On this episode of Retina Mentor Moments, John W. Kitchens, MD, and Jonathan Jonisch, MD, discuss Dr. Jonisch’s journey into a specialized retina-focused and research private equity practice.
Building community connections: Dr. Jonisch's journey in medicine
Dr. Jonisch is a native of Long Island and works at Vitreous Retinal Consultants of New York (VRCNY). He completed his residency at North Shore University Hospital, which is a pseudo-affiliate of NYU. During his medical student rotation at Long Island Jewish Medical Center, an affiliate of Albert Einstein College of Medicine, he was introduced to VRCNY.
VRCNY was founded by Peter Schwartz, who likely introduced vitrectomy to Long Island in the mid-70s, and by David Fastenberg, who joined him in the 1980s. While a resident, Dr. Jonisch met some of the doctors at VRCNY, which influenced his interest in retina and his approach to practice.
He completed his fellowship at the Retina Institute at Barnes-Jewish Hospital. This experience was unique because it offered access to both a resident clinic and a high-volume private practice. However, the practice setting has changed since then, and the university and private practice are now separate entities.
Returning to Long Island, a large and diverse region, Dr. Jonisch enjoyed working in the community where he grew up, often caring for familiar faces like former teachers. The strong camaraderie within his pro-private practice residency was advantageous, as many private practice doctors volunteered to cover clinics.
This helped Dr. Jonisch forge connections with them. Consequently, he was already acquainted with a broader network of referring providers than some more experienced physicians, which ultimately supported his patient growth.
Growing with care: The evolution of patient practice at VRCNY
The practice has always been expanding. Dr. Jonisch notes that “in private practice, you always feel like you could be capturing more patients and helping more patients. I definitely never feel like it's finished.” However, he doesn't feel he's struggling to attract patients, as the practice has grown from 10 doctors when he joined to 18.
An average day at VRCNY involves seeing about 65 patients, up from 50 when he first joined. The practice doesn't see 40 patients a day, nor does it see 100. VRCNY's approach values patient care and lifestyle, so doctors aim to leave at a reasonable time to spend time with family.
Bridging research and practice: The VRCNY model in retinal care
VRCNY was a founding practice of Retina Consultants of America (RCA). The original concept of RCA was to focus on retinal research, not just to be a retina-focused private equity group. The idea was to unite the top retina groups to support retinal research.
While Dr. Jonisch was skeptical that retina research would be a major value creator for the group, he noted that RCA in Houston was approaching it differently early on and sharing best practices with other groups. VRCNY established a research center next to a clinical office in Westbury.
Having a standalone research facility works because it has dedicated, well-paid staff who are solely focused on research (recruiters, coordinators, etc.) and who can take ownership. This dedicated infrastructure makes it easier to recruit patients without friction and boosts the bottom line.
Empowering through leadership: A framework for job satisfaction
The initial structure of RCA included a business leadership board (C-suite, private equity, CEOs) and a medical leadership board (two doctors from each group, like Phil Ferrone and Jonathan Jonisch). Unlike some private equity models, RCA maintains a structure in which doctors, who ran the business before joining, still have significant input and are not seen merely as "widget makers."
Job satisfaction is higher among doctors who keep some management responsibilities than among those who are only expected to punch in and punch out, even when pay is the same.
- Pain-free injections: It is possible to build a practice around them, which is highly valued by patients who may switch doctors for a less painful experience.
- Keep your macular holes closed and your retinas attached on the first try: Reoperations erode patient and referring doctor trust. Suggestions include adding an extra buckle to vitrectomy for detachments and using more C3F8 than needed for macular holes.
- Quick routine cases: Macular holes and puckers should be fast and efficient; you want your routine cases to be routine. Don't rush, but be in a rush when in the eye.
- Call referring doctors: This is a lost art, but it's super valuable for closing the loop on a referral, and they appreciate it.
- Give out your cell phone number: This relates to the previous point, so referring doctors can text you in a HIPAA-compliant way.
- Keep up to date: You must adapt to the times, attend meetings, and stay in touch with colleagues, pharma, and industry.
- Be open to new techniques and surgeries: New surgeries are not easy to do mid-career, so maintain an open mind and be willing to learn from younger colleagues.
- Foster good relationships with industry and clinical trials: This provides another avenue of satisfaction and interest beyond the daily monotony of injections and helps keep you relevant.
- Get involved in all aspects of the practice: This includes billing, marketing, human resources, and scheduling to help the group, which makes senior partners happy.
- Realize that your patient visit is the most important part of their day: Patients feel rushed and unimpressed if a visit is too fast, even if the care is excellent. The goal is to make a personal connection so they don't feel like just a number.
Conclusion
It is important to establish a practice that fosters an environment where doctors can build relationships with patients and take the time to communicate, giving patients the impression that more time was spent with them.
