How Medical and Dental Practices Can Grow More Profitably with Ibrahim Ashmawey

Speaker A: Your practice might be growing while hidden costs quietly cutting into your profit margin today. Joining me is Abraham Ashmarwe, founder of Golden Profit Group, a former Wall street investment banker and a healthcare cost saving expert with over 15 years of uh, enterprise transformational experience. Listen as we uncover how to spot operational waste, calculate the true cost of every service and stop scaling in efficiency. Healthcare entrepreneurs, are you ready to rewrite the rules for your business so you can have more time off, a great team and more income while creating a positive social impact? Then you are in the right place. Welcome to the Provider's Edge. I'm your host, Sabrina Rumbach. I'm a provider, an international peak performance keynote speaker and a best selling author. Let's open the gateway to profitability for you today. My guests and I help health healthcare entrepreneurs and startup founders like you break through barriers so you can control your business, control your life and control your future. This is your defining moment to be a disruptor in healthcare. Before jumping into today's interview, I wanted to share something might be very useful for all of us who are visionaries. Whether you are a founder that just launched your company or you are a student or clinician who has a new idea that want to see if the market really care for it. Come to our Hot or Not pitch diagnostic lab where you are presenting 2 minute of your pitch of any idea that you had in the health, dental and wellness space in front of our clinicians, operators and investors. Each month there is a different theme so go to luma.com healthboard advisors so you can check out each month's theme. We look forward to hearing all of your amazing ideas.

Speaker B: Today we have Abraham Ashmoui who is the uh, American's leading expert in cost saving strategies for healthcare practices. With over 15 years of experience in enterprise transformation, Abraham has helped medical organizations across the country recover millions in lost profit by uncovering inefficiencies. Uh, hidden in the plain sight. As the founder of Golden Profit Group, he brings a result driven approach that blends deep financial insights with operational. He was born in Washington D.C. and currently based in Orange County, California. Abraham holds a degree in electrical engineering from the University of Michigan Ann Harbor. He began his career on the Wall street as an investment banker before shifting his focus to helping healthcare practices thrive and beyond the business. Abraham is a published author and a filmmaker whose work explores themes of purpose, personal development and human condition. His unique combination of um, technical expertise, financial acumen and creative expression makes him a rare and dynamic voice in both the healthcare space and creative industry. So glad you're here. We connected uh, a bit time back and really talked about that profit first. What does that lean business actually means? And I believe in that early stage of startup, uh, when they use a word, lean, they're not really using uh, correctly in their head. And how to figure out how do you contribute financially? Intelligence, but actually create enough ROI and knowing what's not to waste or capturing what they don't even know has been in the waste. I think that's something that every single startup, every single business, right? Doesn't matter if you have one clinic, multi clinic, you are online practice no matter what. Those are the things that most people are never taught to think that way. And most um, people, we also say they never probably trying to see a balance sheet, right? Like they don't even know what they're looking for. And then you have the people on the other spectrum, they're documenting everything, they're trying to project everything. Now I'm like, you're over projecting that it takes anywhere three months to try anything new to go to a new campaign. There's no way that you're launching one clinic this month and you're starting to launch another one next month. It's just not practical. Right. So I'm so excited for us to be here for you to shine uh, some light into when they just start a business, right? In that first couple years of what do they need to pay attention to, what are the bleeding costs versus people are a lot more established, right. Sometimes they got too used to how they do things and then they're not really diving deeper into what they should be catching the things they just never know. Right. So I wanted to really also take a moment for you to introduce a little bit more on um, that personal side of why making the switch, right. You working Wall street investment banking, very different dynamic how you decided to make that shift. Also for helping the individuals, practitioners and business owners now.

