Space

With financing secured, the first order of business was to find an office space. It’s amazing how many things require you to have a business address prior to being able to submit an application (ie. Medicare, Medicaid, other insurance plans, incorporation, hospital privileges, business license, etc). So, promptly obtaining an office space was my number one priority. In order to do so, I first needed to figure out was exactly how much space I needed.

Space requirement will depend on a variety of factors:

1. Ambition (Do you want to create an empire or a mom & pop outfit)

2. Budget
3. Equipment
4. Subspecialty
5. Patient volume goal
6. Optical shop?
7. ASC? Refractive suite?
8. The number and type of employees
9. Willingness to relocate for expansion?

10. EMR vs. paper charts

No one in their right mind will start out with an ASC. I’m also pretty sure not many people will have a LASIK suite right off the bat. So, these things won’t apply to most of us.

Every single attending recommended that I should get more space than I would ever need in the beginning. They all told me that their practices eventually grew more than their original space could accommodate. It’s better to have more space than you need rather than not having enough space when you need it. Worse comes to worse, if you end up never needing that extra space, you could probably sublet it to another physician. So, when figuring out my space requirements, I calculated the amount I anticipated needing  3 years into practice.

In Hijack Your Practice, I mentioned that I had obtained the dimensions of every room and hallway at Rush Eye Center. With this information in hand, here’s what I mapped out.

1. Exam Lanes

When clinic went nuts in residency, I ran as many as 4 lanes without technician help.  That is probably way more than I would prefer. I think I will be comfortable with up to 3 lanes. However, I will realistically end up using only 2 lanes. Since I anticipate eventually hiring 1 to 2 technicians, having room for 4 exam lanes sounds appropriate. I would have one dedicated technician lane and another miscellaneous lane that could be converted into a diagnostic or laser room.

The lanes in my residency clinic were 10′ x 9’6″. I thought they were quite roomy, so I planned to build my exam lanes to a similar size. However, I’ve seen other practices with lanes as big as 9′ x 12′, and as small as 9′ x 8′.

Exam lanes: 95 sf (square feet) x 4= 380 sf

2. Minor Procedure Room

I want a minor procedure room for simple procedures, diagnostic tests, and lasers.  The one in our residency clinic was 12′ x 14′ for 6 residents.  Mine could probably be smaller. I estimated mine to be 11′ x 10′. I could also use this room as another makeshift exam lane or technician room.

Minor procedure room: 110 sf

3. Waiting Area

I want one main waiting area at the front and another in the back as a dilating area. I guesstimated the size of my waiting area by the number of chairs I would need. This number will probably depend on my desired patient volume. Ultimately, I think I want to see 5 patients an hour. If each patient visit takes up to 1.5 hours, I would need to accommodate up to 8 patients at once. I would also need to have enough chairs for  family and friends that tag along, which I estimated to be an additional 1.25 people per patient. That means that my office will need to support up to 8 + 10 = 18 people at one time. Probably 2 or 3 patients will be sitting in an exam room, 2 or 3 companions will be sitting with them in the exam room, 3 or 4 will be dilating, and the remaining 8 to 10 will be in the main reception area.  That means that I will need 10 chairs in the main area and 4 in the dilating area. I made it 12 in the main area and 6 in the dilating area so that I could have a little wiggle room.

A chair is probably 2 feet long. For simplicity sake, lets say that the chairs lie on 3 sides of the wall and the reception desk is on the last side of the main area.  I’ll put 6 chairs on one wall and 3 chairs on the other two. I gave an extra wiggle room of 5 feet to each wall.

Main Waiting Area: (2′ x 6 + 5′) x (2′ x 3 + 5′) = 17′ x 11′ = 187 sf

Let’s do the same for the dilating area. Of the 6 chairs, 3 will go on two sides of the wall, and I added 4 feet of wiggle room to each wall.

