On Episode 22 of Decision Dialogues, Mark Willoughby and Tom Orecchio welcome Dr. Sameera Daud of Metropolitan Endocrinology in Edgewater, New Jersey, to talk about her experiences as a new small business owner. Having previously worked for another private practitioner for twelve years, Dr. Sameera talks about how now, running her own practice, she is able to make business decisions that ultimately benefit her patients, thereby increasing referrals through word-of-mouth thanks to her patient-first approach, among many other topics.

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Transcript

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Thanks for joining us on Decision Dialogues. We’re thrilled to have you along. My name is Mark Willoughby, and I’m a Principal and Wealth Manager at Modera Wealth Management, LLC. Today, my partner Tom Orecchio, who’s the CEO of Modera Wealth Management, will be chatting with Dr. Sameera Daud Ahmed, a founder and owner of Metropolitan Endocrinology, based in New Jersey. Welcome everyone to the show, and I’ll hand it over to Tom.

Thank you, Mark. Dr. Daud, nice to have you with us. We’re gonna get right to it, and you know, I’m gonna ask what I think might be a relatively difficult question, because most doctors don’t do this—but you went into private practice, and started a business. What was that like, and how has it impacted you personally and financially?

Thank you so much, first of all, Tom, to give me this opportunity to be here. Most of the doctors that went to the medical school to serve humanity, and that is what they nurture during our medical school. Business-first decisions actually create internal conflict to the core value to this. And that leads to unhappiness and unsatisfaction, in my opinion.

So, is it fair to say that you did this as much for your own satisfaction and happiness as you did for anything else?

Yeah, I think, it’s also actually a patient-first approach to business can actually be not only good for businesses, but also for the patients. So patient-first, then business, can thrive—a more thriving, and loyal practice—with the better outcomes for the patients, as well as the medical practices.

So you have a partner, correct?

Yes, I do have a partner.

So tell us a little bit about how you became partners, and why you decided to go into business with someone else rather than on your own.

It was the best decision that I made to have a partner, because when you are with another doctor—there’s financial stability, of course, because then you have another doctor with you. So shared cost is divided. Then at the same time, you reduce risk of burnout. When I’m on vacation, she can be there; when she’s on vacation, I can be there. Better work-life balance, I would say, that will with that too. Yet at the same time, that was the hardest decision, because in my mind, I was worried about losing the friendship. She’s my best friend.

Wow! So you guys were best friends prior to becoming partners?

Yes, she’s my best friend and my neighbor.

That’s a big step.

So my biggest concern that I was joining that people were asking me, “Oh, are you nervous to start a private practice?” And at that point, I was like, “You know, I have full confidence in our professional skills for confidence that we have the ability to have built a reputable patient-centered practice.” I didn’t want to do that, at the end of the day, that we have a successful practice with a successful business partner, but I lose my friendship.

The reason I was concerned about it, is because we are very different people—that complement each other, right? Like when you’re making a business decision, that can possibly create friction. We have learned to be disciplined, and we actually don’t bring business to or friendship and so far, fingers crossed, last quarter is done. So far, so good, we have learned a lot.

It’s good to hear. What would you say the easiest financial decision you have made?

The easiest financial decision, I think was to hire my medical assistant. She was my previous medical assistant. Really, to bring the right customer service is very, very important to the business aspect of it, especially in the medical field. Our patients love her. She’s very trustworthy. And I think that brings the best outcomes for the patients.

And if you look at it, any big company—look at the largest companies like Apple. What do they do? They start on the customer service, and it’s evident that it provides the business. So that will definitely lead to a better financial outcome, one less stress on us, and we can concentrate more on patient services.

Well, we couldn’t agree more. That’s how we’ve built our practice, but it’s amazing how many businesses don’t. It really is.

So Mark I know you’re looking to ask a question—can you dive in?

Yeah, I’d be happy to Tom. You know, it’s funny Dr. Daud, I heard you saying at the start about the conflict between taking care of the client and running a successful business. And can you expand on that a little bit? Because, you know, here at Modera, we recognize what you’re saying, but we also, I think we’re very aligned in the sense that we feel like if we take care of our clients, everything else takes care of itself. Can you expand on what you meant by the conflict between putting the client first and running a successful business?