Speaker C: Yeah, absolutely. Well first of all, thank you for having me on. I really appreciate the invite and the conversation and you know, starting I guess with the latter question of what brought us to Golden Profit Group and why it is that we really wanted to start this endeavor. You know, my degree was in engineering and I found a love in finance, which is why I started working in investment banking. And slowly I found myself looking at numbers in a different way because I was an engineer at heart. So I brought both the financial and the engineering pieces together and I started looking in a couple different industries and I found a home in healthcare because I found that that industry was Perhaps the most removed from the financial aspect. Healthcare is so into the science and keeping up with every single new idea and every single new discovery out there. And recently, as you know, all of your work has been doing bringing in technology as well. Right. But where there was a huge gap was understanding that if you don't have a good financial background, you're not following the right fundamentals. You may have amazing ideas and amazing work, but you may not be able to sustain the industry, you know, sustain your business in the industry. And unfortunately, we've seen situations like that. We've seen companies and startups that have been doing such amazing, um, work and their quality is so good, but they lack certain fundamentals. And so unfortunately, they don't continue.

Speaker B: Yeah, exactly. That's when people start. Usually they come to us. They're either in the valley of death, right? They're like, we made progress. We've been going for a few years. We. But now it feels like whoever is our ideal client is not exactly the right person. Or we're just not making the most out of it. Right. Or they're like, oh, no, no, Sabrina, let's just get us, uh, start raising capital, right? So we can survive. We can just go to the next iteration. Maybe we just need to make our product service better. I'm like, you probably are missing something else, right? Like, right in that middle of what do you need to make a decision? It's never just like, oh, let's make a decision, raise more capital, work, go figure out making more revenue. Clearly you have a gap in there. And most of the time it is those financial numbers doesn't make sense. Right. Or they will present to conversation.

Speaker A: Right.

Speaker B: I always love to ask this for people. I feel like sometimes they got annoyed because I'm like, but what are they saying to you then? If you have all this investor conversation, why do they not write check? What have they been saying to you? And most of them will always say, oh, they're very encouraging. Like, that's great. But underlying that polite. No, there's some things you're not sharing with them. You're creating unclarity or whatever. The number doesn't make sense. Now they're creating even more question mark. And anytime people have question mark, they have fear. Right. So when you are seeing and working with these, whether it's a startup side or the practice side, what do you think are some of the critical things? They're m. Truly just not seeing and then falsely believe they have a good model.

Speaker C: Right. So two very different worlds. The startup World versus the very well established companies. And when we're talking about the startups, I've seen two different kinds of entrepreneurs. One who is not looking at the bottom line and not looking at the profit. Right. These are the people that believe that I need to have a proof of concept, let me be able to have my service or product sell it, actually have somebody buy it. Because all an investor wants to see is that somebody wants to buy my product and they believe that's enough. They're not pausing to think this product, how much is it truly costing me to create and then how much am I selling it for? They believe that so long as I'm able to scale it, I'm going to have the profit when I scale. But if you have the inefficiency with one product, you're going to have that same inefficiency with a million sold. And unfortunately it's not like the inefficiency gets smaller. It's going to continue to scale as you are scaling revenue. So if you don't fix the problem from day one, you're not going to be able to fix it in the future. It's going to be much, much, much harder and you m may not even unfortunately get to a future. And that comes, you know, with small practices. I've even seen this with multi billion dollar companies to when they finally decide, you know what, we are going to start creating new products with Bex Business excellence, right. The business excellence team that they literally created full on teams to make sure that when they have a new product, a medical device, a even a pharmacy or whatever from day one we are taking profit into the conversation. And then you have the other people that are so focused on the Prof. That they are sacrificing quality before they even have their first product. And those are the people that are and I'm sure you've, you've seen and you know come across this people that are coming into the business just for the money and the cash flow and the profit rather than actually having something that can be innovative and change the world.

Speaker B: Yeah, you have to find a middle ground because we see a lot of founder coming to us. They're very impact driven. So when people are impact driven I say stop giving me a minimal viable product. That just means you have something you can demo. You need to give us a minimal sellable product. So tell me if you already spoke to at least hundred people who are potential buyers for you, whether those are physician that can represent the services to their community or your end user, are the people that are actually using it, Right? Let's say a pelvic floor exercise, right. To uh, prevent inflammatory changes. Do you have a platform for people to engage, discuss or have even leverage influencers who already have personal story, patient advocate, right. To really get into these deeper conversation to prove the market is already there. Otherwise who are you to do this? Because then you just going to be a best kept secret due to exactly what Abraham, you're saying. Many people who are scientific mind, they believe in order for them to sell, all they have to say is I'm from mit, I'm from this other institute, I have all this degree, I'm um, the first in research. It's great that you are the first or you the unique. But do people actually need it? Is it that much easier, cheaper, better and more practical than the solution existing?

