Ep. 166: Build a Profitable Urgent Care in Year 1 - Interview with Dr. Andy Miller from Evergreen Urgent Care

PCMP (00:00)
Welcome back to Walk-Ins. Welcome. We have a podcast guest episode type situation today. I'm super excited about it because I, Dr. Dr. Andy's been with us for a while. We know him, we love working with him, but more importantly, we're always here to help you get more patients, deliver better care, get repeat visits, scale your clinic. What's up, Michael? What's up? Yeah. mean, and side note here, it's about the snow here. we're for Alabamians. We're very excited. we are in short sleeve t-shirts. know we're in short sleeves, but it's frigid outside.

Andy Miller (00:26)
you

PCMP (00:28)
But no, we're super excited with Andy because Andy found our podcast over a year ago, engaged with us. Now he's been a client for over a year essentially. And it's the best stories to tell because it's a bootstrapped urgent care situation. And there's so much there because today's episode, we're going to be talking about how that got started, the journey of all that. And we're very pumped to have that. But just a couple of background things here. So Dr. Andrew Miller, officially Dr. Andrew Miller, we call him Andy.

He has Evergreen Urgent Care. He's been in the, he's been a doctor though for quite a while. He was in the ER space for a long time. So he has 20 plus years experience. He left the ER space, leaned toward the urgent care space, was an urgent care doctor for a while and then started his own clinic. And here we are chatting with him. I'm so happy to have you on today. Dr. Andy, welcome to the podcast. Say hello to the Walkins welcome family and tell us one thing about you that nobody else knows.

Andy Miller (01:21)
Hey guys, thanks for the warm welcome and hi to all of the audience out there. Like these guys said, I've been a long time listener and first time guest. So here we are. And I know this icebreaker question and I've heard it before and I've heard people confess like criminal activities and jail time. I'm not going there. I was tempted to go confessional, but I'm going to go softball on this one. And just before being an ER doctor before med school, I was a race car driver in the Canadian rally series. So back in the college days. Yeah.

PCMP (01:35)
Yes, yes, yes, I have.

Okay.

Andy Miller (01:51)
So racing cars in the snow and ice and dirt roads and back roads all across Canada up through Quebec and everything. So super, super fun. I forget about that, but that was my previous life.

PCMP (01:59)
So.

Okay, so I'm a car person, so I'll just take a sidestep right here. What kind of car were you, mostly what kind of cars were you driving?

Andy Miller (02:11)
This was back in the nineties and it was, we were in a production class. And so we were in a Honda Civic hatchback that was fully kitted out with cage and skid plates and advanced suspension. And it was such a blast.

PCMP (02:22)
Nice. We may just lose this podcast. I was even going to ask like what kind of Subaru do you have? Like I'm a Subaru first. I was like, what if it's a Subaru? But anyway, that is so cool. I'm always fascinated. You're right. We have had some fun criminal backgrounds in full disclosure. I was doing an interview with somebody one time and turned out, you know, she was a stripper. I don't care about that, but I wasn't expecting it. Like that's

Andy Miller (02:33)
Yeah.

PCMP (02:48)
I'm not, I'm not, judgment. I'm just saying that I wasn't expecting it. Right. So, Dr. Andy, you have had quite a journey. call it Dr. Andy, but see, I call you that around the office. So I can't help it. Dr. Andy. so you've had quite the journey 20 years is no joke in the medical space, starting in an ER. What I would love to hear is just your journey from, from an ER doctor to owning your own, urgent care. Can you just start, start there at that beginning of that?

Andy Miller (03:17)
Yeah, for sure. The ER is fantastic. It's exciting. It's super satisfying to make a difference in people's lives. But after a decade or two in the emergency department, I started to get bothered by the fact that there was so many, so many minor cases coming into the ER. And it's kind of bothersome to me as the provider, like you're trying to save a life in one room and then you're taking care of a family with strep throat in the next room. And then I realized though, it's annoying for the patient too. They don't want to be there. They don't want to deal with a long...

wait times, they're just looking for access to care. And so said, what could we do to get better access to care? And that pulled me into, into urgent care. And in urgent care, I saw a fast moving system, fast paced environment solutions for the patients delivered quickly. And I was there for the peak of the pandemic and that was pretty exciting. Just working operationally to see how many people we could move through the system.

