“Medicine and Business Practice” – A Model for Success for Dr. Sonido and PCCH
By Edwin Quinabo
As large corporations and venture capitalists gradually pushed out of the marketplace smaller mom-pop sized competitors in the 1990s, small private medical practices was an exception to that trend. Small physician practices still flourished as “niche” markets — meaning that their unique service (personal physician-patient care) could not easily be substituted by bigger conglomerates. These practices held their market share and doctors back then were not hard-pressed to develop new business models as other small businesses in other industries.
But starting in the 2000s, and hyper-accelerated since the passage of the ACA in 2010, the medical regulatory environment underwent massive changes. Ten years later up to current times, small private medical practices that haven’t made necessary business adjustments have either closed down or underwent consolidation.
Medical practice and business practice today are like wearing one jumpsuit.
To survive, private practitioners must have both medical proficiency and business savvy.
Dr. Charlie Sonido, this year’s Filipino Chamber of Commerce of Hawaii’s (FCCH) Entrepreneur of the Year Awardee puts it this way, “wearing two hats between entrepreneur and physician is a hard act. I’m lucky to have physicians and managers working with me who are not only smart but very patient-oriented. If you have the patient’s best interest first and foremost, you cannot go wrong. The business part becomes secondary.”
President of FCCH Dr. Nancy Atmospera-Walch said “Dr. Sonido is truly an entrepreneur because he went beyond just his office. He bought other offices through merger and acquisition and expanded his business to other islands.”
Sonido’s Primary Care Clinic of Hawaii (PCCH) started as a solo practice in 1983. Today, it is an LLC with 70 employees including 9 physicians, 2 advanced nurse practitioners, 2 nurses, 7 managers, 3 physical therapists and 2 massage therapists. PCCH has 5 locations in Waipahu, Kalihi, Liliha on Oahu; a clinic in Lihue, Kauai. And remarkably, at a time when medical practices are struggling due to the COVID-19 pandemic, Dr. Sonido recently opened up yet another clinic in Hilo, Hawaii.
One of Sonido’s first medical assistants Dr. Arnold Villafuerte nominated his colleague for the FCCH award, saying “Dr. Sonido has single-handedly addressed the issue of physician shortage by recruiting physicians and nurse practitioners (APRNs) to the team and providing much-needed healthcare.” Some of PCCH’s target communities are underserved.
Dr. Sonido said PCCH is “probably the biggest clinic of its kind in Hawaii.” It is primarily an adult care clinic that sees an average of 200 patients per day as walk-in/ appointment and telehealth. It also has Rehab services in two of its locations.
John Elflein, a medical research expert for Statista estimated in 2018, the largest percentage of physicians saw between 11 and 20 patients per day. Just 1.3 percent of physicians saw between 51 and 60 patients per day during that year.
PCCH’s highly credentialed physicians team of 9, each sees an average of 23 patients per day (based off the 200 total), just over the average ratio of most physicians — showing that PCCH is helping to meet the community’s health needs and at a rate that patients are afforded quality time with their doctors.
Sonido remarked of his staff, “Our employees must meet all three core values: competence, compassion and cultural- sensitivity. They need not be all Filipinos because our patients are not all Filipinos.”
He said of his physician staff in particular, “Three of us have been selected Physicians of the Year by our colleagues and the public, five of us are professors at the University of Hawaii School of Medicine, three of us graduated with honors from medical school and one went to Harvard for undergraduate. We bring with us years of experience in both the outpatient service and academe.”
Turning medical practice into a viable business model
Goldin Peiser & Pesier, a financial group that specializes in working with medical providers, mentioned in their blog that one of the most common reasons why medical practices fail is because of the assumption that expert skills alone will create a viable business.
Knowing this fact — that building a competent team with a strong medical background was just one side of building a viable medical business practice – Sonido actually saw expansion as the only way to survive. “Status quo was not an option. The old business truism is true: economy of scale works.”
In other words, larger companies will have more cost savings and higher production levels. But the key is finding the “right scale.” To date, PCCH is still growing, in part, because Sonido says the company is still earning a modest profit.
How far could finding that “right scale” could go for PCCH? “We aim to be in every place that needs our services,” Sonido said.
