Expanding a medical group

Good morning,

I am seeking advice from my entrepreneurial minded colleagues. I am PGY-10 FM trained, ER career doc. A few years ago I started an urgent care that has done very well. We now have 2 locations and our third opens in a couple of months. We have also started a primary care clinic and have two providers that are nearly full, and are hiring our third.

My goal here is to create a truly great medical group. PCP and UC go hand in hand and it's working well, and we all work hard to give the best possible care for our patients.

I'm always thinking about what we can do next. We moved PCP from a space built out attached to our urgent care to a larger clinic space, so now that space is empty. The space is actually perfect size to add a CT and US machine. This would cost me about $80,000 in electrical upgrades and remodeling. I already have a radiologist to read all imaging. CT, auto-injector, and US would be about $210,000 (refurb) - and all would be financed via lease. This is attached to an urgent care so there is always a provider there in case of IV contrast reaction.

Our break even for imaging would be about (on average) 3.5 CTs and 3.5 USs per day.

My thoughts are that between 3 UCs and 3 PCPs we generate more than enough imaging to break even, and locally there are imaging centers but no one actually advertises, etc, and we can get enough other business to actually do well.

But this also is a lot of risk, its $80,000 in upgrade/remodeling that I could lose, expensive equipment that I could turn around and sell if needed, and then the whole pain of finding a RIS, billing, etc, and a whole new RCM to worry about.

The alternative is that we can simply not do imaging, and I can focus on building urgent cares.

My ultimate goal is to sell and quit working. But sometimes I feel in my heart I want to grow this into a truly excellent medical group and really make a difference in our area. Meaning I would love to still be in charge of this in 40 years. But I also don't know how sustainable medicine is in the long run, with our never improving reimbursements from insurance but everyone wanting a pay raise/cost of everything going up.