I am by no means an expert (yet, but I am working toward that goal), but I will give you my experience. First off -- let me say that my recommendation would be to postpone any large expenditures or debt assumption until after we see what this November holds. A "comfortable" amount of debt for an annual income of >350K is quite different from 200K (despite what people may say or think).
I started a solo practice after my fellowship in 2006. Construction delays pushed us out 4 MONTHS, which was a pain. I had no sources of personal funding, so everything had to be accomplished through a line of credit. I started with a $200k revolving line of credit set up as a sweep account (any monies left over in the account at the end of the business day, after bills were paid, were applied toward the LOC loan, paying it down), with a lockbox for electronically filed insurance monies. Fees are a little higher, but the protection from embezzlement afforded by such a situation allows you to maintain focus without having to worry about it quite as much. This was simply for operating expenses and equipment leases (purchase the equipment and then sell it to a leasing company until cash flow is such that you can reassume it and take the depreciation or, if you are starting early enough in the year, just purchase it outright and hope that you pay it off within that tax year). The line of credit maxed out at around 170-180K prior to paying it down, and it took 11 months to pay the portion that was not covered by the major equipment lease. I paid myself very little during this time period (only enough to keep up with the bills as each dollar is essentially borrowed money at interest, much akin to living off of a low interest credit card).
I think that the key thing is to be realistic in your income expectations and not bite off more than you can chew. Do your homework and understand what you can realistically expect to collect on a month by month basis, and determine what your operating margin should be. Do not become a slave to your fixed overhead. As far as the ASC goes -- potentially risky maneuver. Consult an experience healthcare attorney regarding the latest Stark provisions as well as other potential conflicts with physician owned entities.
