Whether it’s their first year in business or decades down the track, Insight speaks to those who know what is involved in establishing an ophthalmology practice, and where to turn for advice.
Despite being in the early stages of his ophthalmology career, Dr Jonathan Kam is well versed in the challenges of setting up his own ophthalmology clinic, having learnt through experience what works, and what doesn’t.
His keen observation skills and business acumen have helped guide his newest venture, Inner East Eye Surgeons, a clinic he has recently established with colleagues Dr Nicholas Cheng and Dr William Tao, at the Epworth Eastern’s recently built 14-storey East Wing Tower in Box Hill.
“Being able to build our clinic at Epworth Eastern has offered many advantages. The quality of the fit out and level of infrastructure is very high, and we are in close proximity to a lot of other specialists in other fields. It also has allowed us to connect with the Eastern Clinical Research Unit and get involved in research trials to help progress medicine,” he says.
“We felt that being in an area which we live close to – and have also grown up in – and associating ourselves with the hospital would put us in good stead to establish ourselves.”
Each of the ophthalmologists completed a fellowship in a different subspeciality, so together they can provide a comprehensive range of ophthalmology services. Dr Cheng completed his fellowship in retinal disease and uveitis and Dr Tao completed fellowships in glaucoma and paediatric ophthalmology, while Dr Kam did a fellowship in complex cataract surgery.
Kam says he and his partners considered purchasing a bricks-andmortar house converted into a medical clinic, common in the profession, but found that the capital investment for that was not something they were keen to take on at this stage in their career.
They rent their purpose-built suite and the three-way partnership means each own a third of the practice.
“I’ve always wanted to start my own practice, although this is actually the second practice I’ve started,” Kam says, adding that it’s the first for Cheng and Tao, who he has known since they were in medical school.
He started his first practice immediately after finishing his training, four years ago.
“I started in a close-by suburb renting two rooms in a commercial retail space which was set up as a health hub. It was doing well but when the pandemic hit, a lot of the health hub tenants moved out. The owners of the health hub decided to close because they couldn’t run their business anymore,” Kam explains.
Forced to move out of necessity, only two years after establishing his practice, Kam relocated his practice to Doncaster Eye Centre, a wellknown clinic with 12 ophthalmologists.
“One of the reasons why I joined Doncaster Eye Centre was because I had trained under their doctors, who are all very good; they knew me and they felt that I would fit into their practice well,” Kam says.
“Doncaster Eye Centre was where I learned economies of scale firsthand. You can do bigger things with more people. After running my practice by myself as a solo clinic – at the health hub – I realised that there are things that you can’t do as one person that are much more possible with three doctors.
“It also means you don’t have to shoulder all the costs yourself and you can hire enough staff to provide a good service. That’s ultimately why we [Kam, Cheng and Tao] came up with this plan of three doctors in a medical suite that didn’t have a large capital investment required, but enough that we could buy quality equipment, and have a quality fit out.”
Kam says his business acumen has mostly developed through observation. When working in different locations, he has taken mental note of what works well – and what doesn’t.
“I enjoy learning different skills and that’s what attracted me to running a clinic. I thought, wouldn’t it be great if I could put a clinic together that had the best elements of all that I’ve learned along the way,” he says.
“I also read a lot of books. When it comes to finance and negotiation skills, I learn from books. There’s a great book called Never Split the Difference by an FBI negotiator [Chris Voss], which I found insightful.
“What I’m discovering, with the clinic that we have established [Inner East Eye Surgeons] is that you do have to learn skills outside of medicine, and there are many avenues to learn.”
Kam believes that if you want to evolve the practice of medicine, you must adapt with the times, including the path to establishing your own clinic.
“For a young doctor to buy a big property nowadays, it’s very hard. And when you take on a lot of risk and debt as a doctor, I feel that it can affect your stress levels and your decision making. You want your patient care to come first.”
Setting up Inner East Eye Surgeons in consulting suites connected to a private hospital allows him to execute his vision at a level he wouldn’t be able to achieve without collaboration.
“The practice is set up to provide a level of care to patients in a way that I always wanted to. I know I have the knowledge and skills but then having the setting, tools and staff to help me is also what I need to practise in the way that I need.”
When it came to purchasing equipment for Inner East Eye Surgeons, Kam, Cheng and Tao were guided by quality and cost.
“We wanted reliable instrumentation that is modern and is latest technology. I’m a ‘details’ person, so I look at the specs, and the cost. We bought the best of what each company can offer. For example, we bought Ellex lasers because it’s what we’re familiar with and it’s Australian-made. We bought Haag-Streit because it’s the gold standard of slit lamps. I felt that buying from each supplier means you know that you’ve bought what is needed, rather than getting roped into a package deal.”
“Together our goal is to work as a team to provide up-to-date and individualised patient care.”
