Learning to Operate

I studied finance at Tulane and returned to Houston in 2010, in the aftermath of the Global Financial Crisis and a difficult job market. I asked my father if I could work at his medical practice. He initially said no: he had paid for my education and wondered why I would immediately come work for him. My mother eventually persuaded him to give me an opportunity.

There was no predetermined succession and no executive role waiting for me. The staff was approximately a front-desk employee, an aesthetician, a nurse, and my father. I worked at the front desk, checking people in, answering phones, scheduling appointments, taking payments, and configuring new-patient charts. I learned the practice from its basic workflows rather than from management meetings.

About a month after I joined, I filled several pages of a legal pad with things I thought needed to be improved or completely overhauled. I invited my father to lunch and pulled out the list. He had spent about 30 years building the practice; I had spent about 30 days working there. He was so upset that he did not eat his salad, and we went straight back to the car.

I do not tell that story because I was right and he later came around. It taught me that seeing an operating problem and having the experience or authority to change it are different things. I did not stop noticing opportunities for improvement. I changed how I approached them.

By the end of 2010, I had begun making small changes that did not disrupt my father's clinical work and reduced friction for the staff. One early example involved preparing the next day's consultation paperwork. The front desk was repeatedly creating essentially the same H&P file and selecting the appropriate broad anatomical diagram. I created preconfigured templates for face, body, and breast consultations.

By December 2010, my father was appropriately skeptical about handing major responsibility to a 22-year-old with limited experience. The practice hired an experienced operations and marketing professional from South Florida. As I remember it, he had operated a large practice and arrived with a clear playbook for taking market share. He led. I learned. I helped execute.

The practice moved from what I describe as a push strategy toward a pull strategy built around SEO, SEM, and social media. I remember that substantially increasing lead volume. Its importance here is not a marketing claim. It explains why a small practice began needing a more capable organization behind it.

As demand increased, the organization added people handling surgical inquiries, medical assistants, additional nurses, aesthetics staff, operating-room support, recovery support, and a wider front office. The South Florida operator focused increasingly on marketing while I took on more operational work: HR, hiring, training, compliance, sales, payroll, inventory, and general operations.

The practice I joined had approximately three employees. Across the broader organization, staffing eventually reached approximately 50 people at its peak. That growth reflected the work of my father, the experienced operator, clinicians, staff, providers, and the wider team.

When I joined, the practice occupied approximately 3,000 square feet at Memorial Hermann Southeast near Hobby Airport, and surgeries were performed through the hospital's day-surgery facility. As the practice grew, my father and I worked with the design and construction team to develop the purpose-built, approximately 15,000-square-foot facility at 4208 Richmond.

The building brought surgery in-house and changed the operating model by bringing clinical, surgical, and aesthetics work into one facility. The dedicated 4208 Richmond case study tells the fuller development story.

VCS remained the core medical practice, with the surgical operation managed as its own operating concern within it. Mirror Mirror added an aesthetics business with its own providers and front-office work. These were operating components of a more complex organization, rather than a description of its legal structure.

By around 2016, I was no longer trying to understand a tiny physician office. I was trying to understand an organization with clinical practice, surgical operations, aesthetics, marketing, sales, staffing, scheduling, inventory, and administrative work happening together. As the organization became more complex, I increasingly needed systems that could help me understand and operate it.

That need led me to teach myself SQL so I could work directly with the business data. It later led into learning software development and building BIVI. The BIVI case study picks up that next chapter: moving from asking questions of the information behind the work to building software around the workflows themselves.

Standing Out in the Lone Star State

MedEsthetics profiled Dr. Paul Vitenas and the growth of Vitenas Cosmetic Surgery, including its Houston facility and marketing operation. The article identifies his son Alex as part of the practice’s business and marketing team.

I left in 2020 because I knew my father would eventually retire, and I felt I needed to establish a career and identity outside the business he had built. Despite what I had accomplished during the decade, I did not fully feel that I owned my own success while it existed inside my father's organization.

COVID-19 was a jarring disruption to life and contributed to the feeling that it was time to make a change. I sold my equity in Mirror Mirror and transitioned to full-time investing. I left a chapter that had gone well because I needed to find out what I could build independently.