Would love to hear from those brave souls who have gone solo.
Feel free to PM me.
Feel free to PM me.
gone solo?
- Thread starter guttata
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Popular thread! 
I'm not solo, but would be interested to see if you've heard from anyone. Going solo is difficult, but not impossible, in this day and age. Reimbursements are down, and overhead is up. Most docs are looking for shelter in groups. They already have a lot of school debt, and don't like the idea of accumulating even more. The majority of solo docs nowadays are those who've been in practice for many years. There are a few younger solo ophtho docs in my area, but they're definitely the minority.
As I see it, there are 2 main options to go solo, each of which have problems:
1) Buy an established practice from someone who's retiring. In some cases, there may be a year or so of overlap, as they phase you in, but you're going to be solo. Adv is you have a ready-made practice. Disadv is that someone who's retiring likely has outdated equipment, and will likely want more than you want to (or should) pay to buy the practice. You also can't be guaranteed that the patients will stay with you.
2) Truly start your own practice. Adv is you can build it the way you want. Disadv are it will take a lot of loan money (which may be hard to come by in these times) and there will be a delay in collections. As long as you can hang on, it should pay off down the line.
Anyone else have input?
I'm not solo, but would be interested to see if you've heard from anyone. Going solo is difficult, but not impossible, in this day and age. Reimbursements are down, and overhead is up. Most docs are looking for shelter in groups. They already have a lot of school debt, and don't like the idea of accumulating even more. The majority of solo docs nowadays are those who've been in practice for many years. There are a few younger solo ophtho docs in my area, but they're definitely the minority.
As I see it, there are 2 main options to go solo, each of which have problems:
1) Buy an established practice from someone who's retiring. In some cases, there may be a year or so of overlap, as they phase you in, but you're going to be solo. Adv is you have a ready-made practice. Disadv is that someone who's retiring likely has outdated equipment, and will likely want more than you want to (or should) pay to buy the practice. You also can't be guaranteed that the patients will stay with you.
2) Truly start your own practice. Adv is you can build it the way you want. Disadv are it will take a lot of loan money (which may be hard to come by in these times) and there will be a delay in collections. As long as you can hang on, it should pay off down the line.
Anyone else have input?
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Popular thread!
I'm not solo, but would be interested to see if you've heard from anyone. Going solo is difficult, but not impossible, in this day and age. Reimbursements are down, and overhead is up. Most docs are looking for shelter in groups. They already have a lot of school debt, and don't like the idea of accumulating even more. The majority of solo docs nowadays are those who've been in practice for many years. There are a few younger solo ophtho docs in my area, but they're definitely the minority.
As I see it, there are 2 main options to go solo, each of which have problems:
1) Buy an established practice from someone who's retiring. In some cases, there may be a year or so of overlap, as they phase you in, but you're going to be solo. Adv is you have a ready-made practice. Disadv is that someone who's retiring likely has outdated equipment, and will likely want more than you want to (or should) pay to buy the practice. You also can't be guaranteed that the patients will stay with you.
2) Truly start your own practice. Adv is you can build it the way you want. Disadv are it will take a lot of loan money (which may be hard to come by in these times) and there will be a delay in collections. As long as you can hang on, it should pay off down the line.
Anyone else have input?
It is do-able, even now, but takes some planning and a careful eye on expenses.
Buying a practice is worthwhile only provided it is reputable and in good operating condition, that is, not a practice that has been allowed to dwindle as its owner continued to practice into late career. I would be very wary of buying any practice that did not continue to receive a good flow of new referrals or where the doctor has been off staff at local hospitals or where the surgery volume has been dropping. Those are all signs of a practice that will need salvaging, and as such should be priced accordingly. At least with a going practice, there will be some patients, and likely some mechanism in place for getting charges collected, even itf they are in need of updating. That ability to secure cash flow is important.
Cold starts are the most difficult; those are cases where having the local hospital providing some support to a new doctor is useful. That still happens in some areas, but not usually in many urban or suburban areas, unfortunately.
I am in this process, about a year from launch. Although I was a student of practice management in the past, I won't kid you that launching your own practice is an education in an of itself. Still worthwhile, I think.
orbitsurgMD, are you doing a cold start? I would love to hear about your experience, especially with your selection of office space/location.
