Welcome to Shorr Solutions: The podcast. I’m your host, Jay Shorr. I’m the CEO and founder of Shorr Solutions, a national and award winning consulting firm, assisting aesthetic and surgical practices with their operational, administrative and financial success. I have an amazing team of practice management experts and clients across the US and as an industry expert with firsthand experience owning a multimillion-dollar cosmetic, dermatology and plastic surgery practice.
Listen in as I lend you my expertise and best tips to successfully manage and grow your aesthetic practice. I will also be bringing in guests along the way, so get ready to be equipped to operate your aesthetic practice strategically and profitably. Welcome to Shorr Solutions: The Podcast.
This podcast episode was originally recorded as a webinar with Mohsen and Marzi Ghoreishi. However, we thought the content was so important, we wanted you, our loyal podcast listeners, to hear it as well, we hope you enjoy!
00:01:10:11 – 00:03:15:23
Jay Shorr
Welcome everybody to another episode of Shorr Solutions: The Webinar. And I’m your host, Jay Shorr. I am the founder and CEO of a national practice management consulting firm specializing in the operational, administrative, financial, health and guidance of your aesthetic, cosmetic and plastic surgical and medspa practice. Today, I have the honor of presenting a topic which is very interesting to many people because they really don’t know about it.
And our topic today is What to Look for When Designing Your State-of-the-Art Aesthetic Practice. And today with me, I have two colleagues of mine, Mohsen and Marzi Ghoreishi, and they are the co-founders and managing partners of Kohan Architecture. Now, it’s very interesting because I share the stage and I share the podium many, many times with Mohsen.
But not only is he a colleague, but in the last couple of years, Mohsen and Marzi have really become personal friends of Pat and myself. So it’s very interesting because we look forward to collaborating and collaborating, and sometimes we even share some clients and throw things back and forth to one another so that we’re able to get good professional opinions about what we do that can aid and assist our mutual clients or our individual clients. What’s very important is that I and our team help a lot of physicians and medspa owners open up a practice from a warm shell from the ground floor.
But one of the things that I know very little about is how to design the office, how to do the architectural design of the office, and what needs to go into it. So today, I’d like to introduce Mohsen and Marzi Ghoreishi, the co-founders, and the managing partners of Kohan Architecture. Please, Marzi and Mohsen. Please say hello.
00:03:16:00 – 00:03:27:17
Mohsen Ghoreishi
Thank you, Jay. I appreciate your your invite. We’re very honored to be here to be part of this webinar. And thank you for your professionalism and definitely your friendship. Thank you, Jay.
00:03:27:19 – 00:03:40:12
Marzi Emami Ghoreishi
Thanks to Shorr Solutions and specifically, thanks to wonderful Jay Shorr and of course, your family. It is our honor to know you and your family and you’re such a beautiful person that we admire knowing you.
00:03:40:18 – 00:04:10:12
Jay Shorr
Thank you so much. I’ll give you the $20 bucks when I see you this month at another conference. Thanks. So as we start, one thing I’m always asked, and this is not going to be planned as part of the presentation, but it is a question that I have people asking me, what’s the difference between an architect, a contractor and a designer?
So Mohsen, why don’t you start with what the differences are between those and then I’ll go on to the next question with Marzi.
00:04:10:14 – 00:05:56:14
Mohsen Ghoreishi
The difference between an architect, a designer and a general contractor. An architect has to go to school of architecture and pass a pretty rigorous examination and then do a pretty difficult test, state board test and acquired state license. And also architects can get licensure through reciprocity throughout the entire country and some other countries abroad. The designer is basically a person who has no license in the field of architecture and who also has more than likely no formal education in architecture.
Some do have formal education in architecture, but they have not acquired licensure yet. Therefore, it is imperative to work with a company or a team that is licensed or has licensed architects on board and on payroll, and designer is a pretty big word. They encompass anything and everything possibly that is called design. It’s a very, very big word and anything they can… as far as a general contractor, of course, also general contractor has to acquire a state licensure through the general contractor license board and like any other professional, like the doctors we work with. We all, their license professionals are liable for the work that we do.
And also we are set and bound by certain regulations and ethics, if you will. The general contractor basically takes what the architect designs and is permitted into reality, basically building to spec. And so they are very much complementing one another. It’s very important that both team to be really in sync and work together well to actually make that beautiful office happen.
00:05:56:16 – 00:06:15:10
Jay Shorr
Marzi. Growing up, I always thought of architects are men with big rulers and these angles and these big clipboards, and it was always the men. How did you, as a female, get into being a professional architect? Because I don’t see many of those.
00:06:15:12 – 00:07:14:23
Marzi Emami Ghoreishi
So basically, architecture is a word that you have to have knowledge of design, beauty and creativity. Plus you have to have knowledge of technicality and also some sort of law regards to the construction as an architect, as a licensed architect. So for many people, regardless they are men or women, if they need to get to that professional level, they have to go through a different process.