Well, when you put the clients first, what’s gonna happen? It’s gonna actually bring you more referrals, right? Don’t underestimate the power of word of mouth referral. Actually most of my referrals, I would say over 75%, is by word of mouth. And it will generate even more referrals, then you don’t have to worry about that part. And it’ll automatically generate the referral base that will lead to financial stability. And once there is financial stability, you can concentrate more. 

Because what do we do? What is the reason when we have more client base, then we are in a better negotiation power with insurances, or better reimbursements, right? So indirectly, we did not try to generate more business by advertising. What we are doing—we are providing better service, and yet, we are doing the better outcomes. If you look at it, in my field, especially, what is the bread and butter? It’s like diabetes, which is, the prevention is better than cure. Look at obesity, which still has the stigma attached to it. If we look at it, that obesity bias is really there. Wherever we go, whether we go to the workplace, or a public place, everywhere, it is evident. Providers are not comfortable. They don’t have enough time. That leads to patients to feel uncomfortable, they feel like they are unheard. As a result, they never want to start that conversation, or they don’t want to even go for that conversation. So if you make them feel comfortable about it, that could lead to more client base.

You know, it’s interesting, Dr. Daud, you provide a completely different service to our firm. But our philosophy around making sure the client is taken care of first and foremost, our philosophies are exactly the same. Everything flows from that, as far as we’re concerned.

One other part, Tom, if I may—there’s an interesting challenge that you faced, number one, when you were deciding to launch your own business. You had your best friend—you had that challenge to face. You know, one of the things we help our clients with is the financial side of it. Talk to us about the decision making and the financial decision making that you had to grapple with, before you decided to launch your own business. You worked before launching your own business, right?

Yes, I was actually in practice for 12 years.

So you had a lot of experience before working for another employer. Now you’re at the point in your career where you feel like “Okay, I can do this on my own, I might need the help of my best friend and her professional expertise.” Talk to us about the financial decision making that led you to be comfortable launching your own business.

So what we did initially—we both have a successful husband’s practices or business. We didn’t have to worry about it. So we said, “Okay, what we’re going to do is we’re going to actually put in at least a year of business running, so we don’t have to worry about it.” Because remember, what was our motive? Our motive, the two core values that we decided that is the first thing that we both agreed upon. And I think that was the main reason why we don’t conflict. The two values were, “patient comes first, then business goals.” I’m not saying go back. As we talk about it, if the patient comes first, it’s automatically generating the business. We’ve already surpassed or expected number of the clients at this point.

Then the second core value was keeping our employees happy. Because if they’re happy, employees are going to bring good customer service that ultimately, the desire is to keep the patients happy. That’s why we did it, and I think that really helped us. It’s still very premature to say—it’s only four months into our practice. We already, as I said, we are definitely what I thought where we would be closer to a year mark.

The parallels are eerie between the approach you’re taking and the approach we’ve taken for the last 30 years at our firm. Clients first. Our whole idea of the culture of our firm is of course there has to be some sort of hierarchy in the firm. Our entire approach to the culture of the firm is that every single employee is treated with the same amount of respect and dignity—and Tom and the rest of the ownership group at Modera are passionate about that. We feel we create that culture. We have a happy group of employees and like you, we feel if we have that, they will take good care of and serve our clients.

It’s so reassuring to hear somebody who’s in 30 years of business and at the same moment, there’s no I in team!

So I will ask the obvious question that has to be asked to every one of these and that is, everybody would like a do over card, like I get to do one thing differently. And now that you’re in business for a while, what is the one thing you think you might do differently or might have done differently at the outset?

I wouldn’t stress about it as much. I would change my belief system right from the beginning. And yes, friendship and business can happen together. I’d change my attitude towards there’s no such thing as failure, there is only success and experience.

It’s an attitudinal thing. And wow, a lot of people can learn from that. I know that we stress over things, and every once in a while, we ask, “Well, why are we stressing over this? It’s not going to make it any better? only gonna make it worse. So what are we doing?” That’s a great answer, love it.

