Why we went from nine centres back to four

Key takeaways

• We grew to nine centres around 2014-15, and then I consciously took us back to four.
• The aim was to keep the doctors personally involved, rather than spread across more locations.
• Research on continuity of care suggests that seeing the same doctors over time matters for patients.
• Today I see patients at Thane in the mornings and Andheri in the evenings, and I personally run the monthly reviews in the online weight programme.
• Four centres is a size at which standards, pricing and follow-up can stay the same in every room.

What happened around 2014-15?

I opened Dr Tvacha in Thane on 28 November 2005. Over the following years we grew, and by around 2014-15 we had nine centres across the region.

From the outside, nine centres looks like the natural next step towards twelve, then twenty. Many healthcare businesses follow that path. I chose not to. We went back to four centres, and we have stayed at four.

I am not going to dress this up with a dramatic story. The reason is plain: so the doctors stay hands-on.

Why would a clinic choose to get smaller?

See, what happens is, every new centre needs a doctor in the room, every day it is open. I can only be in one place at a time. As centres multiply, a founder's job slowly drifts from treating patients to managing the people who treat patients.

For some kinds of business that is fine. For a practice built on diagnosis, judgement and follow-up, it changes what the patient gets. My view is that in treatment, the dose is the skill. General protocols suit most people, but adjusting for the individual is where results are made or lost. That adjustment needs a doctor who knows you, has seen your earlier reviews and remembers what was tried.

So the question I asked was not "how many centres can we open?" It was "how many centres can our doctors genuinely look after?" The answer was four.

What does "depth over scale" actually mean?

Depth over scale is a trade-off, and I want to be honest about both sides.

I decided that the right-hand column mattered more to our patients. That is a choice, not a claim that other models are wrong. Plenty of good care happens in large networks. This is simply the shape that fits how our doctors and I like to work.

Why does seeing the same doctor matter?

There is evidence behind the instinct. A 2018 systematic review in BMJ Open, by Pereira Gray and colleagues, looked at 22 studies on continuity of care, meaning seeing the same doctor over time. In 18 of them, more continuity was linked with lower mortality. The studies were observational, so they show an association rather than proof of cause, and they were about general health care rather than aesthetics.

Still, the logic carries across. When the same doctor follows your case:

• They know your history without you repeating it at every visit.
• They can see small changes from one review to the next.
• They remember what was tried, what worked and what did not.
• They can adjust a dose or a plan with context, rather than starting again.

For hair treatment, which runs as monthly sessions over four months, and for weight care, which is reviewed every month, that continuity is a large part of the care itself. That is very important to understand.

How does this show up at Dr Tvacha today?

The four-centre decision shows up in small, practical ways:

• I am still in clinic. I see patients at the Thane centre in the mornings and at the Andheri centre in the evenings.
• Online weight reviews are with me. In The Endgame Weight Programme, I do the monthly review myself. I do not hand it to someone else. See how online weight loss consults work.
• The same process everywhere. Diagnosis first, fees in writing before you pay, review dates fixed on day one and a plan for maintenance, at every centre.
• A private consultation room at every centre. So that a proper conversation can actually happen.
• One clear focus per service. Weight care is online across India, hair care runs at all four centres, and women's midlife care is at Cocoon × Dr Tvacha on the 2nd Floor of Suraj Arcade, Thane West, with Dr Anagha Karkhanis.

The current addresses, phone numbers and timings are all in our guide to our centres.

Does staying at four mean the clinic will never grow?

Not necessarily. It means I measure growth differently. We have added things since going back to four: online weight care that reaches patients anywhere in India, and Cocoon × Dr Tvacha for women from 40 onwards. Both were added in a way that keeps a named doctor responsible for each patient.

If you want the longer history, read how Dr Tvacha began. If you want to see how this approach shapes treatment itself, read why I plan treatment like a chess endgame.

How we approach this at Dr Tvacha

Whichever centre you visit, the first step is a diagnosis with a doctor. We explain the options and write down the fee for each before you pay. You can find the nearest of our four centres, or start with hair care or online weight care. What you choose after that is up to you.

Written by

Dr Amit KarkhanisAesthetic Physician · MBBS, Dip. Dermatology (UK) · Reg. No. 2001/02/1124

Founder of Dr Tvacha, practising in Thane since 2005. Leads the weight loss and hair programmes.