How She Grew a Medical Practice to $30M, With Meredith Hirsh

My background's in advertising. I grew up in a family of physicians and those within healthcare and never wanted to be in healthcare. And I got launched into it because my husband was an associate of another practice we had just had. Our third kid had a mortgage. So he and I looked at each other and I'm like, you have to start your own practice. We launched what was then Advanced Rheumatology Center. Want to attract and convert more leads? Want to learn how digital pr, branding and SEO can establish and build your brand identity? Welcome to the Market Movers Building brands and links with Linkify Podcast. We answer these questions and help you ramp up your brand visibility and credibility. Let's cut through the noise and make your business the talk of the town. We're your host, Nick and Chris. Let's get this show on the road. Welcome to the Market Movers podcast. Today we are joined by Meredith Hirsch, CEO of the Hirsch center for Arthritis and Sports Medicine and host of Working Healthcare. We're digging into what it really takes to grow and operate an independent medical practice, from leadership and retention to patient acquisition, trust, digital visibility, and the business pressures reshaping healthcare. We're really excited about this one. Welcome to the show, Meredith. Thanks for having me. Meredith, it's great to have you on. To kick things off, why don't you tell us a bit about your background and how you got started in the space W. That's a very long story, but to summarize it, actually, my background's in advertising, so I think it's very apropos for this podcast. I grew up in a family of physicians and those within healthcare and never wanted to be in healthcare. And I got launched into it because my husband was an associate of another practice, and when partnership became available, it was not what he had expected. We had just had our third kid, had a mortgage, and I'm like, we've gotta pay our bills. So he and I looked at each other and I'm like, you have to start your own practice. With my background in real estate and education and advertising, we launched what was then Advanced Rheumatology center, which is a big story on how you have to spend more time naming your company because had to rebrand it. And we opened up and saw eight patients on the first day. I created a sign, a billboard for a company, actually, that I used to work for. The Tribune Company owned billboards around the area. And I had a bus shelter that said Dr. Hirsch moved. And that's all I did. I set him up. I'm like, peace be with you and I went off on my own. And in six months, the staff was calling saying, please come back and just run this company. So that's how I got thrown into health care. Wow, that's awesome. And we're now like 19 years later, 60 employees. Tell us, what did the. Those early growth that. That early growth Strategy look like? 8 patients on the first day is awesome. But I imagine it wasn't just like growth upwards from there. Like, what did that look like to get to where you are now? So we benefited because we grew up in this area. We are both South Floridians. I spent a lot of my life moving around the country, but my husband was born and raised in Miami, and he did his TR at the University of Miami and Jackson Memorial, and having those connections really helped with the growth. He also worked at another practice locally for about four years. So just having that platform and the eyes on him within the area really helped. So the first day we had eight. The second day we had 15 patients. And we kept growing and we brought in another physician. About a year and a half in, we knew that we needed to move into our own space. We rented space from a podiatrist. We actually shared space at the time. And within a year and a half, we had bought our own condo. We had. It was 3,100 square feet. I thought it was so large that I wanted to rollerblade down the hallway. It was not that large. Now we're in 10,000 square feet. But we just looked at recruiting other physicians to be there. We looked at our marketing efforts, because it's not just word of mouth, that's really not an advertising platform. But being able to build relationships with the physicians within our community, being able to have those patients who are our existing patients, they're the best referrals. And being able to create patient touch points so that we could continue to build the practice. So how do you get eight patients on the first day, 15 on day two? Is that bringing old patients with you or is that new patients? Like, how do you open the doors with patients ready to go? Yeah, it's actually bringing patients with us. And that's really what happened. He was the busiest physician in the group that he was an associate, and so that certainly helped. But we have about, at this stage of the game, on average, 250 new patients a month. Wow, that's phenomenal. That is. Yeah. Though, Nick, since you asked this question, which I thought was really great, when we chose the zip code in which we were going to buy our condo to Start this practice. We looked at demographics, geographics, and we were in the zip code that had