Point of difference
Ophthalmologist Dr Louise Robinson established Coastal Eye Surgeons at Hope Island on the Gold Coast in September last year, soon after completing her fellowship. “I always wanted to own my own practice, or be in a partnership,” she says.
Perhaps unlike many of her peers, Robinson has a business background. She has corporate finance and accounting degrees and was working in banking before returning to university to study medicine and finally, ophthalmology.
Her first step towards attaining the goal of practice ownership was narrowing down a preferred location where she was going to be happy living and working.
It was difficult to decide between Sydney and the Gold Coast, she says.
“I did my training in Sydney and had colleagues and professional support there. On the other hand, I had family and had grown up on the Gold Coast.
“To set up a practice, I needed a point of difference which I determined was my sub-specialty and location. I needed to find a location where a need was evident. Once I established the area, I needed to find a suitable premise. I did a lot of research myself to find a location.”
Around that time, Robinson attended a conference run by The Private Practice, a Sydney-based company that provides health professionals with business and financial resources which are tailored to different stages of their careers.
“The conference covered different aspects of starting a healthcare business, such as practice design, advertising, website, as well as business structures, insurance, income protection amongst many other topics,” she says.
Once she found a suitable site, Robinson contacted a property consultant who negotiated the lease.
“The area my clinic, Coastal Eye Surgeons, is located is predominantly residentially zoned on Hope Island (north of Southport). The area has many privately secured communities, retirement villages and there is very little commercial space available. I found a new commercial development – the building is three years old – and my clinic is part of the Professional Suites that includes a GP, cardiologist, physiotherapist and allied health.”
Robinson’s site was a 146m2 shell that required interior construction and installation, including consulting rooms and a surgical room for minor procedures.
Through The Private Practice, Robinson was put in contact with the Health Business Network’s founding director, Mr Russell Lee, who specialises in medical practice growth and strategy.
“He assisted me in all areas of the business set-up from finding a finance broker to setting up computer and phone software and recruiting staff. I chose a local architect firm who had experience in setting up ophthalmology clinics, which was invaluable, as they understood the equipment requirements, size and patient flows that work,” she says.
“The business developer was on site every week, overseeing construction, ensuring the builders followed the architect’s design. Once construction was complete, I had to choose equipment and software, a task you want to do only once and do it well. Software had to be ‘cradle to grave’ and paperless; from booking appointments, letter generation to billing and accounting.”
But it wasn’t all smooth sailing, as the COVID pandemic disrupted Robinson’s plans.
“I found the site after completing my fellowship, and not long after attending The Private Practice conference, it was all put on hold. Thankfully I hadn’t signed the lease prior to the beginning of the ‘lock down’. The lease was signed in March 2021, and the design and build was a six-month work in progress,” she says.
While Robinson is the sole owner of her clinic and works fulltime, her business development manager, who oversaw the construction, continues to oversee the clinic’s business operations, accounts and staff.
“He is like a remote practice manager. He manages staff contracts, he does the financial figures, and we sit down on a quarterly basis and go through the accounts.”
Since Robinson has achieved her goal of owning a business, RANZCO has subsequentially created resources that can help ophthalmologists in the transition from training to Fellowship.
Robinson is also doing her part to support her peers. She is a member of RANZCO’s Younger Fellows’ Advisory Group.
“I represent Queensland-based Younger Fellows in RANZCO. We have a collegiate meeting every quarter where we welcome Younger Fellows and provide them with support around working in private practice.”
Coastal Eye Surgeons celebrated its first anniversary in September this year.
“It is a challenging, daunting, yet rewarding experience setting up a practice by yourself, but worth it. I wanted to create a work environment which was modern and relaxed, somewhere that my staff and I enjoy working, which in turn is enjoyed by the patients.”
Three-fold growth in three decades
Orthoptist-turned-business manager Ms Donna Glenn manages a large privately owned ophthalmology clinic in Australia which will celebrate 30 years in business next year.
Gordon Eye Surgery, north of Sydney, has 18 ophthalmologists, plus other specialists including a neurologist and an immunologist, and a satellite practice in Lane Cove, which opened in 2016.
“I originally trained and worked as an orthoptist and then moved to consulting in accreditation and quality management for practices and day surgeries giving me insights into the running of practices, so practice management then became a logical progression,” Glenn says.
Glenn was practice manager of Gordon Eye Surgery for nine years, changing into a business management role for the last six years overseeing both locations.
She is also a former RANZCO Practice Managers committee member and is now chair of RANZCO Professional Standards committee and is also a NSW representative of the Australian Association of Practice Management.
She can’t overstate the importance of ‘doing your research’ before selecting a location.
“Understanding the demographic of the area where you are setting up an ophthalmology clinic is vital to success, including the age and socioeconomic demographic, and looking at what other services are in the area,” Glenn says.
