Many women retire, quit, or take another position outside of medicine due to burnout. In the medical field, how are women treated? In this episode, Dr. Somi Javaid, the founder of HerMD, talks about a women’s health care model that cares for female patients and makes happier patients. The model gives the providers mission-driven work and allows them to practice medicine the way it was intended. Dr. Javaid also added that they could maximize the amount of care under the umbrella of HerMD. Tune in to this episode for an insightful conversation.
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Recreating The Women’s Health Care Model
Dr. Somi Javaid And HerMD Are Not Your Grandmother’s
We are speaking to a physician turned entrepreneur similar to you who has said, “This system of treating women, especially women in perimenopause and menopause, doesn’t work, and I’m going to fix it.” We are talking to Somi Javaid of HerMD, and she is a force of nature.
This is somebody who comes with the background that is needed to start centers to take care of women’s health on many fronts because she has been on the front lines. That is important, especially these days when it is big businesses and corporations that are trying to provide patient care, and they frankly haven’t had that personal experience.
What I also love is instead of it being gloom and doom, the sky is falling. She and her team at HerMD have such a bright item, a bushy-tailed outlook. The energy and the response from patients are palpable. She is working incredibly hard but has this suitable enthusiasm. The other thing, you have done this too. I love to hear your perspective. She is also trying to eliminate calls. She is a mom and has three kids. A lot of her executive team are also working parents. She is sensitive to what it is like to be a female physician, especially an obstetrician, which you have practiced for a long time, as did she, and the demands it makes on your life and how likely it is to lead to burnout.
I love the story also because we are seeing many people retire, quit, and take another type of position outside of medicine altogether through the last couple of years due to burnout. Instead of quitting, she has found a solution, which is going to be all that. Let’s talk to Somi.
We are excited to welcome our guest, Dr. Somi Javaid, who is the Founder and CEO of HerMD. She owes many accolades, is a brilliant physician, and is a winner of all kinds of awards, but she has now decided to focus her prodigious talent on a business opportunity that takes advantage of her huge experience. Welcome, how are you?
I’m great. I’m excited. Thank you for having me.
We are excited, and I always love it when I have had a chance to know the people we are speaking to and know a little bit about their stories. One of the things I know is love is putting you and Alyssa together, physicians who have so much in common and have both used those skills after being successful clinicians to also start your own businesses. We are going to turn it over to you. You were an award-winning practicing OB-GYN. You have many areas of expertise in menopause, sexual medicine, and intimacy. Tell us how you got from there to the creation of what is going to be a medical empire, HerMD.
Thank you for that. It is a personal story. I knew that I wanted to go into women’s healthcare because I nearly lost my mother when she was only 45 years old. I was pre-med at the time. She presented with left arm pain, shortness of breath, and chest pain. If you Google that now, even if you are not a physician, you would be like, “It is her heart.” She had EKG changes.
Science and data at the time couldn’t explain why a 45-year-old thin non-smoking woman would ever present with the four-vessel disease. Luckily for her and for us, she finally got a diagnosis, although it required emergent quadruple bypass surgery, and she is alive to this day. That was my a-ha moment when women needed advocates, and I was going to make a difference.
Fast forward through residency in medical school. My first job smacked me in my idealistic face. I was seeing 50 patients a day in a private practice setting where we take insurance. I didn’t have time to go to the bathroom or eat lunch, let alone advocate for my patients or make a change. When the timing was right, both personally and professionally, and I am a working mom, I opened the doors to the first HerMD center in Cincinnati, Ohio, in 2015. I noticed that women from 35 states and 3 countries were coming to Ohio. We knew we were onto something.
Talk about that. Those numbers are astounding. I know as you have opened each new facility, the wait lists are thousands of people from all over the world. I wish you could see both these physicians’ faces nodding. I love that your story had a personal catalyst but a happier ending than many of the stories that we hear. What was it that you did that was different? You are about to open your fifth clinic. Talk about the model. I love Alyssa to chime in and talk about how she has seen some of these changes affect her practice.