Do you have any book (practice admin/billing/medical practice) recommendations?
Do you have a part-time gig?
I am in a group practice now, but I feel it is not the best long term situation for me. The practice is dying. I feel like I am wasting my life here, but I need the income to support the family, especially in this economic environment. The overhead is much too high for the ancillary services provided. There are so many employees who have been ingrained in the practice that it would be nearly impossible to fire these people- even if I made partner. I think I can do better on my own. I am targeting an open date 12-16 months from now.
We know we want to stay in the area. But, honestly, going solo with all the unknowns (especially financial) scares me. The area is pretty saturated, but the few who have gone solo seem to be doing well (years ago) and growing. I doubt the local hospitals would support an ophtho start-up.
Do you have any book (practice admin/billing/medical practice) recommendations?
Do you have a part-time gig?
I am in a group practice now, but I feel it is not the best long term situation for me. The practice is dying. I feel like I am wasting my life here, but I need the income to support the family, especially in this economic environment. The overhead is much too high for the ancillary services provided. There are so many employees who have been ingrained in the practice that it would be nearly impossible to fire these people- even if I made partner. I think I can do better on my own. I am targeting an open date 12-16 months from now.
We know we want to stay in the area. But, honestly, going solo with all the unknowns (especially financial) scares me. The area is pretty saturated, but the few who have gone solo seem to be doing well (years ago) and growing. I doubt the local hospitals would support an ophtho start-up.
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Drawing up a business plan is a good place to start. If you can take your patients with you, you may not need a side job. Consider how you will draw new referrals and from whom.
Once you have decided to start, hiring a lawyer to draw up corporation documents is a good idea. They can advise you of the alternative structures for small practices (LLC vs S-Corp., etc.).
With a start date a year off, the time will allow you to hopefully examine and reduce your personal and family expenses. Needing money for personal expenses is expected and can be financed, and that need is part of what your business plan's budget will reflect.
For one doctor, you won't need a huge amount of space. Office space inventories are up in most places, so renters have more leverage. Take some time to draw up a space budget you think you will need for your first 24 months. Having a space for a second or even third exam room, for instance, even if you don't plan to equip it fully at startup, will allow you to expand usefully once you become busier.
As goes equipment, remember that you will get paid the same whether you do your exam on brand-new top-of-the-line equipment as you will on good but used equipment. For some things, getting new stuff is worth the money or unavoidable, but it pays to be selective. I started carefully buying things a year before I launched while I was still working.
Hiring a good accountant ahead of time can really help you a lot. Look at several and make sure they have an understanding of small practices and startups. You can get names from other doctors in your community to start.
PM me if you have specific questions.
One thing to consider, especially if you are staying in the area, is what sort of non-compete clauses exist in your current contract. A set radius where you can't practice, as well as being prohibited from taking your current patients (or contacting them) is pretty standard.
Also, what is your relationship with the ODs in the area? Endocrinologists? Other primary docs? (Your likely referrals.) Start cultivating those relationships now. Consider going to a few local business association meetings, etc.
How can you get your name out there and make a reputation? Is there a local newspaper (perhaps free publications) where you could write a few articles for? Perhaps with the Spring sports season coming up, you could write about common sports injuries, etc.
Definitely write out a business plan. Have a friend with an MBA or CPA look it over. Ask some other docs if it sounds reasonable (not at your current practice, of course.) Plan on having cash to cover operating expenses for at least the first year in this economy. Also, see what you can learn by sitting in on your current practices business meetings.
Good luck.
Also, what is your relationship with the ODs in the area? Endocrinologists? Other primary docs? (Your likely referrals.) Start cultivating those relationships now. Consider going to a few local business association meetings, etc.
How can you get your name out there and make a reputation? Is there a local newspaper (perhaps free publications) where you could write a few articles for? Perhaps with the Spring sports season coming up, you could write about common sports injuries, etc.
Definitely write out a business plan. Have a friend with an MBA or CPA look it over. Ask some other docs if it sounds reasonable (not at your current practice, of course.) Plan on having cash to cover operating expenses for at least the first year in this economy. Also, see what you can learn by sitting in on your current practices business meetings.