But I think for a woman, I think this process is, I would say it’s more comprehensive because the ability of paying attention to details, not only creativity parts, is much higher for a woman, I believe, because I work with a lot of women and men. And I would say also is very interesting still, the sense of, you know, managing the whole entire system because the construction requires to have a system from A to Z.
00:07:15:00 – 00:07:28:13
Jay Shorr
I won’t doubt the art of creativity is best served by a woman. Look at my home, which is all has the female touch to it. I stay away from that.
00:07:28:15 – 00:07:32:17
Mohsen Ghoreishi
Can I add something to that?
00:07:32:19 – 00:07:38:07
Jay Shorr
Sure. This is a family show, Mohsen. I know you.
00:07:38:09 – 00:08:29:20
Mohsen Ghoreishi
What I wanted to say is, anybody can build a building. Anybody with a hammer and a nail can build a building. Architecture is not steel, is not bricks, not mortar. It’s how you put these elements together, where it brings that feeling and emotions that you as a client are after. Okay, that is what architecture is. And that’s why it’s so different from construction, because a contractor can put brick on the top of each other and make that building happen.
But the actual architecture is putting those elements together to bring that emotions that you are after into reality. So when you walk in to that space, you feel that is exactly how you wanted to feel if you were the architect. And that is all it is. It is easy to say, but really is very difficult.
00:08:29:22 – 00:09:16:20
Jay Shorr
Right. Marzi, what are the most important steps to take when starting to build your own practice because we specialize in aesthetic, cosmetic, plastic surgery, medspas, dermatology office, facial body, plastics, cosmetic, plastic, gynecology. Most of it, if not all, is fee for service. They may have insurance based, but what steps and what are the most important steps to take when starting to build their own practice? We’ll take care of the operational, administrative and the financial part of helping a doctor or a service provider build a practice inside the practice. What are your first steps in helping them to build that warm shell or just square room with nothing?
00:09:16:22 – 00:10:15:24
Marzi Emami Ghoreishi
So as we know, construction is a very complicated process. So basically what we start with our clients, we ask them a lot of questions, and three most important questions for them is, okay, what is the situation that they have specifically? about their timeline and more importantly about their vision that they have, and also that vision. You also help them a lot to have their vision set up.
So the other item, which is very important because that’s the reality on fact, is a budget. So before we start anything, we talk with our clients about all these three important items in detail and make sure they are all set to go. So another thing that probably is very important here, we need as part of the vision, I think that’s the accreditation that our clients are pursuing to achieve. And this is one of the other main factor that basically they need to consider.
00:10:16:04 – 00:10:26:19
Jay Shorr
All right. What factors, when you are first designing that building, for example, how do you determine suitable square footage for the desired facility, Mohsen?
00:10:27:00 – 00:11:59:04
Mohsen Ghoreishi
That is a really important question because a lot of people, they just follow their friends or they’ve heard we can add for build two ORs 5000 square foot or what have you. But the most important thing, again, like Marzi said, it is important. What is it that goes inside the building? And more most importantly, what kind of accreditation you are going to get. If it’s going to be a, you know, quad-A-SF (AAAASF), triple-A-HC (AAAHC), if it’s going to be a state licensed facility.
The square footage changes if you go one way or another. And really, for a physician who is doing this for the first time, they really need to dig in and realize what is it that they want to build, What is their vision? like Marzi said. And that means what goes inside the building. So the architect can assess the number of square footage required where they can actually build it rather than it be lesser than they need.
We have quite a few examples. Doctor in Texas had 2500 quare foot and he wanted a state accreditation facility and they already leased it. And guess what? They couldn’t do it and they had to go through the process of returning the building. But if you consulted an architect who knows what they’re doing, and more importantly, the architect has to guide the client to really dig into their mind and see what goes in there and to guide them.
And then before you even purchase a building, before you lease a building, before you look for a building, realize the square footage.
00:11:59:06 – 00:12:34:00
Jay Shorr
So sometimes it’s really important, Marzi, to even hire an architect to tell you not to do it. I always tell a prospective client that sometimes the best money that you can spend is to hire me to tell you not to do something. Because although it might be a few thousand dollars, $5,000, $10,000 that you might feel was a waste, it was an investment to help you not lose hundreds of thousands or millions in a contractual commitment.
What would you say to that as well, though?
00:12:34:00 – 00:13:52:18
Marzi Emami Ghoreishi
Great point, because we don’t know what we don’t know and more due diligence that we do anyone. We do that before starting any project that is more beneficial and that’s the best investment we can do for our practice. For example, I would say a doctor come to us and said, okay, I found a sweet 2500 square foot. They told me that they can fit two rooms or three rooms in there and this is the lease or in our buying situation.
I’m going to go for that. So something that also comes to the play and also I’m sure you basically help your clients to see that some of these people doesn’t have a growth forecast, so they start a project, but the time that they finish, they are in the full capacity that they cannot grow and all the effort, time and money they spent, so it is not worth it for a long time process, which this is one of the situation that, for example, we said no doctor, this is not a good place or is not a good situation for you to starting even the construction. So I know there are a lot of stories about a specific problem that a space may have or a specific restriction and, you know, limitations that the space may have, which we can help them.
