Risks, Mistakes, Regrets, and WTF Was I Thinking???

As I was editing and reposting Equipment Financing Part 1, I couldn’t stop cringing at what I was reading. I called my 2010 self an idiot more than I care to admit. I really had absolutely ZERO clue what I was doing. I was just banking on the fact that I was smart and diligent enough to become an ophthalmologist, I was willing to invest the time and energy to learn on the fly, and that I was not afraid to make mistakes that could potentially lead to my financial demise.

The last part is probably the most important key to building a successful solo practice or any other business. You have to be willing to take risks, and have the gall to stomach their consequences. I was more than prepared to crash and burn, and had contingency plans in the unfortunate event that my fears became reality. Unfortunately, this kind of risk-taking behavior is also the exact reason why the barrier for entry into solo medical practice is so high for our generation. In general, doctors tend to be a conservative, risk averse cohort. Even when practicing medicine, we have been taught throughout medical school to avoid gambling with our patients’ lives and well-being, and to do no harm. On top of that, one of the main attractions of medicine is the fact that it near-guarantees a six-figure salary with great job security. Not quite the profession for action junkies and thrill-seekers.

Now, when you send these types of people into unknown territory with the risk of financial ruin, then of course the industry will be fraught with naysayers and doubters. The only reason that the old guard had the gumption to pursue solo practice 30 years ago was because each cataract surgery paid $3,000 versus a paltry $700 today. Any bonehead could probably run a lucrative practice at those rates. It’s just that decreasing reimbursements have now weeded out the bozos from the entrepreneurs. This is exactly why you have well-respected members of the community saying “the days of solo practice have gone the way of the dinosaur.” They might be amazing clinicians and surgeons, but they never felt the impetus to build and hone their business skills. It’s just ironic that the ones that bark and complain about how solo practice has gone downhill are dinosaurs themselves.

Having re-read my old post, maybe these doomsdayers actually have a point. I had no prior business experience, and most of my 20’s were spent trying to figure out what the heck was the difference between an S3 and S4 or just trying to be able to see the retina with my 78D lens. I never had any formal business training, and was pretty much flying blind. All I had to rely on was a brief 3-part article series on starting a solo practice that a consultant wrote on AAOE, whom also happened to be with the same consulting firm that I had hired before I realized I was being taken for a ride. Everything else was through professor Google.

Now, here’s what I should have NEVER EVER done:

  1. Sign a 5-year lease, that costs $300,000+ in rent, without securing financing. My exhaustion and desperation for any kind of financing clouded my judgment. I should have obtained some sort of commitment letter guaranteeing my financing prior to signing a lease. If I felt Funding Well Capital was shady and wishy-washy, I should have moved on. I was just afraid of not being able to find another lender, and also feared losing what I thought was a good location for my office space at the time. I neglected the fact that it was 2010, and that space was probably going to be available for a while.
  2. Put down a 10% security deposit for Zeiss equipment without having any way to pay for the remaining 90%. I don’t even remember if my security deposit was refundable, and most likely, I probably didn’t even ask. Zeiss, whose sleazy sales tactics and offensive customer service is a topic of another future post by the way, made me think that I HAD to commit before month end if I I wanted to lock in their fiscal year-end “discounts.” This is the oldest salesman trick in the book, and I fell for it like a complete dodo brain. I do believe that you can get a better deal at certain times of the year, but you have to realize that these guys run sales all the time (ie. ASCRS, AAO, end of year, end of fiscal year, etc). Just because you miss one discount period doesn’t mean that there won’t be anymore to come.
  3. Think that the Small Business Jobs Act will actually help small businesses. That’s the same line of thinking as Obamacare helping uninsured and underinsured individuals.  Did people who like their doctors really get to keep their doctors under Obamacare? (hint: the answer is NO). Government is not your friend in small business. They will not help you bake your pie. They will only eat a piece of it when it’s ready.
  4. Try to get a $100,000 laser when I still didn’t have any money to buy a slit lamp or chair. I probably don’t have to say anything further to convince you I was missing a few IQ points on this one.

Man, I was so all-in on the idea of going into solo practice that I let my emotions get the best of me. I should have taken it a little slower. I should have approached my friends to see exactly how much they would be able to lend to me. I was too proud to give this route a serious thought. I just wanted to prove to myself that I could achieve my goals independently. After all, I already felt bad for borrowing $100,000 from my parents.

In retrospect, if I was struggling to obtain financing, I should have just worked per diem for 1-2 years anywhere in the country, and then try to secure a loan again. I would have had a much better chance then. After all, many members of Solo Eye Docs Group started their solo practice after working as an associate for a few years. Most of them did not struggle  as much as I did to obtain financing.  I was just impatient and couldn’t swallow my pride enough to work for anyone, now that I had already prematurely liberated myself professionally in my head.

In conclusion, you need to have a respectable appetite for risk, but you should not let emotions, desperation, sense of urgency, pride, and impatience cloud your ability to stratify that risk. Luckily, I was able to eventually secure financing, albeit at pretty crappy rates, and I was able to eventually pursue my professional dreams without further delay. Hence, you will also need to be ready to capitalize on any luck that comes along your way. Good luck everyone.

3 thoughts on “Risks, Mistakes, Regrets, and WTF Was I Thinking???

  1. This is Howie. I have every admiration for Ho Sun starting his practice from nothing; I worked as an employee for a few years which made things much easier for me, having saved some money and not worrying about financing. Although I didn’t have the google group’s advice at least I had Ho Sun’s original blog and the advice of a few friends in solo practice.

    I also had NO idea what my startup costs, expenses or revenue would be, and was also just winging everything hoping it would work out. Folks in our google group know I am very risk averse and conservative with my decision making. When I opened, I thought there would be at LEAST a 50% chance that I’d be out of business in a year- because I knew nothing about running a business and had no experience.

    Having said that, my view is for most of us, starting a solo practice isn’t the highest risk undertaking- in retrospect it is one of the lowest risk highest return investments (both financially and in terms of personal satisfaction) that I’ve undertaken. And the overwhelming majority of our google group feels the same way!

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  2. Oh, those sleazy salesmen…another thing I learned is that costly annual warranties are a racket — I will never again buy equipment without haggling over the warranty and deciding if I really need it. Gave thousands to Heidelberg for marginal service, could have saved so much if I’d spent my own money mailing in the gear myself when it needed repairs/updates. By the way, my most reliable equipment has been refurbs that come from Calcoast Ophthalmics — great service, great prices, speedy delivery.

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    • We will have a post on why annual warranties almost never make sense, and we agree there are a number of companies across the country that sell gently used equipment at reasonable prices.

      Often you can find someone local to do repairs at less than what the companies charge- definitely speak with colleagues in your neighborhood!

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