Here’s another one that we frequently asked, because people come from all walks of life, all different types of businesses. What do you think the best financial advice you ever received was?

Invest in myself, for my professional development—that’s very important. A lot of the time we ignore ourselves. And remember, when you are running a practice or a business, if you yourself are not well versed on it, or not [focused] on your well being, you won’t be able to run it. I think that was the best advice.

Can I jump in there, Tom? So Sameera, let me just expand on that, because you’ve just started your own business. I’m assuming in your prior life, 12 years working for another practice, a large portion of your time would have been spent on patient care. Now you’re a small business owner. Let me ask you the first question—do you like the different aspect of running the business as opposed to taking care of your clients?

The business management part is there, but at the same time, it makes my life easy in certain ways, of making decisions. Because every patient is unique, every patient has different criteria that I need to meet to make their outcomes better. And the business management, if I can make a decision without relying on somebody, then it actually helps their outcomes better. And remember, if the outcome is better, that’s gonna make the outcomes for my company better too.

Interesting. So I’m going to predict that as you meet more and more success, and you get more and more patients, at some point, you may have to make a sort of a decision yourself: Do I want to stay with patients, or do I want to run my business?

If I have, at that point, I will hire somebody to help me manage the practice. But still, I will be the one who can I guide them, instead of they guiding me what to do.

So I want to get back to the question I asked, what was the best advice you ever received, and you said to invest in yourself and your well being. Can you give us an example of one of the things that you’re doing now outside of the workplace that helps you grow or that just provides you entertainment?

First thing I did—interesting, right at the time I gave my resignation. At that time, there was a—it’s a powerful group of physicians, mom group, a Facebook group, so creating on your own legacy and time, “I’m starting my own,” “she’s starting her own thing.” So like I mentioned it to this, thinking, “Let me help another business startup.” Actually, that helped me the most. And that’s where I learned that we need to invest in ourselves and our time. We have to invest in our time to create more time. That sounds so silly, but if we invest in our time to make a calendar, all of a sudden, we create so much time. The same way we invest in our money, we create more money. The same way we invest our time to create more time. We invest in our health to get healthier.

You know what that reminds me of, Dr. Daud? It’s an approach that my good partner here Tom has taken over the last 20, 30 years, which is talking to other owners of businesses like ours—learning how they run their business, how they run their practice. The amount of learnings that we have developed from talking to other business owners has been so beneficial from our perspective, that I would definitely encourage you to continue to talk to other small business owners because you learn so much from them.

That’s true. We learn from their experience, we learn from their failure, and sometimes all you need is sharing that. When I would just come home and I would be just, “I had a patient who would cry in my office and I would just feel so guilty about it,” yes I know I’m making the right decision for my patients’ outcome, for myself, they will be there to cheer me up.

So my understanding Dr. Daud is that your practices split between obesity, nutrition, endocrinology. Sounds to me like you have a passion for obesity, the obesity area. Is that right?

My passion is really about prevention. So how did I get into obesity? Most patients are diabetics—or I should not say diabetics, I should, the better word is patient with diabetes, right? So patients with diabetes, and by the time they get to me, the damage is already done. And that led to me asking how can we prevent it by reducing the unhealthy weight? That led me to this obesity management. And then if you look at it, we talked about it, this stigma earlier. What would be worse than the stigma? It’s the only disease, that insurance company can actually put it as a plan exclusion. There are companies that straightaway insurances can say that it’s a plan exclusion until you get a complication. So we wait for the complication to happen, then we start treating it.

Which doesn’t make a lot of sense from a health point of view doesn’t or even a business point of view! Because it probably costs more to treat it long term that if it would be avoided altogether.

If you look at it, what happened, then these people feel isolation. What it leads to this isolation is if you look at loneliness, and isolation itself, there are studies showing these social isolations actually can lead to a lot of the problems, including lower immunity, more risk of heart attack, more risk of stroke—don’t forget Alzheimer’s disease, depression. What would it lead to? More absences at work. Actually there was a paper on loneliness, mortality. And not to my surprise, there was an increased likelihood of 26% mortality on these people. So that alone, without even getting into the complications of the disease itself—just the loneliness can lead to these problems.