I was caught in this system that was broken both from a patient and provider perspective. You do not see any significant change. For me, the biggest thing was, “How was I going to give women the time and space that they deserved to discuss these personal issues?” Many people told me, “You are never going to be able to do it. Why bother? Your husband makes enough money. Why are you trying to do this? Stay home. We are going to be able to change the system.”
I took my idea to multiple hospital systems and got patted on the head, like, “Little girl, go away. You are never going to be able to do this.” What I had to figure out was how do I make longer appointment times in an insurance-based system. What was important to me was providing menopause and sexual healthcare to my patients within an insurance-based system. I had to think about revenue streams.
I brought in a surgical center, ultrasound, a lab, and a medical spa. People thought that was crazy. I knew that I didn’t want to go membership and concierge, as a lot of my colleagues had done. I know and I respect that because in insurance companies, the dollars and cents don’t make sense. It is not going to work. You can’t see a patient for 60 minutes and not have any other revenue streams.
For me, it was important to offer this type of healthcare. We offer fillers, Botox, cool sculpting, and laser hair removal. As an OB-GYN, I was talking to patients about all of these symptoms anyway. If you have a woman who has polycystic ovary syndrome, they have hirsutism, which is excess hair growth. They have acne, abnormal bleeding, and infertility. We are able to take care of their nutrition needs, ultrasound, contraception, or fertility. They were like, “I don’t like having this goatee. I want to do something about it.”
That is what I love in our postmenopausal patients. They like to come in for their annuals and talk about sexual health. They will say, “I’m going to come in for my Pap, hormones, and Botox.” They love it because they have a deep connection with their providers. That allows the care continuum. The amazing thing about it is that spa not only unlocks all of these procedures that women are seeking but truly supports the gynecologic side of the practice and allows our providers to see patients for 40 to 60 minutes.
That was the other problem we solved. Give providers mission-driven work, allow them to see fifteen patients a day max, and allow them to truly practice medicine in the way it was intended. We have almost zero provider turnover at HerMD. What I love is that we looked at both sides of the equation and tried to solve that.Give providers mission-driven work, allow them to see fifteen patients a day max, and allow them to practice medicine the way it was intended. Click To Tweet
First of all, I’m falling off my chair because I have PTSD from seeing 35 to 50 people a day. I have stopped the madness, but I have to ask, how is this possibly realistic on an insurance based? The way I’m envisioning this, and please correct me if I’m putting it wrong, is that there is a traditional medical side with evidence-based medical care and wonderful providers who are doing traditional things. I have a couple of questions about that. There is the other side, the aesthetic side, which doesn’t take insurance as its feeding. Is that the way it works where that side feeds the other?
They both feed each other, and you are right. On the medical side, you have providers, researchers, and clinicians. We are doing clinical research trials that we are presenting at ASCO, NAMS, and ISSWSH. We are data-driven. We have digital algorithms of care that have not only been singly peer-reviewed but doubly peer-reviewed by outstanding providers in the sexual health environment.
We got this, but we have a separate set of providers that provide those aesthetic-based services. I did not want any confusion among patients. It is off-putting if someone does your Pap smear, grabs you by the hand, and says, “Come on, let me go inject your face.” The providers are separate and distinct but cross-trained.
For example, if a woman comes over to the medical spa and wants dermaplaning, where you use a scalpel to remove excess hair, our providers have been trained that if it is not a typical amount for a patient, they will say, “Have you ever been worked up for hormonal abnormalities? Is there something else going on?” It is the same if they have crazy amounts of acne, “Have you been to the dermatologist? What have you tried? What medications are you on?” It is the same with medical providers. They are able to offer patients laser hair removal or acne peels.
That is the nice thing. As we are not dependent upon a singular revenue stream, there is no hard selling in the offices. What people have a hard time wrapping their heads around is that it is a natural transition. The offices are beautiful. The spa is laid out right next to the medical offices and the JCO-accredited surgical suite. We are doing ablations, Sonata procedures in the office, and bread-and-butter gynecologic care. Yes, we also have a med spa, but that was my workaround to not go concierge and membership model, which a lot of my competitors have done. It has been fantastic. It is a win-win.
