Live Oak helped Dr. Ambay with his ambulatory surgery center expansion.

Dr. Ambay: An Ambulatory Surgery Center Expansion Story

A note from the author

When I called Dr. Raj Ambay to get a few additional notes on his practice and ambulatory surgery center expansion loan with Live Oak Bank, I was expecting a pleasant conversation. I could see he had some impressive accomplishments and I was looking forward to hearing more of his story. I did, however, underestimate just how remarkable he is. Dr. Ambay is easily one of the most interesting people I have spoken with in a long time. He is a decorated army veteran turned entrepreneur, surgeon and medical software developer who still devotes his life to helping others recover theirs.

To be honest, it has been hard to dwindle his story down to a single post. I am just not sure I can do him justice in so few words. So, here is an overview of his story. If you ever run into him, however, I suggest that you buy him a cup of coffee and ask him to tell you the whole story himself. You will not be disappointed.

 

Pursuing the America Dream

Raj met his wife Aparna in 1993. They got married just two years later. Here is where they began their true American Dream story.

Medicine is a second career for both Raj and his wife, Aparna. Raj’s first career was the military. Aparna, who is also very impressive, was an EKG tech before getting her MBA and then Masters degree in Public Health. Aparna had always wanted to be a doctor and to own a practice, while Raj came to this realization a little later in life. Over the years, several people commented to Raj that they thought he would make an excellent doctor, and eventually he realized it was something he wanted to do. It became a shared dream for the couple.

Both came from families of modest means. Neither family had ever produced a doctor, and both families lacked the ability to help support the pair through medical school. Raj and Aparna knew that if they were going to do this, they were going to have to do it on their own. They gave up everything to go to the Medical College of Pennsylvania (now part of Drexel) together and made a deal: If one of them failed, they would drop out of school to help support the other until they finished. They were both so afraid to fail that they worked tirelessly and sacrificed everything in order to succeed. Eventually, their efforts paid off, as they entered into two of the most competitive specialties in the medical industry. To obtain residencies in these fields, students must be in the top 10 percent of their classes. Even that, however, wouldn’t guarantee a residency because of the industries’ small number of spots: Less than 250 in the country.

 

Tragedy strikes

Raj joined the military in 1996. He was a decorated Colonel in the U.S. Army Reserve and had received the Combat Action Badge, two Army Commendations, U.S., and NATO Medals as a CSH and Forward Surgical Team Member assisting U.S. Special operations in Iraq and Afghanistan.

On September 11, 2001, the Ambays were in school in Philly watching in horror as the twin towers fell on TV. Although Raj was finishing medical school, he was deployed a month and a half later. Luckily, school did not penalize him for leaving in the service of the country, and actually allowed him to use his military medical service as credit towards his degree. When it was time for him to graduate, the army gave him 24 hours to fly from Fort Bragg, North Carolina back to Pennsylvania to attend graduation.

Dr. Ambay served in the military for a total of 21 years. He served in combat roles from 1996-2002 and as a military surgeon from 2002-2014.

 

Defining his medical career

Dr. Raj Ambay spent most of his surgical career in the military. As a result, he obtained a lot of experience in trauma surgery. He saw many injuries not commonly seen in U.S. trauma centers, such as injuries from IED blasts, shrapnel dipped in rat poison and multiple limb losses in a single soldier or an entire unit. He had to be nimble and diagnose quickly in the field from his medical acumen rather than relying on lab tests and CT scans.

When deciding which direction to take his career, he wanted to continue practicing in a way that would allow him maximum patient interaction and the ability to provide long-term, life-changing care. He found this in reconstructive surgery, which he felt would enable him to help people feel better about themselves and to get their lives back post-injury or post-accident.

 

Industry innovation

Not only is Dr. Raj Ambay a decorated veteran and successful doctor, but he is also an entrepreneur.

He created Nine Line Medical, a software platform to improve medical scheduling. According to Dr. Ambay, “Most practices take a static approach to scheduling. Nine Line offers a dynamic approach, like a GPS that re-routes you when you get off track.” At its most basic level, the software makes scheduling dynamic to enable you to pre-determine whether or not you will be off schedule. It automates messages to patients with their new appointment times so that they can plan accordingly versus sitting and waiting in the office.

When deciding which direction to take his career, he wanted to continue practicing in a way that would allow him maximum patient interaction and the ability to provide long-term, life-changing care.

“A measure of a good doctor used to be how booked up they were, but now everyone’s time is important, not just the doctor’s. The software is designed to value the patients’ time, and make the doctor more efficient by staying on time.” says Dr. Ambay.

Aptly named, Nine Line is a field term used in the military. It’s a specific code that allows people in the field to communicate with medics so they can be ready to provide the best care possible when a wounded armed service member reaches them.

The idea for Nine Line came to be when Dr. Ambay was still in the armed forces. He was hit by a rocket-propelled grenade in 2014, and while in a military hospital, he had to wait hours on a gurney before receiving treatment. He became irritated by the inefficiency of the military medical process. He also saw that this inefficiency was quite common, even in the civilian medical system.

 

Ambay Plastic Surgery

Dr. Raj founded Ambay Plastic Surgery & Suncoast Breast Restoration in Tampa, Florida in 2013. The practice offers an array of cosmetic surgical and non-surgical procedures, but specializes in reconstructive breast microsurgery. Dr. Ambay is regarded as one of the most prestigious plastic surgeons within the breast cancer field, having earned the American Society of Plastic Surgeons Presidents Award in 2014. He is one of only a select few plastic surgeons in the U.S. who performs two niche and highly-advanced breast cancer reconstructive surgeries, and many patients travel hundreds of miles just to see and be treated by him.

