years down the track now, I'm very happy I made that decision. 

Steven Tait:

Okay great. That's good. No regrets. 

Geoff Cashion:

No, no regrets at all. 

Steven Tait:

Okay, great.  

Now, as we had mentioned in the introduction, that some of the focus of this conversation is around the coronavirus and the recent pandemic because as you're running these clinics nationwide, especially in Australia, which had a lot of border closures, you know, that would impact, we imagine that would impact your business quite a bit. So, can you tell us a little bit more about, sort of, your initial reactions to the beginnings of COVID in Australia? 

Geoff Cashion:   

Yeah, look, the timing was interesting because I had just moved from central Queensland in November 2019 to Sydney. Back to Sydney, we'd lived here before. And things were starting to really pick up and were, the main reason was to, you know, to get Vasectomy Australia, to get a bit closer to Adelaide, closer to Melbourne and those clinics.  

So, when the, you know, the pandemic really hit hard around, sort of, February, March last year, we couldn't operate at all. So, we, I just want to say 'we', we took, as in other, vasectomy doctors as well, made a decision that we would follow the, sort of the pause on elective surgery at that time. So, for, I think it was around March, March - April, it would have been, last year, I think. We didn't do any vasectomies at all, not even in our own town. 

So that was a pretty, yeah, it was a pretty stressful time because, you know, I'd just sort of it was really, the business was really starting to take off. Obviously, once those restrictions had been lifted on doing elective surgery, we could get back to doing them, but unfortunately, for the rest of the year, and even right now, the border closures have been a huge impediment to my business as well, because I can't go to South Australia or Victoria. Often because of outbreaks we've had here in Sydney or in Victoria's case last year, it was because of their outbreak. So, that's been challenging. 

Steven Tait:

And how do you deal with that? 

Geoff Cashion:

Well. Initially, you look at ways. 

I mean, you use the downtime, I guess, to try and work on, you know, work on the business and look at other ways. When we had the closure last year, we actually pivoted straight into, I mean, I had a family to feed, so I had to make a decision of, "What am I going to do?"  

And the first thing I did was call, you know, friends who own general practices here in Sydney. And say: 'Hey, it's Geoff, you know, you've got some work for me?" And they were like: "Yeah, sure, come in." But of course, no one was going to the doctor. 

So, I'd go in and there'd be, I'd see four patients for the day and that wasn't really going to pay my rent. So, at that time, you know, there was a big push for telehealth. And so, I figured, well, I'll just set up a telehealth general practice. So that's what I did. And we set up a little telehealth business called 'Your GP Online', and we got that up and running quite quickly. 

Steven Tait:

Yeah. Great. How quick of a pivot was that? 

Geoff Cashion:

Very quick. Very quick.  

Yeah, it wasn't something I could develop a plan over a few months and get up and running. I had to get it going and I had to provide cash flow pretty quickly. So, I would say that once the decision to do it, to actually create this business, we were seeing patients within a week or two, which was quite phenomenal. You know, I was very fortunate to have you guys, to get the website going pretty quickly. And also, I had some good IT support to get a remote database, clinical software program going quite quickly as well. 

Steven Tait:  

And I mean, this was an opportunity for you to obviously find more income, or find income, during this period as you couldn't do your elective surgeries, did it sustain that period? 

Geoff Cashion:

Yeah, it did actually. It was quite surprising how quickly we got it going. 

And I would say within a month I could be seeing up to 40 patients, a day, online, from home. So that was, it was good. It was certainly not what I've wanted to be doing, but what I had to do. And when you're in that situation, where you've got to provide an income for your family, I've got two young daughters, and that's just what you've to do. And I was quite happy with how quickly we were able to make this business cashflow positive. 

Steven Tait:

Right.  

It's one of the things that we always stress with any business that we're working with is the ability to be nimble and flexible, and make changes. It's very interesting from your perspective, because you've made a change into really a different sort of space entirely than what your product currently was at that time. 

And so that's interesting that you've made that choice, but you're right. You do need to make money and keep food on the table. So, necessity breeds invention. 

Geoff Cashion:

That's right. Absolutely. 

Steven Tait:

Great. 

And, so now we know where this story goes, but for our audience who may not be as familiar, how is Your GP Online, today? 