Good luck.
I'm drawing up a business plan and would like some opinions on the amount of space required. I don't want to go too small or too big. I do not need 20' lanes. Some say that 1000 sq feet is enough but that seems a little small. But my perception may be skewed by our poorly designed space at my current practice. I know a lot will depend on the design/build of the office space, but general estimates will help me.
I will need at least enough space/room for
-one lane (with space for 2 lanes)
-waiting room
-ancillary/testing room (double up as a pre-testing room)
-one restroom (staff), maybe two (+public) if no common area
-staff room/eating area
-storage/chart room
Not necessary (for now)
-office
-optical space
-minor procedure room
Also, this probably sounds stupid, but what patient registration software do you recommend?
Thanks for now. Have a ton of more questions.
I will need at least enough space/room for
-one lane (with space for 2 lanes)
-waiting room
-ancillary/testing room (double up as a pre-testing room)
-one restroom (staff), maybe two (+public) if no common area
-staff room/eating area
-storage/chart room
Not necessary (for now)
-office
-optical space
-minor procedure room
Also, this probably sounds stupid, but what patient registration software do you recommend?
Thanks for now. Have a ton of more questions.
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1500-2000 sf is a better figure to plan with.
I suggest two lanes, minimum, with a third room suitable as either a minor procedure room or a lane. A table-mounted slit lamp would be beneficial for use in this room that could be used as an occasional exam lne, but used mostly as a procedure room. A fourth room for perimetry and OCT/HRT/GDx,
whatever you are going to use. You need a break room with kitchenette and coffee service, mini fridge, etc. Small fridge=less cost=less electricity=less mess=less to clean.
Charts can be stored in cabinets. Consider when you will eventually go to EHR.
You need one patient restroom and one staff restroom (if your building does not have a common-area restroom, which is even better.)
A small office for the doctor is something to include.
You need to work up a budget for a phone system (figure at least $3000-4000; roughly $1000 per line), you should plan ahead for cable drops for your computer system and for integrating your diagnostic devices. The best time to install this kind of thing is at the beginning and all at once. It is better and far cheaper to have too many and some unused cabling than to have not enough or not enough in the right places and to do the additional installation later.
Practice management software is an interesting topic all by itself. It is easy to spend a lot of money here on a system with lots of customizable features and on-site support that you won't necessarily use. It is nice to have something that integrates well with an EHR, either one that is written by the same publisher or one made to integrate with one of the popular products like NextGen.
Trying to get to the nitty-gritty for budgeting in my business plan.
1. Can anyone recommend any ophthalmic equipment leasing company (slit-lamps, chairs, OCT, HVF)? I can't tell if the ones that show up on google search are scams or not.
2. Without equipment, what is generally the cost to build-out (per sq ft) - probably varies a lot dependent on location.
1. Can anyone recommend any ophthalmic equipment leasing company (slit-lamps, chairs, OCT, HVF)? I can't tell if the ones that show up on google search are scams or not.
2. Without equipment, what is generally the cost to build-out (per sq ft) - probably varies a lot dependent on location.
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Most equipment dealers have at least one leasing company with which they do business. It is worth getting quotes from more than one, as the "buy" cost and the money factor will go into the leasing cost. The other option you should think about is to buy the equipment yourself and depreciate and/or expense it over the term of your equipment loan.
Build-out cost in leased space depends on how much building out you need to do. In "warm bare shell" (exterior walls and windows, no interior walls, concrete floor, little if any HVAC ductwork, sometimes no heat, AC, no interior plumbing or wiring), which is common in new construction buildings, the owner often provides a share contribution to buildout that is a negotiated amount per square foot. The balance would be your responsibility and would typically be financed on a business construction loan. Typically, the owner would accept a larger share of the buildout allowance (or a reduced rent per square foot) the longer your lease term. For setups like this, new buildings, five year terms for the lease are common, but there are exceptions. Triple-net lease ("NNN") is also the norm in many places; your rent is not inclusive of property taxes, utilities or association fees. You need to find out what those typically cost when calculating your overall monthly space costs.