But the well-known doctor-entrepreneur is not alone in expanding his company’s market share. There is a race in the medical industry for hospitals, large system clinics and big physician groups to buy out smaller ones. The process is called vertical consolidation. Another version of vertical consolidation (besides complete buy-out) is when physician practices enter into formal affiliation agreements with hospitals while maintaining their separate ownership structure.
Expanding market share builds a company’s asset portfolio which could in turn improve capital flow and greater leverage in borrowing for even greater opportunities for expansion to take place. This is an old business formula and reason why corporations get bigger and bigger.
But expansion alone is a set up for failure unless 1) efficient operating business models are implemented; and 2) overhead costs are contained.
Sonido said there are built-in “best practices in our business model that allow us to be very efficient. For example, we use medical scribes in all our locations.”
Medical scribes are specially trained assistants that help with physicians administrative tasks required in electronic health record (EHR). This enables physicians to spend more quality time with patients (improves patient care and business reputation); and it helps with today’s common problem of physician burnout (worker retention).
The Harvard T.H. Chan School of Public Health calls “physician burnout” a “public health crisis,” affecting 78 percent of physicians, “sometimes, often or always.”
On overhead costs, PCCH manages to control the biggest overhead cost most Hawaii businesses face due to the islands’ premium real estate – renting costly lease space.
Sonido said all the buildings PCCH operates from are owned by PCCH, giving the company leeway to put more resources into other areas that may include investment in workers, equipment or investment in expansion, or all of them.
Always staying on top of current medical trends, Sonido said while COVID-19 has brought new challenges to medical practices, he feels PCCH will be able to adjust well with its telehealth services, and keep in-person visits safe through their reconfigured office space for safe distancing at all of its locations.
Expansion, operational efficiency, overhead cost containment are sound business practices Dr. Sonido has utilized. As far as his guiding business principle, he says: “You have to enjoy what you are doing, be honest, work hard and smart and stay humble. Pay attention to details in practicing medicine but in business it is more important to be pound wise than penny wise. Don’t burn bridges especially in Hawaii. Don’t go for the zero-sum principle when negotiating a business deal. Make everyone a winner, fair and square. Share your glories.”
He says business deals to him now are gut feeling-intuitively driven. But before finally closing on deals, Sonido says he still relies on an old trustworthy habit — he spends money to get every advice that he needs from lawyers, accountants, financial advisors. Input from family and close friends are also highly considered.
“But in the end, it is my call, and I’m not afraid to call it. I know numbers and I know the bottom line,” asserts Sonido.
Like most medical doctors, Sonido hasn’t had formal business education. But the company’s staying power, growth in employees and location, response to adversity (a few of the criteria for the Filipino Entrepreneur of the YearFEOTY) impressed this year’s judges enough for him to take this year’s esteemed award.
Judges for this year’s FEOTY were Annalisa Burgos, anchor/reporter, KITV-4 Island News; Mona Choy-Beddow, Senior VP, Retail Banking Regional Manager; Robert Cundiff, Chair, Hawaii Small Business Regulatory Review Board; Beth Hoban, 2004 FEOTY awardee, President & CEO, PrimeCare Services Hawaii, Inc. and George Pascual, VP, First Hawaiian Bank.
Hawaii Medical Preceptorship Program (HMPP)
Sometimes what’s good for business can also have roots in projects directly intended to help others.
Thirty years ago Sonido established the Hawaii Medical Preceptorship Program which helps graduates of international medical schools land a spot in the U.S. residency matching program. Participants undergo 3-12 months of rigorous hands-on medical training. Only two-thirds of graduate-participants will eventually become practicing doctors.
“We try to enhance their chances,” he said.
From this program, Sonido has recruited workers for PCCH. “Five of those physicians and two of our APRNs are now working with me at PCCH. Two more are slated to join me next July 2021. In effect, the program is the equivalent of our ‘minor league.’”
Nichaelle Aquino, RN, MD, has been the executive manager of PCCH for the past two years. “I started in Primary Care Clinic of Hawaii as a medical preceptee under the mentorship of Dr. Sonido. It was during that time when I saw his love for teaching and his dedication in advancing the medical knowledge of the students and trainees he mentored. He would lecture on different conditions, update on current managements, and share his knowledge on current evidence-based practices. Knowing that I had roots in Hawaii, Dr. Sonido then offered me a position to join PCCH after my months of preceptorship. Accepting that opportunity has been one of the finest decisions I made, and the greatest blessing I received that year.”