But then we were moving a lot, but then it died off, right? And we come into this post pandemic era where the volumes are down. Some urgent cares are struggling. The revenue isn't there. And I was, I was working for one of the bigger brands in urgent care and they're just kind of trying to find ways to squeeze more profit, push the providers more, do more with less. And as I thought, I wonder, I wonder if there's a way to do things differently. And I kept.

PCMP (04:12)
And I'm sure you were moving a lot. Yeah.

Andy Miller (04:42)
thinking that out loud to the point where I realized I needed to go prove it to myself whether or not things could be done differently.

PCMP (04:51)
And here we are living the dream because we've watched Evergreen from scratch to where we are today. I remember one of the first set of emails that you and I had, you were like, okay, I need a landing page so I can get some insurance stuff moving in the right direction. Can you help me? Like, yeah, whatever you want, man. If I can get you going, I'll help you. So yeah. So kind of walk through. you've looked at it. It's like, there's got to be a better way of doing this. We now have Evergreen Urgent Care here. So talk about, because I know your journey is considered quite

Andy Miller (04:51)
So.

Thank you.

PCMP (05:19)
different than most on starting up the urgent care because we had somebody on a different episode talk about how to get capital investment, how much money, all these different things you need from an investment standpoint and the time framing of everything. And that's when you reached out to say, Hey, I had a different approach to this and it's working. I love to kind of talk about some of that. And we love that too, because we recognize our listeners, there's quite a few on here that they're thinking about starting them, but they're scared or they don't want to go down the investment route. They rather just see if they can cash flow the whole thing somehow.

So I want you to kind of talk about the decision making and then the pitfalls and the, know, I should have thought about that, but I didn't, but it worked out. It kind of goes through that process.

Andy Miller (06:00)
Yeah, for sure. And I'll tell you, the story actually started about two years ago at the UCA conference. I was thinking these thoughts in my head and then I attended a lecture there or a panel discussion on how to start your own urgent care. And essentially what they said was find $1.5 million, plan for hiring a big staff, getting a flashy office, losing a lot of money in the first year, hoping to break even in the second year, and maybe you're profitable by the third year.

And I said, why does it have to be so expensive? What if it could be done more cheaply? What if we questioned everything about the traditional urgent care model and tried to do it differently? And so that's, that's how we started. And boy, I started talking to you guys more than a year ago. Um, that was when I was needing that landing page to get set up. So the insurance companies would believe I was actually a real business. We opened our doors on April 15th of 2024, um, for our first urgent care patient.

It was a slow start. saw two patients on the first day and here we are in the peak of the flu system coming into the flu season that is 2025. Our numbers are up. We're busy. Not to brag, but we are profitable here in our first year. you guys know this, the Google reviews say five stars straight across the board. So I must be doing something right. And I'm happy to share the recipe.

PCMP (07:17)
Yes. That's right. That's right.

I mean, so like there's a lot there, right? So you went, because I even have to say to what's impressive to me, you start, cause we've heard this quite a few times from an insurance standpoint, getting actually credentialed and stuff like that, that sometimes take a year plus. What was your, I'm just curious, what was your actual timeframe from the initial start to you got approved and you get to open your doors on that site for insurance related reasons.

Andy Miller (07:47)
Yeah, for anyone who hasn't done this before, figuring out the insurance is the biggest moat to cross. When you wonder why there aren't more independent clinics out there, it's because of the complexities of getting contracted and credentialed with health insurance companies. And I started this ball rolling more than a year ago, probably six months before opening the doors to urgent care. And that's tricky because

Some of those insurances want to see that you've got a legit phone number and a website and a business address and a business license. So you're, you're starting all of these things, but understanding that the insurance companies aren't going to sign you up and get you going for three months or six months or nine months, or in the case of United healthcare, we're still waiting 12 plus months later. So it's frustrating and it takes a long time.

