Strategies for practice growth: the multi-doctor practice

Avant Growth Academy* is a series of two-day, in-person workshops delivering insights specifically curated to empower doctors at each career stage.

We’ve brought together expertise from across Avant’s group of businesses, as well as selected external specialist partners, to deliver a comprehensive program that will give you the knowledge, skills and tools to help you build a successful medical practice.

Program Director, Steven Macarounas, Avant Growth Academy talked to some of the team who will be presenting at our upcoming ‘Future-ready Private Practice’ course in Melbourne from August 9-10, about possible growth strategies with a focus on establishing a sustainable multi-doctor practice to leverage revenue growth.

“The rule of business growth says that every business, like every child, is destined to grow! Needs to grow. Is determined to grow... Once a doctor has started a practice, it’s his or her job to help it grow. To nurture it and support it in every way. To infuse it with: purpose, passion, will, belief, personality, method.”

This powerful sentiment from Michael Gerber, author of The E Myth Physician: Why Most Medical Practices Don't Work and What to Do About It, is particularly relevant when our lives are changing at an unprecedented rate.

In this era of disruption and increasing competition, it’s important to focus on growing your practice. As the saying goes, if you’re not growing, you are standing still and actually going backwards.

Steven Macarounas spoke to some of the presenters at our upcoming ‘Future-ready Private Practice’ course about establishing a multi-doctor practice. This structure represents a fundamental principal of leverage in business; providing greater patient access and availability, and in turn, multiple income sources.

Tell us about the philosophy behind your decision to establish a multi-doctor practice and the operational framework that underpins it?

“Establishing a medical practice is no small undertaking. Whether it’s a practice for one doctor or 40 doctors, the same quality of design and governance needs to be in place,” Dr David Williams, a neurologist at the Neurology Network Melbourne and a practice owner says.

“Setting up a practice properly may not be taught in medical school but it’s something that experts can assist with. Working with practice management consultants can help get systems, software, processes and staff set-up in the right way – and you can learn along the way,” he says.

Based on his own experience helping hundreds of doctors start and optimise their practices, Dr Williams believes financial success is built on good planning.

“I encourage everyone establishing a practice to create a business plan and commit to a strategy that mirrors your mission,” he says. “Whether it’s growing patient numbers, growing practitioner numbers, or building out to new sites, you will always do better with a comprehensive and well considered business plan.”

“While decisions about branding, software, staff roles, administration systems and financial systems are likely to differ depending on your growth plans, I recommend obtaining advice from an experienced business consultant at this time,” Dr Williams says. “Following these steps will reduce your business risk and provide comfort when setting up your practice, even in the absence of no formal training.”

How can practice principals overcome the significant challenges associated with a multi-doctor model?

Ben Ryan, Partner, Commercial & Corporate, Avant Law, says good governance is the best way to address the growing pains inherent in this business structure.

“This goes beyond just service agreements, and includes agreements to govern the relationship between the practice owners themselves as well as good internal policies and procedures that provide staff with clear guidance on how to address issues and meet compliance expectations.”

“For multi-doctor practices, depending on the structure of the business, we recommend having a shareholders and/or unitholders agreement or a partnership agreement in place to outline the agreed governance for the business,” Ben says.

“At a minimum, these types of agreements need to address how an owner joins the practice, their management or partnership responsibilities, and what the exit requirements are when an owner wants to leave for the purposes of succession planning,” Ben says. “For example, if the business structure is a unit trust or a company, do the existing owners have pre-emptive rights ahead of third parties to buy the units or shares of the exiting owner?”

Practice growth usually requires reconfiguring the practice space, adding rooms or even relocation. Tell us about the finance considerations?

Kate Farley, Head of Residential Lending, VIC and SA, Avant Finance, highlights the importance of doctors having a practice site that can grow with them without the need to relocate.

“This can be done with minimal capital outlay as the fit-out and set up can be completed to a base standard with the room/s available to be set up at a future date and the cost incurred at that point,” Kate says. “We often work with buyers' advocates, fit-out companies and project managers at this stage to ensure our clients set up a practice that is fit for purpose in the long term.”

“Having expert assistance to provide guidance on how to maximise your investment is an essential part of the funding process as it reflects longer term strategic planning and sets you up for growth,” Kate says.

Growth often comes with risk. What are the medico-legal risks of significantly increasing the number of staff in a practice?

Based on her experience helping members, Gail Wang, Risk Adviser, Avant’s Risk Advisory Services, pinpoints scaling too fast as the most common risk for practices.

“When this occurs the structure doesn’t adequately support the business’s growth and we see complaints rise, stress for practice owners and high staff turnover,” Gail explains. “For example, owners have business plans and goals, but the staffing is left behind.”

“Many owners also underestimate the time it takes for staff members to become fully trained and able to perform their role autonomously,” Gail says. “Other issues include poor onboarding with inadequate support for new doctors, nurses and allied health, siloed training, and high administration staff turnover due to no career progression opportunities, poor pay, feeling unheard or undervalued, or the repetitive nature of the work.”

How can these risks be managed?

Gail says it’s imperative to train your staff and contractors, and build a culture where they are heard and valued, and to have processes in place which support those working in the practice.

Tracking daily labour hours to identify staffing gaps, creating structured training plans with clear timelines and addressing workplace issues immediately rather than putting them on the backburner will also help to mitigate any risks.

As the practice grows, Gail recommends reviewing your lines of delegation and authority and ensuring they are clear, creating formal HR processes and developing succession planning for leave coverage.

Building a multi-doctor practice is just one of many growth strategies worth exploring. While this business structure can introduce challenges, these can be addressed through a better understanding of the solutions, expert advice and support, and resources available.

2025 Avant Growth Academy events

Want to hear more insights from Steven Macarounas, Program Director, Avant Growth Academy and the Avant team?

Register now for our ‘Future-ready Private Practice’ program coming to Melbourne on August 9-10, 2025. Tailored for doctors and practice managers with established practices, this course is your gateway to exploring strategies to help you improve operational efficiencies and elevate your medical business to new heights.

The program will expand on possible strategies to facilitate growth such as ‘multi-disciplinary practice’, ‘advanced marketing and community engagement’ and ‘business intelligence and performance metrics analysis,’ to name a few.