I’m curious about a couple of nuts and bolts. On the medical side, what happens when someone needs major surgery? Are they affiliated with a hospital and take care of that outside of your four walls? Who covers calls at night for emergencies? How does it work where you seem to have the best of both worlds, but all the difficult things that I know I have been through and I’m sure you have been through, I’m wondering where is that taken care of?
A lot of our providers do perform hysterectomies and take care of patients in the hospital. They want to do that. What is nice is that we are able to maximize the amount of care that you are afforded within the HerMD umbrella. As far as care or call, it is funny that you asked that because one of my major initiatives was how do I improve my work-life balance even more.
You and I both know this as physicians. The number one reason for medical errors is not lack of knowledge. It is burnout. When providers are exhausted and you are making decisions. I wanted to eradicate the call. We are about to eradicate calls for all of our providers with a two-step approach. We are giving the call to a company called Zipnosis that will take care of calling in an antibiotic if you have vaginitis or a urinary tract infection.
The nice thing about Zipnosis is, let’s say you are nervous and you are scared, and you still want to access an MD. They are able to do that for our patients, which we typically have not been able to do after hours because you can imagine, I can’t staff that yet. We are not quite there yet. We also have a doc-in-the-box system where we have partners who are willing to help HerMD take the call because we hand off all of our obstetrics patients. We do not do OB past the first trimester. It is this mutually beneficial relationship not only for the providers, “I get this. You get this,” but also for the patient. These are our trusted partners that will take care of you. That is how we have been able to take care of patients during office hours and afterward.
How come nobody thought about this beforehand? I’m in a massive practice. There is no such thing as Zipnosis, but believe me, I have written that down because calls do burn people out. I love that it is like a one-stop shop for every type of procedure that people typically have to be farmed out for to another specialist. That is amazing.
The reason is you and I both know that most physicians are not the decision-makers when it comes to hospital and healthcare systems. We are seen as providers or cogs in the wheel. We don’t matter. The one amazing thing is you are venture-backed, meaning we have been invested in, and one of our founders is a physician. He gets it. We are led by an executive team. It is rare you are in business and have a position on the exact team or for people to even pay attention to that.
I’m a great storyteller. Most of us who go into business, you are. I paint the picture of what it is like to be on call. They were like, “It is no big deal. You guys aren’t doing deliveries.” I said, “You can’t be more than 30 minutes away. You can’t go to your child’s game two hours away. You can’t drink because God forbid if you get called in.”
I said, “Yes, we did this study and saw that few calls were coming in because we educate our patients well. We give them great data on what to do in case of emergency.” They were like, “Only X amount of calls are coming in.” I said, “You understand your life stops when you are on call.” That is all it took for me to tell the story of what it’s like and what it does to providers after hours. It was like the light bulbs went on. No one has ever told them in a way in which they understand what it is like when you are on call.
Here is the hot flash. What are care deserts? Care deserts are areas where people do not have nearby access to healthcare. March of Dimes reports that more than 2.2 million women of childbearing age live in maternity care deserts that have no hospital offering obstetrical care, no birth center, and no obstetric provider.
I have worked with lots of businesses where the person buying the services or the products were obstetricians and gynecologists. What we would hear back is, “We don’t want to do these aesthetic procedures because it is not science. We don’t want to find these different sources of revenue that are too commercial.” You have said, “Okay, I get it. I’m going to make them connected but not overlapping.”
I remember telling Alyssa. I have been on the phone with my own gynecology practice where you hear the advertisement when you are on hold to make an appointment that they want to do hair removal. It sounds like the person that went to medical school is the same person who is doing your hair removal when it probably shouldn’t be.
In addition to having the insurance piece, which, as we know, doesn’t come close to covering all the costs, you have the aesthetic piece, and you also have an addition that many other practices and businesses don’t have, which is the products that you have in the office and that you own the future have on an eCommerce website. How does that fit into your business model?