Speaker C: Right? Exactly.

Speaker B: It's too hard for people to make another movement. Then why would they spend money, energy to learn about what that is? And I do believe sometimes founders have the tendency of uh, what you mentioned, not thinking profit first. If I just pour everything out, I can make enough for the beginning to show that it's viable. Right? And then something will come back. But we know viability is never the same as uh, sustainability and it's never the same as uh, scalability. And I think most of the time people mistaking what is true scalability. Right? Scalability should be your. You have the same capital, the same people, the same resource, and you can produce double, triple, quadruple of output. If you have to put more things in there, you're not scaling, that's simply putting more for exchange of growth. That's not the same thing. Right? So when you are thinking about supporting these companies and um, figuring out where they can save, where they can actually improve the financial intelligence, where do you get started first?

Speaker C: So we get started with two things, okay. After we understand the business and what they believe the problem is like, we have to ask them what do you think the issue is, right? And then we're able to kind of contrast that. But we really start with two simple things. Number one, what is it truly costing you to create your product or service? Just to be very, very simple, if somebody is selling, you know, a pill and you ask them how much is it costing you to produce this pill? They simply talk about the pharmacy they're getting it from and here's how much it's costing me. They're not taking into account every single person who touches it and their billable hours and everything from the AC to the, you know, the electricity. Every single second that pill is living somewhere, it's costing you money. Are you rolling that all up into your cost to understand how much you should be actually selling it at the end of the day? So how much is your product or service costing? That's where we start. And number two, we also look at what is your current cash flow looking like? Where is your money currently going? And that's where it gets surprising. And you know, even you or I, I'm sure we're guilty of when we look at our financial expenses at home, we say, oh, I didn't realize that I have, you know, three subscriptions to Netflix instead of one.

Speaker A: Here's our uh, key takeaway so far. Scaling does not fix a weak financial model. It makes the problem more expensive. Abraham reminded us to understand the true cost of delivering each product, while I challenged founders to move beyond a minimum viable product and prove they have a minimal sellable one. Before you add more people, tools or capital into your company, your practice confirm that customers will pay and that every cell actually going to increase your margin. Now, before we jump into the second to third of our conversation, let's take a quick pause. I want to invite you, whether you are a founder who already already ran a series A above company, or you are a organizational leader, a clinician who wanted to showcase what you have been building, who you have been serving, and the system that you have been improving in the space. Then go to the providersedge.com to apply to be a speaker on um, our podcast.

Speaker C: But people don't normally audit where their money is going and they don't even think about it. And sometimes it's because when times are good, you don't need to. Right? So a lot of companies, even the ones that are making money, when they start looking at their financials, they start realizing, wait a second, I am just funding a payroll machine. You know, when, when cash is flowing, I'm not even looking at it and so much money is being wasted. And it's not that it's going towards anything good, it's literally just being thrown away.

Speaker B: Oh yeah. Knowing where things are going and leaving you and then be able to have that honest check, uh, in with yourself. Right. And sometimes I feel like people over project that as well. Right. They thought, oh, I really need three people to do this. Actually, if you think about the workflow, you're thinking about how things can be done. You don't need three people. It's probably one person job. How are people demonstrating their value and then uh, how they performance do you even have any KPI to track that? Right. I think financial and operation always go hand in hand. And then you start adding into the other factors of, uh, marketing, sales, Right. Where people pour a lot of their money too. And we're like, well, do you even know the conversion truly? Right. If your sales arm is actually converting really well, why would you need it to do so much more front end work?

Speaker C: Right, Right.