Dilating Area: (2′ x 3 + 4′) x 2= 100 sf

4. Reception Area
I plan on going straight with EMR, so I won’t need much filing or storage space.  The width of the reception area with be the same as the waiting area. Of the 17 feet of wall in the reception area, I set aside 4 feet for the hallway entrance.  So, my reception area ended up being 13′ x 9′.

Reception Area: 117 sf

5. My Office
I don’t care for a fancy office that’s as big as the batcave. If I were to be the only person to use this office throughout the life of the practice, I would probably want something like an 8′ x 8′ space. However, since I haven’t discounted the possibility of hiring an office manage or an associate, I wanted to make it around 11′ x 12′. If more people come on, no one’s going to have their own office. We will all share the same office, distributed equally.

Office: 132 sf

6. Bathroom
Needs to be ADA (American Disabilities Act) certified. 6′ x 6′ should probably work.  Some buildings have community bathrooms in the hallway, so you could possibly discount this space.

Bathroom: 36 sf

7. Break Room
10′ x 10’= 100 sf

8. Optical Shop
I’m not interested in having an optical shop.

9. Hallways
I arbitrarily added an extra 15% to the total space to account for hallways.

10. Miscellaneous
100 sf (For closets, server rooms, etc.)

Summary

Exam Lanes: 380 sf
Minor Procedure Room: 110 sf
Main Waiting Area: 187 sf
Dilating Area: 100 sf
Reception: 117 sf
Office: 132 sf
Break Room: 100 sf
Bathroom: 36 sf
Misc.: 100 sf
Hallways: 15% extra

Grand Total: 1445 sf.

You have to understand that this will only be the usable square footage. When landlords calculate rentable square footage, often times they add some of the common area space outside your office to the usable square footage, which is called a “load.” I hear that this number can be in the 8% to 12% range.

So factoring a 12% common area load, my space requirement becomes 1,618 sf.

This wasn’t the most scientific calculation, but I think it ended up being a very good guesstimate. I’m actually about to sign a lease on an office space, and I got pretty close.  My space will be 1689 sf with a 12% load factored in.

3 thoughts on “Space

  1. Thanks for the summary of space planning. I was wondering if you could share some details on: [I understand this is asking a lot so no worries if this is beyond what you wish to share.]
    1. How much your buildout was calculated to cost(did you use an architect or were drawings provided by lessor?, what type of cabinetry, sinks, IT cableling, Vision chart system, and type of flooring, flag or light systems you used or didn’t use.
    2. lease cost per sqft and term,
    3. type of lease you chose.
    4. What type of building you chose(example primarily a medical building or general purpose office space that you modified for medical office use
    5. How long the process is expected to take (building permit, construction bidding or if buildout handled by lessor ) until your expected receive the occupancy permit. These type of details are important to determine especially when planning for equipment delivery and staff hiring. You mentioned you might consider hiring one or two techs in the future, I’m assuming your going to have a receptionist to start and what are your thoughts on hiring for this position-regarding experience vs. you will train a newbie?

    Liked by 1 person

    • We will go over all of this in future posts. I have a five year lease. The more your tenant improvement concessions are, the longer your lease tends to be since it is essentially amortized into the lease by your landlord. I got lucky because I found a psychologist’s office and the rooms were the right size. It can take six to eight months for a full buildout. Put penalties in your lease agreement if they don’t deliver and watch them (contractors and supervisor) like a hawk to make sure things get done on time. Everyone we know experiences delays.

      Medical vs general purpose: near the hospital is nice for a new practice because it makes you look legit. Also proximity to primary care among other docs. But there are plenty of people we know that are in general purpose and are doing fine. Location is probably most important but you can’t go wrong near a hospital, they have consultants who research demographics.

      Staff: four years in I still only have one employee. Most of my colleagues start out with one but build to two or three (or more). Depends on how many patients you want to see as well as how many of the small tasks you’re willing to do yourself. Keep billing in house.

      Like

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