The biggest problem that I wanted to solve is I love prescribing HRT, doing surgery, and fixing a problem. I’m evidence-based. There are many patients who are like, “I don’t want HRT or this procedure, but I’m willing to try a product.” They bring me bags of the products they are buying over the counter, like Happy Hoo-Ha cream.
Is that doesn’t work?
I’m sorry, whoever made it, I’m not an endorser of your branding or your ingredients. I always get myself in trouble. It is like coming from a place of I have to protect you from this and looking and seeing that there are no physician-curated products or sites out there that can get to the patient. I had no interest and time in developing my own product line for HerMD. I was like, “Let me highlight the people like you, Alyssa, who has done this and have made this their lives work. Let me take the best of the best and add this as a risk-benefit alternative when we are talking to the patient, depending on whatever chief complaint they are coming in with.”
We all know this in sexual healthcare, there are no FDA-approved options for orgasm dysfunction or arousal disorder and a handful of options for sexual pain. I wanted to bring in quality-based products that were evidence-based, especially for those women who weren’t candidates for HRT and weren’t ready for it or told me they didn’t feel comfortable.
Even though I broke down the data for them, they were too scared. They were like, “We are ready for this.” The product they tried, I wanted them to have success because the other thing that upset me is women are like, “I feel like invisible patients.” They get dismissed. We face delays in diagnosis. We wait longer than men for our pain medications in the ER. We are more likely to die of cardiovascular disease or heart attacks like my mother.
I heard the stories of women who felt like they were broken because they finally spent $30 to $50 on a product that made all these careless claims, and it was worse. I wanted to make sure that I curated products for them, that I knew worked, were safe, the branding and marketing like the patients saw themselves in it, and it wasn’t like a shriveled, dried piece of fruit that I remember one time going, “What is this?” That was important to me. That is why it is important for us to bring in products for our patients.
There is the convenience factor, but there is also the embarrassment factor. A lot of people do not want to receive boxes in the mail that may have some shameful labels. I have a couple of questions. I think your model is amazing, and this is dedicated to women only or people who are identifying as women. How are you going to compete, and how do you compete with the big guys, UnitedHealthcare and Oak Streets? They are big guys who get such great deals with insurance. What is the plan there?
I have prepared value-based care models and value props. I ask for meetings with the chief medical officers. There are some markets we go into. They say, “We have enough GYNs in Tennessee. We are not even going to contract with you.” I’m like, “Wait. I’m going to kill them with data. There are three ISSWSH-trained ends in your entire state, one of which is in Nashville. You are telling me that your patrons don’t need our care and services.” I have been known to go on social media and encourage insurance companies to please play nice with HerMD. I got lots of bags of tricks.
The bottom line is killing them with that internal data that we have. For example, we pulled an internal study on IUD complication rates at HerMD with the way we insert IUDs at HerMD. The national complication rate for IUDs is roughly up to 10%. At HerMD, it is less than 1% with the small things we do. We are pulling all of this internal data now and showing this to our partners, the insurance-based companies.
As far as the competitors, I go into these because we are raising again, but we closed another troche. We are raising again. I don’t feel like we have any true competition right now. There are a lot of other national women’s healthcare brands that are popping up. A lot of them are focused on fertility, obstetrics, cash-based, or membership model-based. None of them are doing clinical research trials if you look at what they are offering. They will say they are doing menopause, but they do the consult, refer off, and don’t prescribe.
I’m lucky. HerMD is a blue ocean opportunity. We are the only integrated, both brick-and-mortar and virtual, within an insurance-based system where we are offering menopause and sexual healthcare, and 100% of our providers are ISSWSH and NAMS graduates. They go through HerMD University. They are trained by the bigwigs. We have those algorithms of care that I talked about. There is no competition right now as to HerMD provider and what else is out there.HerMD is a blue ocean opportunity. We integrate only within an insurance-based system where we offer menopause and sexual healthcare, and 100% of our providers are ISSWSH and NAMS graduates. Click To Tweet
When you talk about product market fit, you often say, “The market will tell you.” We talked a little bit about your first location, people from 35 states and 3 countries. Share a little bit more about the spectacular response you have gotten. You are in Ohio, Kentucky, Tennessee, and soon-to-be New Jersey. You are a Broadway hit wherever you go. Talk a little bit about those numbers and some of the responses you are getting from patients.