PCMP (08:34)
shocking turn of events to no one,

Well, I'm very interested in the startup phase specifically regarding profitability. UCA, which I think we can all agree that that is a fantastic organization. you go to a seminar that talks about starting up, you're looking for a different and better way to do this. I think as any business owner would agree, profit is greater than revenue.

So revenue is sexy. Don't get me wrong. It looks really good when you're putting up the numbers, but profitability is what feeds your family and your team for that matter. on this path, they're telling you that you're going to lose money your first year. You're just over a year now and you're making a profit. Let's talk about how you were able to do that. Where are the areas that typically would make you lose money that is helping you gain money? Yeah, obviously there has to be some pretty unique changes that you made.

that would, because they're talking about losing money off of $1.5 million initial investment. It's a lot of cash that just went out the door in a year. So I'm curious, like, where were those major things? Like, they said this, I did that. You know, what did that look like?

Andy Miller (09:39)
Mm-hmm.

Right. And the numbers that were told to me all make sense and they're, they involve like building out a space, getting up and running, hiring staff before patients are coming through the door. And I will say that profit comes not just from increasing your revenue, but controlling your costs. And so that's where my main interest was. So.

PCMP (10:07)
Yes.

Andy Miller (10:10)
Everybody who starts in urgent care is told go pick a site, which is at a busy intersection. want four lanes of traffic intersecting four lanes of traffic with a traffic light. You want to be in a plaza with a big box store or a pharmacy or grocery store because you want, you want to be seen. But I will tell you that all of those spaces cost a lot of money. And what we did instead is we chose a out of the way, unfortunately, very tough to find to location.

but it does have free parking. so we saved over $10,000 of monthly rent just by choosing the hole in the wall location off the beaten path. It's still in a good neighborhood. It's just two blocks back from the big intersection. And so we saved all that money per month right off the bat. And similarly, we didn't take an empty storefront and spend hundreds of thousands of dollars building a clinic. We took a dental office. We added some walls.

PCMP (10:42)
Right.

Andy Miller (11:09)
took out the dental chairs, put some medical equipment in there, had the landlord carry some of the cost of that work. And so upfront, we weren't paying anything for our space.

PCMP (11:20)
Nice. And to put a little context, this is out of Portland, Oregon. So just kind of give a little context there, because for the listeners and also like where you are, you're in some like neighborhood style area. It's very not traditional at all, honestly, because you're talking about the four lane stuff, because a lot of our clinics are in those little shopping strips that are off some major highway that you can see. You have great visuals from the road. so

But yours is definitely not that route at all, which is so fantastic that you're showing like you don't always have to have the perfect location to make things work. I ask you a quick follow up question of that? How much is location ego driven in the urgent care space? I'm being serious. Like I really want to know because I, for me, when I first started my company,

Andy Miller (11:57)
for sure.

You. Yep.

PCMP (12:13)
We're in this nice tower. It's overlooking the city of Birmingham. Man, that don't matter at all to me now. My just, my whole scope has changed and I know that that was more ego driven for me. So that, wonder what that's like in your space.

Andy Miller (12:27)
I bet that factors in for other people, but I would turn that around and I would say that when you are visiting a new town, if I came and visited you guys in Alabama and I got sick and needed urgent care, I wouldn't know where that good neighborhood is. I wouldn't know which urgent care I'd driven past 10 times. I would look on Google Maps and I would find the one with the good ratings and I would drive there. And that's how I imagine Evergreen appealing to the customers that are yet to find us.

PCMP (12:54)
Yeah. And that plays out, we can see the data. Yeah, we can see for sure. So if you really think about that, let's just do the math on it. You're saving roughly $10,000 a month and not paying in rent. Okay. So that gives you the freedom. If I'm making $200 on an average visit, well, you're not making that, but that's just the value of the average patient I would expect, especially in Oregon and over on West Coast. That's 500 customers.

