Physician. Operator. Co-Founder. One reason any of it was possible.
Ask Velma is not a theory about delegation. It is the operating system Dr. Rad Miryala built to run companies without becoming the bottleneck in every one, turned into a company so practice owners can use it too.
Dr. Rad Miryala, MD. Physician. Operator. Co-Founder.
Virtual assistants are the reason he could build any of it.
E-commerce. Physician staffing. Healthcare software. Facility operations. Real estate. Wellness. A family foundation. Some still running, some wound down, some handed off. All of it while practicing emergency medicine, running physician groups and holding medical directorships.
That is not a time management story. Every one of those businesses hit the same wall, and it was never the offer. It was administrative capacity. Someone has to answer the phone, chase the paperwork, do the follow-up, reconcile the numbers. In an owner-run company that someone is the owner, at eleven at night, in every business he owns.
Two things broke the ceiling. Write the process down. Put trained people on it who are not you. He has run everything that way since. The ones that grew are the ones where he got out of the way.
Physician-founded. He does not recommend a system he does not run himself.
The order he learned to hand things off.
Not a philosophy. A sequence, worked out the expensive way across every company he ran, and the same one a practice runs.
The work with a right answer.
Scheduling. Verification. Records requests. If a written rule produces the correct outcome, it does not need you.
The work that only needs following up.
Prior auths. Recalls. Aging claims. This work fails from neglect, not difficulty, and neglect is exactly what a busy owner produces.
The work you tolerate because it is easier than explaining it.
The inbox. The faxes. The forms. The tier most owners never hand off, and the one that quietly eats the most hours.
The work that is genuinely yours.
Clinical judgment. Relationships. Direction. Everything else was in the way of this.
Nothing that kills a practice is clinical.
He learned it as an operator in his own companies. Emergency medicine showed him the same thing happening in everyone else's.
Revenue leaks quietly
Calls ring out. Prior auths sit while procedures slip off the schedule. Claims age past the window. It never arrives as a crisis. It arrives as a margin that keeps thinning for reasons nobody can name.
Goodwill leaks faster
Patients do not leave over a bad visit. They leave because nobody called back. Every one of those is a task a drowning front office skipped.
The physician absorbs the rest
Whatever the front office cannot carry lands on the doctor, after hours, unpaid. Charts at midnight. Inbox on Sunday. That is the tax that eventually makes selling look reasonable.
Then the practice sells, the patients get absorbed into something larger, and fifteen years of relationship becomes a portal message and a sixteen-minute slot. None of that was a medical failure. All of it was fixable.
Physician-founded changed what got built.
It changed what we refuse to do.
Ask Velma is a staffing company, not a healthcare company. It does not own clinical process and keeps no copies of patient data. That line exists because a physician drew it, and it is the first thing a compliance officer looks for.
It changed who we look for.
Nursing, pharmacy, medical technology, health information management. Healthcare backgrounds, not general administrative ones, because someone who has read a chart before learns your workflows in weeks instead of quarters.
It changed what we optimize for.
Not placements made. Placements still running in year three. A cheap VA who leaves in five months costs more than the invoice ever showed.
One good placement rarely stays one task.
A practice starts with reception or verification. Then keeps handing over more, because the VA keeps absorbing it. Phones become refills. Refills become verification. Verification becomes recalls and outreach.
Same curve he watched inside his own companies. The first handoff is the hard one. Everything after it gets easier, and the ceiling moves.
Where one placement goes
The two things people ask us here.
Is my practice too small for this?
Most Velma clients started with one placement. Several started with one and now run a team. The system does not care about your size. It cares whether the work is written down, and if it is not, that is the first thing the call sorts out.
What if I have never delegated before?
Then you are the normal case. Nobody hands off well the first time, including our co-founder. Onboarding exists because most owners have spent a career doing everything themselves, and unlearning that is the actual work.
Start with one conversation.
Thirty minutes on your bottlenecks, your hours, your EHR. You leave with a staffing plan and a flat quote, whether or not you proceed. Ask Velma was built by an operator who ran out of hours, and the whole company is designed around getting yours back.
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