Article Date: 10/1/2008

Step 3 in Starting a Practice from the Ground Up

Step 3 in Starting a Practice from the Ground Up

Learn how to choose a contractor, select equipment and design your office space to prepare for opening day.

By Gina Wesley, OD, MS, FAAO, Medina, Minn.

This article is the third in a series about what it takes for a new OD to start a private practice. Gina Wesley, OD, MS, FAAO, a 2006 graduate of The Ohio State University School of Optometry, will discuss how to obtain contractors' bids, choose equipment and implement office systems, hire the right staff and prepare for opening day.

IN PARTS ONE and two of this series, I discussed how to search for office space, develop a budget, negotiate a lease, devise a timeline and design an office. If you've taken these steps already, you're more than half way to opening your own private practice. Now you're prepared to find a contractor, estimate financial expenditures to build out your office space, choose equipment and establish operating procedures.

Dr. Wesley practices at Complete Eye Care of Medina and Crystal Vision Clinic in Minnesota. You can reach her at

Quest for a Contractor

Assuming you've had a reputable architect develop building plans based on your concept office design, now it's time to start submitting the plans to contractors from whom you'll be obtaining bids. The bids you receive are the dollar amounts the contractors will charge you to build out your office space.

I didn't have any experience working with contractors, so I asked several optometrists in the area what companies they used for their office build-out or remodeling. I also called several dental practices, because their offices often have similar designs to optometric offices. As a result of the calls I made, I obtained a list of five or six contractors.

First, I called the contractors to ask how much experience they've had in building optometric practices. I submitted my architectural plans to four of the six contractors with whom I felt comfortable. There's a small fee you have to pay your architect for submitting your plans to various contractors. So I suggest you narrow your list to only those companies you're seriously considering to avoid paying unnecessary architectural fees. For instance, I didn't submit a bid to the contractor who told me to "get other bids and then contact us when and if you want to go cheaper." This wasn't the level of professionalism I was looking for to help me complete my dream office.

When you submit your plans to contractors, give them a deadline for the bid. The architect I worked with gave me good advice in this regard. He told me to make sure I gave each contractor a reasonable amount of time to submit a bid. So I gave each company two weeks, to provide them with ample time to obtain subcontractors' bids. Note that many contractors use subcontractors to complete various aspects of the build-out, such as plumbing and electrical work.

My architect also was helpful because he provided me with a guesstimate on how much my project should cost. This piece of information was good to know when I received my first bid, which was much higher than I expected it to be. I knew I needed to receive the other contractors' bids to make a comparison. I also considered how long each contractor would take to complete the project. If a company offers a low bid, but can't start for 4 months, you'll need to think about the repercussions this may have on your business. You also should consider how long construction might take once it begins. My office was completed in 6 weeks, which is an ideal timeframe on average.

After I received my bids, I met with every contractor to discuss the bids and my plans in more detail. This was instrumental in helping me understand everything I needed to know about the build-out. Like many optometrists, I didn't know much about drywall, electrical circuitry or heating/ventilation design, but each contractor made sure he answered all of my questions. As I learned more about the build-out, I was able to negotiate different aspects of the construction process. For instance, I asked about less expensive approaches to designing my ventilation system. I also decided that I didn't need to have my interior walls heavily sound-proofed for the privacy of patients. Both of my exam rooms were located in a secluded location of my building where you wouldn't hear voices through the heating/cooling ducts. Another item I questioned was the construction of a door versus a doorway. The walkway between my front desk area and business office didn't need a door. Choices like these can save you thousands of dollars on the bid.

Once you feel comfortable with the bids you've received, you'll need to narrow down your choices. Cost aside, consider which contractor has the best communication skills and customer service history and put him at the top of your list. That's what I did. As a result, I didn't select the contractor with the lowest bid. Instead, I chose a contractor who had a slightly higher bid because of his communication and customer service skills and his experience in optometric office design. After you select a contractor, sit down with him and review the construction plans. That way, you'll understand each other's expectations and those of your architect. Make sure you pay attention to the smallest details during the planning stage, because they can cost you a pretty penny later on if you don't address them up front. For example, my architect forgot to include a door in a high-traffic area of the office in his drawings. If I hadn't mentioned this to my contractor up front, he would have been forced to construct an extra door frame and install a door in the middle of construction, which would have cost me well over $1000. Since I noticed this error before construction began, it cost me nothing.

Choosing Equipment

As construction gets under way, you're ready to choose equipment and office systems. In this next phase, you'll need to determine what equipment is necessary to keep your office running smoothly. Afterward, make a wish list of all the equipment you'd like to buy if money wasn't an option.

I spent several hours on a few occasions at a local equipment vendor to test various slit lamps, visual acuity systems and autorefractors. This helped me determine what I liked and didn't like. My work experience as a student and new optometrist at several practices helped me make wise purchasing decisions. If you're not located near a major optometric equipment supplier, consider attending one of the national or regional conferences that has an exhibit hall. There, you'll be able to talk to several equipment vendors and test-drive their products.

After you've decided which equipment you'd like to buy, you'll need to consider the cost. What can you afford? Some suppliers offer deals if you purchase several pieces of equipment from them. I shopped around for smaller devices, such as lensometers and optical hand tools, new and used, on the Internet. One item I decided to splurge on was my slit lamp. I wanted a slit lamp that was high in quality and that would last a long time.

Once you have an equipment supplier, or suppliers, ask them to meet with your contractor to discuss where to place electrical outlets. Your contractor probably will need to place outlets strategically for certain pieces of equipment, such as your visual acuity chart, for your convenience and ease of use.

Furthermore, make sure you develop a plan to pay for equipment repairs. The equipment I purchased needed two minor repairs within the first month I opened. If I hadn't signed a warranty from the supplier to cover the costs of the repairs, the repairs would have cost me $1,000.

Another thing to remember: Make sure your equipment will be delivered in time for opening day. Keep in mind that special orders, such as an exam chair in any color other than black, may delay delivery. Finally, once you've opened your office and have begun practicing, you'll need to determine future equipment needs, such as a retinal camera, a visual field analyzer or other devices for additional exam lanes. My second exam lane will serve as a dilating area until I'm ready to purchase equipment.

Implementing Office Systems

Once your equipment is installed, you'll want to establish office procedures for employees and put them in writing to ensure day-to-day operations run smoothly. With the help of my consultant, my optician and I developed a list of daily responsibilities and expectations. These included procedures for opening and closing the office, ordering spectacles, balancing end-of-day financials, greeting patients and more.

The weeks leading up to opening day are a great time to become familiar with your computer system. Whether you've decided to implement electronic health records or a practice management software system, learn how to use it before patients arrive. I experimented with my new system until I felt comfortable with it. You'll be on a learning curve for a while after you open your office, but at least you'll be better prepared.

Closer to the ‘Big’ Day

Once you've completed this third phase of starting your own practice — selecting a contractor, purchasing equipment and implementing office systems — you're well on your way to opening the doors. In the next, and final, installment of this four-part series, I'll discuss how to hire the best employees, prepare for opening day and provide marketing tips to help build your practice. nOD

Optometric Management, Issue: October 2008