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Buying equipment is as exciting as ever, if you ask me. While my tastes are probably slightly different than yours, in the sense that I buy '90s flash gear and DSLRs, I have been doing this for around five years and have come up with a few tips on how to save money when buying gear.
The first thing you need to consider if you want to save money buying gear is to buy used. The thing is, as soon as you walk out of the store with your brand-new gear, you've just lost about 20-30% of its retail value. Essentially, buying new kit is equivalent to burning money. Buying used can be tricky, and this article is meant for photographers who want to save money but may be reluctant to buy used because of the risks associated with such purchases. I understand your concern. When buying used, you may not get the manufacturer warranty, the gear may be damaged, the person selling may not be entirely truthful with you, and so on. I aim to help you out with this article and show you some of the things you need to look out for when buying used cameras, lenses, lights, modifiers, and other miscellaneous equipment.
When it comes to used cameras, the property most will suggest you consider is the shutter count. That, however, is not the first thing I will look at, to be frank. The reason being is that while some cameras can have tens of thousands of actuations on them, they would've been used as studio units and never seen daylight. Other cameras may have under ten thousand actuations but were used in the field and had all sorts of cosmetic wear on them. My own camera has been everywhere at this point, and I would not want to buy it in the condition that it is now. The main thing you need to look at when buying a used camera is the user of this camera. What style of photography are they doing? What sort of user are they? Do they keep the camera pristine or bash it around? The fewer marks and scuffs there are on the camera, the better for you. I would buy a camera in mint condition with 100,000+ actuations over a bashed camera with 10,000 actuations any day of the week.
When it comes to lenses, there are way more things that can go wrong. As a rule of thumb, don't get the cheap prosumer lenses used. They are generally made for medium use, and not heavy-duty 2,000 captures-a-day use. This is why if you are buying used lenses, look at the L-series from Canon or the G-Master from Sony. This is the league of lenses that will be reliable performers even if bought used. Truth be told, I never ever bought a new lens.
When it comes to lenses, you might be worried that minor scratches will affect optical performance. Sure they will, but not nearly to the degree you are imagining them to. It is safe to get a lens if it has no more than one minor scratch on the glass. When buying a used lens, you need to check for dust inside of it, possible fungus, and weather sealing. Ask the user what kind of photography they were doing with the lens. Another thing to check is how well it mounts on the camera, if there is any rattle in it, and so on. Cosmetic wear such as writing on the lens is negligible in my opinion but can be used to bring the price down. Lastly, one of the most important things to check is that every zoom position works with every aperture setting, and that the aperture closes consistently. One of the first things to fail in a lens is its aperture flex cable. Things such as a lens hood are advised to have, but not a must. As long as you are getting a decent lens, with all lens caps, you are good.
Used lighting is generally also best bought from top brands. For example, I recently got an ancient Pro-5 generator as a backup piece for my equally ancient Pro-7a. That said, I also never bought new flash equipment. The reason being that I use Profoto, and getting it new is far too pricey. Also, because the system that I use runs off Proheads, which cost around $3,000 new. With lighting, you need to first decide if you are looking at battery-powered solutions or mains-powered solutions. If a light is battery-powered, don't expect to get the best battery performance from it and be sure to get a few fresh new replacement batteries to be sure that you won't run out of power. If it's a mains-powered light, just look at the cosmetic wear on it, make sure the key functions work and so on. There is really not much that can go wrong with a light, which is why getting them used is so good. One particular thing that does go wrong with lights is flash tubes. I generally suggest making sure that the flash tube is as close to clear as possible. If it appears foggy or perhaps worn out in some way, knock the price down by a few hundred as you will be replacing that tube fairly soon.