Speaker B: So it's really first is thinking about the cost unit economics on cost, um, per patient.

Speaker A: Right.

Speaker B: Cost per service and then what's the lifetime value of that and then where your money coming in and out. Right. The cash flow. Now do you feel like I also have startups telling me, oh, Sabrina, you're asking for those numbers, but we're not there yet. Right. We're just on the pilot phase, demo phase. But to me, isn't it that even you're in that early stage, you should still be able to know what's your manufacturer cost or anything that's within that pipeline. So when you are turning on the funnel to get a lot of people using the services of product, you actually should know what the cost unit economic of today to be able to know where the future come from.

Speaker C: Yeah, yeah. You know, it really goes back to the lemonade stand. Okay. If you want to sell lemonade in the street, the most thing people think about is do I have lemons, do I have sugar, do I have cups, do I know how to make lemonade? Is it going to taste good? Okay, where am I going to stand to sell it? The last thing they think of is how much is all this costing me? And if it's costing me X and I make this many cups, how much can I sell each one for? And here's the biggest one. If I want to make a profit, my markup, is anyone really going to buy that or is it too much every single time? You know, my kids made lemonade stands, I had to show them that this was fantastic, this was great. But you lost money, right? It cost you more to make it than it did for you to sell it. And we're not even counting your time and effort and any of that stuff. So it just goes back to fundamentals, which kind of begs the question. And you know, you work a lot with startups and entrepreneurs who really want to. A lot of them are just brilliant, brilliant minds. Right. And they really do have good ideas and good products that could change the world for a better place. There's no question about that. And I think what's amazing about what you do is that you take that and you help it make it a reality so that the world doesn't miss out on these great ideas and great inventions. What's amazing to me though is that when I pry and when I push as to like, why are you guys doing it in this way? Or why haven't you thought of this? I do hear a lot of the things that, you know, even you mentioned of you, you know, well, I'm selling myself, right? I came from MIT or I came from Harvard. I'm not selling my product, I'm selling myself. And when I pry into, well, who told you that you can just sell yourself? Unfortunately, a lot of it is they're getting information from incorrect sources, right? There's not that solid core of knowledge on how to run a business. They're not reading books, they're not going to business classes, they're learning a lot of it online with certain just catchphrases like sell yourself or the most important thing is the marketing, or the most important thing is the product. If the product is good, everything else will fall in place. The whole build it and they will come mentality, which is just not reality. It's not really how the world works.

Speaker B: Exactly. I think healthcare in itself make you think that way. Because if you think about all of us who are clinicians, we train for years after years. And when you graduate, you're hoping that you're signing to a facility, a hospital and they take care, right? You show up the patient just in front of you. Yes, we're gonna have overbooked issue, right? Because there's no matter what, there's a shortage as the senior generation retired. There's not enough upcoming. I have plenty of people that I know that teach in med school and saying plenty of them, once they finish residency, they're not gonna practice medicine. So we have this, uh, not enough for sure. So then people have the false belief of, well, if I'm there, I have the reputation, I'm locally available, people just going to come to us. But in business it's never that, right? In business, we know, yes, there's a trust factor for you as a founder, the trust factor of your company as a, uh, reputation. If you have the brand, the knowledge and trust, awesome. But if your company has not really demonstrated, then why would people go to you, right? Just yourself is not enough. And I think as an investment perspective, curious about when you are investing. At the same time we always think if there's only a one shiny object, right? The shiny star, which is the founder of the company, but no one else. We don't really see the true support, support system behind her of him. We actually don't truly believe in this company. Right. It's just one person that can burned out, something happened to it and what's going to happen. Right, right. And then finally it's the product service. That means we do need to see all the pilot, all the research, all that stuff. Right. So was that similar to when you think about financial stability and investment, that really is one of the critical thing that everybody, uh, looks at.

