Dr Akash Patel on the Rule of 1000:

[RAMESH DORAIRAJAN]

Akash Patel:

*RULE OF 1000 while considering buying an equipment -*

ANY equipment(for that matter anything viz. Car, Scooter etc)we buy has a price..and there is something called cost of ownership which includes Not only the price, but also the -

-EMI(at least the Bank interest if you are investing from your own pocket), 

-Annual Maintainence Contract, 

-Expert staff requirement to assist or perform the job, 

-Recurrent cost of consumables viz.Tubings of phaco,sleeves, needles

-Add on must have accessories required viz. Stabilizer-CVT etc, 

-Repairs, 

-Replacements 

-Marketing of service

so on and so forth..

Unless we factor these into our price calculation, we may lend up buying a machine at wrong stage in practice where it may prove to be a white elephant..whats more is we may lend up doing a bad business..

Worse is, when one go out to sell these after 5 years..it may fetch 

This is often realized late when a phaco probe or cavity or cable of laser machine  is damaged and needs a replacement and the company person charges lakhs for such replacements..

Any standard company machine is suppose to last at least a 1000 times before actual palpable wear and tear ensues..(if u feel the company machine that you are considering buying may not last even this long, you may want to think again..)

Added, with ever changing technology if one cant at least recover what he invested in 1000 days(~ 3 years), the machine he bought goes outdated as per prevalent practice standard and what his competitors are offering..since its after these 1000 procedures, any tangible economic benifit will be visible..until then all will be sucked up by the EMIs..

Whatever you earn above this 1000 procedure is your profit..

Before buying a heavy(costly) equipment- viz. 

Phaco

OCT

Laser

HVF

Know the final cost to you after all the negotiations.

Divide this cost by 1000.

That is going to be ur price of equipment per case.

Then add 500/1000 for the cost of ownership depending upon whther the equipment is at high risk of maintainence viz. Phaco or low risk viz. Microscope- OCT...its arbitary..and would depend on how well u take care of ur equipments..

viz. 10,00,000 phaco

Divide by 1000

= 1000

Now, Add 1000 

2000 is cost of ownership of phaco

Another example-

20,00,000 OCT

Divide by 1000

= 2000

Now, Add 500

2500 is cost of ownership  of OCT

Step 2.

Ask yourself a question-

Do I hv sufficient patient base so that I can recover the cost of this equipment from 1000 patients in a 1000 day period..at charges that are downcost to me- thec cost of ownership(one is not profiting..he is just recovering the money invested..)...

In another words will my patients be able to afford this new technology at extra cost..

Do I hv sufficient patient base to make this project viable..

Be brutally honest with yourself while answering these questions..

Whatever sortfall u get is a proportionate risk..viz. if the answer u get is 500 pt instead of 1000 required..you are risking 50% of your money..if its 300 patients only, you are incurring 70% risk..

So next question is-

Do I intend to risk 70% of my money..?

You will get the answer..

If the answer is NO, wait for some more time for your practice to mature..

NB. Rule of 1000 dosent apply to must have equipments

viz. Autoref, Digital Vision chart, A-Scan etc

because without these you cant necessarily even initiate you OPD or OT practice..

Also it may vary from surgeon to surgeon depending on the way he wants to project his practice...

viz. for a Retina specialist OCT would fall in category of a must have..which may not be a case for anterior segment surgeon unless he is a multifocal-toric surgeon

vice versa..for Phaco..

So on and so forth..

Also surgeon charges are not included in this..its just the cost of ownership thats inclucated..viz. if a Retina person is assigned to do the job, he may want his share for interpreting the OCT..

Moreover, there may be alternate forms of recovery..viz. having an inhouse OCT may have value addition advantages for a phaco Sx..and he may choose to do OCT for free or at lower cost t