Better Together: A veterinary specialty collaboration

For the specialty veterinarians who work at Pittsburgh Veterinary Specialty and Emergency Center (PVSEC), the choice between autonomy in their craft and the financial backing of a larger corporation is easy—they want both. PVSEC, in Pittsburgh, Pa., is structured such that the five founding partners own a veterinary management company and a separate real estate business. That real estate company owns the building, from which doctors representing nearly every specialty rent their portion of the practice. The result is one large specialty-referral center with separately owned practices contained within. And it's the best of both worlds, says co-founding partner John Payne, DVM, MS, DACVS.

The exterior of Pittsburgh Veterinary Specialty and Emergency Center in Pittsburgh, Pa. The facility is a veterinary collabortion that now houses 32 specialists. (PHOTO COURTESY OF PITTSBURGH VETERINARY SPECIALTY AND EMERGENCY CENTER)

One roof, many practices

"One of the benefits of our arrangement is that I can have a dog in for surgery, notice a dermatology issue, and just cross the hall to a dermatologist to get it taken care of all at once," says Payne, a veterinary surgeon. "Personally, I like having all these consultants under one roof, with all the interaction between the specialties. Our driving force is getting the best care possible for our patients and doing it quickly. Having these specialists right here, where I can consult with them quickly—that allows us to offer the best care possible."

This practice model originated from a humble mobile surgical practice in 1993 with Anthony Pardo, DVM, MS, DACVS, as sole owner. The next year, a nearby group of veterinarians opened an after-hours emergency service, followed by a stationary surgery practice opening shortly after. In 2005, the doctors joined forces as a referral specialty group. That quickly growing practice soon found the need for more space, as well as the need for a management group to help run the show.

"That's when the doctors hired me as the hospital administrator," Kenneth Spokane says. "They told me when they hired me that the new facility they were building—and I would help run—would be about 12,000 square feet. That 12,000 square feet soon became more than 30,000 square feet—and we're already expanding another 4,000 square feet to give us more space." PVSEC now houses 32 board-certified specialty veterinarians and 18 emergency veterinarians, interns and residents, covering 14 areas of expertise.

The business is structured so that practitioners enjoy the benefits of being under one roof, yet each specialty operates as its own entity. "We get to make our own decisions without all the red tape one might find at a university or different hospital structure," Payne says.

By the numbers

For example, if Payne and his surgical partner decide they want a new piece of surgery equipment, they talk it through and make the purchase without having to consult the other specialists or even the overarching management team. "In some ways, we can do even more than a university hospital can, because we can buy the equipment we need and make decisions more easily," he says.

As far as finances go, each practice within PVSEC pays the real estate company, Veterinary Ventures LP, rent for its space. The founding-doctor practices pay for services and products purchased by the management company, Veterinary Management LLC, and the practices pay their share based on actual usage, revenue percentage or number of employees. "The company is a pass-through structure that handles human resources, customer service, facility management, administration and environmental services," Spokane says. For example, health insurance is purchased through Veterinary Management and the practices are charged by the number of employees enrolled.

The independent specialists and emergency doctors share the benefits of being under the umbrella of PVSEC and, more importantly, a common goal: doing what's best for the client and patient. "Strategically, this model doesn't work for everyone, but it does for us, and one of those reasons is that we all have the best interest of our clients and patients at the heart of all we do," Payne says.

To keep continuity in check, the founding partners and Spokane meet every Tuesday morning. During this meeting, they discuss management issues that arise and affect the entire business. "Whenever we have a difference of opinion, we go back to what's best for the client and patient," Payne says. "Once that's answered, that's what we do."

For Spokane, the main focus is helping make decisions based on what's best for the hospital, not just for one doctor or department. "And the biggest challenge of my job is that I do have six bosses," Spokane says. "I have to make sure all six bosses are satisfied with all decisions made."

Payne says the partners rarely disagree, but when they do, they talk it out until the situation is settled. And when they vote on an issue, it's always unanimous. "It doesn't always start out unanimous, but by the time we've heard each other out and considered all sides, we easily come to an agreement," he says.

A model practice

Now, this kind of plan isn't for everyone. Whether it will work or not depends on many factors, most notably where you live, Payne says. "A practice like ours couldn't survive in a little town, of course," he says. "And there is still tremendous need for small practices, especially in small or rural areas. They are an essential part of the business structure. We don't even do vaccinations or routine exams, so we need to partner with general practitioners."

But Payne says he does see this model of combined practices to be where the profession is heading. "There is an enormous change in our profession right now, and people are demanding higher levels and more kinds of specialty care," he says. "To survive, we have to go with the change."

Spokane approaches the business with a background in human medicine. After 15 years doing finance, facilities management and operations with two large Pittsburgh Health Systems facilities, he was able to help bring PVSEC together and help it grow. He says a structure like this allows PVSEC doctors to enjoy the financial benefits of marketing, a large, well-equipped facility and strong relationships with referring practices within the community—elements of practice that can be difficult to do as a one-man show.

Yet Payne says as evidenced recently in human medicine, not all doctors need to go big or go home. "In human medicine, that's what doctors did for many years, and now we're seeing it come full circle with a return to one-doctor, boutique-style practice," he says. "There will always be a need for small practices, but the business has changed enough that it's not simply a matter of hanging a sign and being successful. For us, this practice model works."

Sarah A. Moser is a freelance writer and editor in Lenexa, Kan.