Scaling: Lessons from Growing a Practice with Dr. Sacha Obaid

July 31, 2024

In this episode, hosts Brad and Michael are joined by Dr. Sacha Obaid, board-certified plastic surgeon and founder of North Texas Plastic Surgery. Over the past 17 years, Dr. Obaid has grown his solo-practice into multiple med spa and plastic surgery practices, including a surgery center. Discover the key lessons Dr. Obaid learned on his path to expansion, the importance of building a solid business foundation, and how addressing operational challenges and collaborating with other surgeons enhances patient care. Tune in for insights on effectively scaling your practice.

Listen to the full episode using the player below, or by visiting one of the links below. If you have any questions or would like to learn more, email us at info@byrdadatto.com.

Transcript

*The below transcript has been edited for readability.

Intro: [00:00:00] Welcome to Legal 123s with ByrdAdatto. Legal issues simplified through real client stories and real world experiences, creating simplicity in 3, 2, 1.

Brad: Well, welcome back to Legal 123s with ByrdAdatto. I’m your host, Brad Adatto, with my co-host, Michael Byrd.

Michael: As a business and health care law firm, we meet a lot of interesting [00:03:00] people and learn their amazing stories. This season we’re talking about businesses who decide to double down on their business. They’re going to scale. Our theme this season is, Growing a Business.

Brad: Yeah, Michael, for those that don’t know, growing a business is just one of those seasons of business. What are the other seasons?

Michael: Yeah, so the way we talk about it, there’s four seasons of a business. When you’re ready to start your business, you’re starting a business. And then you may be in the, what we call the operating season, so you’re running a business, the scaling seasons where we are now growing a business, and then the buying and selling season, so that’s when it’s time. 

Brad: That’s awesome. Well, I’m real excited for our guest today, Michael. It’s like we have like a rockstar on.

Michael: Yeah. Well, our guest is a long time client and friend. In fact, he started working with us around the same time that you and I started working together. It’s coming up on like 17 years or so. 

Brad: Sounds right. 

Michael: Without doing too much math. We’ve [00:04:00] had a seat by his side as he’s made decisions to scale his business over the years.

Brad: Years! That’s awesome. Well, before we bring him on, do you have anything we’re going to start with?

Michael: Well, I’m going to share something Brad and it’s going to be kind of meta because you and I are certified oversharers.

Brad: Yeah. That’s probably true, and sometimes it can be inappropriate at the same time. But is that because I always say how old you are?

Michael: Well, that’s not oversharing Brad. That’s just mean. No, we don’t have a problem with sharing other people’s stuff. In fact, I’m going to give you a compliment. You are one of the most trustworthy people in my life to hold something that’s private in confidence.

Brad: So what’d you hear? I didn’t tell anyone about that thing that you told me that I wasn’t supposed to tell anyone about.

Michael: Yeah. Our problem stems from a good intention and it’s that we highly value transparency and authenticity. And so for example, if someone asks me how I’m doing, I’m prone to share more [00:05:00] than the person may actually want to hear.

Brad: So Michael, how are you doing?

Michael: Oh, Brad, pretty great. It’s summer. Things are a little slower on the home front, so not as crazy as during the school year, but I’m starting to grieve a little bit because Ava’s getting ready to go to college. But I’m getting used to it, she’s my fourth, so I’m fine. Brad. Wait, that’s kind of a good example of what I do.

Brad: Yeah, yeah. Don’t tell anyone. Don’t worry. Nobody heard you. It kind of reminds me, when we first started our firm, we wanted to be very transparent, and we would have a slow month and we’d let everyone know, “Hey, we’re having this slow month. Then all of a sudden we learned later that it was making everyone really nervous and they didn’t understand the big picture of all the positive activities and things that were happening at the firm, and that we were still growing. And so we actually had to learn how to focus on those issues that the team cared about and not overshare things that they didn’t care about.

Michael: Yeah, we’re getting better. And Brad, there’s hope for us. [00:06:00] Because I read an article recently, there’s something trending that benefits oversharers on TikTok. Have you heard of this trend called loud budgeting?

Brad: Negative.

Michael: So it basically means that people are setting goals or budgets and they’re telling their friends about it. People are setting their budgets, and then they get their social circle involved. And the idea is to create accountability. And so this is kind of taking – it has a lot of momentum and energy in the social media world.

Brad: All right. So they’re having accountability with their friends, and that helps them obviously create a new habit, so they’re letting everyone know about it. Okay, got it.