Used modifiers can go wrong in three spots: yellowed-out diffusers, broken rods, and torn material. I really can't say more about modifiers than this. With this in mind, if the rods are broken or the diffusers are yellowed-out, you can usually get replacements. As for torn modifiers, I would say skip buying that unless you are good at sewing. When it comes to soft modifiers, go for the RFi range from Profoto or an equivalent high-end choice from your brand. They are constructed with more reliability in mind as opposed to OCF or clic. As for modifiers such as hard reflectors, really no need to worry about most things. Even if it is slightly bent or dented, it will do the job as well as a new modifier. Broncolor and Profoto hard reflectors made for their Proheads are notoriously well-made. I think I have some zoom reflectors from the s that came with my ProHeads and they do the job.
A safe alternative would be, of course, to buy gear from places such as MPB, B&H used section, or refurbished from the manufacturer. These will usually be more expensive than buying used from a private person, though. It all depends on the budget you have. If you are trying to save as much money as you can, go ahead and purchase from private individuals. If you want to find solutions for slightly more money but which have been tested and checked by the company selling them, go ahead and buy from companies specialized in selling used kit.
Over to you, what is your experience with buying used kit? Let us know in the comments below!
When it comes to upgrading or adopting new technology for your OR, it can be difficult to decide what is worth investing in, when and why. Whereas refractive surgery technology can add lines of revenue for an ophthalmic surgery center, the revenue from retina surgical cases is capped by insurance contracts. New expenditures have to be justified by increased efficiency in time or costs or by an increase in safety or improved outcomes. New machines and devices are introduced to the market frequently, and researching all the options can feel overwhelming and perhaps unnecessary, particularly when you feel satisfied with what you have. However, making the right investments could benefit your clinical practice and surgery center in ways you might not have considered.
Retina surgeons have the duality of being attracted to new technologies and simultaneously surgically averse to changes. In the operating room, this can translate to staying within the confines of one or two company suppliers or platforms and only trying the new technologies associated to their chosen platform. To achieve better return on our surgical investments, it may be best to utilize a standardized process for evaluating new retina surgery technology.
The most obvious barriers to adopting new technology are financial. The most important, on the other hand, are logistical. Learning about new technologies should begin years before time of purchase, by constantly following the trends and exposing the surgical team to new devices and platforms. The last important hurdle is the natural resistance to change by both the surgeon and the supporting nursing and technical team. Other common barriers include:
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Before proceeding with large expenditures, evaluate the equipment at your facility. Where is it in its life cycle? Approach the vendor and sales representatives to analyze future issues with technical support, as older equipment may soon be unsupported. Are there any available upgrades that can extend its life span or increase capacity without requiring major capital investments?
In the process of understanding your current and potential future situations, it is important to discuss with all the stakeholders their opinions, problems and needs. Stakeholders range from the surgeons, nurses and technicians to the staff members responsible for ordering supplies. When multiple vendors provide clinically equivalent equipment, other non-clinical factors become more important, like ease of ordering and payment flexibility.
When discussing equipment preferences with surgeons, some may resist any changes in their operating room. In my experience, these surgeons are usually early in their careers and are uncomfortable with any modifications in the midst of their learning curve, or they are at the tail end of their surgical careers. The best approach usually requires an open discussion of advantages and drawbacks, constantly demonstrating the benefit to patients and the surgery space. Colleague mentorship through these transitions can alleviate many difficulties.
From a general perspective, retina surgical equipment can be divided into three groups: large platforms, smaller consumables and peripherals. The two larger platform categories are microscopes (top right) and vitrectomy machines (bottom right). These usually require significant capital expenditures and have a life cycle of more than 7 years. Smaller equipment ranges from metal reusable instruments and disposable forceps, cannulas and laser probes. Peripherals are equipment used outside of the operating field that support efficiency, documentation and education; this category includes tools such as cameras, video screens, digital video recorders and EMR technology.
Vitrectomy machine platform selection is perhaps the most significant decision to be made. Not only does it determine the basic capacity for vitrectomy surgery, but also disposable packs and equipment purchasing depend on the machine chosen. This is a decision with large clinical and financial consequences. It is also the decision with the largest psychological component for surgeons, since many have not performed surgeries with more than a single platform. This decision is best approached with an objective and critical lens: Are you using your current equipment at its highest capacity? Trying out the different platforms to objectively compare them in surgery can help highlight their similarities and differences.