So one of the things that I really wanted to do, that I was not able to do in my other practice, and that led me to, was I wanted to do shared medical appointments. Which basically what you do, it’s like moments where you have about eight to sixteen patients, of course, all by their consent, we all sit in a group. So you feel like first of all, you’re not the only one who’s dealing with it. We all learn from our experience. It’s more of the satisfaction also. In a typical doctor’s appointment, you’re with the doctor 15 to 30 minutes. Now all of a sudden, for 90 minutes, you’re with a doctor and other providers like a nutritionist or a coach, together. And as you’re talking, you’re learning, because what I do every 30 minutes, I’m repeating myself. But instead of repeating myself, I’ll be touching on all the different subjects. You’re covering a lot more, and we are building a community.

Do you find that those types of appointments are a little bit more therapeutic?

Actually, studies have shown that ideally, on a very limited time, I believe in 2014 or ‘15, they were not able to continue for the reasons—business decisions, patients are still remembering they still ask for it.

You know what it reminds me of Dr. Daud? I mean, it sounds like the same concept of group therapy, where you’ve got people in the same room who think that they’re exceptionally unique in having the issues that they have. But once you put them in a group therapy session and they hear other people’s stories, they start to relax and realize “I’m not a whole lot different.” And then literally, it becomes a sort of a very beneficial and healthy progression where they talk out their issues. It’s almost like you’re taking the same approach.

Exactly. And funny thing is—not funny, I should say—interesting thing is my husband’s a psychiatrist. So he went through that route, where it was a stigma. Now we have overcome that. And I think that’s exactly what’s going to happen with obesity, and insurance will ultimately cover it.

So I got to ask the obvious question, then. You had to get the patient’s consent to do group meetings like this to go to group appointments. Does the insurance company cover these group appointments?

Yes, this is covered actually. I did my training actually at the Cleveland Clinic, and they do a lot of these visits. These are really good ways of preventing preventable diseases, for the diseases with a long term chronic diseases.

Yeah, I mean, I think the connection between the mental side and the physical side—the hip bone is connected to the brain. Usually the hip bone is connected to the thigh bone, the body is connected to the brain, and you got to get both working together.

Simply example is that if you have a cut in—let’s say a paper cut—that little paper cut can distract you so much.

It’s funny when I heard you describe this first I thought it was you bringing a group of other medical professions into the room with one patient. It’s almost like you’re bringing in a group of medical professionals to a group of patients which is even more powerful. And it’s so similar to the approach, we feel like we’re at the center of our clients’ financial universe, but there’s so many other experts in that whole area, like accountants and attorneys, and insurance agents. So you’re taking a very similar approach to us where you know, you bring in nutritionists, maybe a life coach.

A life coach, or health coach, or cognitive behavioral therapist to help them because, you know, what is the most satisfying thing? What is the thing that we do the most—eating. Every day. That’s real, right? And then we associate it, that every time and we are at home and relax, and at night, eating is making us feel better. No, it’s being at home is making us feel better. But we are corresponding—our brain, we are training our brain, that that is making us happy.

I personally think you’re definitely onto something with the shared professional approach and getting people with similar challenges in the same room doctor, so I wish you the best. I think that the benefits that can bring to that group of patients…

Yeah! It’s not only that the obesity is tied to—even like the Type 1 patients we see, a lot the problem, especially when these young people come on, or the patients who are insulin dependent at a young age they develop diabetes. These are the people especially when they go from parents’ insurance to independent, right? At the same time, they’re becoming independent. These people—first, they are not comfortable, they feel like they are not accepted in the community, that their pumps, or insulin need—insulin is not covered, or insulin is expensive. They start actually rationing their insulin. And I have seen unfortunate stories, all these things. And for that I want to actually do the shared medical and I also want to do things on social media to make awareness.

You’re striking very close to home here Dr. Daud, because my daughter was diagnosed with Type 1 diabetes when she was six years old. My nephew back in Ireland was diagnosed when he was four. I’ve been very involved with the Juvenile Diabetes Research Foundation and raising funds for diabetes research. And I agree with everything you’ve said.