Construction loans (for leasehold improvements) can be scaled over longer terms than the property lease, say ten years, which makes the payment lower, but also leaves you with a loan balance at the end of your lease. This usually isn't a problem if you anticipate buying your office as a condominium before the lease expires, but there is still the possibility you could lose the lease while still having a principal balance for a substantial amount of money. The loan goes with you even if the interior construction does not. Just something to think about. Also, if you find your space inadequate for your practice requirements and need to move to a larger office (a good problem to have, usually) you may not want any old debts for old spaces hanging over you.
In my area of the country, where things are Mid-Atlantic expensive, The lowest figure per square foot I encountered for a complete build-out was around $95.00, for attractive but not fancy fitments. (I had heard of numbers as low as $80, but I could not verify them.) That figure is basic building and decoration, no custom ceilings, standard white walls, gray nylon industrial carpet, basic overhead lighting, etc. Things like upgraded lighting (parabolic reflectors, ceiling cans), extra controls, extra ductwork, extra HVAC zoning, dimmers, millwork, decorator paint, upgraded flooring all add to that figure, sometimes substantially. I have been quoted owner participation between 25-40% of that cost. So, for example, a 2000sf shell, with a basic 100.00/sf buildout cost split 60/40 tenant/landlord would cost you $120K before interest. You can run the numbers in an amortization calculator depending on your terms, but for that much build-out, I think it would be reasonable for a landlord to come down substantially in the rent figure. For example, if your area class A space rents at $22-24/sf/year, I would suggest you shoot for half that if you are doing a big build-out.
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Hey everyone... thinking of going solo too. Will it be a major problem if one is not Board Certified when applying to become a provider for medical plans? Obviously, it may take up to two years after residency to become certified -- so I wonder how this situation is handled. TIA.
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Being board eligible is fine to start (even in an established group practice, you have to be individually credentialed with the hospital(s) and various carriers). The problem arises if your don't pass your boards in a timely manner. That can lead to loss of hospital privileges, as well as provider status with at least certain carriers.
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I'm planning on going solo too. Have attended some courses at AAO about this but still unsure about many things. For those of you who have done this, how much of it did you do yourself vs getting help from a practice consultant? I know I have to write a business plan, hire lawyer and accountant, get loan from bank, get onto insurance plans, order equipment, and get hospital/ASC priviliges, among other things. What types of tasks did you outsource to others or a consultant vs doing yourself? Obviously I would want to get a lawyer to review any lease, but for example, I already have office location tentatively planned but should I get someone to review it to make sure I'm picking right place?
FYI, I'm a self starter (for example, I enjoy doing my own income taxes myself so I can figure things out) but I've never had to tackle a task of this magnitude! My job is light so I have time during and after work to take care of many things myself, but I don't want to get "over my head" and will pay for help if necessary.
Any resources to recommend? I've already looked at all the threads on this board that relate to starting a practice, some of the articles from "pearls in ophthalmology" have been helpful, I've also done internet search for articles. I'm going to order AAO coding book among others. Anything other books or resources, like "Starting your own ophthalmology practice for dummies"?
FYI, I'm a self starter (for example, I enjoy doing my own income taxes myself so I can figure things out) but I've never had to tackle a task of this magnitude! My job is light so I have time during and after work to take care of many things myself, but I don't want to get "over my head" and will pay for help if necessary.
Any resources to recommend? I've already looked at all the threads on this board that relate to starting a practice, some of the articles from "pearls in ophthalmology" have been helpful, I've also done internet search for articles. I'm going to order AAO coding book among others. Anything other books or resources, like "Starting your own ophthalmology practice for dummies"?
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I'm planning on going solo too. Have attended some courses at AAO about this but still unsure about many things. For those of you who have done this, how much of it did you do yourself vs getting help from a practice consultant? I know I have to write a business plan, hire lawyer and accountant, get loan from bank, get onto insurance plans, order equipment, and get hospital/ASC priviliges, among other things. What types of tasks did you outsource to others or a consultant vs doing yourself? Obviously I would want to get a lawyer to review any lease, but for example, I already have office location tentatively planned but should I get someone to review it to make sure I'm picking right place?
