1. Higher cause/vision and mission statement :

Setting up a vitreoretinal surgery / medical retina practice should come with a higher calling apart from simply making a living. It is very important to have one to sail through tough initial months or years till your practice reached a break-even point. Till the business starts making money this higher calling will keep up your spirits high and motivate you to continue the journey.

Having worked in for seven years in other eye hospitals where the primary interest was in cataract and refractive surgery and when the sustainability of stand-alone retina practice was questionable, for me the higher calling was to establish a center for excellence in diseases of vitreoretina and uvea.

2. Base building:

It is always good to work in established hospitals or in group practices or with anterior segment surgeons for a couple of years to learn many things that are not taught in medical schools apart from building a base of your satisfied patients and testimonials that would follow you . its also important to learn How not to run your business apart from the knowledge of the right way of doing things . this would be learnt only from practical work experience in other centers. in case someone is planning to start practice straight after a fellowship it would be a good idea to take a tour of different practices, understand their functioning, values, lacunae, and have a plan as to what difference is your practice going to bring to the patients.

3. Skill set:

It is essential to learn and master all the basic surgical skills with reasonable proficiency before embarking on the entrepreneurial journey. One should also be confident in doing surgeries and managing complications without supervision. one should also reasonably be confident in redo surgeries ( recurrent retinal detachment with PVR and failed macular hole surgeries) which are seen in 10 % of cases in best of hands worldwide.

4. Location:

The location of practice is one of the most important factors in the success of health care service providers and ophthalmology/ vitreoretinal surgery is no different. One has to keep in mind whether the patient source is from a particular geographic location or a referral practice from other parts of the city or surrounding towns and cities. In case a referral model is being planned one has to choose a location that is easily accessible to all via all means of public transport. It is also important to choose an area with good parking space and avoid main roads.

5.Key Opinion Leaders:

They could be your potential referral ophthalmologists or physicians, endocrinologists .it would be good to engage them prior to starting your practice in deciding the location, its accessibility, and the current lacunae and future collaborations.

6. Management Composition:

One should clearly make up their mind regarding the ownership and top management composition,. Sole proprietor, limited liability partnership, or private limited company. While each has its own advantages, when you begin to scale the operations to multiple centers or look for an investor or partner it would be easier if you start as a private limited company. One should have a fairly detailed discussion with a chartered accountant and company secretary to come to a decision

7. Investment:

Ophthalmology and especially vitreoretinal surgery requires a high investment and has to be done judiciously. It is always good to start with minimum equipment and gradually add equipment as practice picks up rather than buy all at once. It is better to avoid raising huge personal loans to buy equipment with personal liabilities as much as possible, though it is not completely avoidable in the beginning. Its good to start slow and raise loans in the name of a business entity with no personal collaterals or liabilities.

8. Admin/manager recruit and practice type :

Doctors who have been predominantly involved in patient care are good at strategizing and prioritizing and typically inexperienced in administration, people management, and unaware of all the legal and statutory requirements in running a hospital or daycare center. It is ideal to hire an experienced administrator to handle these affairs so that the promoter and chief ophthalmologist can concentrate on patient care. Sometimes it is better to avoid a family member or spend your own family time in this role.

9. Marketing plan in place :

Doctors have to be mentally prepared to market their skills and the new center unabashedly in the initial years. As vitreoretinal surgeons who depend on referrals, one has to use all their goodwill to attract patient referrals from colleagues. One has to have a plan to engage the doctors in regular CME activities. it would be good for the doctor to open and operate all the social media accounts of the hospital during the initial years and it would be easier to monitor at a later date when you might engage someone else to handle the social media accounts.

10. Multi-tasking and Delegation of Authority:

while it is good to do multi-tasking during the initial years to reduce the operational expenses it is very important to delegate responsibility to the appropriate new recruits and the doctors concentrate on their core competencies of patient care and continue to have an advisory role in all other departments related tp HR, marketing, etc

Finally, the guiding principle once someone starts practice is ‘patient comes first, employee next and profitability follows’