Michael: And so as it’s becoming a trend, people in their twenties are now asking friends to have potlucks or do free activities rather than go out to expensive dinners. And they’re even being upfront about not being able to do something because it’s not in the budget. This is very counterintuitive [00:07:00] for Dallas culture, by the way.

Brad: Yes. Are you suggesting that ByrdAdatto have a “loud” budget?

Michael: No, I think that’s a little too much, but I have a kind of small example. And we could say that you can’t buy that private jet you want for ByrdAdatto because we don’t have that money, Brad.

Brad: I’m definitely now against this loud budget concept. I would like a second opinion on the lack of funds for this private jet. I’d like to make a TikTok loud budget video saying that I need a private jet; does that help make you accountable?

Michael: I don’t even know what to say to, Brad. I think we need to bring our guest on. Okay, here we go. So joining us is our friend and client, Dr. Sacha Obaid. So, Sacha is a board certified plastic surgeon. He’s the owner and founder of North Texas Plastic Surgery with locations in Southlake, [00:08:00] Plano, Dallas, Frisco, and Fort Worth. Sacha’s originally from California, and I learned this when I looked up your bio, he was a star water polo player and swimmer. He was undergrad at USC, medical school at Harvard, and did his residency at UT Southwestern. That’s where we first met him and in addition to his medical pedigree, we personally get to see Sacha’s unique talent on the business side of medicine. Sacha, welcome.

Sacha: Well, thank you so much, Michael. And thank you for the partnership, as you said. Over 17 years ago I was fortunate enough to meet you, obviously, through your dad who was one of my mentors and inspirations at UT Southwestern. And so, I think we’ve been working together since I was a chief resident, and now we’re 17 years on. And as you mentioned, a lot of changes. [00:09:00]

Brad: That is amazing. Well, Sacha, I guess I have a very important question here for you. Are you an oversharer?

Sacha: Yes. If you asked the real brains in the Obaid household, which is my wife Debra, she will tell you that you will get way too long-winded of an answer from me to all the questions that you ask today, so I apologize in advance. And if there is some sort of subtle signal like touching your nose or something that is intended for me to shut up and move on, just go ahead and feel free to do that.

Brad: Well, good. You’ll fit in perfectly here. 

Michael: Yeah, that’s perfect. Well, cool. So let’s start. I’d love for you just to kind of introduce the audience by telling the audience a little bit about you and your practice.

Sacha: I’m the founder of North Texas Plastic Surgery. I started this practice 16 years ago in a small office here in South Lake, Texas. [00:10:00] And over the past few years, we have grown that practice, or I have grown that practice from one small office, individual, traditional private practice plastic surgery into five locations across Dallas-Fort Worth. We’ve expanded from just having the plastic surgery practice to also having a  AAAASF accredited surgery center with six operating rooms, overnight capabilities. We have five medical spas across the metroplex with 10 providers. We have grown from being just a single surgeon practice to now four full-time attendings. We are actively recruiting for additional attendings. 

We have ASAP’s endorsed aesthetic fellowships as well, where we train [00:11:00] young plastic surgeons on how they can transform from just sort of standard plastic surgery to really elite aesthetic plastic surgery. We have a real estate entity that owns some of the office buildings that we occupy. We have a anesthesia group that we started that has four full-time anesthesia providers as well and all told across all of our organizations now, we’re at about 115 total staff members.

Brad: Wow. That’s incredible and the most amazing part about all this is you did that despite the fact that Michael Byrd was working with you. I mean, that’s just really…

Michael: I’ll just get out of the way. 

Brad: I’m most impressed by that. 

Sacha: No, I am I’m very, very thankful to Michael. I think he’s been instrumental in the growth process for us. [00:12:00] He’s been a sounding board for a lot of my crazy ideas some of which were not fantastic, some of which were, and so I’m, I’m very thankful to him along the way. And I have to say he is, knock on wood, has never steered me wrong.

Brad: Well, don’t let anyone hear that – hey, Kennedy, can we cut all of what he just said? Yea? Okay good. I appreciate that and I love hearing that story. Because I mean, your story, you know, this season we’re focusing on growing a business and hearing just your explanation of just starting off as the traditional one man shop and in one location and all the different med spas and other service lines that you kept adding on. So, just talk about that journey as you decide. What made you decide to start scaling your practice?

