• Surviving the Start-Up Circus: Learning Valuable Life Lessons

    by Erin Gibbs

    The early years of founding and growing our healthcare management company, network of multi-site specialty clinics, and an independent retail company within those clinics felt like a circus. I put up the tent, hired the help, and ran the three rings—along with my physician husband. Thankfully, “Ringleader” is no longer an apropos job title because we are now a second-stage company with deep roots and a visionary plan. 

    Starting a new business in health care is not only expensive, it’s truly like running circus with needs and requirements in every direction. Sometimes it’s entertaining, but oftentimes it’s immediate and critical. 

    I affectionately look back at the last six years of getting our company off the ground in terms of the “green years,” when we opened up and were making good profits in one small, manageable location, the “lean years,” when we were tight on cash because we grew so fast and opened multiple locations, and the “mean years,” when we made some poor hires into key leadership positions. Now we are in a yet-unnamed stage (what rhymes with green, lean, and mean but denotes getting organized?). 

    Along the way, we carefully curated our “secret sauce” in the form of great employees, and we've weeded out the nonperformers. We have hired people from outside our industry and from within our industry; some new to small, privately owned business and some who have exclusively worked directly with owners in small businesses. This makes for excellent diversity in perspectives, but it also occasionally creates roadblocks when bandwidth runs short, ideas run big, money is tight, and philosophies clash. 

    In an entrepreneurial business like ours, we regularly venture into uncharted waters and entertain “crazy” ideas to make our delivery of health care better. We are now at 50+ people on the payroll and hitting 20 percent year-over-year growth in revenues. We are creative, growth-oriented and excited about the future. Sounds great, right? Those numbers don’t tell the personal toll of all-nighters, lost business, and the dissolution of personal relationships—including firing one’s best friend—or signing personal guarantees and taking out personal loans to get the doors open and into liftoff mode.  

    What I have noticed, including at the HFMA HERe conference last fall in Florida, there is no playbook for small businesses in healthcare. There’s no blueprint for cashflow management. And there is certainly no guidance for women in leadership roles. 

    In our case, we aren’t a hospital, we aren’t a pharmaceutical company, and we also are not a solo practice in a small town. There are many guidebooks and self-help publications for those on the extremes: small startups and large public companies. But there is very little for the operational, financial, branding, and personnel issues of a growing company—one like ours that is a small business that operates like a big one. So, it’s been like earning an on-the-job MBA for my physician husband and myself. 

    Our story is not unique; there are countless husband-wife duos operating medical practices around the country. In fact, both of our parents and my husband’s grandparents on both sides were business partners in medicine. However, the 1950s-1990s were very different from the current political-medical landscape. The extreme constraints on cash and difficult reimbursement process (familiar to anyone who tries to get paid for providing medical care) pushed us to deploy a number of strategies to develop a repeatable and scalable business model—strategies that create a magic intersection between the high cost of growth/expansion and the revenues we need and expect to stay in business. 

    Thankfully, we have exited the startup circus period when the company had very little in the way of policy, procedure, and process. Throughout the last six years, we have been a team of “do what it takes” and “all hands on deck.” From what I understand, most startups die in this phase. At times we’ve felt wounded, but near death? Never. 

    Founded in 2010, we entered rapid growth in 2012, going from one small clinic in Pueblo, Colo., to five sites in two states. We now have seven clinics in two states, a full-scale management company with a centralized headquarters in Colorado Springs, Colo., and an independent retail company for medical and athletic compression socks and stockings. We are understaffed at 50+ employees and working hard to fill the gaps while at the same time achieving positive cash flow and management of the debt we’ve accumulated through all of this visionary growth. 

    As we’ve expanded, the casual family atmosphere and “do what it takes” culture of the past became chaotic and ineffective, and it was difficult to understand for anyone new coming on board. We are now diligent with managing expenses and placing culture, training, processes, and procedures, including boring things like producing an HR manual, marketing plans, expense reports, branding guidelines, etc., as priority.  

    Another challenge for me is to remain true to myself and my children while at the same time meeting the expectations of corporate America. There is expected nuance to handling emotions, negotiations, and general business that I’ve had to adjust to. 

    That said, as owners of this business, having the ability to work as a team, and to think creatively and independently has worked well for us. Conditions on the front lines of our business change rapidly, and we felt a detailed business plan felt irrelevant or restrictive because opportunistic growth is our style. Conforming to the “grown up” rules and regulations expected of a mature business is a welcome challenge. Now we lead our small company of the past into the big company of the future with the training, hiring standards, operating processes, compensation and benefits, and financial savvy while at the same time engineering a culture that values our secret sauce: Our people and our brand. 

    How are these challenges similar or different from your experiences in the business of healthcare? 

    Erin Reilly Gibbs, along with her husband, Dr. Gordon Gibbs, is the co-founder of three businesses: American Vein & Vascular Institute, American Vein & Vascular Institute Practice Management, and The Compression Center. 

  • About HERe

    The HERe initiative is an effort that aims to inspire not only women but men invested in the professional development of women leaders in the health care field with the tools and resources they need to succeed. We hope to inspire one another, learn together, and connect with colleagues across the industry.

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