Purchasing of disposable equipment, by virtue of its lower unit cost, requires less initial financial commitment. But, disposables require adequate inventory management, which is more complex from an administrative perspective. The supply of disposable devices needs to be constantly updated and verified. The amount of inventory at hand needs to be tracked. Nursing and technical staff need to be trained not to open all pieces of disposable equipment that may be needed in a surgery, which is typical in a hospital setting. Instead, it should be available yet unopened until the moment the surgeon specifically needs said equipment. In the retina operating room, each surgical vitrectomy gauge has its line of disposable and reusable equipment. That means a whole additional line of inventory management. This not only increases the administrative burden but also decreases the ability to predict utilization of each specific instrument or device, risking not having equipment available when necessary. I personally recommend that centers agree to predominantly use a single vitrectomy gauge. That allows a more predictable inventory and purchasing system. In addition to simplification of ordering, consolidating the volume into a single line of equipment may also allow negotiations for lower purchasing prices.
Once you've done your homework, it's time to evaluate objectively. Ask yourself: 'Could this technology allow improved surgical efficiency or patient outcomes? Improve the patient experience at my practice? Benefit my staff and/or me (eg, ergonomic design, reduced workload, increased revenue or money saved in the long run)?'
Cost of equipment can be significantly offset by time of surgery. The cost of every minute inside an operating room can be calculated without including equipment costs, anesthesiologist billing time and surgeon professional services cost. The factors that then drive the cost of each OR minute are: real estate expenses (lease or mortgage and amortization of leasehold improvements), non-physician payroll (nursing, technicians and clerical staff) and other fixed operating costs required to maintain compliance (administrative, equipment maintenance and sterilization, surgical gases and supplies). The cost varies between setting (hospitals being more costly than surgery centers), but it is not unusual for costs higher than $25 a minute. In other words, reducing 10 minutes of surgery time can save upwards of $250 per case. This is a reasonable way to evaluate the financial cost/benefit ratio of an instrument.
Consider efficiencies with consolidation. Certain vitrectomy platforms are also excellent cataract surgery platforms, for example. When there are separate rooms for anterior segment and posterior segment procedures, having distinct platforms for each room may be efficient. On the other hand, if the vitrectomy room is also utilized for cataract surgery procedures, it may be advisable to consider a combined platform. Use of a single platform may require less consumables, occupy less space in the room, provide a single point of contact for sales and support and, most importantly, allow techs to learn a single user interface instead of several.
Once a specific piece of equipment has been chosen, the next steps are purchasing and implementation. Depending on the type of equipment, capital cost and vendor, there may be different options for purchase or lease. The correct decision is different for each individual center based on financial situation and volume projections.
Incorporation of equipment and maximization of utilization are common problems, particularly with complex electronic systems. It's not unusual to have one surgeon utilize a piece of new equipment more than his or her peers. This discrepancy is both a sign of inefficiency as well as an opportunity for improvement. This can be improved with communication and training, to allow those more resistant to change to accept and adopt new technologies. I am a strong believer in standardization of procedures inside an operating room, since standardization improves efficiencies and quality. The more the staff trains in a single process, instead of distinct processes per surgeon, the more the output of their efforts is maximized.
Evaluating new technology can be time and resource intensive, but it's a critical step in ensuring that you are delivering the best possible patient outcomes and optimizing your practice. Following these steps will help streamline the process and ensure that you make decisions that maximize your return on investment. OM
Jorge I. Calzada, MD, FACS, is founder of the specialty clinic Deep Blue Retina in the Memphis, Tenn., metro region, and of Panamerican Vitreoretinal Consultants in the Republic of Panama. He serves as adjunct professor of ophthalmology and vision science at the University of Nebraska.
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