the oldest median chronological age for the demographics of anywhere. We're in rheumatology, our average patient age is 76. So we are seeking patients who are Medicare age and affluent because I don't know how many of your listeners know about the insurance industry, but right now, Medicare, typically traditional Medicare, is the best payer. That's awesome. I mean, that's the older Dodge. Location, location, location, isn't it? You could have got that wrong from day dot, but you made the exact right call, by the sounds of it, on where to be. Was that that a powerhouse combination then? I'm assuming, I think you probably told me this on our pre chat, that your husband is not sort of the marketing businessman. He's just great at what he does medically. And that combined with your skills, is that what took you for eight patients, 15 patients, then upwards growth? Is that the magic combination? I always say I'm the agent and he's my talent. Yeah, I like that. But my husband certainly is the talent, at least in the services that we provide. You do not want me injecting a patient. Okay. So I assume a lot of doctors want to go out on their own outside of marrying someone who's a great marketer. Like, how do they go about that? Because I imagine most doctors, not great marketers, a lot of doctors, not great business people as well. It's kind of two different skills. So what is the process? How hard is it to go out and start your own clinic? I think it's really hard now to say how do you hang a shingle? But I will tell you, I just wrapped up a meeting last weekend with Florida female physicians down in Fort Lauderdale, and there were 150 doctors who got together and most were seeking out direct pay models or concierge models. They wanted to hang their own shingle. A lot of them had a similar story to me, but. And I think that's why my roundtable discussions were so popular at that event, because they wanted to know, how do you do it? Which is one of the reasons why I teach at Florida Atlantic University's Certified Medical Business Management Executive Ed program. And I do it because I have a lot of physicians who take the class because they want to understand the business side of medicine. It's tough. I mean, I have an mba, but I didn't get it until we started our practice. I have a background in marketing and advertising, but we have our own head of marketing at our practice practice right now there's only so much as the CEO that I can do, but I think having the background in advertising is like my secret sauce. And so somebody saying, hey, I just graduated from my residency, I just finished my fellowship, I want to go hang a shingle. It's really hard. Unless you're part of a managed service organization or you are a direct pay model, it's tough. And then to build up patients, I will tell you, I have a lot of doctors who have worked for me throughout the years. And when they do not live in the area in which they work, they're at a disadvantage because they also need to have those handshakes, they need to build up those referral sources. The best referrals are those from existing patients. It's not in my field. And I know you guys have a whole SEO like gig going on, which I, I'm huge into SEO. And I think for us, when we are searching out new patients, it's because people have heard our name before. It's because they're playing mahjong with their friends and they've seen ads and they don't know where they've seen the ads. They don't know where they've seen us on Facebook or on Instagram or on the bus shelter. They've seen us and they're like, oh, the Hearst Center. Oh, the Hearst Center. And so they're playing mahjong. And the friend's like, oh, I can play mahjong today and I could play pickleball tomorrow because I was taken care of by the Hearst Center. And they're like, oh, I've heard of them. It must be great. Sort of like the political candidates, right? You don't know if the incumbent is. Today's episode is brought to you by Linkify, the digital PR agency that gets brands featured in top publications worldwide. If you're looking to build authority and boost your search rankings with powerful, high quality links, Linkify has you covered. Ready to take your brand to the next level. Visit linkify IO and let's get you in the headlines, good or bad, but you've heard of the incumbent. There you go. I think that's indicative of doing good work over the best part of two decades. On your part though, that multi touch points and then having people, we've heard of the Hirsch center, you know, maybe they're playing margin with their friends and they get a recommend. You know, they hear a referral or recommendation. So that, that's just good business on your part. For nearly 20 years. What do people get wrong? And I'm sure you've seen this, I'm sure you've had physicians work for you that have done it for a while and said, I'm going to go and do this on my own. Like what do, can physicians still go on their own and start a practice and outside of like do it in an area that they live and choosing the right location, like what do you see people get wrong? Can it still be done? I love that question. If you are not on social media or you think you are not on