Geoff Cashion:

Well, it doesn't exist anymore. It came and went pretty quickly. 

I think we probably had the business open for about three or four months. Fortunately, we could get back to doing vasectomies. So that was obviously a big, big reason for it to settle down, but look, one of the other reasons, as well, was that with general practice, it was going to be very much again, and this is something, one of the main reasons I got out of general practice the first time. It was going to be heavily regulated, Medicare compliance, threats of audits and that sort of thing.  

And, you know, I just didn't want to go back there. Initially, I thought: "Hey, this could be a good little side business to have as well as Vasectomy Australia." , but a lot of competitors very quickly entered the market, it's probably a good way to generate cash flow in the short term, but in the long-term, I'm not sure it's going to be a particularly, you know, particularly profitable business. 

Steven Tait:

Sure. But thankfully, you were able to come back to Vasectomy Australia. 

Geoff Cashion:

That's right, exactly. 

Steven Tait:

And get that practice running again. 

Geoff Cashion:   

And one thing I'd like is, probably what people don't forget is, you know, in March last year, people were saying that this could be going on for months, this would be, of course, it has gone on for months, but we thought maybe we can't operate for a year. "Maybe we're not going to be able to do vasectomies for 12 months, 24 months. Who knows?" 

And that was part of the reason I thought: "I've got to get something going quickly" is because there was so much uncertainty around the whole thing. So, but you know, it all worked out on me, obviously, common sense prevailed and we could get back operating. And that was good. 

Huyen Truong:

So now we know that you have a GP background, you used to run a medical centre. 

Now, lots of our audience would think what a radical change you made from running a medical centre with multiple doctors, a lot of staff, to a vasectomy centre, that pretty much has you, and a couple of staff assisting you. So, what drove you to that decision? 

Geoff Cashion:

Yeah, I mean, that's a good question. 

I mean, if you probably look at it in two ways, you look at the professional side of it and you look at the commercial side of it. So professionally, going from a GP is a jack of all trades master of none.   

You're seeing 30 to 40 patients a day, undifferentiated problems, very mentally exhausting. It's very mentally exhausting. You get home, you're just absolutely, you know, destroyed at the end of every day. So going and doing something more procedural, certainly was, for me, was going to be a much more enjoyable way for me to practice medicine as I, you know, go into my fifties and potentially sixties.  

So, I wanted to do something I enjoyed a lot more than general practice. I just wasn't enjoying the job. Commercially, general practices are a very hard business, a lot of people will say that and it's true. A very huge cost base associated with running general practices. Leases, equipment, staff costs. There's not a lot left for you at the end of the day to take on all that stress and effort.  

And I think that you know, when you run a business, there should be a financial reward for it. And I couldn't really see that in general practice. So, I was fortunate that I could, you know, I could build my practices to a size that would interest someone in buying them and I was able to sell them.  

But I didn't really feel that general practice is, I feel it's always going to have those constraints on it going forward. I think it's always going to be a very tough, tough business to make money in. 

Huyen Truong:

Yeah.  

So, in lots of our videos and podcasts episodes, we talk about how to scale the practice. And one of the things that we have been advising our audience is that to pick one procedure that you really enjoy doing, and you see potential in scaling.  

So that's something you actually nailed, you nailed it, cause, I think you pick a procedure you can do in a short amount of time and you can do it multiple procedures in a week. And so, another factor, in scalability, is to think about adding more doctors to your teams so they can do more procedures for you. Have you thought about that? Or do you still want to stick to a one-man band right now? Pretty much. 

Geoff Cashion:

I mean, it's a good question. 

And of course, I mean, my entrepreneurial spirit is always looking at making things bigger. And of course, one way to do that is to take on new doctors. It's a tricky one because as you talk about scale, you know, when I'm scaling, I'm scaling myself, essentially, so I'm trying, I'm scaling myself with geographically, by being in more locations, I'm scaling the operations, by being more efficient, I'm scaling my marketing by using digital marketing.  

And of course, the next step would be to scale outside of myself. So actually, having another person doing that. Professional services, and I'm sure you would understand this, are very hard businesses to scale. And the simple reason is that you're dealing with highly intelligent, trained professionals, who don't like to be told what to do. And that's not being critical. It's cause I'm probably exactly the same.  

