A shared space practice model

It takes time to develop a veterinary practice based on a shared space model, but it has many benefits, including a decrease in overhead and an increase in offered services.

Most veterinary practices have owners and associates. New services can only be offered if someone at the practice learns them, or patients are referred out. If clients are looking for services that the existing staff cannot offer, a shared space practice model can help solve the problem.

For many years, I ran the Holistic Medicine “department” at a large specialty hospital in the Northern Virginia area. While the public saw the facility as one practice with one name, the group was actually a collection of separate practices working out of a shared space. The proximity to other service providers can offer a variety of treatment options to clients, and also lets them know about your own services for future use.

Dr. Kocen treating a dog with acupuncture. Rooms are designed to be comfortable for the animals so they are easier to treat.

At the specialty hospital, our practice offered acupuncture, homeopathy and Chinese herbal medicine. There was another practice offering rehab, but if I thought patients would benefit from therapeutic massage or chiropractic, for example, I had to refer them to someone outside the practice. This wasn’t a problem, but I didn’t know the hours, fees or areas of service of these mostly house-call practitioners. And I frequently ran out of their cards to give to clients.

Reaching out to other practitioners

While the arrangement I had was working, the limitation to offering additional services prompted me to think about opening my own practice. I wasn’t in a positon to hire practitioners to provide other services. So I thought about developing my own holistic practice based on the shared space model. I called some of the practitioners I was already referring clients to, and asked if they would interested in using my proposed new facility a day or two per week.

Several of these practitioners worked with horses as well as small animals, so they were based away from areas of denser population; this reduced their ability to work with small animals, required lots of driving, and limited the number of clients they could see in a day. The advantage of sharing a space meant they would be able to use an existing small animal facility without having to build and maintain one themselves, or pay full time rent for a space they would use only part time. I explained that a shared space facility would also increase exposure to their services among clients coming in to see someone else. Those clients might consider using their services or inform friends that these services were available. In turn, those referrals would be exposed to our other services. The advantage to the practice owner is that fees from the associates help defray expenses. In our case, the expenses were to be used to build out and maintain a clinic. We would all benefit from the clients of other practitioners seeing the services we offer, and they referrals they would send.

As you may imagine, the prospective associates had many questions: they wanted to know what limitations there might be on the services they could offer, what services they could get for their fees, what access they could have when we weren’t there, and how much it would cost.

Protocols in a shared space practice

Coming from the world of the “referral hospital”, I was used to clients having diagnostics done before they arrived for initial consultations. I also recommended that they have their regular vet do any follow-up diagnostics. We also did not do annual exams, nor dispensed conventional medications. Since clients returned to their “regular vets” for these services, it let the conventional veterinarians follow the progression of holistically-treated cases and see the pets getting better. Since I was not competing with them for the services they offer, they were more likely to refer cases to me.

In a shared office space, rooms can be chosen that are appropriate for the modality. This room is often used for chiropractic (Dr. Bierly) and physical therapy.

In our current shared space practice, practitioners are allowed to offer any treatment options they think the patient needs, apart from conventional therapies. They may do diagnostics but we are not staffed to provide conventional medicine assistance. The two associates who offer chiropractic are also certified in acupuncture, so even though my own practice already offers acupuncture, the associates are not limited to offering just the therapy they list as their primary therapy. It is also understood that no one has an exclusive right to any therapy. We have two chiropractors and two massage therapists, but they come in on different days. We have another practitioner who offers acupuncture and Chinese Herbal Medicine, as does my practice. She has a strong interest in cancer treatment so we are happy to refer cases to her.

I don’t see any of this as competition, but as providing a wider array of services. Ultimately, it would be great to have all therapies available every day.

Each associate makes his/her own appointments and takes his/her own fees. We list all the practitioners on our website, with links to their own websites, so clients can learn more about them and what services they offer. We all try to mention the other practices in our space whenever we are at promotional events, so that everyone benefits.

Building a group takes time

Over time, I have found that each associate views the arrangement differently. Some have complained about slow growth of their clientele. For each individual practice to grow, however, the practitioners should ideally reach out to the public, to human practitioners in their fields, and to the general veterinary community. It is unrealistic to think that increased clients will come entirely from internal referrals. Not working to grow an individual practice can have a negative impact on the other practices in the shared space. Therefore, even though each practice is separate, there should be an understanding that supporting the facility as a whole will help everyone.

We have had a few practitioners start and leave, but most have stayed. A few I spoke to decided that what we had was not for them. In time, however, I think the “right” group of people will find us, and help us develop this practice to reach its full potential.