thanks for the post tippy toe. i appreciate you taking the time to share.
i understand it is very, very difficult to start cold but i am still holding out hope. i plan on working a couple days part time somewhere else until i can start generating an income from my practice. i expect to lose money at first, but it's discouraging that it took you FOUR YEARS to break even. was your office in a good location-one where you could generate walk-in traffic?
I'm in a professional office complex beside a dentist. We are on a major road but very little walk-in traffic. I set up as a 'medical type' office targeting exams and eye treatments over optical since the competition here is outrageous. It's worked out well overall. I do have an optical but it play a minor role. If i had the money I'd open up on a major corner across from a CVS or other major chain.
The overhead rises as you grow due to more employees, equipment loans, bigger office and TAXES and more TAXES!! Optical overhead also rises of course. As a matter of fact, I posted an acutal monthly breakdown on SDN somewhere a whlile back. You might be able to search for it.
I'd recommend getting set up with an accountant and open as an S-corp right off the bat. You will need him sooner or later. Accounting cost me from $3,000 to $5,000 a year for the phone book size tax returns I do payroll myself through
www.paycycle.com It's very easy and you can do quarterly taxes on that site too. Very inexpensive.
It's been a long time since I opened. Time are definately different. You probably should visit a few cold practices that are a few years old if you haven't already. Just make sure it's not in an area you want to set up or you might not make it out of their office alive. ODs are VERY territorial, petty, jealous and vindictive.
If your set on opening cold and have a good location in mind, you will be much happier and miles ahead of your classmates that end up jumping from store to store.
A couple of tidbits:
1. Book your few patients very close together. A busy looking office looks better than having only one patient there. You'll only need to be in your office 1 or two half days per week. But keep a receptionist there full time. Don't close during lunch because that's when patients want to come to pick up their glasses or CLs.
2. Don't answer your own phone. All you need initially is a receptionist. You can do everything else yourself. Don't answer on the first ring but don't let it ring more than 3 times.
3. Don't schedule the patients too quickly. It looks bad if get them in the next day. People expect good doctors to be booked for a least a week (unless it's an emergency.
4. Have an on-hold message system.
5. You strength being new and opening cold is that you have all the time in the world to spend with the pt. Some like it. Some want to get out as quick as they can.
6. Also pay yourself first if you can. Many times there will not be any money left over at the end of the month. But if you don't pay yourself, it's a sure receipe for burnout.
7. Don't change people too much. If the patients is happy with their acuity. Don't give them another 2.00 diopters of astigmatism (even if they need it). You are asking for trouble. Listen to the patient. They will tell you want they want.
8. Hire personality and train them how you want. Nothing ruins a practice more than grumpy, personality-less employees (or doctor).
9. Don't skimp on equipment. You don't have to have the latest OCT when you first open. But you want to have a plan to get it all over time.
10. If nothing else, learn the foreign language that is insuance coding. Even if you have a coding employee, never forget how to do it yourself. Many a practice have suffered by an insurance person embezzling.