social media, you are on social media. Everybody Google searches their doctor before they go to see the doctor. And if it's not your 76 year old patient who's Google searching, it's their kid who's Google searching and looking at the reviews and seeing if you're out there. I go on to, I'm on LinkedIn all of the time. I live and breathe LinkedIn. And for people who don't even even have their profile on LinkedIn shocks me. For people who do not claim their Google page or their name shocks me, that happens, it happens all the time, Especially Chris. In medicine, in medicine it is always happening. And so if you don't want to be on social media, I don't know, go move to like Timbuktu and don't practice medicine. But you have to be out there, you have to be part of your community, you have to be visible. It's just who you are. So I think the biggest thing that people get wrong besides the business side, the contracting and you know, understanding the inner workings of what's going on in our American healthcare system, but not being present and visible and thinking, oh, I'm not going to actively seek out five star reviews. People like me, they'll just post, you know, the number one reason for writing a negative review on Google, Bad parking. Bad parking. People who are not actively seeking positive reviews are getting crappy reviews and they have a 3.6 star rating. Who wants to go to a doctor with a 3.6? Yeah, especially if you can't find anywhere to park, right? No, I'm just kidding. I'd rather go to a bad doctor or a good doctor with bad parking than a bad doctor with good parking. But yeah, we see that a lot. So when we set up a new PR campaign, the profile, the visible profile is very important. Like it's the first thing journalists do if you're going to pitch the media, they're going to go and check and see what is this doctor about? Do they have these credentials? And if you don't have your LinkedIn profile set up, they can't verify those credentials. And I think that's, yeah, that's the same as any vetting process. You want to find out more information about the doctor you're going to go check out. Who is this doctor, what are the reviews, how's their parking, what other things like that do Doctor, should they be thinking like even if they're not thinking about leaving to start their own practice, just that reputation building. Anything else we didn't cover in that part? I just think reputation is so important in so many aspects and people so many introverts, especially in my world of rheumatology, it's definitely more of an introverted field. I would say the juxtaposition are the orthopedic surgeons who are totally the gamers and those who want to get out there, but the rheumatologists are much more subdued. I think being aware of how you present yourself in the exam room is so important as well. Being able to look patients in the eye, being able to shake patients hands, being able to be present and staffing appropriately is so important. You have to spend money to make money. We've been doing a lot of work on this recently in terms of AI visibility for places like health clinics. And the AI models will often specifically recommend like doctors associated with clinics as opposed to just a clinic. So they'll say this is a great doctor for this particular ailment from, from this clinic. So that goes exactly to what you've just said about these doctors. This talent as it were. The talent needs to be like demonstrably visible across all places. Social media claimed LinkedIn profiles. Is that something which you sort of mandate to your, to your staff? Like do they have to take an active role in that visibility? And if they don't, does that mean that they don't sort of succeed within the Hirsch Center? How does that look? So we take over our doctors or providers, we have apps, we take over their Google profile. That's all that I take over. We will claim that profile page but LinkedIn and those other items, listen, it's their mini practice within the larger practice. And that's what I say. I, I can guarantee you X amount of money a year but you have to follow the formula. It's your choice if you want to get there. And they've seen the success that I've created and that's one of the reasons why they've joined the practice. But it's up to them in the end if they want to step up and play the game or if they just want to do it on their own. So speaking of, like, bringing new physicians in to join the clinic, once you're an established clinic, what part of, like, the growth equation is that you mentioned earlier? 