Deciding how to financially structure a clinic is as important as finding a suitable location, she says.
“Getting this correct at the outset is important and will save time, money and stress in the long term.
“Think about how to run the clinic, how to fund the project, how to structure it, whether to rent or buy in your preferred location. Getting it right is so important. Think of setting the business up with a mindset of how you would exit the business is important. Think about scenarios, what happens if you want to sell the business, what happens if you want to add a business partner, and so on.”
Glenn says a small group of ophthalmologists own Gordon Eye Surgery, and her role involves working with those owners, who are also clinicians at the clinic, and working with the practice manager to ensure the clinic provides exceptional service.
Over the past 15 years, the clinic has expanded – outgrowing its previous location – and a new business manager role was created for Glenn to oversee its growth.
“Gordon Eye Surgery is now three times the size of what it was, as our capacity has increased three-fold. It was started by two ophthalmologists 30 years ago, and both are still working at the clinic today,” she says.
“The success of the practice is their mindset and the cultural tone they have set. They have stayed true to their clinical ethos despite the practices growth.”
As business manager, she oversees a practice manager, clinical manager and administration manager, 15 administrative staff and 10-12 clinic staff, including nurses and orthoptists.
“Day-to-day, my role has involved managing moving locations as we needed more space which included looking for a new location for our satellite practice negotiating ownership of the location – as in not leasing – plus managing finances and compliance such as Medicare and HR, managing capital purchases such as equipment, and maintaining relationships with our 18 ophthalmologists,” Glenn says.
Three years ago, Glenn gave a presentation ‘Do you need a practice manager?’ to RANZCO Younger Fellows, which has now been incorporated into a RANZCO CPD business modules.
As chair of the RANZCO Professional Standards Committee, Glenn oversees management of the nucleus program available to RANZCO Fellows and says it provides many tools that are useful for setting up a practice including a set of templates for governance.
“Technology and equipment are major investments. Data storage and networking are becoming major considerations for practice management. Ophthalmology is the second most expensive specialty other than radiology, according to the AMA. We rely on technology dayto- day,” Glenn says.
“We are fortunate to have a practice manager at Gordon Eye Surgery that has a keen interest and understanding in technology management which is a resource that is very valuable in a practice.”
“Technology is expensive yet necessary in our business the importance is that it is used to create efficiencies and improved clinical decisions.”
Answering the big question
RANZCO acknowledges that while many Younger Fellows work in the private setting, most do not feel they had adequate exposure on how to start or join a private practice during training.
A demand to know more about the business elements of private practice was the driving force for RANZCO’s learning content coordinator Mr Andrew Chambers to develop a set of modules.
Younger Fellow Ms Tanya Karaconji completed a research project on readiness for private practice as part of RANZCO’s 2018-2019 Leadership Development Program, finishing in 2019. It was the impetus for RANZCO to launch the Business Skills Workshop the same year. This has been on pause in 2020-2022 due to COVID but the content helped inform the online pathway that Chambers developed.
“I am building a set of professional development learning modules around practice set-up and management for Younger Fellows (or any fellow) who want to move into this setting,” Chambers says.
“The first module in the pathway is about learning about basic business development skills, similar to an MBA student, and thinking through the various factors behind this important decision. The other modules will then become more specific to the skills needed.”
Chambers says RANZCO has deliberately used the phrase ‘setting up a new practice’ rather than ‘consulting rooms’, mainly due to the large number of factors that ophthalmologists need to consider.
“We ask them to reflect a lot on their motivations to ensure they are making a good decision or set of decisions,” he says.
“In the first module, the primary skills and knowledge areas we will focus on are all related to learning the basics of practice set-up and planning a new venture.”
This includes understanding the basics of business analysis as it applies to practice set-up, performing business analysis in order to make a business plan, and structuring practices for better collaborative work practices and management.
“We’re also answering the big question: ‘Are you ready to transform and take charge of how you practice?’,” Chambers says.
“We included several business models, frameworks, and skills that relate directly to practice set-up/planning, business planning, and practice sustainability which we believe they [fellows] would find useful.”
Recommendations on ways to collaborate and network with others are also provided, although it is self-paced.
Chambers says the second module, currently being developed, is more practical and covers what fellows need in order to set up a viable practice.
“Step by step, this includes the premises, ophthalmic equipment and fit-outs, registrations, merchant services, practice systems and software, basics of staff, recruitment and HR, marketing basics, financing considerations, insurances, asset protection and superannuation.”
The first module in the learning pathway was launched to members in May this year.
More reading
Bringing telehealth and artificial intelligence into real-world ophthalmology practice
Can ophthalmology practice staff really work from home?
Podcast delves into biggest issues in Australian ophthalmology