On the other end of that, then, you’ve got the advances in technology where my daughter is using essentially a closed loop advanced artificial pancreas system, where she’s got a pump—an insulin pump—combined with this continuous glucose monitor, and they talk to each other. It’s a game changer for her. It should be FDA approved in the next year, hopefully.

Yeah, this is actually already. Closed loop is already.

Yeah, but this one is a wireless, closed loop where there are no cables whatsoever.

So the thing is that just imagine if she is sitting in a room with a person who’s newly diagnosed, worried about starting up the pump, and here she’s talking, “Oh, my life is just completely normal.” What’s going to influence them, versus I’m telling. “You don’t understand, Doctor, what does it feel like to have something with me all the time.” Now here I have a clear example.

So I think my daughter is ultimately going to be an advocate in this area. Obviously the work that you’re doing from your end, a lot of people don’t understand the distinction between type 1 and type 2. So there’s a lot of education we need to do.

Exactly. So it’s like a very broad field that I’m dealing with. Definitely the prevention and awareness is my biggest thing, because I think that makes a big difference.

I have one finishing question. There’s something in all small business owners—and so you’re not only a professional, but you’re a small business owner—there’s something about what they do, that gets them excited so that they keep doing it. Otherwise, they drop it and they go work for someone else, or they retire. What would you say the one thing is, that gets you out of bed in the morning, and gets you excited about what you do?

My patients love me. So it was like, you know how when you leave a practice, there’s a non-compete. So there was like one year I had this non-compete. That’s why I had to move my practice far. And the only thing that I saw there was an option that I can take a year off. It’s like, some of my patient would try to find me. Especially the type 1s, that I was more worried or the pregnant patients, or with endocrine problems. Those were the specific ones that I was worried. So I’d say my patients.

Well, we loved having you today. Thank you for sharing your story. Mark, any other closing comments?

What was the last non-financial decision that you had to make, today or yesterday, Doctor?

That’s every morning! If you ask me in the morning, the decision would be, “Should I let my kids be in their bed ten extra minutes or not?” I’m sure that’s just for everybody, right?

That’s the same for all the parents!

And I did let them do an extra 10 minutes today.

That’s good. It was a dreary morning, so I understand that.

Yeah, because I had to get them to the tennis tournament too!

Well, thanks very much to Tom and Sameera for letting us listen in on their conversation. We appreciate your time and perspectives. And thank you for tuning in. We hope you’ll join us next time on Decision Dialogues for more stories from successful business owners. So long for now.

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About Dr. Sameera

Dr. Sameera Daud co-founded Metropolitan Endocrinology after working for twelve years for various medical providers. Her concern was in addressing the hurdles that patients must go through to get good medical care, and the goal of Metropolitan Endocrinology is to create a modern endocrine practice that provides holistic high-quality care by incorporating new technologies making it both a convenient and good experience for you as the patient.

Dr. Sameera strives to provide high-quality care to her patients in a personal manner. As an advocate for all her patients, she works closely and collaborates with them in order to accomplish their desired health and wellness goals. She found that this process was streamlined significantly as an owner of her medical practice.

Dr. Sameera studied medicine at the Dow Medical College at the University of Karachi in Pakistan, receiving her Bachelors of Medicine and Surgery. She is certified by the American Board of Obesity Medicine, has an Endocrine Certification in Neck Ultrasound, and is certified by the American Board of Internal Medicine in Endocrinology, Diabetes, and Metabolism. She has received a number of awards including the Top Doctors in the New York Metro Area every year since 2016, and recognition by Castle Connolly, Jersey’s Best Magazine, and New York Magazine.

Disclosure

Modera is an SEC registered investment adviser which does not imply any level of skill or training. For additional information see our Form ADV available at www.adviserinfo.sec.gov which contains a full description of our business, operations and service offerings including fees. Statements made in the podcast are not to be construed as personalized investment or financial planning advice, may not be suitable for everyone and should not be considered a solicitation to engage in any particular investment or planning strategy. Statements made are subject to change without notice.