250 new clients per month. But I also imagine every time you bring a new doctor on staff, they bring their clients with them. So how. How does that. What's. Is that not. Is that true or no, Actually, totally not true. Not true. Okay. We love to hire fresh graduation. It is very difficult. First of all, I just want to be clear. Post high school education, to become a rheumatologist is 13 years, and that's if you go straight through and don't take any breaks. That's a lot of training. So these doctors are finishing at 33 years of age, typically sometimes even older. The reason why we do it is because of a lot of the technology that we use, and a lot of it is not taught in fellowship training. And so it's a great opportunity to really develop these new fellowship grads into practicing the type of medicine that we promise to offer to our patients. We also hire nurse practitioners and physician assistants. We have hired veteran PAs and nurse practitioners, and that's a whole different story. But there are only 250 or so practicing rheumatologists in the state of Florida. I'm in Florida. We are a huge state. And so when you think of how few rheumatologists there actually are, it's daunting to think about recruitment. And so it is a process of about 18 months. Once you decide that you want to hire a rheumatologist, how long will it take to have somebody join? And I will give you a perfect example, Nick. We have a doctor who joined us in October. Love her. I met her seven years ago. She was finishing up her fellowship training, and she was in D.C. she is originally from Toronto, but she trained in America. We had a conversation, we talked. She was on a visa because she's Canadian, and I could not support that type of visa. So she had to work in a rural, underserved area for three years. She worked almost five years at that clinic in upstate New York, working on getting her American citizenship. And then she called me. She really wanted to be in private practice, and she really loved the connection that we had built, and she wanted to be in South Florida. So when she reached out to me, I was like, really? It's all about connections, right? This is a connection that I had built over six years ago. And she joined us In October from New York. So did she have patience? No, she had to start anew. Now, sometimes these doctors train in areas because we have a lot of seasonal patients and we probably lose about 30% of patients in the summertime. I was at dinner last week and a patient came over and said, I'll see you in September. I have to go back to New Jersey. So we do have that situation. That's why I said it's really important that the doctor who joins our practice live within our community because they build relationships with other doctors who are referral sources. They build relationships within their community. So, no, it's starting from scratch. That's a long, long old slog for education. I was thinking when you said how long it takes and how old they are when they're finished. They're almost at sort of rheumatology needing a age themselves. Yeah. Okay, so that's super interesting. Does that mean then that you have an issue with retention, staff retention? You know, I do, Chris. Well, it lended perfectly into the question about it. Oh my God. You know, and things I can't even control. So I work on building these relationships. Dr. Ludo joined us last fall and I knew her for over six years. And I do have a retention issue and it's for things that completely outside of my control. I have a nurse practitioner who just gave his notice because he's going through and I'm not going to share what's happening, but he's going through some familial issues and he's actually leaving the country for a short period of time. That's tough. He's not American natively. He is an American citizen now, but he's going back. I have another doctor who had her third child and she was with us for over nine years. After her third child, she realized I really need more support and help. And she had family who lived in the Orlando area and they were not willing to move down here. And so she literally uprooted and moved to Orlando. I have another doctor, seems to be a Trend. Had her third kid and I'm like, I have three kids, I'm still working. But she had her third. And after 13 years of rheumatology training post high school, she worked for me for three years. And I don't think she's ever going to practice rheumatology again. I don't even think she's going to practice medicine again. Now let's talk about the supply demand issue. Right. So the problem, it's not that people are like other clinics are Stealing your staff. It's just that there's such a small pool of actual doctors that one of them retires, one of them moves. It takes so long to replace them. Is that right? It takes so long. And so I feel like I'm always working on my pipeline and trying to figure out how I can bring more and more people, because if I don't have the staff, I can't grow. And that was a real issue for me in first quarter of this year. So I'm always looking at ancillary sources. Somebody listening to this podcast is going to think, I don't care about patients. I am so highly involved in advocacy, and I feel like if you help doctors, you help patients, and if you help patients, you help doctors. And you need to ensure the business is viable. And even the American Cancer Society, their goal is to make money, because if you don't make money, you don't stay in business and you can't reach your mission. So I need to continue to grow. And the Medicare physician fee schedule is deplorable. We doctors have not gotten a raise for physician services since the year 2000. By the way, if you look at cost of living and you look at the stagnation of the payment schedule for Medicare since 2000 to now, we have decreased our reimbursement by about 40%, 