00:13:52:18 – 00:14:19:13
Jay Shorr
So Mohsen, from what Marzi just said, within a very short period of time, you can outgrow that facility that you have spent a lot of money in and you can’t grow into something larger. Right? So is it your recommendation to share with the client or prospective client that don’t do it here? Maybe you need 3500 or 5000 square feet or maybe not do it at all?
00:14:19:16 – 00:14:23:14
Mohsen Ghoreishi
Absolutely. We have said that many times to our clients. In fact.
00:14:23:16 – 00:14:50:15
Jay Shorr
What about the electrical? Is that yours or is that a contractor? Because when you go in and you ask, what type of HVAC are you going to have, you might need double phase or you might need, you know, 110 on major regular outlets, but then you’re bringing in some lasers that need 220 and what is the amperage load? And is that you as an architect or is that the contractor, the electrician?
00:14:50:17 – 00:16:26:24
Mohsen Ghoreishi
When an architect takes over a project from the get go, the architect is responsible to accumulate all those informations. So basically we approach the building owner or manager or actually whatever and try to get as much information we can get and we accumulate those informations, we provide to our engineers mechanical, electrical, plumbing engineers. This is before even a contractor comes on board.
This is before, before even you sign on the dotted line as how many years are going to lease or purchase the building because there is certain criteria. We already know by experience how much power you are required to have, what are the domestic water, sewage, what have you, all the infrastructure that you need. We know what you need. So we will provide the list of information to our clients and say, okay, guys, if you’re going to go look for a building, you need to have these things in there. And if you don’t have it, you need to go ahead and make sure the landlord provide it for you. That’s definitely is the architect’s responsibility. The architect provides all of that. Then when we go through design process. The engineers use those informations to create those drawings that are required to pull a building permit and also get the certification.
Eventually it reaches to the contractor. So really the contractor gets all the information as a package within our drawings. Unless the contractor is upfront, and he or she is the one who hires them. So that means there is another way of doing this where the contractor is in the front and architect is working for the contractor, not directly for the owner.
00:16:27:01 – 00:16:29:12
Marzi Emami Ghoreishi
The engineering part will be part of that.
00:16:29:14 – 00:16:56:22
Mohsen Ghoreishi
Yeah. And what that means is the architect consults the contractor and engineers consult the contractor. There has to be a quarterback. The normal practice is the architects is the quarterback for the project and it all is done uncompleted and then goes to the contractor either for bidding process or for actually if you had a dedicated contractor for building process. So there is a couple of ways to build a building and it all depending on where the players are.
00:16:56:24 – 00:17:20:07
Jay Shorr
Marzi, from what I’m hearing, So when is the right time to bring a contractor in? When I see a property before I sign the LOI or after I sign the lease, when I mean, I don’t want to put the I don’t want the tail to wag the dog or put the cart before the horse. When is the right time to bring you in?
00:17:20:09 – 00:18:27:23
Marzi Emami Ghoreishi
So for the architect and team of engineer, I would say before even you have if one conversation with your broker or your real realtor. So please involve the professional engineering and architectural team to be able to look into the infrastructure and also the team of people that help you to see if that space fits your needs and, you know, your growth and other factors.
Because we’ve seen a lot of situation that when we face with the building that the client already signed a lease and they didn’t know about, for example, the structural system of the existing building, that was the factor that impacted on their budget and construction cost a lot because the amount of quarrying, the amount of dealing with HOA, the amount of time needs to just do and preparation for the infrastructure was so much that it really cut a big bunch of their budget and they didn’t see that at the beginning. But an architect and team of engineers, they could help them.
00:18:28:00 – 00:19:10:12
Jay Shorr
So is that something that the doctor or the provider, a nurse practitioner, a physician assistant, when they’re going to go in, is that something that they would bring in somebody like you for a consult fee? All right. Saying, okay, I’d like to have a consult. I’m not ready to do the full architecture because that’s a lot of money.
That’s an investment, but maybe have a consult. And for you to tell me A, move on or move out and B, if we move on, this is how much it will be. And if you move forward, we’ll put the consult fee towards the fee. That’s how every… usually everybody does it. Is that how it works?
00:19:10:14 – 00:20:12:15
Mohsen Ghoreishi
If I may continue on Marzi, (Marzi: Yes, please.) Yes, it does. In fact, that’s what’s called programing slash pre design process that architects do handle that portion where it’s just a whole separate agreement, small agreement with the owner to do due diligence to do the upfront work and normally, normally we involve our general contractors. Probably we involve our trustee general contractors to get feedback. That also includes the budgetary because the owner needs to know not only about the building infrastructure ability to build this and that in there, but also if he can afford to build it and what is really so costly.
