Scaling With Depth: Risk, Numbers, and AI in Healthcare Leadership with Gunjan Vermani

Scaling With Depth: Risk, Numbers, and AI in Healthcare Leadership with Gunjan Vermani

What if the smartest way to scale isn’t moving faster — but building deeper? In episode 41 of Built by Margin, Laurie sits down with Gunjan Vermani, physiotherapist, entrepreneur, mentor, and founder of PhysioCare Physiotherapy, to talk about the risks, numbers, and decisions behind building a healthcare business with both scale and soul. Gunjan shares how entrepreneurship began not as a business ambition, but as a response to gaps she saw in the healthcare system. Over 15 years, she evolved from clinician to business owner to leader of a 60-person team, now expanding toward a ninth clinic in the Ottawa area. Her growth strategy was not built on speed alone, but on depth: investing in culture, systems, leadership, and patient care before those decisions visibly paid off.  The conversation explores how Gunjan learned to connect clinical outcomes with business metrics, shifting from “flying blind” to using weekly scoreboards, EMR data, clinic-level dashboards, and financial reporting to make better decisions. She explains why revenue is often a vanity metric, and why healthcare entrepreneurs should pay attention to “sanity metrics” like retention, per-visit average, clinician utilization, and operational leakage. Gunjan also shares how coaching, Dan Martell’s Buy Back Your Time principles, and AI transformed the way she runs her company. By implementing AI agents, virtual reception support, AI-assisted documentation, and leadership scoreboards, she has freed up 10–15 hours per week while helping her team spend more time on meaningful patient care. At its core, this episode is about building a business that reflects your values. Gunjan and Laurie discuss why not every opportunity deserves a yes, how discipline can be more powerful than ambition, and why the best business decisions are not always the fastest or most obvious ones — they are the ones that build a sustainable company, stronger leaders, and a life aligned with what matters most. QUOTES * “Confidence is not the absence of uncertainty. Good leaders still feel doubt, but they learn how to think clearly despite it." - Gunjan Vermani * "Not every opportunity deserves a yes. Sometimes discipline is more powerful than ambition." - Gunjan Vermani * "It’s not about how much money you’re sinking in — it’s about how much you’re gaining as a person from a mindset and learning perspective." - Laurie Chen LINKS Laurie Chen Instagram: https://www.instagram.com/lauriechencpamba/ [https://www.instagram.com/lauriechencpamba/] LinkedIn: https://www.linkedin.com/in/lauriechen/ [https://www.linkedin.com/in/lauriechen/] Risk Worthy: https://www.riskworthy.co/ [https://www.riskworthy.co/]   Gunjan Vermani LinkedIn: https://www.linkedin.com/in/gunjan-vermani-973b0b36/ [https://www.linkedin.com/in/gunjan-vermani-973b0b36/] Instagram: https://www.instagram.com/gunjanvermani [https://www.instagram.com/gunjanvermani]

Building by Margins, Not Constraints: How Basil Khan is Turning Limitations into Leverage

In episode 40 of Built by Margin, Laurie Chen sits down with Basil Khan, founder of Rev Trinity and LifeOS Technologies, to explore what it means to build an AI-driven startup from a constraint-heavy environment. Basil shares how he structures his companies across Pakistan and Delaware, using local operations and revenue-generating engines to preserve founder control while building toward a scalable U.S.-based C-Corp. The conversation dives into the realities of startup financing, international banking hurdles, and the discipline required to build with cash flow instead of relying too heavily on future funding. Basil also explains how he uses AI across his companies, from meeting tools and financial workflows to productivity systems designed to help teams execute with more clarity. Laurie and Basil also discuss the importance of human-in-the-loop AI, separating personal and business finances, and making decisions with strong financial foundations. Basil reflects on risk, failure, team-building, and how coming from a small town shaped his ability to solve problems one constraint at a time. QUOTES * "I'm proud of the failures themselves too, because at the end, I knew what mistakes to avoid in the next iteration." - Basil Khan * "You need to avoid people who are just all talk and no bite." - Basil Khan * "Experiencing failure is always part of the journey of being an entrepreneur, of being a CEO/Founder. You always fail at something, but it gives you information and data points of which to, you know, run the next successful sprint." - Laurie Chen LINKS Laurie Chen Instagram: https://www.instagram.com/lauriechencpamba/ [https://www.instagram.com/lauriechencpamba/] LinkedIn: https://www.linkedin.com/in/lauriechen/ [https://www.linkedin.com/in/lauriechen/] Risk Worthy: https://www.riskworthy.co/ [https://www.riskworthy.co/]   Basil Khan LinkedIn: https://www.linkedin.com/in/basilkhanbaloch/ [https://www.linkedin.com/in/basilkhanbaloch/]  Instagram: https://www.instagram.com/basil.lifeos/ [https://www.instagram.com/basil.lifeos/]

