Do I need a satellite office for my solo medical practice?

Many ophthalmologists, both those solo and in groups, have a satellite office (or two or three). We have had several threads in our google group about whether the newly minted solo eye doc needs a satellite office. Of course, the answer is “it depends… on your practice and geography.”

The overwhelming majority of comprehensive ophthalmologists in our group, including myself and Ho Sun, have one office and are extremely happy with our decision. Personally, I have absolutely zero desire to open up a second office. We just feel that it is easier to work out of a single office and to build a practice in one location. Indeed, some of the oculoplastic surgeons were in a group where they had to drive around the county to multiple satellite offices and are now pleased they can go to just one office.

At the beginning, when things are slow, you may be tempted to want to open up another office. If you chose the right location and have good fundamentals of practice management, you will build and grow. Depending on where you are and if you specialize, it might take you longer to grow than others- but stay the course. Ho Sun’s practice is now so busy that if he had a satellite, he wouldn’t even have the time to fit in all of the patients for his first office! My point is everyone is eventually going to get busy. When you have a satellite, this means you spend less days in your first office, which causes each location to build to capacity faster. If your goal is to eventually hire an associate, then this may work out very well for you.

If you have a restrictive covenant and plan to stay in town, sometimes it makes sense to open up a small first office which will eventually serve as your satellite, and then open up your “main” office where your restrictive covenant expires. I know someone here in town who did just this and it worked out very well for him. But for me, I purposely didn’t open up in the part of town where I used to work, and chose a location that I felt was more favorable. My solo practice is about a half hour away from my pervious job, so very few patients followed me to my new practice. Another colleague opened up across town from their group job, and was only seeing a few patients per day for the first year. After a year was up, they opened right across from the previous practice- and became super busy instantaneously.

Of course, if you open in a saturated area where you know it will take a long time to build, and there is a spot on the edge of town that might not support a full time practice but could justify having someone a few days per week, you could consider opening up two offices. One of the (non ophthalmologist) doctors in my building told me when he first started his practice, he had two offices- one in Phoenix and the other in Goodyear. He noticed the Goodyear office became busier quickly, and eventually shut down the Phoenix office.

The other obvious situation is if you purchase a practice with a satellite office. Then of course you inherit the satellite office. If you think you can thrive with just the main office, you might want to use this as a bargaining chip to attempt to drive down the price you pay to buy the practice.

You can always re-evaluate the situation a few years down the line. One of my colleagues in practice over fifteen years felt that his practice plateaued so he opened in a city on the edge of town without any other ophthalmologists there. Even being there one day a week, the practice grew very quickly because the patients didn’t want to drive twenty minutes into town, and it made his main office busier because he was fitting in the same number of patients into less days.

The situation is a little different if you practice one of the ophthalmic sub- specialties such as retina or oculoplastics. Many docs in these fields who join big mega groups go a little insane driving across town from one office to another; I personally know some folks who rake up over 35,000 miles per year on their car from commuting! Many of the retina and oculoplastics folks in our google group are doing fine even with just one location, but they might have a side job a day or two week either at the VA, in academics, or at a friend’s comprehensive ophthalmologist office to help generate more patients and pay the bills. See this thread about different ways to go solo for more details.

In terms of the finances, it does require significant cost to outfit another office. You will pay rent for another office, and it’s probably another $15,000 to $25,000 to outfit each exam lane (you can certainly work out of a single lane rather than two). You need to decide if you want to bring patients to your main office for testing such as OCT, visual fields, or IOL master. This depends on your patient population and area- if there is no other ophthalmologist in town, the patients might need to drive to be seen anyway. If the main office is too far, it can get expensive to outfit a second office with all of this equipment.

One thing we sometimes see is renting space from another doctor who has a satellite office, either a internal medicine primary care or specialist, who is using that office only two or three days per week. This certainly reduces the risk of a satellite office not working out with a long term lease. As mentioned earlier, we know plenty of retina and oculoplastics specialists who thrive with just a single office, but sometimes ophthalmic sub specialists travel a single day or half day per week to a comprehensive ophthalmologist’s office outside of their main office’s drawing area.

In summary, while for most soloeyedocs having a single office works great and reduces headaches, there are certain instances you might want to have a satellite office. Just make sure the decision to open a satellite it is carefully thought out and fits into your long term plans, rather than out of desperation because you are afraid you aren’t growing quickly enough at your main location. Everyone who provides good care and makes sound practice management decisions will be successful; it might just take you longer in certain areas compared to others.

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