So we do the programing, predesign, infrastructure evaluations, maximum potential use of space and the actual ability to use what’s required to do in this building plus the budgetary item all in one package. So if they’re serious about the building, if you will, it makes sense to do that in order to really achieve what they want to do. Upfront work is everything.
00:20:12:17 – 00:20:57:19
Jay Shorr
I totally agree. So let me ask you, in a perfect world, it’s a perfect world, but we all know it’s not. All right. So can you give an example of mistakes that you’ve made and mistakes that clients of yours have made? Naturally, some of these mistakes that you make, you may only make one time because they may have been so costly.
You know, that’s not going to happen again, whether it’s getting involved with a specific type of a client. All right. Or what mistakes have clients of yours made? Let’s give an example of both. Oh, let’s ask Marzi first.
00:20:57:21 – 00:22:01:12
Marzi Emami Ghoreishi
Okay. So I think one of the mistakes that I always say we just made and is not going to happen again when we realized the client, they are changing stuff without letting us know during the construction and we had to exit from that contract. So I would say honestly, the construction team, including the architect, the contractor and the client, is the triangle of power.
If you remove one of those corners, your project is going to linger for any reason that you can see and yes, the mistake that our client made was basically feeling that they have to take over and they deal directly with the contractor and that costs them a lot of money and headache, not only money, headache, which I would say, yes, you feel or you think that you can do that because you can do that, but it has a specific process that you need to go to that. And this process is very, very important to protect you.
00:22:01:14 – 00:22:58:11
Jay Shorr
Now, Mohsen, I built two offices and surgery centers and three houses, and I didn’t do it. I hired people to do it. When I say I built for those of you who are listening, you don’t ever want to live or walk inside a building that Jay built. Okay, So with that being said, the one thing that I share with a client when they’re ready to undertake this and this happens all the time, they are moving out of their rental and they want to now build the surgery center.
They’re moving out of their five year or ten year lease and they want to go buy a building. And the first words I say to them is, you’re not going to come in on time or on budget. And they laugh at me. And during the process they all come back and they laugh at me again because I was.
00:22:58:11 – 00:22:59:10
Marzi Emami Ghoreishi
Right, right.
00:22:59:15 – 00:23:34:05
Jay Shorr
Right. And they say, you know, I remember the day that you told me. I said, it’s not to tell you anything not to do it. I’m just telling you five times, two offices, two surgery centers and three homes. They never came in on time or on budget. Whatever the infrastructure was.
Mohsen, why, first of all, does that happen? And you can’t prevent it because I’ve never seen it prevented from myself five times and clients over and over again. How do you minimize it on time, on budget?
00:23:34:07 – 00:25:05:11
Mohsen Ghoreishi
Yeah, I always tell our clients, let’s minimize your risk factor. There is… like there’s people call it bulletproof. There is no such thing as bulletproof because somebody may have a bigger gun. Construction is a beast and it it is a lot of variables involved within construction and there is way too many variables and too many people who are working on construction.
And every project is very different. No matter how many buildings you design or built, every project is different. It’s not a pen that you manufacture in massive amount. Therefore, because of its variable nature, there are complexities and there is always a contingency you have to put in for budget and time. So showing a rosy picture to a client is an awful thing.
I always tell people, always estimate a couple of extra months for yourself to not get frustrated and also based on our professional practice and the standard of our industry, usually at a 10 to 15% contingency on design and also on construction, and that’s about the maximum you want to put in there. So that money is there if in case you need it.
And also I would add time. COVID told us a lot. It destroyed everything we had known in life, and I think people learned their lesson until they forget about COVID. Then everybody wants everything on time and budget, which, as you said, it never happens. But 10 to 15% on budget and time is something we normally assess. Of course.
00:25:05:11 – 00:26:46:18
Jay Shorr
Time is one thing, but 10% on a budget, you know, when you’re at a couple million dollars, couple of hundred thousand dollars is a lot of money. Hopefully, you can get that in the T&I or tenant and improvement from a landlord if you’re renting or the owner of a property if you are buying. But that leads me into my next question that how do you accurately determine a real budget for the project?
Because Marzi, you mentioned that about 20 minutes ago budget when you go in, you ask a client, what is your budget? Well, how do you accurately determine the real budget? And let me tell you why that term scares me personally. Because when I ask that question, when somebody’s ready to open up a medical practice and they ask me, can I help them, I say, Well, of course I can help you.
They didn’t ask, Can I make it perfect? Because on my answer is always going to be, I can’t make anything perfect. All right, but I can help you. My main thing is they come back and they say, Well, if I give you my budget, maybe your price will be contingent upon the budget that I give you. And I say no, It helps me in determining Do you want prices from Bloomingdales?
Do you want items from Macy’s or do you want items from Target and Wal-Mart? They may all be the same. They may look alike. They’re not always the identical quality. And that price determines a sink Is not a sink. Is not a sink. Yes, they’ll all have running water from the faucet and they’ll haul the drained going out to the sewer line. So how do you help somebody determine what a budget is?
