Vision Eye Institute has revamped its operating model into something that would be unrecognisable to its founding fathers, building in new capabilities and flexibility to meet the demands of the modern-day ophthalmology workforce.
Dr Lewis Levitz has been exposed to the advantages and pitfalls of various operating models in ophthalmology clinics – but there’s one organisation that stands out the most, and it’s the one he has been with for 16 years and counting.
In 2008, after eight years in solo practice in his native South Africa, Dr Levitz jumped at an opportunity to move to Australia to work in Hervey Bay, Queensland, for Vision Eye Institute (VEI). It was an emerging group at the time and the brainchild of a handful of established Australian ophthalmologists who figured private specialist eyecare could be better delivered and sustained at scale.
That vision was realised, with VEI now Australia’s largest private ophthalmology provider.
Based in Melbourne today, and one of VEI’s longest-standing ophthalmologists, Dr Levitz has witnessed a “seismic shift” in the way the organisation operates. This is largely due to its transition from a publicly listed entity to privately owned company in 2015 – a move that brought with it greater flexibility to accommodate the more than 100 doctors currently consulting in VEI clinics and/or operating at its associated day hospital network, Vision Hospital Group (VHG).
When he started at VEI, its rigidity meant it only catered to full time ophthalmologists. But fast forward 16 years and “its evolution has been so significant that it would be unrecognisable to those involved in the early days”.
“For example, our CEO Ms Amanda Cranage comes from an orthoptic background and has a unique patient-, service- and doctor-orientated approach,” he says. “The realisation that all our doctors are at different stages of their careers is now what drives our company vision. Gone are the days of the one-size-fits-all partnership. It’s been replaced by an enhanced respect for the doctors’ work-life balance, academic obligations and family needs. We have the flexibility to choose our level of commitment and how our sessions are structured.
“VEI is now a niche group of ophthalmologists who have a common interest in practising ophthalmology without the additional headache of running practices or theatres. We are happy to delegate the day-to-day running of the practices to VEI, with their industry expertise and rigorous systems and processes.”
The modern-day VEI is attractive for several reasons, says Dr Levitz.
The fact VEI funds research by doctors and staff through its Future Vision Foundation (FVF) “is a terrific incentive” for some. Meanwhile, others are looking for sessional work – say two or three sessions a week – perhaps to subspecialise in lower volume clinics such as ocular oncology or oculoplastics, or to fit in with their sessions at non-VEI clinics.
But many, like Dr Levitz, simply want to free themselves from managerial and administrative overheads.
Reflecting on his solo practice in Johannesburg, Dr Levitz says it eventually dawned on him that he didn’t necessarily own the practice. In fact, he often felt like he was working for the bank. And any “freedom” to make decisions was offset by the practice consuming his leisure time.
He points to a well-documented trend amongst ophthalmologists to consolidate practices due to rising expenses and work-life balance considerations. American Academy of Ophthalmology statistics from 2022 show 46% of ophthalmologists are now choosing to work in group practices. In Australia, a University of Melbourne study showed the number of doctors in group private practices has increased by 28.9% from 2013 to 2020.
“Firstly, VEI offered me work in already established and busy practices, but secondly it allowed me to practise clinical ophthalmology without the hassle of paperwork and the like,” he says.
“You do the work you’re trained to do, put your tools down at the end of the day and go home to spend time with your family. You’re not worrying about what will happen to the clinic if you’re struck down by a virus, or how to pay the clinic costs while you take a holiday. VEI takes away the headaches that I believe lead people to burnout.”
Today, Dr Levitz works across three of VEI’s Melbourne practices (Camberwell, Blackburn South and Coburg), with a couple of surgical lists per week. He’s remunerated based on the amount of consulting and surgical work he undertakes.
Aside from his consulting and surgical work, he is also VEI’s national medical director, reporting to the board on the company’s clinical performance and conformance to clinical standards. As part of this, he chairs the Clinical Care and National Infection Control committees.
Catering to workforce needs
Cranage, who has been CEO since mid-2023, says VEI explored new models that allowed more flexibility and responsiveness to changing workforce demands to attract and retain ophthalmologists. Prior to 2015, the company only offered full time contracts but now caters for a variety of scenarios including part time or sessional work.
After starting as an orthoptist in 1996 at Camberwell Eye Clinic – which later became VEI – Cranage has risen through the ranks of the organisation and had a front row seat to its transformation.
“We’ve needed to evolve with the ophthalmic workforce, and what we quickly realised is that some doctors like to work in a variety of practice types, private and public, across a number of locations. They thrive on variety and don’t necessarily want to turn up at the same place every day,” she says.
Cranage speaks proudly of how the organisation has responded to the changing needs of its medical workforce. “Doctors working in our practices have complete flexibility to set their own schedule of patient appointments and fees. We’re simply the mechanism to support them, whether they are geared towards high or low patient volumes.”