So, trying to scale, trying to build a process, build a system and then ask a very successful, intelligent person to come into that system is quite difficult. They will want to do things their own way. And that's one of the real, I guess it's one of the real deterrents to scaling and bringing on other doctors.  

I use the analogy of, you know, looking at McDonald's. I said you know, trying to bring doctors, lawyers, accountants, SEO specialists, into a business and saying: "Here's a process, run it." It is like trying to, you know, it's like having McDonald's and putting a Michelin star chef in there.  

They're not to want to make the same burger every day. Look, and I'm not ruling it out. It's not something that I'm going to never do. But I guess at the moment, I'm quite happy with the way I've done it. And you know, I still feel there's a lot of growth just with me, as the primary doctor. 

Huyen Truong:

Just a side question though. Have you thought about exit plans in the future? 

Geoff Cashion:

No, no. 

And look, to be honest, I come into this business fully eyes wide open that there may not, there's probably not going to be a huge payday at the end of it for me. But I think that trade-off comes from the fact that, you know, you can have a, probably a more profitable business now, but it's very, you know, there would be some value to the business and, you know, five, ten years down the track, but I don't have any expectations that someone's going to walk on with a big check and I'm going to go lie on a beach for the rest of my life. 

Huyen Truong:

The thing is the next question, what are you going to do afterwards? 

So, lots of businesses sell their business and they end up having nothing to do. And then they get bored, and then have to come up with the next project to work on. And I was thinking, why don't you just keep working on what you've been working on so far? 

Geoff Cashion:

Exactly. 

Huyen Truong:

And then grow it and build it into a bigger one. 

Geoff Cashion:

Yeah. 

Steven Tait:  

I'd like to dive in a little bit deeper into some of these strategies that you're using to grow yourself nationwide because you do run a very lean operation. It is just you, as the only doctor here. So how do you feel about having this burden? Well, or is it a burden, I guess, placed upon yourself to be the sole person responsible for growing it nationwide? 

Geoff Cashion:

Yeah. I mean, it's a good question and it's a question I get asked a lot. 

People say, you know, how do you, you're in Adelaide one day, you're in Melbourne the next day, you're in Sydney the next day. You know, obviously, you've got to go where the work is. That's the number one thing you can't sit at home waiting for it to come to you.  

And there's only so many guys in Sydney who want a vasectomy. So, if I want to do this five days a week, then I have to go where they are. And that's a big part of it. It's definitely, you know, coming back to what I said before about general practice, the actual physical burden on myself is not as high as being a GP, sitting in the same room every day.  

For me anyway, it might not be for other people, but you know, I sleep in my own bed 12 nights out of 14. I'm only away for two nights. And that's the day in Adelaide, and then two in Melbourne, the rest of my clinics, apart from a couple of smaller clinics, one in Dubbo and one in Rockhampton, the other ones are within driving distance of Sydney.  

So, I get up early, but I'll drive to Newcastle, and back. I'll drive to Wollongong and back, the drive to Central Coast and back. And then we've got all the things in Sydney as well. So, I mean, that's a big part of it. Just being prepared to put in the work. Being prepared to go where all the work is. 

Steven Tait:

Right. I think that's, and that's good advice too, being prepared to put in the work. 

Geoff Cashion:   

Yeah, well. I think, look, to be honest, I think that would apply to probably a lot of your clients, a lot of your listeners that, you know, people who do not so much, vasectomies, but other procedures where they can build lists, build presences in other markets and go into them and do those procedures there, that they don't have to stay in the one geographical area. 

Steven Tait:

Sure. 

And so, what would say, a vision, for Vasectomy Australia say in five years, like, have you stopped expanding? Are you keen to keep growing? 

Geoff Cashion:

I've probably reached as many clinics as I can do now. 

And it's not just about, you know, growing those clinics. So, I look at, I've been saying five years, I'd still be doing what I'm doing. I would hope that the clinics have matured. So, we've got some clinics that are well and truly matured and some are still in their early phases.  

It's about going to like, yeah, it's, it's really about turning up, keep coming back to those clinics. You know, it's like a rock band. You've got to keep going back. And hopefully, there are a few more people in the crowd each time. And some, clinics might take a year to build.  

