Podcast Ep 172: Sisu Clinic co-founder Brian Cotter talks about how being surrounded by the best people powered his metamorphosis from doctor to entrepreneur.
Who needs an MBA if you start a business with Pat Phelan? That was the thought running through my brain while I chatted with Dr Brian Cotter for the ThinkBusiness Podcast.
Brian started Sisu Clinic in 2018 in Cork with his brother James, also a doctor, and Phelan who happens to be one of Cork’s, and certainly Ireland’s, most celebrated serial entrepreneurs. The business has gone from strength-to-strength in Ireland, the UK and the US with the number of clinics operating worldwide recently reaching 24, with recent openings including Houston, Texas and Fort Lauderdale, Florida.
“That’s the real DNA of the business: it is medicine-first and business second. I really do feel that when you look after the patient, the business looks after itself”
Sisu Clinic has reported 47% growth in revenues year-on-year in H1 2023 and the business raised $3.5m earlier this year to further fuel its expansion plans, adding to the €15m to date from investors.
2023 has also seen the launch of its brand new line of provider-approved skin care products, ‘Sisu Solutions’. The first two items in the line, the Marine Collagen Supplement and the Bio-Cellulose Sheet Mask, are available online and in Sisu stores, with further products to follow in upcoming months.
Necessity and passion
“I think the aesthetic space has gone from anti-ageing into wellness. There’s a longevity piece in it in relation to how I don’t think people necessarily want to look younger. They just want to look better, fresher”
Like many people who starts a business, Brian and James Cotters’ foray into the start-up world was born of necessity and passion. “James and myself studied medicine at Charles University in Prague and when we came back we had relatively large student loans. There’s nothing more stimulating than a bank manager shouting down the phone asking ‘where my repayments?’ I was working at Cork University Hospital and James was working at Mercy and one of the things we were looking at was how do we expedite our ability to get out of the hole of education costs.”
Cotter had an interest in the aesthetics space but felt the business model was broken insofar as it was all about the money and less about the clients themselves. It was around 2012 and they began working for other people in the space.
“As doctors we felt there was a huge discordance between what we were doing in clinical practice in medicine and what we were doing in our side job. So ultimately we decided to open a clinic in Cork on Academy Street. There were 72 steps to get up the stairs and there was no lift. We renovated the space, built a website and read just about every marketing book imaginable. I remember our very first patient, the very hour and the very day.
“What we did was we took solid medical practice and we introduced it into aesthetics. We ran it part-time initially and then one clinic became two clinics.”
Word spread among friends and before they knew it the good doctors’ side hustle was thriving. “Before we knew it we had a wildly successful business that we were running part-time. James and I sat down and we understood and saw very clearly where the aesthetics space was going. We felt like two surfers sitting in the middle of the ocean and pointing at a wave that no one else saw and so we started paddling like crazy.”
At this point they were joined by Pat Phelan who brought his innate blend of scaling experience and business insight, not to mention connections. Phelan had just sold his previous business Trustev for $44m. Combined with the Cotters’ medical credentials, it has turned out to be a killer combination.
A holy trinity
“It is like this holy trinity where you have this blend of business experience and medicine. An I think that’s probably very peculiar and interesting about James and myself is that as doctors we are probably innately entrepreneurial. We can switch between the medicine and the business so quickly that you’re not sure which aspect of the business you’re talking too. That’s the real DNA of the business: it is medicine-first and business second. I really do feel that when you look after the patient, the business looks after itself.”
The aesthetics wave that the Cotters saw in the distance grew gradually closer as Phelan put his shoulder to the wheel. “That paradigm shift has really occurred in how patients and how consumers are in this space.”
Brian explained that the ‘crossing the Rubicon’ moment came when the brothers had to commit full-time to the business. “We had 48 employees and we were working part-time in a business where we were the largest shareholders. For James I think it was probably a little bit harder to step out of medicine than it was for me. He was doing vascular surgery while I was doing orthopaedics. But it was an inevitable piece that we understood what was required.
“Our passions and purpose started to change. Stepping in to the business and focusing on raising money it was very organic. Having great people around us like Voxpro founders Dan and Linda Kiely – they were our original backers – and the rebrand to Sisu Clinic, everything just started to gain momentum.”
Having the right people around them was essential and the appointment of a CFO, Paul Healy, steered the business towards the common goal of building a world-class brand.
The term ‘Sisu’ is a Finnish concept described as stoic determination, tenacity of purpose, grit, bravery, resilience and hardiness.
