Starting a Practice

[Bronze Medal]

I'm wondering how much time, money and effort would go into starting a new practice from the ground up in a medium sized city. I imagine it would be very difficult and I've had two different attendings each tell me that they can't imagine this being feasible for a new grad today. A few questions in particular.

1) How much money would this cost? Approximately. In a mid-sized city.

2) What personel would be needed? Technicians, front desk staff, billing? Would you ideally try and find a partner or would you go at it alone?

3) With regards to office space, would you find somewhere to rent? How many exam lanes would you need per ophthalmologist?

4) With regards to operating, would you recommend finding a local hospital vs. local surgery center? Does operating at a surgery center limit the call you take?

5) With regards to EMR, which one would you choose?

6) With regards to equipment, at minimum what would you need for a comprehensive practice?

7) How would you generate referrals? Make the rounds to visit local optometrists?

8) How far in advance of graduation would you start planning?

9) Would there be significant skill atrophy given the lack of an initial patient population that comes with starting a new practice?

Thanks in advance for taking time to answer.

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[corneainterviewseason]

Can't answer all of them, but will give you my two cents. I think of lot of it depends on the saturation of the market. If it's super saturated, it would be tough. If there is a big need (not the case in most medium sized cities) it would be easier.

1) How much money would this cost? Approximately. In a mid-sized city.
Depends on if you are buying/renting equipment, buying/renting office space, etc... I'm not sure. Roughly $500,000? Will need some help on this one.

2) What personel would be needed? Technicians, front desk staff, billing? Would you ideally try and find a partner or would you go at it alone?
For private solo starting out, probably 2 techs and 2 front office people at the very minimum. A partner would be nice to split costs, but if you're in a saturated area that just means you'll both be slow for a while.

3) With regards to office space, would you find somewhere to rent? How many exam lanes would you need per ophthalmologist?
Ideally you'd have 3-5 exam lanes. Renting or buying are options.

4) With regards to operating, would you recommend finding a local hospital vs. local surgery center? Does operating at a surgery center limit the call you take?
ASCs are more convenient, but many local hospitals (that have health insurance tied in with them) force you to operate there if you accept their insurance.

5) With regards to EMR, which one would you choose?
Tons out there. Epic isn't doable in a single practice due to cost. Have heard good things about Athena, Nextech, EMA. This is a tough one, not a lot of info out there with regards to comparisons between the different systems.

6) With regards to equipment, at minimum what would you need for a comprehensive practice?
Slit lamp, instruments for surgeries and in office procedure, topography, OCT, Lenstar or IOL master, HVF, phoropter

7) How would you generate referrals? Make the rounds to visit local optometrists?
Probably best way is to make the rounds. Again, easy if there is a need in your city. Tougher if it's saturated and the optoms are already in bed with someone else.

8) How far in advance of graduation would you start planning? At least a year, I'd think. Unless you want to be sitting around for a few months after graduation figuring it out.

9) Would there be significant skill atrophy given the lack of an initial patient population that comes with starting a new practice? Probably

Good links

https://www.aao.org/practice-management/article/preparing-to-opening-your-solo-practice-time-criti
https://www.aao.org/practice-management/article/starting-solo-practice-sound-tactical-plan-is-key-
https://www.aao.org/practice-management/article/starting-solo-practice-it-takes-entrepreneurial-sp

 

[Newgradcoldstart]

I am an Optometrist and I cold started a practice in a suburb of a large city. Very saturated area however I did language niche research and demographic research. With renovations and equipment and frames and marketing it only cost me $50,000. No not joking. I am really good at keeping costs down. I bought used equipment and will upgrade in the future. 1 exam lane, no OCT no VF, no fancy stuff. All you need is yourself and a front desk person to take calls while you are working part time at other locations. Keep your overhead as low as possible in the beginning and upgrade as you go. My front desk person does billing. If you wish to learn more then email me at [email protected] . That's not my actual name. And my rent is $1300 a month in a professional building. Good luck, it can be done but has to be done smart!

 

[long]

I would say that for an ophthalmologist, I can't imagine working without a visual field and OCT. And obviously IOL master. So your costs are going to be more than what the above poster has.


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[KHE]

I agree that $500,000 is a completely absurd number to start off. You don't need to even sniff that. I helped a local ophthalmologist set up shop several years ago and we did it for way less than $100,000. Now, everything was used and/or leased but the doors were open and we were seeing patients for much less than six figures.

Your biggest expense in most businesses is labor. You do not need multiple techs and multiple front desk staff. You need one, maybe two at max to start. You can always add as you grow.

Regarding rent, buildouts and leases can be expensive. You may want to see if you can sublease from another doctor. Perhaps, if you're going to do general, see if you can sublease from a retinal surgeon who has an extra room. Or even a primary care practice. Get a separate phone number from that office that you can easily port to your new "permanent" office a year or two down the road.

As far as equipment goes....used, leased, refurbished. Don't need new, state of the art when you're starting out. Your equipment has to make you money. No point having a $50,000 OCT sitting there doing little while you see just a few patients a day and build your practice. Contract with a company that can bring in an OCT a day or two a month and schedule them all on that day. Or contract with your local retinal guy to have their staff run them.

 

[long]

One question I have wondered is what do you do if you want to take a vacation as a solo guy just starting out? Just tell your patients to go to the ER if they have a problem the week you are gone?


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[MullerCell]

One question I have wondered is what do you do if you want to take a vacation as a solo guy just starting out? Just tell your patients to go to the ER if they have a problem the week you are gone?


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The ER is likely not a good option for coverage and I'm sure patients would be quite put off (not to mention the ER you are dumping on and the ophthalmologist covering that ER assuming they have coverage). Would be wise to find another ophthalmologist in the area that is willing to cover for you and arrange in advance. A sub-specialist looking to garner referrals rather than your direct competition would likely be most willing. Otherwise, I wouldn't leave town.

 

[MstaKing10]

In our community some ophthalmologist have banded together and pool their call so that one doc is ok call for multiple practices at the same time for holidays and the like.