As a result of his success, Dr. Ambay’s practice was growing rapidly. His original facility was unable to keep up with the demands and needs of his patients. In addition, 30 percent of his revenues were being paid to surgical facilities to rent their operating rooms for procedures.

 

360 Dermatology

360 Dermatology, founded in 2012 by Dr. Aparna Ambay, offers general dermatology care and specializes in skin cancer, MOHS surgery, dermal fillers and Botox. Before opening a new facility, she added three new service lines as well as a call center that yielded an average of 153 calls per day. Dr. Aparna needed additional space to hire another dermatologist, two nurses and an esthetician, as well as a space to offer laser procedures. With cases of skin cancer increasing in number, she also found that she needed a larger lab space. Their previously-leased space did not have the capacity to meet the growing demand.

His original facility was unable to keep up with the demands and needs of his patients. In addition, 30 percent of his revenues were being paid to surgical facilities to rent their operating rooms for procedures.

A consultant evaluated the practice, revealing that there was an approximated $252,000 of unrealized revenue in skin cancer reconstruction, which the practice previously referred out since it could only be completed in a surgical center. Some of this was referred to Ambay Plastic Surgery, but given their scheduling overflow from a lack of space as well, Ambay Plastic Surgery was unable to meet the full demand of the referrals.

 

The solution: Expand the office and create a surgery center

Drs. Raj and Aparna Ambay–both needing new practice facilities–decided to also create an ambulatory surgery center. Aptly named Transformations, they envisioned an improved, tech-focused facility that would allow patients to receive all their treatments efficiently and under one roof. A new surgical facility within Transformations would capture lost revenue, expand the scope of their product lines, reduce inefficiencies, improve employee and patient satisfaction and create a unique business offering in their marketplace. More importantly, they wanted to provide a high level of healthcare without investors and healthcare administrators placing profits above people.

With complimentary practices, it always made sense to the couple to share a facility. In addition, the new software they developed could be beta-tested at Transformations. No wait times. Lights, temperature, artwork and music all working on IoT technology that would enable them to change these in every exam room to meet the personal tastes of patients. They created partnerships with tech companies in Tampa, Austin and Silicon Valley. In short, they wanted a facility that was truly “smart” and that would empower them to generate data to help them excel in the new healthcare environment.

 

The right partner: Live Oak Bank

Every dream needs a partner, and while Raj found that in Aparna, they also needed a financial partner to make their dream a reality. Luckily, they found Live Oak Bank.

Before Live Oak’s project with the Ambays, both practices operated out of a shared 3,850 square-foot leasehold with no surgery suite, a mere five exam rooms for 360 Dermatology and only two exam rooms for Ambay Plastic Surgery.

With a $4,000,000 ambulatory surgery center expansion loan from Live Oak Bank, the Ambays were able to refinance an existing loan for the land purchase, ground-up construction of a facility and new equipment for the surgery center.

“Very few banks will visit you, look you in the eye, shake your hand and go to bat for you. Most banks just look at your PNL and decide about you on paper. I got the loan because Live Oak believed in my vision. Everyone at Live Oak has been amazing, even during the nightmare of construction and later Hurricaine Irma. Live Oak stood by me. Most banks wouldn’t do that,” said Dr. Raj Ambay.

“I am so grateful for Live Oak. In the Army, every soldier has a battle buddy when they deploy to a theater of combat… a person who will stand beside you no matter the hardships. They always have your back. When I came home, I needed a battle buddy for my civilian career. Live Oak had more than just a fancy brochure, commercial or a jingle…. they had my back. Loyalty and honor is everything,” said Dr. Ambay.

“Very few banks will visit you, look you in the eye, shake your hand and go to bat for you. Most banks just look at your PNL and decide about you on paper. I got the loan because Live Oak believed in my vision. Everyone at Live Oak has been amazing…”

Where they are now

Ambay Plastic Surgery & Suncoast Breast Restoration opened their doors on May 20, 2017. In the following months, they were ecstatic with the results. “Patient satisfaction has increased: Every patient has told us they think our new facility is beautiful! Two local newspapers and three television stations have featured our facility. Recently, we were nominated for Business of the Year and Business Leader of the Year,” said Dr. Ambay.

It took them six months to get their surgery center accredited with the state, but since they became accredited in August, their revenues have increased 30 percent just from keeping their surgeries in-house. Because of the facility garnering so much attention, they have had more than 30 surgeons ask if they can rent the operating room for their surgical cases. Additionally, because of the technology in the building, may tech firms have requested tours.

In conclusion, Dr. Ambay stated, “It was a rough time getting the facility open, and we are just now getting our bearing, but we expect the revenues to grow exponentially when we get our stride in the first quarter of 2018. Right now, I am focused on stabilizing our financial revenues and implementing our plan for growth. Then, the only question becomes ‘what next?’”

“Live Oak had more than just a fancy brochure, commercial or a jingle…. they had my back. Loyalty and honor is everything.”

Download the case study to read more about Dr. Ambay’s story and his ambulatory surgery center expansion. To learn more about Live Oak’s healthcare practice loans and our expert lending team, visit our website.