Yeah, is that about right? So that's 500 customers a month just to make rent.

Andy Miller (13:30)
It makes it so that you don't have to be so paranoid about how many patients are coming through the door. And then it frees up the money for you to ask other questions like, how would I rather deploy that money? And should I invest that in fantastic staff? The answer is yes. Should I invest that in marketing so people can find me two blocks off the main road? I've certainly done that and it's helped. So I like not having that fixed costs over my head.

PCMP (13:36)
Yeah, right.

Andy Miller (13:59)
And similarly, we've been

PCMP (14:00)
That brings

up another question, Dr. Andy is, you just said it's a wise decision. Well, you didn't say it this way, but it seems like a wise decision to invest more into your staff. How has that played into your success just having the right people on the team?

Andy Miller (14:17)
In terms of the dollars, I've seen other companies lose staff over one to $2 an hour, and it's not worth losing your best staff over that. If you have a staff member who is bilingual, they deserve more. If you have a staff member who outperforms everyone else that does that job, they deserve more. And so my goal is to hire great staff and have no staff turnover and knock on wood. Here we are at the end of our first year.

We've only hired new people. haven't had to replace anybody. And that is so key for having staff that's great with patients and knows how the system works and can be efficient.

PCMP (14:56)
I mean, that's just a plus to you, right? Because yes, mean, pay does matter, but obviously you've developed some type of culture in your business that people do like. Because at the end of the day, the urgent care space is very stressful. We hear lots of like, turnover is a big deal in the urgent care space because there's just so much going on. But I am curious to talk about staff as a whole. what was your first hire? And what was your first, like most important?

like I need this hire to happen. Were they the same hire or did you have to hire something different and then get to the bigger or more important hire?

Andy Miller (15:35)
Well, I've talked about making sure that I don't spend too much money on this. So I was the first employee and the only employee in the beginning. And then when it became too much for me to answer the phone and take care of the patient and keep up with all the paperwork details, that's when I made my first hire. And from that first hire, we've kind of established our rules for recruitment and hiring. First is we hire people for their potential, not past history or past performance.

So our first front desk person has zero medical experience. She used to run a mini Mart. She's kind of entrepreneurial like that. She's got good customer service skills, but had never been in a healthcare environment before. And she's fantastic and still with the company. Our next hire was someone who was researching seals and like doing all this other stuff, but wanted to get into medicine and she's fantastic as well. And so.

My thought is if you hire the right people and the right personalities, the skills come after that. So we would rather get the right people from the beginning and give them those skills. Similarly, we're not afraid to take a physician assistant fresh out of school if they are the right cultural fit, because we know that their medical skills will come along as we invest in them.

PCMP (16:56)
That's good. love this. It's funny that we share a similarity in that I'm not always looking for somebody who is like a well-versed paper click person. I'm looking for somebody who is going to fit in with us culturally. I'm looking for somebody who has a vision and a passion for taking care of our customers and our clients. And it sounds like you've taken a very similar approach. I think obviously there's areas where you need to...

you know, if they're going to be putting needles in people's arms, they need to be trained in that. But at the same time, you're not looking at the full past history. You're looking at the opportunity ahead of them. I love that. think that's fantastic. I want to switch gears for just a second. I want to talk about where you see the industry going over the next, let's just say three to five years. I know most people don't have a spy glass that looks out 10 years, but the industry itself is changing so quickly with the introduction of AI, just the way the world is changing. Your thoughts on that.

Where are going?

Andy Miller (17:53)
my goodness, how much time do I have? This is the big topic. I don't know where the industry is going, but I know that where we are is not where we're going to be in a couple of years. And the only way for me to be a part of the future is to get in the game. And that's why we have Evergreen. Evergreen is small, it's nimble. We can move to where the patients are telling us they need us to be. So we spend a lot of time listening to the patients and what clicks for them.