4 0%. So in order to be a business person in the world of medicine, you have to be scrappy and you have to hustle and you have to figure out how you are adding different ancillaries, like the vertical integration of these insurance companies. So we have ultrasound guided joint injections that we started using in 2008, and we became the premier practice doing that. We have principal care management. We now added a medically integrated dispensing pharmacy. So we actually have a pharmacy within our clinic now. And so our revenue has increased even if our patient numbers haven't. But the only way that I can continue to grow is to add doctors. And the only way we can continue to take care of more patients because the demand has increased so much, is I need to increase my supply by adding more doctors. Has that growth trajectory over the past 19 years? Have you had a growing. So we grew too quick as an agency in the early days, and we had to hire into that growth, and that was like a nightmare. But we could hire into it because, you know, the talent was available. Like, did you have a situation where, like, you just, you had to, like, try to stop growing or have you. Have you been able to manage that? And it's just become more of a problem recently. Like how has that growth trajectory looked? I feel like that's a really interesting question because I go back to all of the business books that I've read. If you stop trying to grow and you flatline, you're essentially going on the decline and you are going to better your business. So you're always having to be inventive and entrepreneurial and adding different sectors and figuring it out. Right. I'm really good at problem solving and figuring it out. So when we first started in 2007, my husband was our only provider and he was seeing patients back in 2003, at least in independent medicine. Prior to that he was in his training. Fast forward to 2016. We were on the decline. I stepped away from running day to day operations of the practice in 2014. It's really hard to raise three children and to work with your spouse. And I, I really wanted to go back to school, had gone through two different master's programs and I've left for various reasons. And I started at the University of Florida getting my MBA and I left after three semesters because I had three very little kids at home. My youngest was four. And I was still very, very involved in the practice. And I didn't give myself the CEO title until probably about 2019 because I really wasn't the CEO of this practice. I went from office manager to practice administrator. I think I was CFO at one point. I was some vice president of something at one point. But I really wasn't the CEO until 2018. So I finally, I was like, I have got to, for myself, for this company, feel like we're in a good place. I think I want to go the consulting route. I don't know if I still want to stay within this practice. And we were still at the time Advanced Rheumatology center, which was really hard because people would call and I'd say, hi, this is Meredith. You called Advanced Rheumatology Center. They're like, what? Dermatology never were. I'm like, no, that's my brother, he's a dermatologist. But you definitely have to pay attention to your name. So when I left, I, it was hard. I thought I had set up the practice in the manner that it needed to be set up. And shortly after I left, two doctors left, left and one moved out of the area and the other one went and set up his own practice. And so I was like, we're obviously doing something wrong. We've got to figure out what to do. And I really do need to figure out how to do this, get. Get my graduate degree. And by the way, it wasn't easy. It wasn't online. I went to the University of Florida and drove up to Gainesville. And you're not familiar with this area, but I went up every month for three days and it was about four hours away. So I got up there, I was there Thursday night, I came home Sunday night. Still three kids at home and still this practice. And in 2016, I came in and cleaned up shop. We changed the name to the Hirsch center for Arthritis and Sports Medicine. I recreated the company culture because it was not where I wanted it to be. And we have successfully created, grown and grown and grown every year since then. I mean, last year our revenue was about a little over 26 million. And this year I expected to hit about 30 million. Wow, that's amazing. That's such a. That's a crazy story too, of just, of how, just how much went into building this. I think people, they see like the highlights of where a business is and they're like, oh, yeah, I can do that. And then when you really, like, peel back the layers and you look at what went into it, like all the hours, like the hard work, I think that's what it takes to build a business that's going to last 20 years and is thriving at this point. So that's really cool to hear. I definitely work more hours with in all entities of this practice, even teaching. The fact that I teach is still helping me continue to learn. I'm teaching medical, business management. I'm constantly on the cutting edge and I probably work about 70 hours a week. Wow. Even more, I live and breathe