HMPP has turned out to be both a business opportunity and community service. The program also helps with the state’s physician shortage by providing a continuous pool of possible recruits.
Another one of the main criteria for the Filipino Chamber’s FEOTY was “contribution by the nominee to the community” – which happens to be one of Sonido’s strongest suits.
Besides his large practice, or being known as a reputable physician in Internal Medicine (and one of only four physicians in the state of Hawaii who is certified by the American Society of Hypertension as a hypertension expert), or as Assistant Clinical Professor of Medicine at the UH-Manoa John A. Burns School of Medicine, Dr. Sonido is arguably most known for his invaluable community service.
He co-founded (along with Dr. Herita Yulo) the Bayanihan Clinic Without Walls (BCWW) when he was President of the Philippine Medical Association of Hawaii (PMAH) in 1997. BCWW provides free healthcare to newly-arrived immigrants of all ethnicities. Recently the charitable organization added to the groups qualified for free healthcare — the unemployed who’ve lost their health insurance due to the pandemic. Currently, BCWW has 50 volunteer physicians and nurses, seeing about 100 patients per month.
PCCH sees about 3-5 patients a day for free as its contribution to BCWW and to meet one of its company’s mission goals of helping underserved segments in the population.
Through the years, Dr. Sonido has led and joined numerous medical missions through Ohana Medical Mission to serve poor communities in foreign countries like the Philippines. Most recently, he led 82 medical volunteers to a medical mission in Ilocos and Caloocan regions of the Philippines. Besides providing free medical services, Sonido has raised and contributed financially to missions, as well as donated medical supplies.
BCWW and medical missions are just the tip of the iceberg to Sonido’s mammoth body of work in community service to the state of Hawaii and internationally.
PCCH’s team, from physicians to administrative support, all work toward the goal of providing a range of top-quality services in primary care, adult medicine, women’s health, pediatrics, school physicals, sports/athletic clearance, annual exams, minor surgery, No-fault and Worker’s Comp.
Mary Ann Castillo has worked for Dr. Sonido for 21 years. She said, “he has always emphasized compassion and service not only to our patients but the community. I have had the chance to go with him and participate in medical missions to the Philippines and other outreach programs. It is not only the job and the passion that have kept me with the company for so long, maybe even more of an incentive is because of Dr. Sonido and the other doctors who have allowed me to apply what I’ve been trained to do, and to continue to grow professionally.”
Castillo hit the mark on “compassionate.” Sonido said the mission of PCCH is to render the most “competent, compassionate, culturally-sensitive care to all of their patients.”
Rey Oliva has joined PCCH Rehab in 2018. “I have been with the company for almost two years. I love that this organization always seeks how to be better in patient care and it developed a culture of a winning mentality against any challenges.”
Dr. Dennis Scheppers said, “I have worked for many employers and companies since coming to Hawaii in 1992. They were all nice, some more than others. It wasn’t until I came to work for PCCH Kauai did I realize the utmost organization one could work for. You can describe this organization in one word – caring. Caring for patients and their needs. But also caring for the people who work here. I see people grow in their positions because they are allowed to grow.”
Ofelia Lagat has been with Dr. Sonido for 34 years. “For as long as I have worked for Dr. Sonido, he has taken care not only of his patients but of everyone who has worked with him. Throughout the years, his leadership and excellence have kept the office together with such high professionalism and standards. The workplace environment has pushed me to excel in my skills in a medical office setting.”
PCCH Patients’ Feedback
Arlene Peralta of Royal Kunia, said, “I am a Registered Nurse and have been going to the clinic because of the trust I have in the doctors and staff. I trust in the quality of patient care they provide not only for myself but for my family.”
Rolando Advincula, President of Pasuquinio Association of Hawaii, has been a PCCH patient for two years. “The service is quick and the staff is personable. The atmosphere is conducive to healing and peace of mind.”
Rev. Alan Patadlas, UCC Minister-Kalihi, said he likes PCCH because the “medical staff are competent and friendly.”