PCMP (17:56)
As long as you want. Yeah, as long as you need,

Andy Miller (18:22)
We have lot of interest in communicating with patients about price transparency, access to care. These are kind of longer conversations we have, and it helps us to really connect with the patients on a deep level. So while I don't know the future, one of the things I know is the retail urgent care that we know, where it's all about how fast the patient can be seen and how much profit you can get off of each patient. I think that's going by the wayside. And I think we're shifting back to a relationship driven

model of care where patients put a premium on a doctor or provider who listens to them and involves their thinking and decision making in the ultimate medical decision.

PCMP (19:03)
So I love that you have you have employed a software or at least a software team, definitely a software that's helping you build that relationship better with your client. And I don't want you to spend a ton of time here, but the reason I want to talk about it is because you were so quick to adopt it while and really it's an AI driven product. So I'll just throw that out there. So there's no secret.

but you were so quick to adopt it when everybody else has got their hand up saying, Hey, wait, I don't know what's going to happen. I don't know what's going to do. And I don't know. So let's talk about that for just a second. How are you employing AI into making your practice more human?

Andy Miller (19:46)
Yeah, for sure. And this is the advantage of being a new clinic. don't, we're not established. We're not married to any one way of doing things. we like our EMR, but let's face it, nobody loves their medical record system. Right. And so we, we met this company called fluency.health. they, they came onto our radar cause we didn't like this scheduling component of, of our EMR and they offered to build us a custom online scheduling tool.

PCMP (20:00)
For sure.

Andy Miller (20:15)
And I said, sure, whatever. And then a week later they were back with exactly the product we were looking for. And that was great. And then a week later, Fluency came back and said, by the way, now we do your registration as well and import all the data into your EMR. And then they came back and they said, you know how your patients are sitting in the lobby for about five minutes before you bring them back? Well, now we're having a conversation with them using AI, gathering the whole history from them so that when you go to bring that patient back,

now you know what you're seeing them for. It's already asked like the top 10 questions relevant to their chief complaint. And then now just the other day, he said, by the way, now fluency is listening to your conversation and transcribing the entire visit for you and automatically importing it to the, into your EMR. So you pretty much don't have to go into your EMR anymore. I'm like, this is fantastic. And, I know it's fantastic because the patients have mentioned it in the Google reviews. Now they've said, wow, that was the easiest check-in.

How can you get me checked in in under two minutes? Like no other clinic does that. So it's fantastic.

PCMP (21:18)
That's good. mean, but that goes back to what you were saying that set up that tool removed all the paperwork side and allowed the relationship side to grow with the doctor and their patient. Because now all your basic questions are answered. Now you're just having a conversation of what how are you actually feeling based on what I'm seeing here? I'm going to go this route, but let's run some test. You just have like a more natural conversation because I admit like when I go into like a primary care and like they're sitting there with their laptop so

Why are you here? And they're staring at their laptop while they're typing. I'm just like, you haven't looked in my eyes, I haven't even looked straight in my face yet, you know.

Andy Miller (21:57)
I love the AI because I can go into the room already knowing what's going on, already seeing the patient's history. I can ask a clarifying question or two, and then I can take that time to just ask the patient, not just about what we're seeing them for, but how that injury or ailment is affecting them and their life and the impact that it has on them. And that's that human connection that I think is missing from most medical interactions right now.

PCMP (22:22)
So let's talk a little bit about healthcare. One of the things that I know is that you're trying to make a positive impact on what feels like a broken healthcare industry. Okay. So it just, comes across in how you present yourself and how you present your clinic. So from that perspective, what are some things that an urgent care clinic can do, especially if they get to make their own decisions like you do? What are some things that we can do to make positive impacts in the healthcare industry?

Andy Miller (22:54)
One of our biggest things right now, and thanks to unfortunate recent events in the news, it's on the top of everyone's mind, is the issue of the cost of healthcare. Denials and claims issues. And then every year more and more people are on a higher deductible health plan. Their deductible is getting larger every year. A lot of patients will walk in the door, they'll ask what their copay is, and we'll say it's like $20.