Sacha: Well, I have to be honest, I wish I could sit here and tell you that I sat down before we opened up [00:13:00] and created this fantastic business plan that said that in year seven, we’re going to open a surgery center; in year nine, we’re going to hire our first associate; in year 11, we’re just… I didn’t have any of that. In fact, I actually had the reverse. When I started out, my number one focus was on keeping it small. I didn’t want my attention divided. Like many young surgeons, when you first finish, you’ve been trained to do plastic surgery, but that’s it. You don’t really know how to run an organization. You don’t know how to run a surgery center, or you don’t know how to manage nurses. You don’t know how to manage anesthesia personnel. You just really know how to roughly technically execute a handful of operations. 

[00:14:00] My number one thought process when I started was, let’s simplify, simplify, simplify. Let’s keep it to the bare minimum of what we need to, and then let’s get really good at that. And once I did that, then I started seeing the problems around me. And that’s ultimately what led to the scaling. So I can tell you that I see so many plastic surgeons, they come out and they either right away start trying to build their own OR, or buy an existing OR from someone that’s retiring, et cetera. And it’s just too much. It’s too much that your attention is divided and it’s too much to learn and take on, in my opinion, or at least for me when I started. [00:15:00] So, I really wanted to focus on being really good at plastic surgery.

Once I started getting really good at plastic surgery and I started getting more and more experience, I started to then see some of the shortcomings around me. And that’s what ultimately led me to expand. I’ll give you an example, and I know we have a diverse audience, but for the surgeons that are in the room or are listening in; probably the most frustrating thing when you go to an operating room is you go and you scrub in, and the first thing you hear from the circulating nurse, that’s the nurse that is kind of in charge in the operating room, is, “well, I normally do orthopedics, so today’s just going to be terrible.”

Brad: Yeah. You don’t want to hear that.

Sacha: Well yeah, but you’d be shocked at how often you hear that, right? 

Michael: Yeah. 

Sacha: And so then you start asking for, okay, can I have this retractor or this instrument? [00:16:00] and they say, “I don’t know what that is. We don’t have that here.” Suddenly now your attention is being diverted away from what should be a hundred percent on the patient into now managing, okay, what tools do they have here and what do they not have here? What is the setup like et cetera, right? And you start realizing, my attention’s divided. I’m not paying attention to the patient, and so I’m not delivering the best operation possible. And it gets even worse than that when the patient then hits the recovery room, because I had patients come to me and they would tell me – and I’ll never forget this story.

I had one that came to me and she said, “Dr. Obaid, I love my surgery. I love my results. I got to tell you that the hospital experience was terrible.” And I said, well, what happened? And she said, “Well, I was lying in the recovery room and I was in pain. [00:17:00] And I kept asking for the nurse to come and bring me pain medicine. And we were in one of these big standard hospital recovery rooms where everything’s separated by a curtain.” She goes, “I can hear the nurses talking outside the curtain, and I hear the nurses saying, ‘I don’t know why she’s complaining. She wanted to have this surgery. She should’ve known it was going to hurt, et cetera.’” And the problem for me in this scenario is obviously it’s a terrible experience for the patient, right?

Brad: Yeah.

Sacha: But ultimately, when I’m just a guy operating at a hospital, I don’t really have any recourse in this situation. I don’t have any control over the nursing staff. I don’t have any control over the patient experience. I don’t have any control over [00:18:00] the supplies chain in the OR et cetera. And so, I realized, if I wanted to bring or deliver the best results to the patients, and also the best experience to the patients, I had to expand outside of this little tiny bubble. And I had to start controlling more things, so that everything was the way I envisioned it should be for the optimal patient experience. So I decided, okay, now I have to have a surgery center. And now I’m far enough into my practice where, okay, I’ve got the plastic surgery side of things down, now I can start to manage the nursing staff. I can start to manage sterile processing, et cetera. [00:19:00] So that ultimately led to us building our own surgery center. Well, then once you build the surgery center, you start seeing other things.

Michael: Well, that’s fascinating. And so what I’m hearing is, you master what you’re doing, and then you see a problem and you make a decision to solve that problem, that involved scaling in the sense of, now you’re adding a surgery center. And so I’d love to hear just a little bit about like, how long did that take to do that? What was that like? And then I’m sure that then there’s kind of an anesthesia component to that now, because now you’re running your own OR, and you need to have anesthesiologists. So, I’d love to kind of hear how that part works.

Sacha: Yeah, so two things there Michael. So the first thing is, you make a giant investment [00:20:00] financially as well as personally from a time perspective in building the surgery center. And when you do that, you’d be shocked, first off, at how much goes into that. For me personally, I actually took a course on how to become a surgery center inspector, just so that I could learn what exactly is involved on the inner workings of a surgery center, things that were never taught to me, so that I could make that as streamlined and as perfect as I could possibly make it. But then, like you said, once you have your own surgery center, you start saying to yourself, okay, well now we have to have anesthesia personnel.That’s a critical role, and that’s something that I’ve never been trained in, right? 

