Women's business

Health conditions don’t happen in neat categories, although we often treat them like they do. Even when a practice says it specialises in the needs of a group of patients, frontline medical services are often built around the training and skills of the doctor who owns it. That was something psychiatrist, Dr Gaurav Tandon had always been aware of, but a dinnertime discussion with his partner, Hema Prakash, about the challenges female patients face during menopause led to the start of a new, and different, type of practice.

“We were at a restaurant called Enoteca Ponti,” he recalls. “Hema was reflecting on how she and many of her friends found it hard to access appropriate help for problems associated with menopause and peri-menopause. Problems like long waitlists to see an appropriate doctor, and how often a patient may feel unheard with their concerns, or the doctor may not have the adequate time for appropriate assessments. On top of that, in my private practice, I was also seeing an increased number of women being referred in this transitional age, with a variety of challenges. And we thought, ‘Why not put our money where our mouths are?’”

Career moves

If starting a clinic for perimenopausal and menopausal women seems a little outside the remit of a psychiatrist, it’s not a big leap for Dr Tandon, whose philosophy of treatment is built around the individual. 

He started out, many years ago, as a paediatric registrar, but realised his real interests lay in learning about people; “their stories, their histories, and getting to know them and matching that with what was happening in a medical sense. I was interested in the interactions between the environment and the biology of a person.”

One of his final rotations during his basic paediatric training was in the children’s mental health ward at Westmead Hospital, an experience he found engaging and inspirational. It cemented his interest in psychiatry, and, after a brief break, that was what he pursued.

Psychiatry’s embrace of a biopsychosocial model of assessment and treatment sat easily with his interests, and Dr Tandon could also see similarities with his previous training. “Some of the people who I've come across would remind you that perimenopause is just like puberty, in that it’s a transition period,” he says.

“My job is sitting, learning, hearing and observing changes. It involves taking into account a person's environment and their biological requirements. It is actually working with changes in women, around their transition periods.” 

The science is also captivating. “I've always been interested in learning new things, and certainly the impact of the neuroendocrine aspects of hormones is something that we're rapidly learning a lot more about.”

Dr Tandon’s personal approach to treatment has always been to treat a person’s function rather than their symptoms. “So let's just focus on medication for the moment,” he explains. “If we don't think of medication as a panacea, but instead, as a scaffold on which we can build other measures of success, that's where we find the treatment approach is working better than the medication in isolation.”

To treat function, he realised, you can’t do it in isolation. If you’re going to build an ideal medical practice, then you also need the ideal team for the patients of that practice.

The Ponti Project

On the back of a napkin that night at Enoteca Ponti, Dr Tandon and Hema started sketching out ideas for what they called ‘The Ponti Project’. Of course, other women’s health practices existed, but for this to be different it needed to take a very patient-centric approach to care. “We wanted to create a comfortable safe environment
that is spacious, that has light, that is actually inviting and feels that, ‘Yes, I'm comfortable and I can sit here, and I feel that I'd be heard’,” he says.

The practice would need a primary care physician, someone who would get to know patients well and spend significant time with them. “My approach is to use medicine as a scaffold, whilst allowing other aspects to work,” says Dr Tandon. “So we started thinking, what would be those other scaffolds? 

We thought about nutrition, particularly about the specific needs as women grow older, their loss of bone densities and so on. An ideal practice then should have a dietitian, a physiotherapist and an exercise physiologist. It should also have expert input from an endocrinologist, from a gynaecologist, and they would then all work as a multidisciplinary team.

Dr Tandon’s role is being one member of that team. “I'm very much in the back seat at this new practice,” he explains. “The primary seats are taken by our primary care physicians, our allied health and our other specialists.”

A business is born

But perhaps their strongest insight was that they needed someone to help patients navigate their way through their own healthcare. “Women in that age group, in that transition time, are time-poor, often with children, parents, husbands, partners, and they tend to not prioritise themselves."

So they wanted to create a position of ‘practice concierge’, who could keep track of different specialist recommendations and close the loop on any questions the patient might have. “That's what the model of Ponti
Health came along as being, where I came in with my medical wish list, Hema came in with all of her non-medical, yet really important input in regards to patient flow, patient stimuli and patient experience. Ponti is a confluence of these two ideas.”

The couple set about finding a suitable premises. “The first challenge was finding the right place that was accessible enough, where people can actually use public transport, and don't have to drive across the city to come,” says Dr Tandon. They eventually came across an old fabric warehouse in Surry Hills, in what used to be Sydney’s fashion district. But that was merely the first challenge.

“Running a medical practice is not cheap. There are all sorts of consumables. Then there's indemnity, insurance, electricity. Then there's electronic medical records, which you need to make sure are safe—all sorts of things that the general public does not realise add to the cost of seeing a doctor.”

At least finance wasn’t as big a challenge as it could have been. Dr Tandon knew Avant Finance’s Daniel Pike already, having secured a home loan from him previously. Avant provided him with indemnity insurance, and their responsiveness and provision of timely and good medical legal advice, especially with the work he does, instilled a level of confidence.

“Daniel's been absolutely exceptional,” he adds. “He understood exactly what we wanted to do. He actually spent some time, came in, sat with us over an evening, we took him over our ideas. It really was helped by the fact that Hema comes from a private equity and finance background, where we had a model which had been worked on by an actuary, and they'd gone through all the business modelling and all the projections and everything else, and there was a very solid working document in the background of all of this. Daniel understood exactly what we wanted to do, and it was a really, really fascinating process for us, a very easy process.”

Ponti Health opened its doors to the public last year, and now the process begins of educating future clients on the value such an approach to healthcare brings.

“Challenges always remain, but what we have now, what I can see and what we all feel is, if we get this right
eventually, I think we'll be really in a good position to be able to offer a holistic care environment to any person who chooses to be here,” says Dr Tandon.

According to Avant Finance’s Daniel Pike, it was Hema and Dr Tandon’s unique and well-thought-out vision for Ponti Health that helped them become one of the first Avant Finance loans on a greenfield site. “They called me and said, ‘If you've got some time, we'd like you to come over to our house—we have an idea’,” Daniel recalls. “They had been talking to a lot of their peers and colleagues and realised that there's a gap in the market. Their idea was to start a brand new multidisciplinary menopause clinic. I put them in touch with a fitout company (Akord Projects), and I introduced them to Avant Law, our in-house legal, and they did some of the contracts for the consulting doctors. I put them in touch with people that I knew throughout the industry to help them get the ball rolling, and at the same time talked them through what type of finance would be available. We made it really easy for them, but there was a lot of meetings to get this signed off. Because at the time, it was the largest transaction we'd ever done in-house.”

Daniel Pike - Relationship Director, Avant Finance