it. Like my hobbies are all about healthcare. All of my friends are in healthcare. It's just all consuming for me. I'm not saying that that's healthy, but it is all consuming. When we started our practice in 2007, my youngest was one year old. I mean, when I said my kids were young, they were young. And I was working as a, not really a mortgage broker, I was like the original hgtv. I was flipping houses, I was flipping foreclosed properties. When we had the recession and the housing crisis starting in 2005, 2006, 2007, and I could do it with a baby on my hip and I can go ahead and do it. I got great at construction. I've built out four medical practices now. That's how we raise money. I mean, that's how we earn money. We did not get paid by Medicare for five months. And so when people see my speedy little car, which I now have, and they're like, wow, must be nice. I'm like, hey, like you can have it too. You just have to be willing to do it. I had two full time babysitters when my kids were little. Two full time babysitters because I was literally working 70 hours a week plus. Yeah. For someone who didn't want to be in healthcare. And now you live and breathe it. I think that's great. Yeah. And it's a testament to your success as well, Meredith. As we approach the end of this, it's been absolutely fascinating by the way. It's spurred me and fired me up to go and just work harder, I think. What are your fears and excitements for the future in your industry, especially in relation to things like AI? Yeah, I'll be really interested to hear. So I love that you brought that up because my son created a tech company, so he created a data analytics company in the aged spirits industry. Bourbon, whiskey, tequila. He worked in Kentucky for two summers working for Buffalo Trace, Sazerac. Nice. Yeah, that fun, right? He's like, see mom, I was in medicine too. This is like the original medicine. I'm like, but he actually is a mechanical engineering major from Purdue and he really wants to get into the consulting world and he's, he loves data, he loves AI. And so I begged my, pleaded, encouraged him to work for me for 90 days to follow shadow. By the way, he's in New York. He's still following and shadowing my staff, having a lot of interviews with them and seeing where low hanging fruit is right now for AI opportunities. I had a leadership meeting yesterday. My staff is super psyched about it, which I was really worried about the nepotism and bringing my kid in, but. But they are beyond excited. He is helping my front office team figure out how to automate. I have far too many people right now, I feel on my front office staff and I love them. Nobody's going anywhere, but I have a couple who are going on to their master's programs and so when they leave, why do we have to replace them? We should be able to automate a lot of this, especially in my billing. We outsource and have a lot of virtual assistants on my billing side. But my revenue cycle management director is overseeing this team that is remote and also overseeing my local team. There's a lot that can be automated. So I am very excited because I feel like that is not my wheelhouse. So it's so important to Be able to build yourself around those who can assist. I feel like the smartest one in the room is not the person who's the. Has the highest intelligence. It's the person who knows who to ask. It's the person who knows who to outsource to. And so I'm excited that Ethan is working on this project with our team because we definitely need to get into the AI world. And I feel that healthcare is so far behind in being able to do that. That's lovely that you've got direct access to someone who can come and help you. And I'd be excited as well. Cause it sounds like you're just gonna make yourself even more profitable once you correctly implement this stuff. And yeah, that is the one. We've had quite a few, like, health leaders. And when it comes to AI, it's like what the one space where compliance is sort of that barrier to sort of fast adoption. But I think, you know, just on think on things that you can easily automate. You'll see, like a huge ROI in a short space of time. So that's exciting. You can get another second really fast car, I think, by the sounds of. I don't know if I need to, but I am at that point where my lease is expiring and I'm like, I don't know. I want you to really learn to use this car. Like, buy out my lease or do I actually go the other direction? I'm realizing, I don't know how much I love all of this crazy technology that's coming into our. Meredith, it's been an absolute pleasure. I mean, you are a machine. For people that don't know, you host a podcast as well, which is fantastic. Fantastic. So I recommend to check that out. You also teach as well. I don't know how you find time in between everything else, but if people do want to get in touch with you, where is the best place that they can go? So I have a website, meredith hirsch.com M E R E D I T H I R S H dot com. Anybody can go ahead and fill out a form. And I do respond. My head of marketing, Mercy and I are constantly checking that and I'm very visible on LinkedIn. That's awesome, Meredith. Thank you so much. Thank you.