PCMP (22:59)
Mm.

Andy Miller (23:20)
but they won't think to ask what's the actual bill because it's $20 copay to get in the door. And then the system is still going to send you a bill down the road. So we have that conversation with the patients. We are fully transparent on our costs. If someone doesn't want to use their insurance and wants to just pay cash for the visit, we have super easy prices. We do a cost plus model.

So if you wanted like your CBC, your complete blood count, I've seen that as 40 and 50 bucks if you go to the lab or go to a different urgent care, we charge 10 bucks for that because it's so cheap to do the test. And we'd rather have a patient keep coming back for visits than to make money off of that one visit.

PCMP (24:02)
Yeah, repeat visits in my book, that's where the real win is, is one, it's a vote of confidence. I'm coming back to you. And two, it's sustainability for a business. It's so much cheaper to get a repeat visit and always attracting that new one every time. Yep. Easier to keep a customer than it is to get a new one, right? So some of the things that you're talking about here, again, I want to take your experience over the past year, year and a half, really two years, if you look to even before you opened.

speak to the clinic owner, what are some of the pitfalls that they can expect that you didn't see when you were starting your clinic?

Andy Miller (24:44)
Okay, I'm to give you the easy softball one right off the bat. didn't, I didn't make this mistake, but it's always tempting. Barrage repeating. Don't go into business with your family and friends because it's bad for your marriage. It's bad for your friendships. You're going to, you're going to want to go into this and you're going to feel lonely going in solo and you're going to want someone to support you. Just don't do it. Don't, don't rope your friends in.

PCMP (24:54)
Hahaha

That's

That's so good. Like I can't explain it because I'm highlighting it right now. I'm honestly, cause like we're in the Be the Bee world, right? And I remember, gosh, 12, 14 years ago when I first started in this industry, I was like, I can just kind of lean on my family or a friend. And then it's amazing how you just basically become ousted by your groups. We're like, Oh God, where are going to be talking to me now about or whatever.

Andy Miller (25:11)
you

PCMP (25:30)
And it's so real though, because at the end of the day, I want to keep my family, my family, not my family with a monetary tie to it or some sort. same with friends, because a business deal will kill a friendship so fast. it is so real. And at the end of the day, you'll find like that first set of people that you thought were going to be the people that carry you through years of business. They're there for maybe a few months and like, this isn't for me, because they don't have the passion or the drive that you have. And it's just...

It's amazing. It really is amazing.

Andy Miller (26:02)
Yeah, I'm going to give you a list of other tips, but that passion and drive that that's tip number two. If you are going into this business because you see dollar signs and you're looking for maximum profits, it's going to be very challenging. I would encourage everyone to be a mission driven organization for us. It's to be patient centered in all of our decision making price transparent and everything that we do with our patients and to be provider owned. Ultimately it's team owns provider owned just kind of.

PCMP (26:05)
Do it.

Andy Miller (26:32)
vibes better with the patient centered and price transparent and provider owned. But that is our mission. We don't have it on the back of our IDs or painted on our wall because everyone knows it. No one needs to be reminded of it. That's how we just do it every single day. And that keeps it fresh. That keeps people motivated and that keeps our team together.

PCMP (26:51)
That's good. Is that it? want as many as you want to shoot off, man. I'm taking notes. Seriously.

Andy Miller (26:52)
Yeah. no, there's a list. Here we go. Here we go. I

told you, I told you that getting credentialed and contract with insurances is going to take a lot of time plan well ahead. If you think you're going to be opening for the fall flu season, I think you should be targeting actually opening in the spring because there will be setbacks along the way. And on that same theme, do not quit your day job. You need a source of income while you're bootstrapping this before the money starts running in.

I will share a personal note that if you are well-liked at your current employer, give them 90 days notice and they might turn back around and say, what could we do to have you stick around for 90 more days after that? And in my case, I was fortunate enough to be able to negotiate down to a part-time job at a generous hourly rate to keep at my old position as I tapered out of that before coming here. But you do need that source of income.