00:26:46:20 – 00:28:19:12
Marzi Emami Ghoreishi
Which basically takes us to the beginning of the conversation we have with the clients. And it happens a lot of time that basically for us as an architect, we have to assess the budget for the project or the financial basically resources that the client has to be able to make sure if the project can happen or not and happens actually, for example, 90% of the time we have an accurate, actually we have a number that we walk around that and sometimes our clients, they don’t have a clear budget, which is another situation that may be problematic.
But then we have a budget from the client, then we work around the budget and we provide and develop the drawings and the spec and working constantly with the contractor, with the kind of perspective contractor or trustee contractor during the design phases of the project to make sure we are in the realm of the number that we start with.
And as Mohsen said, just budget time or budget or sometimes unforeseen situation at the construction site that happens, that also impact on the basically construction cost. When we do have more information during the design and less questions during the construction, you can achieve more realistic number before you start the construction. And that happens when your specification and your drawing is more detailed.
00:28:19:14 – 00:28:33:01
Jay Shorr
Sometimes you don’t know what something is going to look like until it’s up. How many times have you heard move this wall? I want a door here. I want a window there. I didn’t think about that then. What happens then?
00:28:33:01 – 00:29:34:07
Marzi Emami Ghoreishi
Not we have not heard that because the reason is, there’s a reason for that. We have a very, very extensive process of design and we spend a lot of time and energy and back and forth with our client to make sure really what they have on the paper is something that they’re going to get. And we provide them with the different, you know, tools that they can see the space, for example, 3D renderings or, you know, VR walkthroughs or stuff like that, that they can see virtually their space, how it’s going to look like. In regard to the detail and thought tuning finding.
So basically, sometimes the client ask, would you, instead of having this shade of gray, I would like that shade of kind of more brownish, which that’s a fun part of that because we’d always accommodate our clients. But regarding the layout and flow and use of basically, I would say, a space, we didn’t have that experience so far.
00:29:34:09 – 00:31:02:10
Jay Shorr
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00:31:02:12 – 00:31:20:18
Jay Shorr
Good. All right. Mohsen, this question is for you. Because I know how proud of an architect you are. So what sets your designs apart from one another that ensures that their unique and not just simple cookie cutter creations?
00:31:20:20 – 00:32:50:02
Mohsen Ghoreishi
Oh, that is. Yes, that’s one of my pet peeves on that. Ever since we established the firm, we’d been practicing that. When we start talking to our guys immediately they tell me, for example, I want it really modern but not too cool. I really like it warm and not too too classic. And make sure everything is clean with fine lines. And these are words that we hear but we have no clue what kind of story is behind it, because everybody has a story behind what is not cold or what is not too warm. So what we have, we have a process that we go through.
We go through our clients head and see the world through their eyes. And that process is about three and a half hours meeting with our clients and reviewing and dissecting many pictures, many photos, asking very detailed questions. And the process is quite fun. We see what eventually they see in their head and they no longer, when they tell us they like something modern but not too cold.
We know what that cold means or we know what that modern means. And if we were to buy them a birthday gift, we know what to buy them to put a smile on their faces. It is at that time it is at this time, we can actually go ahead and start creating that space where actually when they go into that space, they can feel the way they… were It is modern, but not too cold, and that is a very important process.
00:32:50:04 – 00:33:43:14
Jay Shorr
Now, when I look to buy something or look to deal with a contract or even when a patient goes to pick a specific type of a surgeon, everybody looks at letters after their name, me included, different type of certifications you mention. For those who don’t know, the accreditation for surgery centers or quad-A-SF(AAAASF), or triple-A-HC (AAAHC) or whether you’re going and you’re picking out a doctor and it’s FACS and he is a fellow of this organization.
But architects also have the same thing. Yes. So my question to you is, can you explain the various types of accreditations and certification, the distinctions real quickly between them? So when somebody is looking at an architect, I want to know what are all those fancy names and accreditations distinctions that you guys have.
00:33:43:16 – 00:34:49:23
Marzi Emami Ghoreishi
So basically, first of all, an an architect is a licensed professional and then the one that they can practice nationally, they have their accreditation as NCARB that they can practice all over the country. So besides that, there are few accreditation, but the architecture is more of a specialty. So some architects define themselves as a specific and specialist in the field of healthcare, for example, some of them, they do more commercial buildings, some of them they are very special in residential.
One thing that is important is they go to the architect, that they have a good portfolio of the healthcare project. If they want to start with their basically project. And they’ve done different skills of the project because you know what? There is a phrase that I’ve been there, I’ve done that. So they can tell you a lot of other stories from other experiences that would help you to basically understand your situation much better. So I would basically go to the architect that they are specialized in healthcare.
00:34:50:00 – 00:35:29:22
Jay Shorr
All right. Now, Mohsen, this question is for you. When we talk about accreditation for surgery centers or office space surgery centers and surgery suites, there is state certification. there is triple-A-SF (AAASF), There is quad-A, HC, there’s a few others. What ways do these accreditations play and how do they influence construction budget and how do you get to know what each one of these surgical certifications really require in all the different states? Does it influence the budget?
