Did You Know: Perspectives on Private Practice - An Interview with Drs. Amit Gosalia and Kira Savin

What are some key strategies you've found effective in balancing quality patient care with the administrative demands of running a private practice?

Amit Gosalia: The fundamental core has to be exceptional patient care, or what we often refer to as patient-centric care. After all, without patients, there's no administration or practice to speak of. In private practice, simply meeting the minimum standards isn't sufficient. We follow strict guidelines for best practices and prioritize unparalleled customer service in our clinic, a commitment that has contributed to our considerable success.

However, the real key lies in the mindset of the owners. Personally, my schedule extends far beyond the conventional 9-5 framework. When we're passionate about our work, we make time - before patients arrive, during lunch breaks, and even after hours. There have been countless late nights, sometimes until 10 or 11 pm, devoted to completing tasks that need to get done. Without the willingness to invest the love and dedication that your practice demands, true success will remain elusive.

Kira Savin: One crucial strategy is scheduling dedicated administrative time. Balancing full-time patient care with managing two practices across six locations nationwide proved challenging. To address this, I allocated all-day Tuesdays and Friday afternoons solely for practice management and development. I protect this time rigorously, ensuring uninterrupted focus on business matters instead of juggling tasks between patients. Staff in New York and California have access to my calendar and can easily reserve time as needed. Additionally, scheduled meetings involve managers and the director of operations from all offices, providing comprehensive data for practice evaluation.

Another key tactic is delegation without micromanagement. Empowering individuals in their roles, I refrain from intervening unless requested, and they present results within set deadlines. I avoid hovering or excessively delving into tasks, particularly once established protocols are in place, allowing team members to excel. Acknowledging my limitations, I prioritize access to essential data, such as from QuickBooks, without needing to delve into procedural intricacies of how it's managed or obtained. Empowering decision-making and offering support alleviate the burden from solely resting on my shoulders.

Can you share any insights or lessons learned from your experience in private practice that others might find valuable?

Amit Gosalia: Throughout my 23-year career in private practice, I've navigated various roles, from employee to owner of multiple locations, to a partnership in a single Los Angeles-based practice. Along this journey, I've accumulated numerous lessons that I now impart to my students. Among these, one crucial lesson stands out: understanding the intricacies of finances, marketing, and business management.

When I first started my career in private practice, I had no business knowledge, and if I had become an owner at that time, I would not have been successful. Yes, we can pay for services from the many companies in the industry, however, having a grasp on the business, and then delegating is critical otherwise, your profit and loss statement won’t look as great as you’d like.

Kira Savin: In private practice, excellence and upholding the highest standards of care are paramount for long-term survival. A common critique is that private practitioners are perceived as salespeople rather than healthcare providers. However, I've learned firsthand that even exceptional sales skills are insufficient if the quality of testing and follow-up care is subpar.

The most significant lesson I've gleaned is the invaluable role of colleagues and staff, who are the lifeblood of the office. It's not "Kira's Hearing Center"; it's not about me. The focus is on the team, encompassing doctors, receptionists, and everyone in between. If the practice revolves solely around the owner or a single "star" practitioner, growth stagnates. My aim is to be the least popular person! This realization was humbling but transformative. The practice thrives on collective effort, where I am merely a small piece of the larger puzzle.

What challenges have you faced in building and maintaining a successful private practice, and how have you overcome them?

Amit Goslia: Arguably, one of the most daunting challenges I face is dealing with my own limitations—and before you scoff at that, hear me out! There are days when I'm just not feeling it and my patients may sense my lack of enthusiasm. Some days, working with a team presents its own set of challenges, particularly when tasks are left incomplete. Other days, the solitude of ownership weighs heavily, with no one to turn to or share my struggles with.

The remedy for these struggles lies in reminding myself of the passion that led me to audiology in the first place. This realization inspired the creation of AudBoss, a private practice Facebook page exclusively for owners, along with their annual conference, open to all private practice professionals. These types of platforms have proven invaluable, providing a safe space for owners to candidly discuss challenges, setbacks, and triumphs. Through sharing experiences, I've not only gained insights from my peers but also discovered that many of us grapple with similar issues. That has emerged as a vital resource, empowering audiologists to confront and overcome numerous obstacles.

Kira Savin: Staffing and assembling a robust team has consistently posed challenges. It involves mastering the art of effective interviewing, establishing achievable expectations, and crafting concise yet comprehensive training protocols. As I've mentioned earlier, the success of a private practice hinges on its personnel. Thus, the primary challenge lies in securing the right fit for every role. A disgruntled front desk coordinator can detrimentally impact the entire business.

The most valuable piece of business wisdom I've received is "Fire fast, hire slow." I strive to operate my organization based on this principle.

Can you elaborate on your approach to assessing and catering to the diverse patient demographics within your practice? How do you navigate the complexities of geographic location of your practice, average patient population age, socioeconomic status, cultural background, and specific hearing healthcare needs?

Amit Gosalia: Our clinic was founded by Dr. Jane Rosner in 2001 in Woodland Hills, CA, an area with a very diverse population ranging from low-income individuals to physicians to A-list celebrities. Our foundational principle is to deliver top-tier patient care, irrespective of socio-economic status, age, or any other factor. This commitment enables us to consistently provide exceptional care to all patients. Every individual is treated with equal respect and receives the same level of attention, ensuring that no one is given preferential treatment over another.

Kira Savin: We employ a "something for everyone" approach to accommodate the needs of the majority of our clients. This philosophy is ingrained in our business model of collaborating with every platform, regardless of affiliation. Our partnerships extend to all major manufacturers, ensuring a diverse range of options for our clientele. Furthermore, we offer discounted rates on donated hearing aids to support those with financial constraints. Flexible payment plans, including financing and in-office options, are available to enhance accessibility.

