Five practices under one roof

When practices merge, sharing expenses and space shine as big benefits. While the Veterinary Referral Center of North Texas did consolidate in places, eliminating redundancy wasn't a main concern for this collection of doctors, whose specialties include dermatology, ophthalmology, internal medicine, radiology, surgery, neurology, and oncology.

Rather than blending in with the surrounding homes, the doctors wanted a more institutional appearance for the outside of the facility to reflect the high-quality health care the group offers. Using stone and a high-tech design helped achieve this effect.

"I was working at a veterinary surgery center, and we were outgrowing our space," says Dr. Darryl McDonald, one of eight co-owners in the practice. "Another specialty center across town, featuring dermatology, radiology, and ophthalmology, also was growing rapidly, so we decided to build a bigger practice and enjoy the collegiality of working in one spot."

Dr. Reid Garfield, co-owner, agrees that shared authority and efficient care ranked as higher priorities than saving a few dollars with communal resources. "We got a strong sense that individual practices wanted to control the way they work," says Dr. Garfield. "For example, we didn't want to have to put a dog on a gurney and travel all the way across the building to radiography. So efficiency won out over economy, and we built three radiography rooms. Ultimately we've spent a bit more, but we've also greatly increased the efficiency of our daily operations."

Award-winning floor plan : Veterinary Referral Center of North Texas

And the doctors, with their developer and investor, Ron Berlin, obviously succeeded in building an efficient, well blended set of practices under one roof, winning a Merit Award in the 2005 Veterinary Economics Hospital Design Competition. In fact, one judge said, "I saw nothing in this practice that detracts from its overall excellence. It's an amazing facility."

Combining forces

To create the award-winning facility, the eight co-owners met regularly to hammer out details for the hospital. When looking for property, they met Berlin, but couldn't afford to pay for his services. So they struck a deal, making him the ninth investor. Berlin located Harold Sargent, AIA, of Brinkley Sargent Architects in Dallas, and helped get the project underway.

The radiology group has a linear accelerator for radiation oncology in addition to facilities for treating cats with hyperthyroidism with the use of radioactive iodine.

Because the owners wanted each workspace to suit the needs of the team working there, the leader of each specialty group met with his or her associates and with the architects to design their spaces within the larger building. "We started by listing everything we could ever want, then we pared down the wish list to fit the building plan," Dr. McDonald says.

The next decision: Should they split the space equally or according to practice needs? "Allotting the same space to each practice just didn't make sense," says Dr. Garfield. "For example, the dermatology group doesn't need as much space. We have about 3,300 square feet, which is the smallest for any group, and that's all we need. The surgical and internal medicine groups have the most space and for good reason. The architects looked at how much space each group needed, then divvied up the floor plan."

Natural light streams into the surgical suite through floor-to-ceiling windows. Interior windows provide team members with a clear view into the two-table surgery suite from the surgical prep area.

The groups still share common areas—the surgery and ophthalmology groups share prep tables, the ICU area off of the prep area, and a kennel. But the surgical group and the internal medicine group both chose to build a radiography room to maximize efficiency.

In the end, the facility features five practices on the first two floors. A leased section on the third floor brings in some rental income—and the practice has space available for future occupancy if needed.

The practices also share a united public face. To accomplish this goal, the doctors chose to build one common entrance to the building, a small foyer, and then branch out into the specific specialties, much like at a human hospital. In the lobby, a lit sign points clients in the right direction.

Interior walls made of imported stone run throughout the facility, tying all five practices together visually, Dr. Garfield says. "The glass block on the outside lets in natural light, projecting a warm feeling throughout, and the stonework provides nice continuity and flow," he says.

"Overall, I think simply being in one building unifies the groups," says Dr. McDonald. "We might appear to work in a big, intimidating structure, but each specialty group's space feels more like a typical veterinary facility, with its own look and feel."

Adding and divvying the cost

Another challenge for this multi-practice facility was in deciphering who would run the building. "When we talked to doctors in other specialty group practices, they often complained when one discipline owned the building and leased space to other specialists," says Dr. Garfield. "In this situation, practice groups paid a fee, shared the reception room, and paid a percentage of gross to the owners for rent and staffing. We don't work that way."

Instead, he says, they wanted to keep operation of the five established practices independent, so every team could make individual financial, equipment, and staffing decisions. So the owners chose to build and own the facility together, then form a limited liability company that leases space to all the practices.

"This arrangement works very well for us," says Dr. Garfield. "Our practices run independently of each other, and this plan keeps conflicts to a minimum."

Growing at warp speed

Dr. Garfield says all five groups have enjoyed tremendous growth since building the facility in 2000. In fact, the dermatology group's numbers have nearly quadrupled. "The synergy of five practices working together, and the space to add doctors, in particular, fueled much faster growth than we would have experienced independently," he says.

Dr. Garfield thinks some general practitioners feel more comfortable referring clients to the facility because they don't share space with any general practitioners. "And it certainly makes things more convenient for referring practitioners that we're all in one place," he says.

Simply put, the new practice better represents these veterinarians' level of service, Dr. McDonald says. "Generally when you see a specialist, you're ready to spend a fair amount of money," he says. "The facility needs to reflect the value we offer and support clients' and colleagues' positive perceptions about the care we provide. We think our referring colleagues feel better about sending clients to us now."

Sarah A. Moser is a freelance writer in Olathe, Kan. Please send questions to ve@advanstar.com.