To me, it is achievable. I knew it would happen because I saw it in Ohio and Kentucky. We are not New York and LA. We are not fun to visit. It is a great place to raise kids. We knew we were onto something, particularly my cofounders. I knew we were onto something when we had patients coming from all over the country, including a woman who drove two days to come to see me because she had HSDD or Hypoactive Sexual Desire Disorder. She had a stroke and was told by other physicians, “Be thankful you are alive. Live with it.” She was on the brink of losing her marriage. She was severely depressed. They were like, “It’s not going to kill you.” She drove two days to come to see us because we took her military insurance. She found us on a discussion board.
That is what was happening. Our patients were our biggest marketers. We had no money for marketing. This is what we were bootstrapped for. In every market we have gone into, we have seen wait lists in the hundreds. We are twenty minutes into our open houses and ribbon cuttings. There are lines out the door. We get 200 to 300 women to show up. They were like, “Thank you for seeing us and for providing a space where we feel heard. Thank you for coming to our market.” That is what is happening in all the states that we are going into. It is humbling, but it is also exciting.
How do you choose your locations? My life revolves around New York. The locations you have chosen are populous, but they do seem a little random. Was there a method of location choice?
That is not a question I don’t get at every day from investors. They were like, “Where is your growth plan? What are you doing?” For me, a girl from the Midwest and watching what happened to my mother, it was tier two markets and what is defined as care deserts, and women who needed access to this type of care because it was not available to them. That was first and foremost.
We have an elegant data collection system and an algorithm for how we choose sites. It is based on population, how many rooftops are in that area, and closeness to a major metropolitan tier-two city. We did a study on how far HerMD patients were willing to drive. It is much further than a typical GYN office. We knew we could be 20 to 30 minutes outside the city and these lifestyle areas like yoga studios and high-end grocery stores. That is where we like to be within a 20 to the 30-minute driving range of a city.
We also look at things where are the SEO searches going on for Addyi, or HSD sexual health, and the needs are being unmet. We look at the ISSWSH and NAMS providers and see how many are in that state and how many are actual gynecologists. We are going to be different from urologists or internal medicine doctors who have gone to those courses because they can’t do ablations, office ultrasounds, or surgery. There are different offerings that we have.
We look at the med spas in the area. It is an elegant method of choosing the cities we need to go into. For those who asked me, “What are you doing?” I’m like, “We are choosing correctly because our two offices right now that we opened in the first month, we hit six-month forecast appointment numbers. I already have to hire third and fourth providers at both of those locations because we cannot keep up with demand.”
Can I ask a little about telehealth? We got warmth with telehealth during the pandemic. Now that we are emerging from that, it seems to have slowed down quite a bit. Are you finding, since some of your locations are a little bit more spread out, that telehealth visits are still popular, especially for follow-ups maybe?
Telehealth for us is still popular, but you are right. We changed our strategy. We learned from some of our competitors not to grow too quickly in the virtual space, especially because there are many people. I do love that as an entrepreneur, and I want a lot of these companies to succeed. There are always learnings. I say that I’m a forever student.
What we are doing is wherever we are dropping a brick-and-mortar, we are picking up that state and the surrounding states because people drive in. They love having that brick-and-mortar place where if they are on HRT and they have bleeding, they can come to get their ultrasound and biopsy if they need it. They love having the chance and the ability to have that face-to-face, but they also love the convenience of online booking and virtual care.
For us, you are right. We will do a lot of our follow-up via telehealth or even those first consults for a woman who wants to decide whether or not she is going to drive in or fly in. We will capture a lot of those, but we changed her strategy to not expand. We were going to try to go to all 50 states by 2024. We are going to grow our virtual step by step, hand in hand with our brick-and-mortar.