How Autyn Is Reimagining Mortgage Lending with Myra D'Souza

In episode 39 of Built by Margin, Laurie Chen sits down with Myra D’Souza, founder of Autyn, an AI-native mortgage origination platform built for mortgage brokers. Myra shares how her background in software engineering, data science, fintech, and real estate investing led her to identify a major gap in the mortgage lending process: borrowers often feel left in the dark, while brokers are buried in manual workflows, PDFs, and admin-heavy processes. The conversation explores what it takes to build AI in a high-trust, highly regulated industry like lending. Myra discusses why explainability, reasoning, guardrails, and human oversight are essential when AI is supporting decisions that directly affect borrowers’ financial lives. She also breaks down the metrics that matter most as an AI startup founder, including net revenue retention, gross margins, AI spend per loan file, and the importance of building customer trust before scaling. Laurie and Myra also discuss the future of work, the role of women founders in shaping responsible AI, and why the next generation of lending should empower borrowers instead of keeping them dependent on gatekeepers. This episode is a grounded look at AI, risk, financial decision-making, and what it really takes to build technology that customers can trust. QUOTES * "We're not just using AI for the sake of using AI, we're using it exactly where we need it." - Myra D’Souza * "We have to be very careful about AI adoption and how we're thinking about that as well." - Myra D’Souza * "You need good financials to build a good company." - Myra D’Souza Laurie Chen Instagram: https://www.instagram.com/lauriechencpamba/ [https://www.instagram.com/lauriechencpamba/] LinkedIn: https://www.linkedin.com/in/lauriechen/ [https://www.linkedin.com/in/lauriechen/] Risk Worthy: https://www.riskworthy.co/ [https://www.riskworthy.co/] Myra D'Souza LinkedIn: https://www.linkedin.com/in/myradsouza/ [https://www.linkedin.com/in/myradsouza/]  Autyn: https://autyn.ai/ [https://autyn.ai/]

Risk, Tax AI, and the Modern CPA Firm with Johnny Terra, CPA

In episode 38 of Built by Margin, Laurie Chen sits down with Johnny Terra, CPA, Partner at LPT CPAs and Advisors,  for a conversation about tax strategy, risk management, AI, leadership, and the personal growth that comes from taking bold professional risks. Johnny shares his journey from growing up in Rio de Janeiro, Brazil, to coming to Texas on a basketball scholarship, building a solo accounting practice from a pantry office, and eventually merging into a larger CPA firm. He talks about the mindset shift required to move from solo practitioner to firm partner, including the responsibility of leading staff, serving more complex clients, and building a sustainable firm culture. A major theme of the episode is risk. Drawing from his background as a bank risk manager and auditor, Johnny reframes risk management as a tool that enables speed rather than prevents action. He compares risk controls to brakes on a car: the point is not to stop movement, but to give leaders the confidence to move faster without crashing. He also expands the classic risk formula by adding two modern factors: velocity, or how fast a risk hits, and persistence, or how long the pain stays in the system.  Laurie and Johnny also dive into how AI is changing tax research, tax preparation, and firm operations. Johnny shares how he uses tools like Thomson Reuters’ AI research platform, NotebookLM, Gemini, and other AI systems to speed up complex tax research while still verifying sources and applying professional judgment. They discuss why AI can increase efficiency, but why trust, source quality, and context remain critical in tax and advisory work. QUOTES * “Risk is having those parameters in place so you can move that car as fast as possible and still have the confidence to know that you're not going to crash.” - Johnny Terra * "“It’s not about what might happen anymore. You have to add two more factors to it: how fast it hits and how long that pain stays in the system.” Johnny Terra * “The coolest thing of it all is the person that you become in this journey.” Johnny Terra Laurie Chen Instagram: https://www.instagram.com/lauriechencpamba/ [https://www.instagram.com/lauriechencpamba/] LinkedIn: https://www.linkedin.com/in/lauriechen/ [https://www.linkedin.com/in/lauriechen/] Risk Worthy: https://www.riskworthy.co/ [https://www.riskworthy.co/] Johnny Terra Instagram: https://www.instagram.com/johnnyterracpa/ [https://www.instagram.com/johnnyterracpa/] LinkedIn: https://www.linkedin.com/in/johnnyterracpa/ [https://www.linkedin.com/in/johnnyterracpa/] LPT CPAs and Advisors: https://www.lpt.cpa/ [https://www.lpt.cpa/]

Building Compass Health: Access, AI, and the Future of Patient Care with Rafael Fernandes

In episode 37 of Built by Margin, Laurie Chen speaks with Rafael Fernandes, Co-Founder and CEO of Compass Health, a membership-based healthcare company launching in Tampa, Florida. Rafael shares how his background in operations, supply chain, and large-scale corporate growth shaped his leap into entrepreneurship, and how the Duke Fuqua network helped him move from idea to execution.  Rafael explains the core problem Compass Health is solving: healthcare access is slow, fragmented, and difficult for patients to navigate. Compass Health was built around four major pain points — access, coordination, navigation, and trust — with a model designed to connect patients to best-in-class specialists within three to five business days while providing high-touch care coordination throughout the process.  The conversation also explores how AI is changing healthcare and startup operations. Rafael discusses how AI can make healthcare more personal by helping patients understand their own data, while still preserving the essential role of physicians in diagnosis, treatment, and trust.  QUOTES * "Success for Compass Health means ensuring patients get timely access to quality care." - Rafael Fernandes * "If you're not well, your company is not well." - Rafael Fernandes * "It was about creating these connections and these relationships that really made me understand what exactly it is that we could build." - Rafael Fernandes Laurie Chen Instagram: https://www.instagram.com/lauriechencpamba/ [https://www.instagram.com/lauriechencpamba/] LinkedIn: https://www.linkedin.com/in/lauriechen/ [https://www.linkedin.com/in/lauriechen/] Risk Worthy: https://www.riskworthy.co/ [https://www.riskworthy.co/] Rafael Fernandes Instagram: https://www.instagram.com/thecompasshealth/ [https://www.instagram.com/thecompasshealth/]  LinkedIn: https://www.linkedin.com/in/rafaelfulton/ [https://www.linkedin.com/in/rafaelfulton/]  The Compass Health: https://www.thecompasshealth.com/our-team [https://www.thecompasshealth.com/our-team]