In the “Practice Partners and Partnerships: The Roles of Physician and Administrator” panel at the American Academy of Ophthalmology 2025 meeting in Orlando, Edwin J. Apenbrinck, MD, and Kristopher Pugh, MD, opened the discussion by providing the background on how they formed their partnership at Dr. Black’s Eye Associates in Jeffersonville, Indiana. The panel, which also included, Bansari Mehta, MHA, chief operating officer of Dr. Black’s Eye Associates, then highlighted important nuances a physician or an administrator should consider with new or established physician partnerships.
“In life, the most important decision you make is who you pick as a spouse,” said Dr. Apenbrinck. “Similarly, on the business side of ophthalmology the most important decision you make is who you pick to become a partner with and/or who you select as your administrators.”
Handling Difficult Conversations Among Partners
Difficult conversations among partners require balance, preparation, and respect. The panelists pointed out that effective dialogue begins with facts, using data such as financial benchmarks or patient outcomes to ground the discussion in objectivity. Also, they said, leaders must listen actively, acknowledge differing perspectives, and redirect conflict toward shared practice goals. In addition, setting clear ground rules around respect and confidentiality creates psychological safety, while administrators can serve as neutral facilitators to depersonalize sensitive issues. Some common pitfalls they advised to avoid are personalizing disagreements, ignoring minority opinions, or rushing resolution. Above all, they said, difficult conversations should remain professional, solutions-focused, and centered on preserving trust and alignment within the partnership.
“Physician partners are essentially in a marriage built on trust, and diverse values and beliefs strengthen that bond,” said Dr. Pugh. “Partnerships flourish when diverse values are embraced as sources of organizational mission, vision, and principles. Disagreements are inevitable, but acknowledging and mending relationships with humility and empathy ensures lasting success. Partnership differences when embraced can fuel growth instead of division.”
How Physician Owners and Administrators Can Preserve Culture and Continuity
As founding or senior partners retire, preserving culture requires intentional planning. The panelists pointed out that practices often underestimate how much institutional knowledge and values are tied to legacy leaders. To ensure continuity, leadership must codify the practice’s mission, vision, and decision-making principles, while actively mentoring rising partners. Structured succession planning, transparent governance, and role clarity allow new leaders to step in with confidence.
In addition, they said, administrators play a vital role in maintaining operational consistency and bridging generational perspectives. When culture is deliberately passed on rather than assumed, practices honor their history while empowering new partners to carry the legacy forward. Equally important, they said, are inclusive gestures like inviting them into decision-making conversations, explaining the history behind choices, and recognizing their contributions. Administrators serve as the bridge, establishing consistent processes, providing objective data to depersonalize difficult conversations, and mediating conflicts.
"An administrator’s role is to foster alignment between partners while ensuring smooth operations that honor both tradition and growth," said. Ms. Mehta. “Administrators should strive to balance diverse viewpoints, mediate conflicts constructively, and create systems that allow physician partners to focus on patient care.”
The Administrator’s Role in Successful Onboarding Practices
According to Ms. Mehta, administrators are uniquely positioned to smooth the onboarding of new partners by bridging generational and tenure-based differences. They provide structure by developing formal onboarding programs, clarifying roles, and aligning expectations early. Administrators also act as neutral facilitators, ensuring open communication between long-standing partners and newcomers, while depersonalizing sensitive issues through data and objective metrics. By offering historical context to new partners and fresh perspectives to senior ones, administrators connect past and future. Ultimately, she said, their role is to maintain balance by protecting legacy values while creating space for innovation, so partnerships evolve without fracturing the culture that sustains the practice.
How to Manage “Too Many Cooks in the Kitchen”
When every physician partner wants a voice in every decision, governance can stall and tensions rise. According to the panelists, successful practices address this by defining clear roles, responsibilities, and decision-making structures. Partners should agree on which issues require collective input, such as strategic vision or major investments, and which can be delegated to administrators or managing partners. Administrators, they said, also play a key role in streamlining communication, ensuring discussions remain data-driven rather than emotional. By establishing transparent processes and honoring boundaries, physician owners create efficiency, preserve collaboration, and prevent decision fatigue, allowing the practice to move forward with unity and focus.
Conclusion
The panelists noted that long-term success in physician partnerships hinges on clear strategic alignment. They stressed that partners and administrators must agree on growth goals, succession planning, and whether expansion into subspecialties such as retina, refractive, or oculoplastics fits the vision. In saturated markets, they said, differentiation through patient experience, technology, or specialized expertise is essential as a team. Private equity adds another dimension: private practices must balance financial attractiveness with protecting autonomy and culture. Here, they said, administrators play a critical role in facilitating dialogue, modeling financial scenarios, and ensuring decisions reinforce shared goals. OM