Structuring a Multi-Physician Practice in a Changing World

In a recent episode of the ESCRS Leadership, Business, and Innovation (LBI) podcast series, LBI committee members Paul Rosen FRCS and Vincent Qin MD spoke with Eric Donnenfeld MD about strategies for structuring a multi-physician practice. Dr Donnenfeld, past president of ASCRS and the International Intra-Ocular Implant Club, is one of the founders of OCLI, Ophthalmic Consultants of Long Island, now one of the largest ophthalmology practices in the United States. The LBI programme is designed for highly skilled surgeons seeking to develop the business and leadership skills needed to become surgeon CEOs.

“I think everyone now realises that the single-handed practice is finished and we all have to combine together to grow together and create value within our medical practice,” Dr Rosen said.

Scaling for success

Turning from theory to experience, Dr Rosen then asked Dr Donnenfeld how he and his partners grew the practice from small beginnings into today’s organisation.

Dr Donnenfeld noted that OCLI began as a small partnership of highly respected ophthalmic surgeons focused primarily on cataract and refractive surgery. As the clinic expanded, it broadened its clinical offering to include retinal pathology, glaucoma, and oculoplastics. Over 20 years, the practice grew steadily to around 25 doctors.

At that point, the partners recognised the external environment was changing. Hospitals and insurance companies were increasingly shaping access to patients, and smaller independent practices risked being excluded from key panels and negotiations. To remain relevant, protect patient access, and preserve clinical autonomy, OCLI needed to grow.

The practice therefore chose to partner with private equity, which provided the resources needed to accelerate their expansion. After seven years, OCLI grew from its 25 doctors to around 170 ophthalmologists. Its footprint expanded beyond New York into four states in the wider New York region, and its surgical infrastructure grew from one operating room to five operating rooms.

“We’ve grown very nicely, and now we’re at the stage where we actually are at the table in conversations where we can speak directly to insurance companies, to third-party providers, and I think that allows us to have a level of autonomy that we feel very comfortable with,” Dr Donnenfeld said.

Navigating potential conflicts of interest

“There’s been a lot of discussion in Europe about private equity involvement in healthcare, [especially] in terms of control and how independent people can be. What are the pluses and minuses of working with private equity?” Dr Rosen asked.

“I think the most important concept is that, for a successful multi-specialty ophthalmology practice in private equity, there has to be a physician-centric model in which the doctor is basically in charge, and they work together with the private equity for a common goal,” Dr Donnenfeld said.

“The problem that can occur in private equity is that doctors sometimes give up their involvement in their practice and their decision making, and they let bureaucrats do the work. To be really successful, [it’s important] to have a great chief medical officer who is willing to stand up and say, this is the right thing to do, and make certain that the private equity people listen to it.”

Growth strategy before private equity

“Before bringing on private equity, how did you approach growth as the practice expanded from its second, third, and fourth locations to around 25 ophthalmologists and collaborators?” Dr Qin asked.

Dr Donnenfeld said that in the early stages, they used a hub-and-spoke model: a central centre of excellence—usually a surgery centre and sometimes a clinic—supported by nearby satellite locations. These satellites channelled patients from the wider area to the surgery centre and main offices, which was critical to growth. Before partnering with private equity, the partners committed significant resources to expanding the practice so they would be well-positioned to control their future when the opportunity arose.

First, OCLI built a large surgery centre with six operating suites and two laser rooms, giving the team capacity to recruit and support more doctors. The practice also implemented a shared computer and EMR system across 15 offices, moving new practices onto the same platform early so the group could communicate, share information, assess best practices, and operate consistently. Since one surgery centre was not enough, they targeted practices with similar hub-and-spoke structures, surgery centres, values, and market profiles.

“How often do you take on new ophthalmologists, people who’ve just qualified and haven’t really got much of a practice, as opposed to buying an established practice?” Dr Rosen asked.

“The best way to grow a practice is to bring in young doctors who are extraordinarily capable,” Dr Donnenfeld said. “It’s one of the aspects about my practice that makes me extremely proud. We are getting the best, highest quality young doctors coming out of residencies and fellowships to join us.”

Paul Rosen BSc, MBChB, FRCS, FRCOphth, MBA is Consultant Ophthalmic Surgeon at the Oxford Eye Hospital, Oxford University Hospital Foundation Trust, UK. phrosen@rocketmail.com

Vincent Qin MD is based at Centre Médical Du Val – Stockel in Woluwe-Saint-Pierre, Belgium.

Eric Donnenfeld MD is Clinical Professor of Ophthalmology at New York University and Trustee, Dartmouth Medical School, US. ericdonnenfeld@gmail.com