Once you have your new clinic open, you're going to need some sort of side hustle. And I don't, there's always all sorts of ways to do this. You could do DOT physicals. There's always a need for that. You could do USCIS immigration exams. You could do preoperative tests. You could do pre-employment physicals. Just something that's cash-based because the insurance companies take forever to set up and then it takes forever for the insurance companies to pay you. So you need a cash side hustle figured out before you go into this.

And then as you're controlling costs, I encourage you to negotiate everything. I negotiated with the landlord on delaying our first month's payment. I negotiated on all the improvements. Any vendor that comes to you and wants to sell you a piece of technology or software, always try to ask them to give it to you for free, at least for the first couple of months, because they've got to meet sales targets and they can be pretty, pretty creative in how things are going. So keep your costs under control.

And lastly, and this sounds like a cheapskate thing. we've got four rooms, have five rooms in our clinic. Only four are built out. And when we first opened, we only had equipment in one. You only need one otoscope, one stethoscope, one blood pressure cuff, and one table. And when you're busy enough to run two rooms, then you've got the money to buy those things. So we just kept the doors closed on all the other empty rooms until we were ready.

PCMP (29:11)
mean, that makes total sense. Like why, why build something that's just not ready to be used? Yeah, I mean, we've had these conversations internally of where we had a financial person come and help us out with some stuff. But one thing kept saying, oh, you should always hire ahead. And that guy's into some hot water. Because the higher ahead thing is like, oh, it's all in good ideas. But you're based on a future you don't you can't fully predict, right? And

Andy Miller (29:29)
Hehehehe

PCMP (29:39)
put us in a weird spot a couple times. Now we're like, no, we hire when we're pushing our numbers where people are a little bit under load and there's plenty of margin to go around. Not like, I think it's time to hire again because we could maybe somebody will sign that will force it. But yes, that's a good idea. Because why dump thousands of dollars in the equipment that may not be used for a minute and just wait till you build up enough off of it. Okay, now we can do another one. Now we can do another one. It's just, I like the

Because from a patient standpoint, those doors are always closed. So I don't know what actually, there may be nothing behind those doors for all I know. So there's no, you know, I got to know, do you go turn on the lights and keep the door closed? Just to make it look like someone's in there.

Andy Miller (30:18)
Sometimes we go turn the lights

on or off just to keep people guessing.

PCMP (30:23)
All right. want to recap this real quick and then, and then we'll, we'll move on. Here's the pitfalls. This is, this is what he's telling you. He's dropped so much value so far. Don't go into business with family and friends. Mission driven is greater than money driven. Credentialing takes time. Open in the spring. If you want flu season, don't quit your day job, give a 90 day notice and you can negotiate further out if you need to. Side hustles, DOT physicals, immigration, pre-op, cash basis type.

business while you're while you're starting your urgent care because of the slow payouts from insurance companies. Negotiate everything. Look for those free trials on the softwares. Make sure they give you 90 days of free trials. You can negotiate it. I promise. And then you only need to build out one room until you're ready for the other one. Move at the speed of cash. There's been so much value that you've dropped so far. I'm like, this is crazy. This is good. Yeah. Because I'm with you. When I was listening, first of all, I don't disagree with what

our previous guest said about, you know, having to have this money, having to have backing. You have to have those things if you plan to look a certain way. Or you don't plan to suffer a little bit. at end of the day, because Andy, you were suffering to some degree, right? Because you had to make sacrifices to make things happen. And there are some people who just simply aren't built for it. They have a lifestyle they're not willing to sacrifice. So they'll take on debt to float that lifestyle.

with the hopes and dreams that in two to three years, it's something in the past for them. But there's always that chance that may not work out. But in your case, in a lot of cases too, like even here, right? Like there was a lot of sacrifices upfront to where we are today. Like, and that takes, I mean, for some of us, faint of heart can't handle it. Like there's so many, there's a reason why so many new businesses fell the first year because they can't handle the stresses and the idea. Like I can't go buy a car right now because I'm, I'm going to pull cash out of the business. I need to go pay somebody for it.

all these things kind of build up because I mean at the end of the day like a doctor has a lifestyle like they were kind of aiming for I'm sure and then the idea of like they're going to have to on their lifestyle for a year plus essentially that's a scary thing. The speed of cash is the key to that. That's right.