Speaker C: Yeah. Especially when you're investing in startups and in companies that want to go public. Right. IPO process is incredibly rigorous. It's perhaps the most rigorous process on Wall street, as you can imagine. And a lot of it there is the people. But you would be surprised as to how much of it lives also in spreadsheets. Right? So yeah, they look at the product and yes, they look at the people and they look at technology. The technology is huge, like how much are you utilizing, what technologies, et cetera. But if the numbers don't work, there's no amount of, you know, oratory magic that, you know, an entrepreneur can do. There's nobody who can do a Steve Jobs presentation and still win people over. Because at the end of the day, we're talking about cold hard cash and people will not give you their money based on dreams and promises. Right? And it always goes back to that story of Walt Disney, right? Like he greatly succeeded building Disneyland, but he could not get the investments for it because nobody wanted to invest in a dream. They needed to see actual money. So he had to put his own money into building it. Which is perfectly fine if a person wants to back themselves up and do that. But obviously it's incredibly difficult, especially in today's world. So if the numbers don't work and you haven't done your research and you haven't done that prep and it's not going to continue like that.

Speaker B: Right, Exactly. And I think that's why nowadays we all want to see that the founders have some skin in the game, right. If you have put your own money into a. You got people, family, friends, crazy enough to trust you, right? You have something going, then people will see. And then the next exactly thing is, where's your number? Does that make sense? Do you have the people that actually prove to us you can deliver all the proposal that you're going to do? Right. And you're just not throwing random numbers out there. And then is that whole. Ultimately, do you have the infrastructure to actually do it. I think no matter what. There's multiple component of what make success a true success. And I think that's the difficult thing, right. For many of us is like how do you find the right company? And sometimes it's like they always come to us, but then it's about how do you really only support the people that you truly see. They have it together for us to take it to revenue and then give them that double, uh, and triple of the result in the next couple years. Right. Otherwise I feel like investment is a long game. Right. Like business is a long run. It's never just like oh, I'm so fed up about the hospital system. My practice, let me just open up a practice myself and I can do it better. And sometimes uh, yes, is that whether you're truly can be a stakeholder mindset versus the employee mindset. But then there's so much to be learned in the process. And I think that's why people needed to come to you even as an early stage. Right. To think about what's the fundamentals of. You have to allow yourself when first put a small percentage of profit, make sure there's some set up. And then how do you then expand and save yourself from um, all the expenditures. Right. What are the right way to write all the costly payrolls. Right. And then all the other insurance things that come into play as people are growing. So as we wrap up, there's so much that can be said. What would you say is a major takeaway? People should keep in mind, I would

Speaker C: say two things to take away as just people are thinking about the future. Number one, know how much your product costs and make sure that you're capturing every single one of your costs. You're saving yourself a lot of heartache in the future. The second thing is in today's world, especially with rising costs for practices that are ultimately leading to smaller practices being absorbed by larger ones, etc. You need to be able to adopt new technologies 100%. But they be conscious of the fact that they can be double edged swords. We can talk for hours about technology, but if you don't adapt to new technologies, you will be left behind. But as you adapt them, be sure that they are bringing you value rather than just being yet another expense that you're paying for.

Speaker B: Yeah, exactly how well would that help you in the entire workflow? Right. And what's the true outcome for you, your patients and whatnot is the whole system and how would you justify for using it? Because no matter what, every single technology There's a learning curve and then we have to give ourselves some grace period to learn it in order to make things better. Right. So if you have to put in the effort, then what's the best thing? Yeah.

Speaker C: Yeah. We've seen practices and companies literally go under because of this. You know, one company, it was a dental group, they had seven different platforms all doing the exact same thing, but they just weren't tracking how many technologies to bring on. Now they needed it, but they weren't even utilizing them correctly. So it's something that you need, but you need to be very wary of how you're doing it.

Speaker A: All right, here is the critical point. Strong revenue can still hide weak operation, wasted payroll and tools no one fully uses. Abraham, remind us that founders must know their cost per product, customer or service. And investors will not overlook numbers that fail to make sense. Your vision might open the door, but clear financials, the right team and the workable infrastructure prove your company can deliver. Now for all of you that are listening, come to join us at our next Pitch Tank event. July's theme is wellness and nutrition. August is focused on biotech and clinical trials. September we are looking at men's health. And October will be on um, mental health. And November is focused on women's health. As we are proceeding to each month there will be a new theme repeating. So we would love to hear your ideas and making sure that they are truly sellable. If you already have a revenue generating idea waiting to get more pilots and funding, then this is definitely the room that you need to be so we can help you to quickly get to that contract and convert it into a deal.