When Cranage visits VEI practices, the overwhelming feedback from previous solo operators is the new-found freedom they now enjoy. Meanwhile, they have access to the latest practice management systems and ophthalmic technology – all with the necessary upgrades and service contracts without the worry of procurement and upkeep.
“The setting is very collegiate, yet doctors have complete professional autonomy in how they manage their patients,” she says.
“There’s also operating rights at our Vision Hospital Group day hospitals where ophthalmic procedures are performed all day, every day. Surgeons enjoy their lists because our specialist ophthalmic theatre teams live and breathe ophthalmology and are prepared for every possibility.”
Cranage says there are several remuneration models, including a fixed-payment model that might be attractive for younger ophthalmologists looking to build their practice with confidence and stability, profit-sharing models, and percentage-of-revenue models. Determining the most suitable model will depend on any number of factors.
And if it doesn’t work out as planned? Both parties can part ways amicably.
“It’s not realistic to think we will be the right fit for everyone. Fortunately, the models we now have in place have promoted strong retention,” she adds.
Cranage says too much focus on the term ‘corporate’ detracts from the dedication and hard work of VEI staff.
“For us, it’s all about patient care, service and outcomes,” she says.
“But there’s no denying the value that our corporate network offers: we can be more efficient in providing that service, provide access to the latest technology, provide comprehensive training for our staff, monitor an incredible amount of patient feedback to understand how we are doing and where we can improve, pilot initiatives on a small scale before rolling them out across the organisation, and provide great opportunities to get involved in research.
“It’s been a long time coming, but people are changing their perception about us. I would encourage ophthalmologists who might be interested in working in a corporate environment at VEI to talk to their peers who work here. Ask them for their honest opinion.”
For those who might not be ready or interested, they can still choose to perform surgery through its day hospitals as a visiting medical officer (VMO). Although owned and operated by VEI, the distinct VHG brand was realised to allay any fears non-VEI ophthalmologists may have about losing patients.
“Our day hospitals aren’t always co-located with our clinics, and we do offer those services to (non-VEI) ophthalmologists who would like to build their surgical practice in the local area. We’d like to engage further with the eyecare community, so it understands the world-class service we offer,” she says.
“Many of our VMOs are complimentary of our ability to go above and beyond to ensure the process flows smoothly for themselves and their patients. They emphasise how reassuring it is to operate in a theatre where there is the expertise and equipment for any situation, so they can really focus on their patients.”
A culture of innovation
For Associate Professor Michael Lawless, who has been with VEI since its early days, Cranage embodies everything about the modern-day organisation.
“When I look around VEI – and I’m on the Medical Advisory Board so I understand how it runs – I see a fantastic team led by a terrific CEO and very strong administrative executive staff. They’ve all been around long enough to really get ophthalmology, the day surgeries and laser suites,” he says.
From a solo practice built on his corneal subspecialty in the 1980s, to a two-man band (joining forces with Dr Chris Rogers and buying Australia’s first excimer laser) that ultimately grew into a multi-subspeciality clinic and day surgery, A/Prof Lawless experienced all modes of practise prior to joining VEI in 2005.
He balanced this alongside a public appointment at Royal North Shore Hospital for 20 years.
The hardest part of running his own ophthalmology practice was securing the funds to purchase equipment. “It’s a capital-intensive specialty,” he says.
As such, VEI’s equipment procurement expertise has helped A/Prof Lawless do much of his pioneering refractive surgery work.
For example, he was the first Australian surgeon to perform laser cataract surgery with the femtosecond laser in 2011, performed the country’s first SMILE Pro laser surgery in 2023 with one of the Southern Hemisphere’s first installed ZEISS VISUMAX 800 femtosecond lasers, and most recently completed the world’s first iris-based OcuLign for cyclotorsion adjustment.
Practising independently can also create an element of loneliness. “I always saw so much power in a group.”
When VEI came on the scene, he was curious. At the time, GPs, radiology, and pathology were all being corporatised and he liked the personalities involved with VEI. So, with a large, mature practice and co-located day surgery, he joined the group. A/Prof Lawless eventually became medical director and part of the board so he could understand and influence how the network was run.
The way he has been remunerated has evolved over the years, but as he reaches the latter part of his career, he now takes a percentage of what he earns for the group.
“If I work harder, I earn more money. If I work less or have more weeks away, I earn less. I can choose to do as much or as little as I like,” he says.
With the VEI model, he says ophthalmologists can become involved in the running of their clinic to the degree they wish. There are also various ways for ophthalmologists considering a job switch to ease their way into the group, becoming more invested over time.
“Ophthalmology is a fabulous specialty to be practising for this last generation and this coming generation. If you’re a young person in your 30s, and you’ve just graduated, have faith in yourself and your future,” he says.
“You are in a terrific bargaining position because you have great skills. Understand who you work well with, respect and trust. Above all, have the courage to make decisions that you’re happy about.”
NOTE: VEI will be an exhibitor at Adelaide’s RANZCO Congress from 1–4 November 2024, allowing ophthalmologists and support staff in attendance to learn more about the organisation, including VHG and FVF.
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