Andy Miller (32:39)
You know, the counterpoint to that is that if someone gives you a million dollars to start your urgent care, you're just going to go out and you're going to buy everything and just go. there's no, there's no learning that comes with that. Spending the time to figure out how to do it yourself and to do it as cheaply as possible are lessons you're, never going to forget. And they're going to actually help your team be better closer knit because you're all in it together. And down the road, you don't have to make any decisions that

PCMP (32:50)
Yeah

Andy Miller (33:07)
compromise your mission because you have to pay back the bank or there's investors looking for their cut or our big hospital system telling you what you have to do. So here we are. We're one year in. We've gotten to profitability by controlling costs. And now the discussion is what does 2025 hold for us? Where are we going to go from here?

PCMP (33:27)
You're talking about having the answer to investors, right? So we have a handful of clients that are private equity back to some degree. And you can tell by the way they talk to us when they're being pressured by their equity people that have no investment in the business other than here's the money, I need return. And we can see the straight, we had one client in particular, he didn't tell us that he had some private equity investor.

And he was just like counting and sounding and sound and he came back and Hey, I got rid of that investor because we weren't driving. And his complete attitude changed towards us. different relationship with that client. Yeah, absolutely. yeah, there is a lot of pressure. Like, and at first it seem like a lot of pressure because like, you're giving us money. get it from the bank. But then when that note comes or when you have to turn in some numbers to somebody and it's not pretty numbers, cause you may have a bad month, who knows.

Then that stress starts to pour on, then you still have to run your business. Even though now you have two customers, you had the patient coming through the door and then you had the person behind you that's giving you money and holding their hand out right now to get money back. So a lot of pressure there.

Andy Miller (34:36)
Yeah. And there's all that pressure. Um, and then, you know, from my perspective, if this works out, because I see each, each week, there's more money in the bank account. There's more patients on the census. Like it's going up into the left. And then where's that money going to go? Like I don't have to pay it back to anybody. So now we can decide, do we invest it in the company? Do we invest it in the next location? Um, at the end of the year, um, I took a lot of that, that profit margin and gave it.

back to the staff. didn't know it was coming. This was just like their whole thing. And you know, the most fantastic thing is a couple of them came to me and said, can I just leave this in the company? Like, I don't need this right now. I want to keep seeing the company grow. So that is what keeps me going, that kind of attitude.

PCMP (35:20)
Whoa.

That's a good attitude. fires me up. I have had one team member do that to me before. And it is a very, it's a humbling experience because you don't want to let them down on their personal investment they're making back into the company. So, all right, Dr. Andy, we are out of time, but I want to first of all say thank you for coming on the podcast. Second of all, and probably most importantly, thank you for trusting us all this time. We love working with you. There ain't a week that goes by.

where me and Grace and Michael aren't talking about your account and what we can do to help on it. And then I want to give you an opportunity. Just give one parting word for somebody who may be thinking about starting their urgent care. What is their first right step to take?

Andy Miller (36:10)
The first right step is just to know that it can be done. I've heard that it's impossible. I've heard many people say a physician can't run a healthcare business. They're just going to run it into the ground. It's not true. You can do it. And you just have to get out there and start doing it. You will learn a ton and you will work your butt off, but you will not regret it.

PCMP (36:13)
Mm, that's good.

There you go. That's so good. I like it. You were the average of the people that you hang around most. You've been listening to the Walk-Ins Welcome Podcast. We've had Dr. Andy, I'm Nick. This is Michael. Hopefully we've helped raise your average. We want to see you next week. Reach out to us, Dr. Andy. Thanks again for being on the podcast. We'll talk to you soon.

Andy Miller (36:49)
Bye guys.