Startup & Equipment Costs, Part 2

I fully agree with Ho Sun that it was difficult to estimate startup costs. As mentioned in my steps to start a solo practice, from talks I went to at national meetings the ballpark estimate for startup costs was $200 to 300 thousand. He went over this, as a follow up to his post I’m gonna list my costs.  I didn’t really have a set budget but just winged it when things came along. I always got at least three quotes on everything and asked for price matching or bulk discounts.

I was fortunate enough that I wound up under budget and didn’t have any delays. It was pure luck that I found a office space that as the right size already built out with rooms the right size for exam lanes. It also helped that since I was employed and had savings that access to financing was easier for me than for Ho Sun.

On other boards such as sermo, I’ve heard of psychiatrists opening for less than $5000, or family practice docs opening for less than $15,000. That’s because they don’t have to worry about expensive equipment or the financing it.

Just like how different practices grow their revenue at different rates, your practice startup expense depends on your philosophy and how much you want to do yourself. My philosophy was to spend my money wisely and get the most out of it.

This doesn’t mean that I always bought the least expensive item, for example in 2013 stratus OCTs were available for $10,000 to 12,500 but I spent multiples more on a cirrus. (For you non ophthalmologists out there, this is a machine that takes cross section imaging especially of the retina and optic nerve to assess fluid levels in the retina to monitor wet macular degeneration or diabetic retinopathy, or the health of the nerve fiber layer for glaucoma monitoring.

But often I didn’t buy the latest model if it made more sense to buy a slightly older model. I’ve heard of people buying equipment or instruments off brand from places like China or India, but the quality can be hit or miss. Sometimes you get a great deal, other times you get burned.

So I did a lot of research and bought most of my equipment used. There were several items I bought new, because the price differential was small. I agree with Ho Sun that eBay was great with buying smaller items, but I don’t recommend buying more expensive items with electrical components off eBay.

Keep in mind that you don’t have to buy all of your equipment at once. Some items can wait year or two later when you have positive cash flow. For example, my friend upgraded his IOL master to a Lenstar when the number of cataract surgeries and premium lenses implanted grew. (A IOL master calculates the length of eye and curvature of cornea and has algorithms to plan the prescription power for the artificial lens implanted during cataract surgery.)

Ophthalmic equipment
Zeiss cirrus OCT: $41,000
Zeiss visucam (bought in 2015): $12,000
Exam lane $21,000. This is where eBay came in handy. Marco 101 lensometer $560, Reichert phoropter $2200, Welch Allyn indirect $1120. Also bought new chair and stand for $10,300. Vintage 1980s Hagg streit slit lamp with tonometer for $3800 bought from another practice in town.
Zeiss IOL master 5.4: $18,000
Zeiss Humphrey visual field 740: $11,000
Ezer autorefracror: $6400
Miscellaneous: $3000

I do in office procedures in my exam lane so didn’t have a dedicated lane. Obviously if you do oculoplastics this will be different.

IT system
Practice management system $8700
Electronic medical record: $10,000
SBX phone system with installation: $3300
Computers, server with installation: $15,000 (server $4200, four computers $3300, firewall $1000, miscellaneous and labor $6500)

Tenant improvements:
Zero

Miscellaneous:
Office furniture: $2200
Website design: $2700
Accounting fees: zero
Consulting fees: zero
Insurance (malpractice and business): $7000
Education (CME) with travel: $2900
Meals: $850 (evidently I eat more than Ho Sun does)
Mileage: $1200

So my total equipment was about $125,000, about $95,000 of which was ophthalmic equipment. And my total startup costs were about $155,000.

The one thing many ophthalmologists do differently from myself and Ho Sun is to equip a second exam lane.  Even in year four, I still work out of one exam room without a tech and still don’t need a second lane.

Especially those of you who are opening up near your previous job and expect patients to follow you to your solo practice, it might make sense to equip a second lane from the get go.  Others can wait until year one, two or later.  Many docs also equip a second room with minimal equipment as a tech screening room.

If I had equipped a second exam lane in year one, I would have had plenty of time to research prices and bid on eBay.  But I suppose that the money invested in the stock market has returned more than any price differences in equipment…

6 thoughts on “Startup & Equipment Costs, Part 2

    • Good question. We have this debate on our google groups all the time. My view is that clearly the costs of a second slit lamp outweigh the benefits. Even the ones that roll around would cost a few grand. A local company can repair my slit lamp in one day and my patients would probably reschedule so I’d probably lose $1000 or less in revenue. Thankfully this hasn’t happened to me yet, but I wouldn’t pay a few thousand to risk losing $1000 every five or six years.

      Do you have two OCTs and two IOL masters at your office in case one breaks down? If you’re busy enough it might justify the cost but in most cases probably not.

      We’ll have related posts on buying equipment warranties and purposely over staffing in case someone phones in sick. Stay tuned and thanks for commenting!

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  1. With regard to startup costs, my worry is employee expenses. I will need in my vein practice: a receptionist/office manager, ultrasound technologist and mta/nurse. I could potentially do away with one or have one perdiem but I definitely need two out of three. How did you manage this is your practice?

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    • Both of us survived on only one employee for the first four years, we room and tech our own patients. Everyone has a different number of patients per day for when they want to hire a second employee. It’s a matter of personal choice, although anything under 10 patients per day you can easily handle yourself for ophtho.

      Probably better to start small and build up. It’s best to be your own office manager at first so you know how to run everything and aren’t held hostage by a single employee’s knowledge of operations. But we have a colleague in our google group who started with a office manager at $26 per hour and quickly hired multiple employees!

      If your specialty is in shortage in your area and you expect a lot of patients from the onset it might make sense to hire multiple employees the first month or two, but if you can do the job of the ultrasound tech or nurse at first, if you are seeing three patients a day it might make sense to try doing it yourself.

      Your field should publish average salaries for the tech and nurse or try to google it, or search on Craigslist pretending you’re an applicant.

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