“There is no singular translation for ‘Sisu’ – it can mean resilience, determination or the idea of wanting something better. When I describe it to people if you can imagine a situation you really didn’t think you could get through. It’s an intangible feeling. But it really hit the nail on the head when James and myself opened our first clinic back in 2014. It takes about a decade to become an overnight success.
“I started to find that it was a slightly older patient cohort of people who were coming in and who looked in the mirror and what they saw wasn’t really what they felt.
“I think the aesthetic space has gone from anti-ageing into wellness. There’s a longevity piece in it in relation to how I don’t think people necessarily want to look younger. They just want to look better, fresher. This has radically changed the trajectory within the business because it’s about people wanting to do something. ‘I want to do something that makes me happy, feel better about’. Not only is it a stronger feeling within people, but there’s definitely a change in the way Botox is no longer a taboo thing.
“People just want to see the freshest, best version of themselves. So the space has definitely changed for Sisu. For our customers it’s a safe space that is owned and inhabited by medical professionals. Sisu gives them that trusted piece. It is a brand that is opening clinics in the US and the UK.”
Entrepreneurial journey
“It really comes down to surrounding yourself with the best people. Nobody is ever self-made. Pat, James and myself would have had lots of quiet conversations with ourselves around why we are doing this. We have learned that when you encounter difficulties, you somehow figure it out. And the next time you do it you remember how”
The curious thing about the Sisu Clinic journey is how much of the heavy lifting in terms of retail roll-out and funding took place while the world was locked down in Covid, no doubt requiring further depths of that ‘Sisu’ spirit.
“I went back to work in the emergency department at St Vincent’s Hospital during Covid and James went back to the Mercy in Cork. All of our other doctors went back. And it was a kind of weird feeling talking about raising money while the whole world had stopped. As a brand we got through it and if you look online today we have 10,000 five-star Google reviews. We see seamless. I think Sisu for me is a relationship with the patient where trust is both earned and given.”
Crucially, the tutelage in entrepreneurship one must gain working alongside a driven and proven entrepreneur like Pat Phelan has changed both of the Cotter brothers.
“It is a fascinating and exciting journey. I have learned things about myself that I probably wasn’t aware of. I think the biggest thing around it is the team we have collected. We kind of win together and we lose together. I’d love to say that it was always smooth sailing and that we never came up against things.”
Cotter said a steely determination is what binds the founders and colleagues of Sisu Clinic
“I remember the very first time when we were raising money, and I walked into an accountants office. The table looked really big. This person is this type of accountant, and this person sets up this and this and this. And then what started to happen as I was walking into bigger rooms, bigger buildings in bigger cities, it didn’t feel as intimidating. So I think I became very comfortable with this space. I think that ability to talk about your business from the inside out, but to understand its DNA, I think that gives you a massive degree of confidence in it. Over the last number of years, we’ve gotten to scale a business to understand different geographies, different markets, different territories, raising money from venture capital, we have a huge amount of inbounds from private equity at the moment. And I think we’ve probably become very rounded.”
The challenge, Cotter acknowledges, as Sisu Clinic scales is to ensure consistency. And the answer to that is to challenge oneself to make the next one better than the last.
“It really comes down to surrounding yourself with the best people. Nobody is ever self-made. Pat, James and myself would have had lots of quiet conversations with ourselves around why we are doing this. We have learned that when you encounter difficulties, you somehow figure it out. And the next time you do it you remember how. So it’s been an evolution rather than a revolution in terms of my development as a business person, or entrepreneur – a phrase that I am not fond of – but I have to use now, I guess.”
Perhaps genetics has something to do with it. The Cotters’ father was in business and their great grandfather was an entrepreneur. “I guess the blend of business and medicine really intrigues me. To understand science is a very powerful tool.”
Coming from Cork may also have something to do with it. “I think there’s a tenacity in people from Cork – the idea of wanting to do something, but to do it on a grand scale. That doesn’t really intimidate us. I think we’re more prepared than most to fail spectacularly too.
“There’s an innate sense of adventure in people from Cork. We are jovial, we don’t take ourselves too seriously either. But if you’re going to fail we almost want it to be a spectacular explosion the sky that everybody looks up and says ‘Jesus, that fellah was doing great, why did he go and do that?’
“But on the flip side, you just want to do incredible things.
“There’s also a stubbornness. The decision is made come hell or high water and that’s what I’m doing. And that’s why I think you are seeing tremendous success stories coming out of Cork.”