00:35:29:24 – 00:37:18:24
Mohsen Ghoreishi
Yes, it absolutely influences the budget. That’s why it is, again, another conversation from the beginning of the design process or even before selecting the building. Because if a doctor is looking to let’s assume have 2 ORs where he is going to get Medicaid or Medicare insurance from… money from government, and then have to have the SC or state certification, that becomes quite cumbersome and that requires a lot more square footage that comes with a whole slew of requirements that they… they have to put into the building.
Meaning if you were to do a state certification and with 2 ORs, you need probably about 3800 square feet, 4000 square foot, where if you did the office based certification where the doctor just got cash or just got a credit card and not any insurances, you can handle that at 2500 square foot where you see is about 1000 to 1500 square foot difference in square footage because your… has got to get wider If you do a state certification, your number of pre-op post-op changes and a lot of other electrical mechanical things changes where it adds to the dollar amount you build that construction. So it is imperative to really know, again, back to vision, what do you want in there, are you going to get insurance? Are you going eventually bring physicians on board to surgery that they’re actually going to get an insurance?
Are you going to rent your OR to another physician or no, you just going to do plastic surgery or any surgery without using insurance and you go office based less money, less a square footage, that’s for sure. So, yes, it does impact dollars and square footage.
00:37:19:01 – 00:37:39:09
Jay Shorr
Sometimes I tell a client of mine who wants to build the surgery center, you can save money in the time of the travel in between the cases. But I don’t know if you’re really going to recoup your money back of what it’s going to cost you to build your own. Volume is key. That’s the only thing that’s going to work your way out of it.
00:37:39:24 – 00:37:54:05
So, Marzi, what costs and what causes cost variations in buildings with the same square footage. Why isn’t 5000 square feet the same as 5000 square feet? What will cause that variation when you go into a building?
00:37:55:01 – 00:39:03:10
Marzi Emami Ghoreishi
Anything that you can touch and feel has a different price tag to that. I would say the finishes is something that first you see and you see that sometimes the clients, they become so, so attached to some sort of finishes which sometimes they cannot afford that. And we have to give them the very, very clear and direct suggestion.
The other thing is infrastructure as Mohsen said. For example, the HFACS system for a ASC accredited facility is much more expensive than a HFACS system for a… for example, triple-A-HC (AAAHC) accredited facility or when you go, for example, for the requirement of the generator or backup power and stuff like that. Those are big numbers and those are big things that we need to basically consider.
But yes, 5000 square foot and also sometimes I would say location, the cost of labor andconstruction in California, it is not comparable for the cost of construction in other states that we work. So you need to consider all of these factors.
00:39:03:12 – 00:41:08:07
Mohsen Ghoreishi
May I add something? (Jay shorr: Sure!) I have a little analogy, and I think I use that in my talks. I probably think, Jay, you’ve heard that. You you’ve looked at, let’s say, a pancake, right? A square pancake or a round pancake. Right? It’s very simple. Everywhere you turn it around, it’s all the same. You could cut it. It’s all the same, you pull it out. This is no matter how many slice you make, it’s all the same. Right? And that is, let’s say, eight inches around pancake. And then you go and this is elaborate. Awesome. I don’t know cake that has got this. You’ve seen it. I’m sure online you can have it. And then it’s also an eight inch round cage. But darn it, that is a whole hell of a lot different from that pancake, relatively speaking, you’ve seen Hampton in hotels is four walls and a roof period.
Four walls and a roof easy to build, easy to construct. And it is typical that you can build it, hundreds of them and it’s pretty interesting. And that’s 5000 square foot Hampton and it’s got a price tag on it. Then you have another 5000 square foot which every turn you make inside and outside is absolutely amazing. It’s got elaborate canopies, it’s got elaborate window, window dressing, and carpet walls and rooflines and what have you.
Now. Now, this is really important. The doctor who a 5000 square foot building comes to me and says, How much per square foot? I have no idea if he wants a Hampton Inn or he wants that pancake or he wants that real cake. I have no idea. And then I give him… and then I try to understand that before I prepare a proposal or tell him how much per square foot is going to cost him.
Because then again, architectural fees are based on that, right? So he gets those numbers from me and he calls another person. Now, what are the chances that I gave him the price for a real interesting cake and the other guy gave me the prices for the pancake? All of them were 5000 square foot.
00:41:08:07 – 00:41:12:22
Jay Shorr
I think the chances are very, very good. That’s going to happen.
00:41:12:24 – 00:41:20:17
Mohsen Ghoreishi
So the cake is a good analogy and I use it all the time and I say, let’s figure out the cake first before we can even touch the prices.
00:41:20:19 – 00:41:24:11
Jay Shorr
But doesn’t that all come back now, full circle, Marzi to budget?
00:41:24:13 – 00:41:25:09
Mohsen Ghoreishi
Yes.
00:41:25:11 – 00:41:26:11
Marzi Emami Ghoreishi
Absolutely.