Speaker B: Perfect. Thank you so much for all the knowledge, all the share. How would people best find you when they wanted to have further conversation?

Speaker C: Yeah. So our company is Golden Profit group. We're@goldenprofitgroup.com and we're uh, on all the socials as well under my personal name.

Speaker B: Awesome. Yes. Check out everything that we're that Abraham has been sharing and we can't wait to hear from you guys. What are the areas that you see your own organization or startups could be saving and then not well adapting all the traffic tools and could be having a better infrastructure so you can truly be profit first and be intelligent about how your financial is it working for you instead of putting a lot more financial just to keep up with everything that's going on. So everybody, whether you have subscribed to us watching it, please comment below and we look forward to supporting you in the future.

Speaker A: Today's conversation Bring innovation back to financial reality. Growth does not fix weak margins, unclear costs, or a product the market is not ready to buy. Abraham showed UH us why Founders must understand the true cost of delivery, validate demand, and make sure every new tool, hire and investment creates measurable value. Before you scale, make sure you are building a stronger business, not simply making an expensive problem bigger. Here are the key learning points from today. Number one Scaling will not fix an unprofitable product. Many founders assume higher sales value will eventually improve weaker margin. But when every cell carries the same inefficiency, growth multipliers the loss instead of correcting it. Before investing in customer acquisition or expansion, founders need to understand the full cost of delivering each product or service. Growth only creates leverage when the underlying business model already works.

Speaker B: 2.

Speaker A: Building a minimum sellable product not just a minimum viable product A product can function well and still fail to attract paying customers. A minimum viable product provides that the idea can work, while a minimum sellable product provides that buyers understand its value and will pay for it. Founders need direct conversation with real buyers before adding more features or spending heavily on development. Market interest must be validated through action, not complements. 3. Calculate the complete cost of delivery the true cost of a product, including more than manufacturing, software, development or material. It may also include staff time, implementation training, compliance, customer support, facility usage, and every person involved in delivering that product. These hidden expenses can quickly reduce margin, especially in healthcare. Founders need to complete cost picture before setting price for forecasting profitability. 4. Do not let revenue High operational waste Strong revenue can make an inefficient company look healthier than it is. Duplicate software, unclear roles, oversized team, and unmeasured marketing expenses may continue unnoticed. While cash is coming in, founders should regularly examine what each major expense UH contributes to gross delivery or customer outcome. Visibility helps leaders reduce waste without cutting the resources that actually creates value. 5. Clear financials reduce investor uncertainty A compelling mission might attract an investor's attention, but unclear numbers often stop the conversation from moving forward. Investors Investors want to understand margins, delivery capacity, market demand, and the company's path to sustainable return. When founders cannot explain these areas clearly, perceived risk increase. Strong financial clarity makes it easier for investors to trust both the UH opportunity and the leadership team. 6. Technical technology cannot create more value than cost. Adapting new technology is necessary, but adding more tools does not automatically improve a business. Each platform should solve a defined problem, improve capacity, reduce friction, or produce a measurable return. Without a clear purpose and AH adoption plan, technology can become another recurring expense that quietly drains cash. Founders should measure value before renewing, replacing or expanding any system. Which expense inside your company right now would be hardest to justify if an UM investor asks you to prove its measurable return today, thank you for listening.

Speaker B: Remember, the positive change we're seeking starts right here with me and you. If you're a fan of the show, or if you are just having struggles

Speaker A: or success that you either experienced in

Speaker B: the past or are experiencing now in

Speaker A: the healthcare industry, these matter to all of us.

Speaker B: I want to hear from you. Visit sabrinarombach.comcomconnect and send me a direct message. Talk soon.