Although I had originally planned to buy most of my equipment used, I somehow ended up buying over 90% of my equipment brand new, including 100% of my big ticket items. I was mainly concerned about used equipment being possibly clinically unreliable and inaccurate, leading to poor clinical outcomes. For example, I didn’t want to buy a faulty autoclave that would incorrectly sterilize my surgical instruments, leading to a bad infection or something. I was also concerned that older technology would result in less than accurate clinical outcomes. (ie. using an A-scan from the 1980s for my IOL measurements).
Remember, I had just finished residency, with little real world clinical experience. I had no idea where I needed to be strict and where I could cut corners. I just wanted to maximize my chances of practicing optimal medicine. In retrospect, I think getting almost everything brand new was a bit overkill, and it cost me a good chunk of change.
For the most part, it is indeed true that you get what you pay for. However, some equipment age better and slower than others. Most of the times, these items will depreciate less, and command a higher price despite being used. Still, if the equipment is sturdy enough and the technology does not evolve drastically, it actually still might not be worth paying full price for a new unit. Mainly, I’m talking about Haag-Streit slit lamps. Although the technology is decades old, the clinical utility of a LED lamp with a camera is not that much better than the good old halogen bulb. So, maybe it is better to buy a 10 year-old refurbished unit for $6-7,000 instead of paying $13,000 for a new one.
Having said that, here are some pros and cons of buying new vs. used equipment.
The argument for buying new equipment is pretty much self-explanatory. You’re getting a brand spanking new piece of equipment with the latest technology and all the bells and whistles. You get a 1 to 2 year warranty, with various servicing and maintenance perks. You get formal training on how to use the equipment directly from the manufacturer. Sometimes, companies even throw in an extra small piece of equipment or software for free. Availability and selecting the proper condition is usually never an issue. The downside, of course, is that you have to pay more money.
The main reason to buy used equipment is because it’s cheaper! However, in general, the prices aren’t as competitive as you would think for the quality of the product. The normal depreciation schedule for medical equipment is 5 to 7 years. This means that in the eyes of Uncle Sam, everything should be worth $0 after 5 to 7 years of use. The used equipment market, on the other hand, says otherwise. You would think that you could get most used equipment for close to half the original price. Nope. Not true. Instead, expect to pay 60 to 70% of the original price from a reputable ophthalmic equipment vendor, even if the equipment is over 7 years old.
Although some equipment like slit lamps, exam chairs, and instrument stands might still be a good deal buying used, you have to be careful with more technologically sensitive equipment. You might sometimes end up buying antiquated technology for an unusually high premium. You really have to be smart and selective about what you buy. Some items, at first glance, might seem exactly the same as a brand new 2017 model, but can actually be made in 1994. You really have to pay attention to the subtle details, including specific model number and generation. With the help of your used equipment vendor, you can often tell how old the model is based on the serial number. The higher the number, the newer it usually is. If something’s is too good to be true, it probably is.
Even if you can buy something for super cheap, you have to be sure the technology is still relevant. Even though a Zeiss Stratus OCT, which originally cost $60,000 for a new unit ten years ago, currently goes for $6,000 on eBay, do you really want to get one just because of the price? In addition, most PC/computer-based equipment get obsolete pretty fast. The Stratus probably runs on Windows XP. If the system crashes, you will find difficulty finding support from Microsoft. Also, upgrading the software to Windows 10 would likely crash the system, and there will be nothing you can do because Zeiss had stopped servicing the Stratus a few years ago.
Even worse, you might see some old automated visual field perimeters from 1985 going for $500. (Dicon LD 400) I don’t care how cheap that piece of junk is. You’re wasting money and losing storage space. Also, you may see a used Humphrey 740 visual field going for $4,000, but a 740i going for $10,000. Yes, that one small letter makes a huge difference. The “i” means that it connects to a computer database, whereas the other is a printout only. Everyone should start practice with EMR, and you don’t want to spend thousands of dollars only to discover that your machine from 1998 will never interface with your system.
Also, these vendors are not manufacturers, but independent dealers that broker used equipment for individual ophthalmologists, most of whom are liquidating because of retirement or equipment upgrade. Having said that, these vendors sometimes refurbish used equipment, replacing certain key parts. So, if you get an SLT laser with a brand new head replaced, maybe it could still be worth the 50% of the original price, without losing the quality or lifespan of the laser.
Regardless of it’s refurbishing, used equipment rarely come with a warranty greater than 6 months. You should expect more along the lines of 3 months to no warranty. So, if your used equipment breaks down after 2 months, your going to lose money from repairs and lost usage time. Sometimes, manufacturers directly refurbish their products and sell them. I would be more inclined to purchase these “used” items because manufacturers generally replace most of the equipment with brand new parts, and they come with a longer warranty. However, you will probably end up paying closer to 70 to 80% of the original price, but you’ll still get a discount for a reliable product. Remember, all delicate technology can breakdown, and a free warranty is worth a lot when repairs can cost thousands of dollars. Also, you probably won’t get any formal training on how to use equipment for free or at all either.
Now, the worst type of listing is the “as is” item. I purchased a Medtronic Tonopen as is for about $1,000 a few years ago. As expected, the thing worked half the time for a little bit, and became less and less reliable with time. I ended up selling it back “as is” on eBay for $400 a short while later, and ended up replacing it with a brand new Reichert Avia tonopen for close to $4,000, which still works very well to this day. Usually, “as is” items come with a lot of risk and headache. If there was any sort of salvageability, the vendors probably would have refurbished these items. However, if the equipment is relatively low cost and low tech, it still might be worth the gamble.
Although used equipment comes with more risk, you shouldn’t completely shut out this option. The smaller the item and the lower the tech, the more likely you should purchase used. For example, manual keratometers, manual lensometers, retinoscopes, prism bars, trial lenses, Ishihara plates, exophthalmometers, etc. are all great used. Especially since new ones go for way more than you would expect. You can easily get these items on eBay for less than half the original cost.
Also, you should probably consider buying less clinically crucial equipment used. I use my Cirrus OCT many times a day, while I use my Atlas 9000 topographer once every few weeks. I don’t regret getting my OCT new, but in retrospect, I should have gotten a used Zeiss 995 topographer for around $7,000 instead of paying $15,000 for a new Atlas.
In summary, the higher the tech, the higher the clinical utility a piece of equipment is, the more likely you should purchase new. Especially, if the unit heavily relies on desktop software. As for lasers, if you can find the right refurbished laser at the right price, you can go either way. All the smaller, low tech, less clinically important items, you should get used.