Melba Mariano said the doctors and nurses at PCCH are competent, understanding, and compassionate. “I can always communicate clearly with them and I feel comfortable as they listen empathetically to my health concerns,” she said.
When you’ve been in the same industry for as long as 40 years — about the longevity of Sonido’s medical practice – being adaptable to change, positioning oneself one step ahead of the curve can make all the difference. The great Charles Darwin himself called this key to survival.
This has always been a truism for business. And for good or bad, adaptability is one standard among others to succeed in having a successful private medical practice today in addition to having “compassion” and “competence” in health care as Sonido has set as a goal for himself, and his staff at PCCH.
MEDICAL STAFF AND MANAGERS
RAINIER DENNIS BAUTISTA MD, DABFM, FAAFP
Physician, Four years with PCCH Kalihi and Kauai
Dr. Bautista is a graduate of the Ateneo De Manila University and the University of Santo Tomas – Faculty of Medicine and Surgery. He completed his residency training in Family Medicine at the Hennepin County Medical Center in Minneapolis, Minnesota, and is certified by the American Board of Family medicine. He is currently an Assistant Clinical Professor at University of Hawaii John A. Burns School of Medicine. He is likewise a mentor of the preceptorship program under Dr. Sonido, giving back and helping current and future preceptees to achieve their goals for residency and training. Dr. Bautista is a Diplomate of the American Board of Family Medicine, and a Fellow of the American Academy of Family Physicians.
DANIEL GALLARES, MD
Physician, One year with PCCH Waipahu and Hilo
Born and raised in San Diego, Dr. Gallares graduated cum laude from University of Santo Tomas Medical School in 2015. He trained with Dr. Sonido before entering the internal medicine Residency Program at the University of Hawaii. He recently passed his board certification in internal medicine and has now become an Assistant Clinical Professor at the University of Hawaii School of Medicine. Besides doing Primary Care, he works as a hospitalist at Kuakini Medical Center during some weekends. He is the primary physician for Primary Care Clinic of Hawaii – Hilo Branch, and will cover and do telehealth for all other clinics.
JON AVERY GO, MD
Physician, Four years with PCCH
Born and raised in Manila, Dr. Go graduated from the University of Santo Tomas as cum laude for his BS in Physical Therapy and magna cum laude for his Doctor in Medicine degree. He did his internal medicine residency at Roger Williams Medical Center in Providence, Rhode Island. In 2012, he got his ABIM Board Certification in internal medicine. He moved to Hawaii in 2016 to join PCCH Waipahu. He brings with him his knowledge and experience from the Texas Diabetes Institute and together with Dr. Sonido, he mentors Filipino and American medical students, paying it forward and guiding the next generation of doctors.
EDWARD S. LANSON, MD
Physician, Five years with PCCH with PCCH Lihue
Dr. Lanson received his bachelor’s degree from St. Lawrence University in New York and went to Newark Jersey College of Medicine and Dentistry for his medical degree. He completed his general surgery residency at The Queen’s Medical Center in Honolulu, Albert Einstein Medical School in Bronx, New York, and Kaiser Foundation Hospital in Los Angeles. Before joining PCCH, Dr. Lanson was a surgical walk-in physician at Kaiser Foundation Hospital, Medical Director of the Emergency Room at Parkwood Hospital, Medical Director at Community Emergency Medical Clinic and staff physician at Verdugo Hills Urgent Care, Motion picture and Television Hospital and Aloha Medical Clinic.
DENNIS SCHEPPERS, MD
Physician, Three years with PCCH Kauai
Born and raised in California, Dr. Scheppers completed his Family Practice Residency at Prince George’s Hospital in Maryland and Youngstown Hospital Association in Ohio. He joined the Primary Care Clinic of Kauai in 2017 where he brings his expertise as a Chief of Staff from Victor Valley Hospital, Chairman of Family Practice from Castle Memorial Hospital and as a private practice in which he would also do obstetrics and minor surgery.