But there was another side of that, and we talked about patient experiences in terms of how they felt they [00:21:00] were treated at surgery centers that weren’t mine, or hospitals that weren’t mine. We had the same thing initially with anesthesia, where we said, okay, we don’t really know anything about anesthesia. We’re going to start by just pairing with a big anesthesia group in town. And we would get what you would expect with a big anesthesia group. You get a different anesthesia provider every day of the week, just whoever happens to be on call that day, or who happens to be available, et cetera. And the problem was that we noticed, that the anesthesiologists that would come, some were fantastic and some were not. And the ones that were not, didn’t necessarily understand the cases that we were doing.

So they didn’t understand when we were getting close to finishing, how far along we were in the case, how to titrate the medicines. For those not particularly familiar with some of the inner workings [00:22:00] of liposuction and body contouring surgery, there’s a tremendous amount of fluid management that the anesthesiologist has to be familiar with, that is ultra-specific to those operations. And they can very easily tank the person’s recovery by either giving them too much fluid, too little fluid, the medications they give, et cetera. And so, we really realized that the only way to optimize how the patients surgery experience and the recovery experience was to optimize the anesthesia. And to optimize the anesthesia, you got to have someone that’s doing it all the time. You are best at what you do over and over and over again. 

So, we really wanted to bring someone, not only that was great, but someone that would be dedicated in-house. And so then we started by hiring our first anesthesiologist that would work just for us. But that creates now another problem, [00:23:00] as we start talking about scale. Okay, so now this is fantastic for patient experience. I’ve got this amazing anesthesiologist who knows everything about plastic surgery. I’ve got this amazing surgery center that just hums and runs it perfectly. But now I’ve got these giant salary lines, these giant expenses, and I only have one guy who’s doing cases there. And you know, now, gosh, I want to take a vacation for once with my family, but you go on vacation, and guess what? All these guys still want to get paid, understandably so. And not to mention the legal bills, we won’t even get into that. 

So you start realizing, hey, we’ve built this thing, but now we need to expand [00:24:00] the plastic surgeon practice too, to having more surgeons, so that, that way when I’m in clinic, the anesthesiologist, he’s still providing anesthesia, right? And the circulating nurses and OR nurses and scrub techs, they’re still working, et cetera. But the great thing about that is then when you start bringing in additional surgeons, it also allows for some synergy between the providers, because now I’ve got somebody who’s working in my operating room every day. I see his results, he sees mine. I start saying to myself, Hey, why does his belly button look so good after he does the tummy tuck? Well, now I’ve got to go peek in and see what he’s doing. And vice versa. He comes by and says, why are her hips so much smaller [00:25:00] and she has so much better curves when Sacha does this case? I’m going to go peek in at him, and now we start going back and forth, so there’s a synergy there. 

And the great thing about that is, then when you start adding additional providers, not only are you challenging each other, but now you’re able to offer other things to patients that you weren’t able to beforehand. So we started seeing, okay, hey, maybe there’s a device on the market that will help 10% of my patients look 10% better afterwards. But you start looking and you start saying, okay, well that device is couple a hundred thousand dollars. And so then you start doing the math, the backwards math. And you say, okay, well if it’s only 10% of my patients that are going to benefit and it’s $200,000, [00:26:00] I’m going to pay this off after I finish paying off my kids’ college tuitions, right? If it’s just you, it becomes a real problem. 

But when you start having multiple providers, then 10% of my patients, 10% of his patients, 10% of her patients, et cetera, now those devices are benefiting a much larger number of patients. It’s much easier to justify these costs. And as we’re able to justify these costs, now we’re able to invest in technologies that we weren’t able to invest in before. So, now we have better technology, we have a more consistent experience across the ORs, we have a more consistent experience across anesthesia, and everything sort of naturally [00:27:00] grows from there. So you’re sort of – you end up in my experience, scaling without naturally intending to, but needing to, because you’re trying to perfect every little aspect of the practice and the experience. 

Brad: That’s so awesome. And what I love about your story, just hearing about it from the time you started with your one shop and as you grew kind of focusing on your different areas, realizing what you were strong at, knowing that you had to bring these different individuals in to help you. So, it was amazing to hear just all the different lessons that you can have offered to our audience. But believe it or not, can you believe it we’re at time? Isn’t that crazy how fast that went? So I just want to, first off, I know you get to work with this guy over here and I give him a lot of – if you don’t know, we make fun of you a lot, but he’s a good guy. I’m glad to spend some time with you today and hear your story, because I know Michael talks about you very highly too. It’s really great that our audience could get to hear your, your story too. [00:28:00] I want to thank you for joining us today.