It is rare for me to meet a doctor whom I’m overwhelmed with. I wish that I could see her as a patient. I say that every time I’m in a conversation with Alyssa. If people only could get to her, that was what they would want to do. What strikes me is, especially after the pandemic, there is so much burnout and dissatisfaction.
Speaking to you about practicing medicine is a literal breath of fresh air. Your enthusiasm, joy, and success you are having are contagious. One of the things that stands out every time I see you or I get to see other folks on your team is positivity. You are bucking the trend and creating something capital-intensive to put up these facilities all over the country, and you are killing it. It is amazing to watch.
Thank you for that. One of the first things that were most important to me was writing down the mission statement and what was important to us. We would not become a toxic medical environment. If you don’t take care of your providers and people, you can’t take care of patients. You can’t if you burn out yourself. There are rough days. The entrepreneur ride is always like this.
I always have another HerMD cofounder or provider for a hug or a high five. What keeps me going is every single day, the social media shoutouts or the reviews we are getting for patients who are like, “Our first day in Indiana, there was so much stuff going on behind the scenes.” Any time you open a new clinic, it is like, “This wasn’t right.”
Be clear. It wasn’t in Indianapolis. It was in Carmel, Indiana.
We have 200 women go through by 618. The entire 4,000 square feet is filled. The next day was the first day, and I was there hands-on because I like being there for the providers. It was a little organized chaos, but it was chaotic. Everyone was like, “We have to do this.” At the end of the day, we hadn’t even had reviews open yet, but this woman took the time to find an ad. Underneath the ad, she puts, “In several years, I have never been listened to like I was at my first encounter at HerMD. Thank you for coming to Carmel.” I screenshotted it, I sent it to my entire team, and I said, “This is why we do what we do.” Everyone was like, “High five.”
It is funny. The kitchen is chaotic, but everyone thinks it is great. Patients are thankful and grateful. They are the fuel that keeps us going. I nearly lost my mother when I didn’t have to. When the surgeon came out, he said to me, “She had a 95% occlusion of her LAD. She would not have survived if the heart attack would have come.”
I remember being in those rooms with her and her pleading with her physicians to listen to her, and they wouldn’t. I was like, “No.” That is what drives me. Women aren’t invisible patients. They are heard. They are partners in their care, but they also are not exposed to opportunistic individuals. A lot of people are jumping on the menopause and sexual healthcare game. That is why clinical trials, evidence-based medicine, and teaching is important to me. It sets us apart. That is what keeps me going.Women aren't invisible patients. They are heard. They are partners in their care, but they also are not exposed to opportunistic individuals. Click To Tweet
You are a breath of fresh air. I have to ask one final question that is personal to me. Do you ever miss clinical medicine? It has only been a couple of months, but after all the training we go through and all the difference you have probably and knowingly made in all these patients’ lives, do you miss that? You are on a major mission, which is important, but I wonder about that.
I do. I talk to many physicians about their second act. That is what they are worried about. I live in Cincinnati, where two of the clinics are close, and I run into patients all the time, whether I’m shopping or out with my kids. They were angry. I had been practicing for several years. I had a giant book of business. We probably lost less than 1% of our patients. They stayed with HerMD. They were loyal. My providers are amazing. I don’t want to say they are extensions of me. They are amazing providers in their own right.
Yes, I do miss it. When I see them, I miss them. I miss their stories, interaction with them, and making that fantastic difference in the room. What I concentrate on is I made a difference every single day in those rooms. By opening all these clinics, think about all of the women that were going to treat. We are also breaking the status quo right now that less than 20% of OB-GYNs are trained in menopause and sexual healthcare. We are fixing that. I’m focused on those goals. I’m lucky I live where two of the clinics are. I get to see them, but I miss them.
We like these to be bite-sized, so we keep everyone’s attention. What you are doing is amazing, and it is exciting to see you saying, “This system is broken. There is a way to do it better. It is working.” It is not working philosophically. You are getting investment and attention. You are driving revenue, and you are changing lives. On behalf of our group, keep up the good work. We will watch your every move and be cheering you on.