FYI, I'm a self starter (for example, I enjoy doing my own income taxes myself so I can figure things out) but I've never had to tackle a task of this magnitude! My job is light so I have time during and after work to take care of many things myself, but I don't want to get "over my head" and will pay for help if necessary.
Any resources to recommend? I've already looked at all the threads on this board that relate to starting a practice, some of the articles from "pearls in ophthalmology" have been helpful, I've also done internet search for articles. I'm going to order AAO coding book among others. Anything other books or resources, like "Starting your own ophthalmology practice for dummies"?
I am assuming you have chosen a location, determined that there is a hospital where you can join the staff, checked out the available surgery center facilities, come to an understanding of the local ophthalmology community and have at least the acceptance of your family, if that is relevant, of the community you are considering. Is that true?
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I called a residency classmate who set up a practice of his own and asked for the name of an attorney he thought could do the job right. Same for the accountant.
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I'm planning on going solo too. Have attended some courses at AAO about this but still unsure about many things. For those of you who have done this, how much of it did you do yourself vs getting help from a practice consultant? I know I have to write a business plan, hire lawyer and accountant, get loan from bank, get onto insurance plans, order equipment, and get hospital/ASC priviliges, among other things. What types of tasks did you outsource to others or a consultant vs doing yourself? Obviously I would want to get a lawyer to review any lease, but for example, I already have office location tentatively planned but should I get someone to review it to make sure I'm picking right place?
FYI, I'm a self starter (for example, I enjoy doing my own income taxes myself so I can figure things out) but I've never had to tackle a task of this magnitude! My job is light so I have time during and after work to take care of many things myself, but I don't want to get "over my head" and will pay for help if necessary.
Any resources to recommend? I've already looked at all the threads on this board that relate to starting a practice, some of the articles from "pearls in ophthalmology" have been helpful, I've also done internet search for articles. I'm going to order AAO coding book among others. Anything other books or resources, like "Starting your own ophthalmology practice for dummies"?
Practice consultants are expensive. For a small-scale startup, they aren't going to be able to do much for you that you don't already have an understanding of yourself.
Have you approached a commercial lender?
Start collecting the names of reliable companies you can use for things like your phones and computer network.
You might start to look into practice management software programs. You will need at least a billing/bookkeeping and scheduling package to start.
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I think you can do it yourself and maybe have a consultant review it. Check out this page with templates (though not medicine specific).
http://www.score.org/template_gallery.html
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I did this myself. You could do the same.
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I noticed that no one was talking about getting a building with an included surgical suite. Is this that uncommon? Is it feasible to start out by leasing a building with 3 lanes + a surgical suite, or do most MDs have contracts with nearby hospitals where they can operate?
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bump..?
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I'm not a surgeon, but the rest of the docs in my group are, and we recently investigated the possibility of acquiring some surgical space in our building that had been vacated by an evicted pain management group. Let me tell you that having a "surgical suite" is not nearly as easy as it sounds. The main roadblock is obtaining a CON (certificate of need). A CON is required to have a surgical facility outside of a hospital. Depending on where you are, obtaining a CON can be nearly impossible. The hospitals have lobbied hard to limit the number of non-hospital surgery facilities. That was what stopped us. In my area, there are no new CONs to be had. You pretty much have to buy one from someone else. Oh, they are also specific, so we couldn't have bought the pain management CON from the evicted group. Even if you can finagle a CON, you'll need staff for the suite (e.g., anesthesia, nursing). If you're solo, you'll never use it enough to cover the costs. You'll have to get someone else to share the suite for it to be cost-effective (i.e., have high volume, daily use). I, therefore, doubt you'll find anyone in the situation you described.
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Thanks so much for your robust reply. Very informative as always!
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Certificate of need requirements vary by state. Some are strict, others not so much. They are politically popular with established surgery centers because they are used to restrict competition. In my state, a single-OR surgery center is exempt, but more than one OR requires a CON. Even for a single OR, the construction and equipment costs can be substantial--like $1M--which if you have a high-volume practice is still nearly a sure thing, but viability will depend on having a consistent flow of cases. If you hit a slow patch, you can be under water quickly if your averages are not consistently higher.