While we maintain inclusivity, we operate as a concierge-level practice, prioritizing personalized care over price competition with retail chains, third-party vendors, or online outlets. We do not participate in insurance networks or state-funded programs like Medi-Cal.

Our clients seek specialized, highly personalized care, and we deliver on that promise. They appreciate our prompt responses to inquiries, same-day or next-day appointment availability, and ongoing support. Typically, appointments are scheduled for follow-up immediately after each visit, ensuring continuity of care. Although we offer options across various budget ranges, our focus remains on serving private-pay clientele. Our philosophy emphasizes value over volume, reflecting our commitment to providing exceptional care, albeit at a premium.

Our approach is not about catering to a broad spectrum of clients; rather, it's about attracting those seeking our distinct level of care and services. We recognize that not everyone may prioritize or be able to afford this level of care, and that's perfectly acceptable. Alternative options are available for those seeking more economical or expedited solutions.

How do you cultivate a culture of collaboration and patient-centered care within your audiology practice, considering the diverse range of stakeholders involved, such as staff members, patients, family members, caregivers, manufacturers and other healthcare providers?

Amit Gosalia: Communication. It's remarkable how frequently we, as audiologists, overlook the importance of effective communication. I often joke that some of us could be considered experts in communication disorders... But all jokes aside, communicating your mission and vision to your teams and conveying it to your patients ensures everyone remains aligned on the path to success. We vehemently promote  for and follow best practices, evidence-based care, and patient-centered approaches, actively sharing this philosophy with all stakeholders. Communication is critical.

Kira Savin: It boils down to empowering individuals to make decisions and trusting your team. Clear communication of our standards of care is crucial, allowing our team to operate independently within those guidelines. Regular discussions and evaluations ensure that these standards are still appropriate and being upheld. We meet as a whole team monthly, while our administrative coordinators meet daily to streamline our schedule. Everyone is held accountable to their role.

Furthermore, it's essential to articulate the practice's vision and goals. What is our mission? Why do we do what we do? Every team member should be versed in these answers. Understanding our purpose drives collective efforts toward our shared vision and goals.

Could you recount a particularly impactful experience from your career in audiology that reflects your dedication to patient care or innovation in private practice? What lessons did you draw from this experience, and how has it influenced you?

Amit Gosalia: When I joined a clinic in 2008 as an employee with the intent to purchase after 5 years, I got to see first-hand how NOT to run a private practice.  From the mistreatment of staff and patients to prioritizing profit over patient care, and maintaining transactional relationships with physicians and potential referrers, it was a sobering experience. The shortcomings were so glaring that I couldn't wait the full 5 years to take ownership. Instead, I made an offer after just 3 years.

This condensed period proved invaluable in solidifying my belief that patient care should always take precedence, and that our team members are the lifeblood of our practice. Sometimes, the lessons learned through experience carry more weight than those taught in school.

Kira Savin: Identifying a single defining event that influenced my leadership style and practice management is challenging. Throughout the past decade of owning and managing my practices, my approach has undergone significant evolution. I've explored various leadership strategies, continually striving to enhance and implement improvements. However, the most profound lessons have arisen from my mistakes and failures - of which there have been numerous. We started as a one location practice in White Plains, NY with 4 staff members and have grown to 5 locations across the country and now have a team of 25.  Putting new processes, expectations and systems in place to accommodate that growth has been challenging.  As our offices grow and scale- we constantly have to adapt to ensure we have the right support in place to do so.  

Dr. Amit GosaliaDr. Amit Gosalia is currently a partner and doctor of audiology at West Valley Hearing Center in Woodland Hills, CA. He is a Distinguished Fellow of the National Academy of Practices, board certified by the American Board of Audiology and in 2024 recognized by the American Academy of Audiology with the Clinical Excellence in Audiology Award. He has been an audiology adjunct professor at A.T. Still University in Mesa Arizona and has been precepting & mentoring audiology students for over 18 years. He has held, or continues to hold, numerous leadership roles within the American Board of Audiology, The American Academy of Audiology, the California Academy of Audiology, the Arizona Speech & Hearing Association, the Audiology Practice Standards Organization, and other organizations. He has presented on numerous topics at many state, national and even international audiology organizations, and continues to give CME presentations to physician groups all around Southern California. Outside of audiology, he serves on physician advisory boards for nonprofits, loves traveling and enjoys spending time with his wife, daughter and rescued dog.

Dr. Kira SavinDr. Kira Savin specializes in providing personalized hearing solutions using the latest and most discreet technology available. Her areas of expertise include hearing rehabilitation, auditory counseling, tinnitus management and retraining therapy, and dispensing of hearing devices and other assistive listening technologies. Dr. Savin is licensed in Audiology and Hearing Aid Dispensing in both California and New York State. She has been accredited by the American Speech-Language-Hearing Association and is a fellow of the American Academy of Audiology. In 2018 she received the Business Council of Westchester's Top 40 under 40 award and was honored by state senator Terrence Murphy for her accomplishments in private practice leadership and development as well as her company's contribution to the community. Dr. Savin completed her residency at SUNY Downstate Medical Center in Brooklyn, N.Y. After practicing in New York City, she continued her career in Westchester County where she co-purchased Audiology Associates of Westchester and remains a co-owner of that practice and its satellite offices. In 2021, Dr. Savin co- purchased California Hearing Center in San Mateo and San Carlos- which is where she practices full time. When she isn't performing her audiology duties, Dr. Savin can be found scuba diving and has been documenting and photographing various shark species from around the world. She lives outside of San Francisco with her husband, two daughters, and her rescue hound, Binkie.