First month financial analysis and thoughts from my second month in solo ophthalmology practice

March 30:

Over the past 4 days, I saw an average of 4 to 5 patients a day.  Now that my boards are over, I have no patients scheduled for the day. wtf?

March 31:

My first month of practice will come to a close today. I don't plan on opening my books to the public every single month, but I thought it would be informative to post my first month's.  All in all, I'm pleasantly surprised by this month's numbers. 

My overhead this month, including $XXXX (to get behind the blog paywall, we will send you a login after you donate $1000 to the surgical scope fund or ophthpac in support of our profession; email us at solobuildingblogs@gmail.com) in loan payments and excluding $3,000 in personal living expenses, was $XXXX, which was exactly what I had projected in my business plan.  

In terms of revenue, by the end of today, I will have seen 51 patients in March and will have performed zero procedures.  That means that I saw about 2 patients a day over 25 full working days. So far, I have received $2,700 in payments, and should collect another $XXXX (my outstanding charges are $XXXXish).  I probably would have had more in my bank account had I not messed up my first Medicare claim.  Not bad for the first month, especially when I had anticipated collecting $1,000 to $2,000.  The thing about this month was that every single patient ended up being a new patient comprehensive, which pays more. 

I'm telling you guys, it's totally doable.  I probably did this well because of my niche market, but if you're good to patients, you practice good medicine, and you pick your location well, it's only a matter of time. 

April 5:

I have my first phaco in 2 hours!  I hear it's like riding a bicycle, but why am I more nervous than my first one ever?

Later that day:

My first phaco went well. Soft 20/30 eye with good amount of cortical spoking. Took under 20 minutes. Had the Alcon rep join me for emotional support. She was absolutely wonderful and awesome! My settings on the SD card somehow disappeared, so she just gave me the standard.

It's so weird getting accustomed to a new system. I was so used to Rush's system, but the people at O'Connor were great!

I did have to load my own lens, which went well with the help of my Alcon person. I definitely could tell that I was waaaay nervous. My hands were shaking pretty violently as I loaded the lens. I think it was also all that tension being released. Same thing happens to people when they stack their chips after winning a big poker hand.

It's amazing how it comes back. First case in 10 months, and it felt pretty good. I'm ready for the next one.

April 16:

I've been in practice for 7 weeks now, and things are really beginning to ramp up.  This past week, I saw 24 patients, or about 5 patients a day.  My ad campaigns are now starting to penetrate the Korean-American community, primary care physicians and optometrists have begun to send me referrals, and most importantly and fortuitously, the 80+ year old Korean ophthalmologist decided to retire 2 weeks ago, and is sending me all his patients! 

It costs me $700+ per day to run my practice.  Based on a very small sample size, it looks like I should be able to hit my daily break even point with 5 new patient visits a day, along with their associated ancillary tests. My guess is that this equates to about 7 established patient visits a day. 

On my busiest day so far, I saw 8 patients, of which all were new visits.  Based on that day's pace, I should be able to comfortably see at least 15 patients a day, consisting of the typical mix of new and return visits of an established practice, with no additional staff.  If you do the math, you can figure out what my potential is.  I think the micropractice model is key. With low overhead, I think I'm going to have a decent chance of creating a concierge practice without concierge prices.  And if insurance reimbursements go deep six, it will probably be easier for me to transition into a true cash only concierge practice.

My insurance payments have been coming in much faster than I had anticipated.  Medicare payments have been taking about 2 weeks to hit my bank account, and commercial payers have been taking about a week to a month.  (via electronic claims by the way).  I'll go over the details of secondary payers, deductibles, coinsurances, etc. in a separate post.  Overall, I'm satisfied with ADS MedicsPremier's bookkeeping and claims processing software.  There are a few inefficiencies and redundancies in the system, but I can live with them. 

As for procedures, as you know already, I did my first phaco 2 weeks ago.  My patient's doing great, and I've scheduled his other eye for the end of April.  I also have another phaco on that same day.  Also, I have another 3 pairs of eyes in the works/contemplation stages.  O'Connor didn't really have the instruments I wanted, and the common practice in this area is for ophthalmologists to bring in their own instruments.  So, I ordered a few things, which should arrive before my next surgery day on the 26th.

Both of my fluorescein angiograms went well.  My venipuncture skills have always been horrendous, but I was able to get it on both patients. (my medical student had to help me start IV's as an intern because I was so bad at it...)  I injected 5 ml of 10% lite fluorescein on each person. One of them got nauseous, but ended up fine.  After talking with one retina guy, it sounds like I should be able to get away with injecting only 2 ml of this stuff from now on. 

In terms of lasers, I've done one LPI so far, and have a focal and YAG coming up in the next week or two. So far, I really like the Ellex Ultra Q.  My patient felt nothing during the PI.  Unfortunately, I'll probably need another session on that eye because she had an uber thick iris.  As for the focal, I'll be doing it at O'Connor.  They're outfitting a Lumenis Trio this month, so I'm going to do it after it comes in.  It will be on a 20/20 eye with CSME originating from one juicy MA just outside the FAZ, and no central DME. 

April 25:

I'm having an Ellex Integre green photocoagulator delivered to my office tomorrow for a trial evaluation.  I got a 10 year financing deal approved at 8.3% within 24 hours of my application.  I guess borrowing money really does get easier  after you open doors.  I'll try out the Ellex, and if I don't like it, I'll look at other companies.  I have no commitment, nor did I have to put down any deposit for this trial period.

Originally, I wanted a solid state Argon (or equivalent) to do my diabetic lasers.  I'm now understanding that I will also need it for my LPI's.  According to the Ellex rep, the Ultra Q is usually good enough on its own to penetrate thick brown irides.  Apparently it's not.  I tried twice on one eye, and got through to about half of the iris stroma.  So, I'm going to try a third time using the sequential argon-yag method.  I especially feel bad because this lady actually voiced her concern regarding my age and "lack" of experience, but still decided to stick with me.  So, even though most others probably wouldn't have gotten a patent PI with the YAG alone in one sitting, I still can't help but feel guilty and insecure about my current predisposition.  She's been really nice about it, and has now expressed her full faith in me.  Nevertheless, I feel crummy.  Oh well, this probably just is the beginning.