A new ophthalmologist with a plan still has plenty of opportunity in the exciting, expanding world of refractive surgery. As a prospector’s success in finding gold depends on a good map, your personal map should contain the critical elements enumerated in this article.

Be prepared to commit serious time and effort to the planning process. Anything less than a fully developed approach with you championing the way can spell a botched entry into the market. And recovery from this kind of misstep can be very costly.

Here’s how to avoid needless problems.

Your business plan will be used to secure investment capital and whip up support for your idea among colleagues in your group. Once you have implemented the plan, it will become an important tool in measuring the performance of your refractive surgery venture against your established goals. Equally as important as having a plan is to make it flexible. It’s a dynamic field; be ready to accommodate new procedures and market trends.

Another key element is to ensure that your plan blends with the current organization and culture of your practice. Plans that require radical changes to the current operation – and especially to the routines of the senior physicians – are doomed to fail.

Your business plan should include four elements:

• goals and objectives
• operational initiatives
• marketing strategy
• financial considerations.

Let’s review how to work these elements into your plan.

Ask yourself what you personally expect from your entry into refractive surgery. Will refractive surgery become your sole occupation, or is this a move to diversify? How much time do you plan to devote to refractive surgery? Remember to integrate your goals with those of the practice. Be realistic when establishing your goals. The process of building your refractive practice will take time. Don’t expect overnight results.

How you gain access to an excimer laser is potentially the most costly and irreversible operational decision you’ll make. Interview all major vendors and understand how their programs fit – or don’t fit – with your objectives.

Here are the most common alternatives:

• Transportable lasers.
These lasers can be moved from a customized vehicle into your facility or they can remain inside a specially designed vehicle that also serves as the operating suite. Laser providers charge a per-procedure fee that is determined by your surgical volume. Because this alternative requires no investment in equipment, it preserves capital for your advertising and other start-up expenses.
Companies that provide transportable lasers furnish a laser technician who is trained to repair the laser in the event of a unexpected breakdown. Most of these companies also furnish a microkeratome and all supplies.
• Open-access laser centers.
Performing refractive surgery at a local laser center is another alternative requiring no capital investment by you. This option is similar to securing block time at your local hospital or at an outpatient surgery center. Open-access laser centers provide a laser technician, support staff, receptionist, supplies and a microkeratome.
• Buying or leasing a laser.
This option requires either a large initial capital expenditure or an extended financial liability in the form of a note or a lease. Numerous, creative financing and lease programs can make this option very attractive and certainly worthy of consideration. This represents the ideal choice for the high-volume refractive practice, because of the low, per-case cost and the flexibility in scheduling surgery.

For other operational initiatives you must consider, see "Consider Your Facility Requirements" below.

Competition for refractive patients is becoming fierce in many markets. National laser companies and large practices are spending huge amounts of money on media advertising. Don’t be discouraged if your budget won’t immediately support a major marketing campaign, including radio, TV, and print.

Design your marketing strategy to fit the internal capabilities and financial resources of your practice. Identify strengths that make your practice better than your competitors.

A well-rounded marketing strategy will combine a less-expensive inward focus that leverages your reputation among optometrists, local medical professionals and your existing patients with an outward focus that reaches out to potential patients through more expensive media advertising.

Begin by aggressively communicating your entry into refractive surgery to the medical community and your established patient base. Use seminars, newsletters, direct mail and direct phone contact with patients and local physicians. Include senior patients in this process. These loyal patients most certainly have grandchildren who wear glasses and contacts.

After careful planning and establishing a commitment to a sustained level of funding, you’ll be ready to incorporate media advertising into your strategy. If you have limited or no experience in this area, solicit assistance from your laser vendors or companies specializing in ophthalmic marketing.

Mistakes in marketing can quickly deplete your allocated funds and make it difficult to go back to the well for additional funding. The results of your marketing programs must be measurable to justify spending and make adjustments as needed.

You can greatly enhance your success in selling your plan to the owners of the practice or to your source of funding if you can prepare financial projections and budgets that reflect anticipated revenues, costs, and profits associated with this new refractive surgery venture. Your practice administrator is a good source for the required financial information.

Consider investing in one of the many business-plan software programs available for less than $100 at your local computer software retailer. These programs, forcing you to look at all aspects of a business venture, can be extremely helpful.

Once you’ve completed your plan, you’ll be ready to make your presentation. It’s imperative to know who the decision-makers are and how to prepare your presentation for optimal acceptance. If the decision-makers are senior physicians in your practice, find out how best to connect with them.

A poorly timed meeting or improperly structured presentation can derail your idea. I’ve actually worked with physicians who have been turned off by high-tech, PowerPoint presentations, but would sign off on a million-dollar investment sketched on the back of a coffee-stained envelope if it seems to make sense to them. It’s all in how you perceive their needs, meet those needs and communicate your planned initiatives.

As I said, developing a refractive surgery practice requires a long-term commitment from you and the owners of your practice. After planning your entry into the market carefully and communicating your goals to all members of the practice, you also need to ensure that everyone in the office is prepared to help you open the door to this new opportunity.

Finally, have patience, as your surgical skills and hard work create a new and rewarding dimension to your career and to your practice.

If you operate a fixed-site laser or a transportable laser, you’ll need to prepare a designated operating suite that meets the manufacturer’s specifications for safe and efficient operation of the laser. The laser vendors are quite helpful in advising you of the required site specifications.

Elective-surgery patients who are paying up to $5,000 for refractive surgery demand quality in every encounter with your office. They will begin formulating their impression of the quality of your surgery when they reach the entrance to your parking lot. You will be subconsciously graded on such things as the overall neatness and cleanliness of your facility, and the condition of your furniture and waiting-room accessories.

Trash in the parking lot, stained carpeting and outdated or scarce reading material will certainly reflect negatively on your competence as a surgeon. Conduct a close inspection of your entire facility and correct any deficiencies in appearance.

Paul White is president of JPW Consulting, Inc., Duluth, Ga., specializing in ophthalmic practice start-ups, practice re-engineering, strategic planning and productivity improvement. E-mail pwhite2020@webmail.bellsouth.net.