Some are busy from the first day. You don't really know. And you can do as much research as you want, but the only way, you know, is: turn up, tell people I'm here and hope they turn up. And you've just got to, you just got to see how they pan out. You've also got to know when to cut your losses too. So sometimes, some clinics just don't work. You just gotta let them go. And before I moved to Sydney, we had a couple in Brisbane like that, that was just, just not working. So, we cut them. 

Steven Tait:

So not every place will be a good location. 

Geoff Cashion:

No, and it's very hard to predict. 

You could go into a market where you've got five competitors and do really well. And you could go somewhere where there's no one doing vasectomies and you're still, only doing two cases. So, it is really hard to predict, but you've just got to give it a go.  

Steven Tait:

Great.

Huyen Truong:

Yeah. So, I have this question.  

So, I've seen that lots of clinics have failed over the years because they fail to adapt to changes, when the market changes, especially what you've seen so far with the COVID-19 situation. So, how have you kept yourself nimble and flexible, you know, over the years of running Vasectomy Australia and that would be very helpful for our audience today to listen to, because running a medical centre, or any kind of medical practice, it's a lot of work and making it nimble and flexible is hard. So, do you have any advice for our audience today? 

Geoff Cashion:

I think it's, pretty simple advice. 

It's just, you know, listen to the market, you know, make sure that you're listening to what your patients and your customers are saying. Try and look for new opportunities. Always be proactive. Don't rest on your laurels. Don't assume that just because the clinic's going well today that it will still be going well in 12 months. Always be trying to improve it, try to look for ways to improve it and look for new opportunities if they come up.  

I like the Mark Cuban, I think has a saying that, you know, he assumes that, you know, for 24 hours a day someone is trying to take him out of business. And I think that's good, yeah. I think it's a good mentality. I think a bit of healthy paranoia is a good thing in business to always be looking to constantly improve your product and your position in the market. 

Huyen Truong:

Yeah, yeah. 

Steven Tait:  

And it's true. I mean, whether it's a conscious decision by your competitors or not, theoretically, everyone else who's in this space is trying to take business from you because they're keen to have the business for themselves. So that's a very good point. Now you do have competitors and, speaking of competitors, you do have some, in your space, including some large brand names. How do you, how have you developed a value proposition that you see as, sort, of being unique for yourself and Vasectomy Australia? 

Geoff Cashion:

Yeah. Look, 

I think it's really about letting guys know that if they come to me and want a vasectomy, it's going to be me who's doing it. So, it's not a brand. Like, yeah, sure. We are, or I am 'Vasectomy Australia' because, you know, obviously, I wanted to let the market know that what you do and where you are.  

So, it made sense to have that sort of name. But when guys look into our website and do a bit more research, they're gonna realise it is me. It's me who's doing the vasectomy when you turn up, it's not a random person who you don't know. So that for me is a big selling point.  

And when, when guys come into our practice, you know, we tell them: "You're our patient for life." "You'll have my mobile number when you leave your appointment today. You can call me at any time, if you've got any problems", and having that one-on-one personal touch, I think is a really, really good thing.  

Steven Tait:

Agreed. 

Huyen Truong:

Okay.  

So, you know, in order to grow Vasectomy Australia, to the level you're having right now, you must have done a very good job with your marketing work. So, our audience would love to hear from you, what have you done in order to generate patients nationwide for your practice? 

Geoff Cashion:

Yeah. Yeah. I mean, obviously, there are.  

Steven Tait:

What a leading question this is here. 

Geoff Cashion:

Yeah.  

You know, it's a good question because, you know, look, when you look at how you build a brand and how you market yourself, you've got the scalable things you can do, and you've got the non-scalable things you can do.  

And I think obviously the scalable things, that's your digital marketing, so things that, you know, you, when you can market when you're asleep. So, a great website, as Steve will, you both will know, you were dealing with a pretty ordinary website, when I joined you, because I had that, like most business owners and doctors, you couldn't let go.  

You had to, I had to be doing the websites, the Wix website, couldn't rank on SEO. I had no content, but I thought it was great. So, I think that was a big start. So, getting a really professional website, getting a really professional web presence, and being able to rank. And we've ranked so quickly in most of our keywords.  