CELINE PEARL SI, MD
Physician, Started August 2020 with PCCH Liliha
After graduating from De La Salle University in Manila with a degree in Psychology, Dr. Si pursued her medical career and graduated from the University of Santo Tomas, Faculty of Medicine and Surgery. In 2020, she completed her Family Medicine Residency Training in Augusta University Medical Center Department of Family Medicine. She previously precepted with Dr. Sonido for several months prior to entering residency. Valuing the aloha spirit of the island, Dr. Si returned to join the PCCH ohana.
SEIJI YAMADA, MD
Physician, Two years with PCCH Waipahu
Born in Hiroshima and raised in a Chicago suburb, Dr. Yamada pursued his undergraduate studies at Harvard and MD from the University of Illinois in 1987. He completed his family medicine residency at the Cook County Hospital in Chicago in 1990. He obtained a Masters in Public Health from the University of Hawaii at Manoa in 1996. He has practiced in the Northern Marianas Islands (1990-1993) and in Hawaii since 1994. He’s also a professor at the UH Department of Family Medicine and Community Health.
BERNICE C. YAP, MD
Physician, Three years with PCCH Kauai
Dr. Yap entered the field of primary care to form long-term relationships with patients, helping the healthy stay healthy and managing chronic conditions in the sick. Originally from the Philippines, she studied medicine at the University of Santo Tomas in Manila, cum laude and later entered residency at Baylor School of Medicine in Houston. She began to work with Dr. Sonido at the Primary Care Clinic of Kauai in 2016, where she has established roots in the community.
MINAMI KONISHI, DNP, MPH, APRN, AGPCNP-BC
Advanced Practice Registered Nurse, Started August 2020 with PCCH Waipahu
Born and raised in Hyogo, Japan, Minami came to Hawaii to receive her Masters in Public Health from University of Hawaii at Manoa after obtaining her bachelor’s degree from Mukogawa Women’s University in Japan. She started her career as a public health researcher at the UHM. She completed an intensive prelicensure program to receive her RN license, followed by a Doctor of Nursing Practice degree at UHM in 2020. She’s also board-certified Adult-Gerontology Primary Care Nurse Practitioner.
TAZIALYNN LYNAM, APRN
Family Nurse Practitioner, Started August 2020 with PCCH Hilo
Born in Honolulu and raised on the Big Island, Tazialynn is an alumnus of Kamehameha Hawaii. She received her Psychology degree from University of Hawaii at Hilo and Associates in Nursing degree from Hawaii Community College. Furthering her nursing degree, she graduated from Chamberlain University with her BSN, followed by her MSN FNP in June 2020. Throughout her educational career, Tazialynn continues to work at Hilo Medical Center in the Emergency Department.
Clinic Manager, Five years with PCCH Lihue
As a registered nurse in the Philippines, Amylou worked at East Avenue Medical Center’s Surgery Department as a staff nurse right after graduation. In her last three years in the Philippines, she was an administrative nurse supervisor. After 15 years of working in the Philippines, Amylou and her son immigrated to Hawaii where she immediately got employed.
RHEA ALARIN, MD
Executive Director, Physicians Relations, Two years with PCCH
Dr. Alarin has been the Director of Primary Care Clinic of Hawaii for the last two years. After graduating from University of Santo Tomas Medical School, she trained with Dr Sonido in his rigorous preceptorship program more than five years ago. She now oversees all PCCH clinics which span three islands. With the unique skill set of clinical and business background, she hopes to expand PCCH to the far reaches of Las Vegas.
NIKKA AQUINO, RN
Executive Manager, Two years with PCCH
Born in the Philippines, Nikka’s love for travel and culture was cultivated by the years she spent flying and living in different parts of the world such as Macau and Hawaii. At a young age, she has always displayed her ability to look after others and to have a thoughtful and caring heart. She then pursued her dreams when she graduated and received her Bachelor in Nursing and Doctor of Medicine degree from University of Santo Tomas. Currently she is a registered nurse in the state of Hawaii, and is pursuing both her APRN degree and USMLEs.
Facilities Manager, 36 years with PCCH
Often times a jack of all trades becomes a master of none, but Nelson Sonido is definitely not one. It is remarkable how he can get any job done – from handyman work to finance and logistics, Nelson is one to rely on. He is Dr. Sonido’s right-hand man for a reason and his actions and output speak for themselves. Nelson has worked with the company for 36 years.