00:41:26:13 – 00:41:40:15
Jay Shorr
You know, both a Kia and a Maserati are both going to get me to the same location. They’re… You know, both have four wheels and a steering wheel, but they don’t have the same amenities. All right.
00:41:40:17 – 00:41:41:04
Marzi Emami Ghoreishi
Yes.
00:41:41:09 – 00:42:09:03
Jay Shorr
All right. So we’re going to move on. What are the fundamental principles and techniques for achieving an innovative and visually striking interior and exterior designs in a practice? I have seen some of your designs, Mohsen and Marzi, and they’re just absolutely gorgeous. But what are the principles and techniques for doing that? I have great taste. I may not have your budget, but I have great taste.
00:42:09:05 – 00:43:40:05
Marzi Emami Ghoreishi
Yes. And actually, that’s what we are here to help, because as we know, we have a specific… as a client. Client has a specific budget and specific property or place or I would say as a street… or tenant improvement. They have a specific specific area to work with. And our job is to basically investigate through their minds and see really if they are a Maserati client or they are okay with Prius.
But what I’m saying that we have different tiers, so we have different tiers that can serve any person that they have. You know, with a specific criteria such as budget. We know this client, they need to get from A to Z, They need to be able to open their practice and we are going to work with their budget and make sure what you specify, how we design and also construction technicality is aligned with those criteria that we set up at the beginning of the project.
So some of our clients really they are Maserati clients and they cannot accept anything less. And this is very different process and we understand that. Some of our clients, they are very, very comfortable with something that, as you said, getting them from A to Z with Prius, which is a very, very, you know, cost effective car. And we also need to get them from A to Z. So I would say we have process for the variety range of the budgets.
00:43:40:11 – 00:44:15:09
Jay Shorr
All right. So Mohsen let’s compound on what Marzi just said. So how can a professional in the aesthetic industry create an inviting and memorable space that enhances their brand perception while still ensuring functionality and client satisfaction without having that typical Greek statue or without, you know, as I say in the aesthetic industry, when I see people and they’re advertising, without this, all right, this is the same as the Greek goddess that I see when I go into a facility.
00:44:15:11 – 00:44:22:00
Mohsen Ghoreishi
I love the way you ask questions, Jay. You’re very elaborate. I love it. It is…
00:44:22:02 – 00:44:25:14
Jay Shorr
You think I’ve been into an office or two, right?
00:44:25:16 – 00:44:26:11
Mohsen Ghoreishi
Yes. Of course. Yeah.
00:44:26:14 – 00:44:28:14
Marzi Emami Ghoreishi
Yes. I am sure you have seen a lot.
00:44:28:16 – 00:46:13:15
Mohsen Ghoreishi
And that’s the reason. You see, the walls are full of portraits and the countertops are full of business cards and pamphlets and so on and so forth, because every turn you make, the doctor does not really feel what she or he needs to feel. That’s why they try to fill up those walls with stuff so that maybe they get that feeling and that is back to vision again. Circle back to vision.
It is the art of architecture. It is the art of creative person as an architect to bring those walls and countertops and floors together so that you do not need to add any more portrait on the walls if you have… Leonardo Da Vinci gave it really well. The body of a human, right? If you have a well trained body, fit body, you can have it naked or dress it, It looks awesome. Regardless because the muscles, the body style, everything is perfect. But the moment you abuse that body, the moment you design that building wrong and you don’t put creativity and beauty in it, you have to dress it up with portraits. So if you want to ask this from a doctor, why did you put the portrait?
They may not be elaborately answer you this way, but deep down, if you are a psychologist, you can say, Let’s go have a sit down. Because this skeleton is not right. So that’s the art of architecture. And that goes back to the vision that the architect needs to really decipher and figure out and pull it out of the client’s brains and bring it to reality with design.
00:46:13:17 – 00:46:55:03
Marzi Emami Ghoreishi
Also, I want to add one thing to what Mohsen well said. It’s the architect also needs to think about another aspect of the business, which is branding. So what that space brings to the client or patient mind to differentiate this space from in many other competitors and this branding basically is not only digital branding or marketing, it’s not only, you know, the act of person at the reception desk and stuff like that.
Also, the unique feeling of the patient when they are in that space and basically that’s how they set them separate from the other facilities.
00:46:55:05 – 00:48:34:23
Jay Shorr
It’s good. This brings me to one of our last questions. You led me right into this. So as an architect, how do you effectively integrate both the form and the function in your design of the esthetic practice? And what implications does this have on the workflow and overall patient experience? People never think about the patient experience, all right?
Because when I go into anywhere now look, my patient experience when I go into my primary care doctor’s office or my orthopedists office or my urologist or my cardiologist that have the wooden tables, they don’t have the mid marks. I’m not picking on any of the others. They don’t have the pneumatic, they don’t have the electric. They have the wood, all right, with the vinyl top.