And then the PPC is obviously just as important, you know, I don't know if it's even more important perhaps, but having, you know, really great PPC campaigns that, you know, really dig into those keywords and make sure you're generating.  

So that's certainly, I'd probably say it's probably more than 50% of the success, but then you've also got to look at the non-scalable things like you know, trying to get those GP referrals. So that's just hard work, you know, you just got to put in that hard work. You've got to, you know, when I first got to Sydney, I was out in the car with business cards and brochures and knocking on doors, and letting people know who I was.  

And then, of course, you've got, once you do develop, you're seeing patients, you've got to get that word of mouth. So, it's all very good to have a great marketing campaign. But if you can't do a vasectomy and you're having lots of complications, and the procedure isn't working, well, no one's gonna be coming back.  

So, you've got to always be working on providing a great, you know, you've got to be great at what you do. You've got to be really good at what you do, and you want that guy to walk out and tell his brother-in-law, tell his mate that: "Hey, this is the guy. If you want a vasectomy, You've gotta go see this guy." 

Steven Tait:

Sure. 

Huyen Truong:  

So, this is good to think about, the fact that you specialise in one procedure because you have all this time and knowledge to build up your skill and to be really good at one thing. And that's what we've been talking about a lot in our previous podcasts and video episodes.  

We talk about: "What's Your One Thing?", right? Cause when we talk a lot with other doctors and surgeons and they tend to offer a number of different services and when patients come to them, they just look at themselves pretty much just like any other clinics because they offer the same type of services.  

And it's really hard to differentiate themselves, unless they have like 30 or 40 years of experience and a lot of the media mentions and stuff like that. So, I think specialising in one thing and making it scalable is a great way to make a profitable and scalable business. 

Geoff Cashion:

Yeah, absolutely. 

I think you and I, we've talked about one of my favourites, I guess, personal development authors is Grant Cardone, who he talks about, "If you're not first, you're last" and what he's saying there is really, you gotta be first in the mind of the person wanting that service. So, you know, when someone thinks of brain surgery, we just think Charlie Teo, you know, if you're thinking of a knee surgeon, you've got to go: "I want to be that knee surgeon that people think of straight away." And I think that's really important. I think exactly what you say. You need to have one thing, that you are the person that people want to go to for.  

Huyen Truong:  

And I also like the fact that you picked the name, Vasectomy Australia because you have a vision for that when you chose that domain name, right? Cause you think about your future of scaling this business nationwide and I love that fact so much. Yeah.  

Geoff Cashion:

I can't think small. 

Steven Tait:

You don't, you don't.  

Geoff Cashion:

Yeah. 

 Steven Tait:  

How you've dealt with coronavirus and have successfully scaled and grown your practice to what it is today. I'm sure our audience will appreciate it. Do you have any sort of final advice that you'd love to instill in our audience listening in today.  

Geoff Cashion:

Just, work hard. 

I think life is sometimes about a bit of imbalance so that you can have a bit more balance later on, but you know, don't be afraid to put in the hours. 

Steven Tait:  

No, and I think that's great advice, a great lesson for people who want things immediately and find it difficult to get them immediately. It requires work, and effort, and time. Great. Well, thank you very much for the chat today, Geoff. Now, if you want to learn more tips and strategies for helping to generate more patients to your clinic or practice, through your sales funnels, then I recommend that you join us in our webinar: the 'Three Must-Use Strategies to Increasing Your Patients and Referrals on Autopilot.' spending one hour with us in that webinar will help you to master the fine art of generating more patients for your clinic and practice, I'll leave the link for that webinar in our show notes below. Geoff, thank you very much for joining us today on our OMD TV & Podcast Show. 

Geoff Cashion:

Thanks. It's been great. 

Huyen Truong:  

Thanks, and making it all the way from Sydney CBD to our studio. That's a long drive of about 15 minutes 

Geoff Cashion:

That's right, 15 minutes down from Enmore. 

Steven Tait:

Thank you very much, Geoff.  

And if you have any comments on today's show, we'd love for you to leave a message for us in the comments section below. Thank you very much for joining us, and we look forward to seeing you at the next show.