Michael: Yeah. Appreciate it.

Sacha: Well, thank you so much for your time. Thank you for having me on. And thank you for the support that your firm has provided us over the years. And like I said, y’all have never steered us wrong, so I’m very, very thankful.

Michael: Awesome. Well, what we’ll do is, we’ll sign off and go into a commercial, and then Brad and I’ll do a little legal wrap up after we come back from commercial.

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Brad: Welcome back to Legal 123s [00:29:00] with ByrdAdatto. I’m your host, Brad Adatto, with my co-host, Michael Byrd. And Michael, for those who don’t know, this season our theme is Growing a Business. And that’s about scaling. And boy, having Sacha on with us to hear his story about how he scaled his business starting off 16 plus years ago as a one surgeon shop, and then to grow as big as it has become. But you know, probably you and I both were having, throughout that podcast, listening to him talk, probably allowed ideas about, well, wow, that’s going to really shift your compliance needs, right, because initially just one shop.

Michael: Yeah. I think we could do like a real quick hit because I know we’re short on time and there’s a 16 year story here, but when you’re starting your business, you want to have the right foundation. We talked a lot about that in season 15 of this year in the starting a business season. But having your entity in place, mastering not just being a great surgeon, which was his focus, but mastering the discipline of running [00:30:00] a business is so important. And then to build on that, when he identifies in his case, he was going from solving one problem to the next, and that was to add a surgery center. What’s like a quick hit thought…

Brad: Yeah. I mean, and that’s a great point. When you do that, there are going to be state regulations, you’re going to have as to whether or not you need to get the state to certify your surgery center. Or you might need to go out and get it certified by someone, an outside third party, and then how are you credentialing those individuals coming into your surgery center. So they mean that’s just right away, he said he wanted to keep it simple in the beginning; adding that surgery centers, you make it more complicated. And then he starts adding other locations.

Michael: Yeah. Well, and even to add onto that, he added anesthesiologists. Is that part of your practice, or is that a separate entity? How’s that structure going to be set up? And then adding a location, you get into what’s the corporate structure, right? What’s the strategy for funding that? [00:31:00] And then just how are you going to service that operationally having these multiple locations. And then I guess we could wrap up to what does he think about if he’s opening a med spa, which he did.

Brad: Yeah. And that then starts going back to the new rules that he’ll have to abide by because people will in different locations, so what type of supervision and delegation, who’s overseeing the people? How are they now clearing these patients at these other locations where they when they’re in one shop, you’re in one place. And going back to the adding the anesthesiologist, I mean, he recognized, do I have the skills to do it? I mean, that’s a whole compliance talk right there. Am I being consistent with the standard of care, unless I have different people who actually truly understand my service line. So just by adding that surgical element, it really changed the other elements of compliance he had to worry about.

Michael: Well great. Well, as we wrap up today, do you have any final thoughts?

Brad: Well, I think what I liked about Sacha is he fits in really well with us [00:32:00] because he likes to overshare too. I don’t know if that was loud or anything like that. There was a loud budget in there, but I’m still very, very upset about this whole pride playing thing. You just can’t get past it Michael.

Michael: I know, I know. Well, we’ll recruit Sacha. I totally agree that the audience is going to benefit from his authenticity, and that’s the…

Brad: I thought you said the audience was going to benefit from us getting a private plane?

Michael: Oh, yes, that too. Well, we’ll recruit Sacha to join us on that. 

Brad: Yes. Well, audience members, we will see you next Wednesday when we have series regular, Jay Reyero, joining us, and we’ll talk about scaling nationally with one professional entity. Thanks again for joining us today. And remember, if you like this episode, please subscribe, make sure to give us a five star rating and share with your friends.

Michael: You can also sign up for the ByrdAdatto newsletter by going to our website at byrdadatto.com.

Brad: ByrdAdatto is providing this podcast as a public service. This podcast is for educational purposes only. [00:33:00] This podcast does not constitute legal advice, nor does it establish an attorney-client relationship. Reference to any specific product or entity does not constitute an endorsement or recommendation by ByrdAdatto. The views expressed by guests are their own, and their appearance on the program does not imply an endorsement of them or any entity they represent. Please consult with an attorney on your legal issues.

ByrdAdatto founding partner Michael Byrd

Michael S. Byrd

ByrdAdatto Founding Partner Bradford E. Adatto

Bradford E. Adatto