And they had the little drawer or the space for the table paper underneath. I don’t really care because I’m going to my primary care for my checkup or I’m going to my orthopedist for a bone or muscle problem or cardiologist to make sure my dick is working properly. But when I go to an aesthetic or cosmetic physician, it matters.
It really, really matters. Because when I look how that office looks, that office, it’s kind of like a look at my face. All right. And I’m sure other people do. So once again, how do you effectively integrate the function and the form to overall the benefit and workflow, or with the all patient experience? People never talk about the patient experience. So you just did so elaborate on that as we closed.
00:48:35:00 – 00:49:59:00
Mohsen Ghoreishi
You have to be very experienced, creative. You have to really understand the functionality of the practice. That means, like I say to everybody, we are one inch wide, 100 miles deep. You cannot be a jack of all trades if you really understand every move the doctor makes, every move the patient makes, every move the providers within a practice make.
That means, you know, by heart, everything they do every day, every second. And you understand the path of travel for patients, for the providers. And then you understand building technology and you add your creative part and bring that emotion, that feeling into it. And combine all of that, like I said at the very beginning, the more layer, the steel, the tile, the wall paper, they are not architecture, they’re just elements we put together and flow and functionality is what you have to learn and know the practice.
That’s why you need to be in it to understand it. You combine all of that, then you can create an amazing space which has a great flow as a great patient experience and it’s efficient and you last for a very long time. You have to just be talented to do that. It’s not easy.
00:49:59:02 – 00:50:27:20
Marzi Emami Ghoreishi
It is not easy. One thing I just want to add quickly, our job is not only of being an architect. Sometimes our clients, they don’t know what they need. And our job also is to consult with them. That doctor. This is a good way to go. This is not a good way to go. So that’s why I think going with the architect that is in health care is very important to give good advice during the design and that matters.
00:50:27:22 – 00:50:50:11
Jay Shorr
You led me right into my final question, like you knew where I was going. But my question is, how did you get in to not just health care, but how did you get into this beauty business? I would understand how Marzi got into it. But Mohsen, how did you get into it?
00:50:50:13 – 00:50:56:18
Mohsen Ghoreishi
I will give you an answer at dinner. But here…
00:50:56:20 – 00:50:58:11
Jay Shorr
It’s a family show, remember?
00:50:58:15 – 00:52:11:14
Mohsen Ghoreishi
Yes. Yes. But the health care, beauty and aesthetic architecture is very important. Aesthetic business is very important to me because I’m a very passionate person when it comes to designing buildings and environments. And I used to do a lot of public health agencies where less privileged people used to go, and normally most of them look like a dump. I felt bad, really bad for those people, and I started to dedicate my private practice to public health agencies and start designing those because I wanted to bring something more respectable, something that fosters respect to those type of practices because it involved people who are sick and also the staff who really work there.
It’s both of them, the team of… so and that led to doing health care facilities and eventually you cannot really implement the passion that I had into, let’s say, a General Hospital, if you will. So the private practices that we design now, the doctors we work now, patient experience is very important. And by that I have the ability to provide that patient experience and put in the passion I have into design and the artistic factor that goes into a space.
00:52:11:19 – 00:52:18:14
Marzi Emami Ghoreishi
I think it’s fulfilled that creativity part of the work that we always wanted to offer to our clients, right?
00:52:18:15 – 00:52:24:00
Mohsen Ghoreishi
And that is very, very satisfying. And when you have a beautiful wife like Marzi that you have to create beautiful things.
00:52:24:02 – 00:53:42:22
Jay Shorr
You know, that’s why I said I understood how Marzi got into it. I just understand how you got into it. Right. So in closing, I’d like to throw up a slide that shares your contact information and also your social media handles and your website so that you can share this with the people that are going to be listening to this.
We will then have this on our podcast. So there it is, the info@Kohaninc.com All right. That would be their email. And Kohaninc.com is their website and all of their social media handles are @TheKohanGroup and @The Kohan Group Inc. for Facebook and LinkedIn. Naturally, you can see ours. You can contact me at jayshorr@shorrsolutions.com, solutions, plural, because we have more than one solution.
Our website address is www.shorrsolutions.com and our social media handles on all the social media channels are @ShorrSolutions. So once again, Marzi and Mohsen Ghoreishi, thank you very much. It is an honor and a pleasure to be your friend.
00:53:42:24 – 00:53:44:07
Mohsen Ghoreishi
Likewise, thank you Jay.
00:53:44:09 – 00:53:45:13
Marzi Emami Ghoreishi
Thank you, so much.
00:53:45:15 – 00:55:18:15
Jay Shorr
Ladies and gentlemen, thank you for sharing a little bit of your time on Shorr Solutions: The Podcast. Until next time, I look forward to hearing and seeing you once again. Good luck. God bless.
So that wraps up today’s episode of Shorr Solutions: The podcast. If we mentioned any website links, you can find them in our show notes to work directly with me and our award winning team of consultants to increase efficiency, increase revenue and decrease costs in your aesthetic practice, schedule a free consult with us today.
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