From Medical Director to Owner: Dr. O’Keefe’s Path to Building Her Own VPP Hospital

The first in a series on VPP’s three pathways to partnership, told through the doctors who’ve walked them.

Every veterinarian who dreams of ownership eventually runs into the same question: How? At Veterinary Practice Partners, we’ve built three distinct pathways to get doctors there. Some, like Dr. O’Keefe, want to build a hospital from the ground up, choosing every wall, room, and detail themselves. Others want to buy into an existing VPP hospital, stepping into a running practice and team. And some want VPP to help them acquire a hospital together, often from a retiring owner. Each path looks different, but they all lead to the same thing: real equity, real autonomy, and a hospital that stays true to the doctor who leads it.

What It Means to Build a De Novo

Of the three pathways, this one is built for doctors who have a clear vision for the practice they want to lead and don’t mind starting from an empty shell. Instead of stepping into something already running, you and VPP identify real estate together, design the hospital from scratch, and build out every exam room, treatment space, and reception area to your own specifications.

A De Novo typically takes twelve to eighteen months from first conversation to opening day, the longest runway of the three pathways. In exchange, you get a hospital built exactly the way you want it, with VPP as your partner every step of the way, from site selection, through construction, to generating new demand for the hospital, all the way to the grand opening, and beyond.

Source: Dr. O’Keefe interview.

Dr. O’Keefe’s Story

A corporate breaking point. Dr. Audra O’Keefe became a medical director just one year out of veterinary school, running a hospital for a corporate group that had acquired the privately owned practice she started at. After a transfer to a different hospital in the Midwest, the support she had disappeared. She was managing eight doctors with eight different philosophies, and thirty staff members, with no backup from the corporate office beyond instructions to cut costs and make people get along. She was doing the work of an owner without any of the upside.

“If I was going to put in that work, I might as well be getting a piece of the pie.”

She knew she was already doing an owner’s job, so she decided she should be one. She didn’t know where to start, but she knew she wasn’t doing another tour managing someone else’s hospital.

Proving it wasn’t too good to be true. Dr. O’Keefe looked at a few groups before choosing VPP, and she didn’t take anyone’s word for it. She picked up relief shifts at multiple VPP hospitals to see how they actually operated day-to-day, and in 2023, before she’d even been offered an operating agreement, she attended VPP’s Homecoming event in Philadelphia and talked to partners from across the country about what their experience was really like.

“It was cool to be surrounded by like-minded people who all wanted the same thing.”

What partnership actually feels like. The contrast with her old corporate job came down to who was making the calls. Where she used to be told what to do and handed metrics to hit, she now runs her hospital her way, and calls her VPP operations partner when she wants advice rather than instructions.

“Now I have a partner who holds my hand, helps me as much or as little as I want in order to solve those problems, versus being told constantly what to do.”

Building where nothing existed yet. There wasn’t an existing VPP hospital anywhere near Dr. O’Keefe, so the De Novo path wasn’t just her choice, it was the only option on the table in her part of Arkansas. Before she partnered, she was driving five hours each way to pick up relief shifts at VPP hospitals in Saint Louis. She and the VPP De Novo team were building her dream from the ground up.

They found a freestanding urgent care clinic that had closed after COVID, right on one of the busiest streets in town. From there, Dr. O’Keefe designed the layout and treatment space around her own wants and needs. Nine months after breaking ground, the doors opened.

Room for a family, not just a hospital. As a young mother, Dr. O’Keefe needed a partner who wouldn’t treat her schedule as a problem to manage. She says VPP never once questioned it when family came first, whether that meant missing a planning meeting or leaving early to pick up her son from school. That flexibility, plus help navigating bank relationships and business plans she’d never built before, gave her the confidence to take the leap into ownership.

“I’m not just on an island by myself, completely alone, trying to figure out how to run a multi-million dollar business. I have someone there who’s going to help me.”

Veterinary Practice Partners · Pathways to Partnership Series