TL;DR: Most bad equipment purchases are decided long before anyone looks at the price. Check you actually have the patients. Compare the machine against everything else that money could do. Get your clinicians on side before you sign, not after. Then treat the whole thing as a marketing and operations project, because that’s what it is.
When I go to a clinic, I sometimes get to see something very sad. The machine in the corner with a towel over it, that gets wheeled out twice a month when a particular therapist is in. Somebody paid £14,000 for that. Somebody is still paying for it.
It is almost never a bad machine. It is almost always a good machine bought for the wrong reasons, in the wrong order, by someone who did the sums on a napkin after a very good conversation with a very good salesperson at a trade show.
Equipment can genuinely transform a clinic. Shockwave, Class IV laser, force plates, decompression tables, all of them can open up new services, lift your average patient value and give your clinicians something real to work with. It can make your clinic a more attractive place to work and be genuinely exciting for your associates. Investing in tech is also a must for clinics looking to scale (see the date in the Private Practice Barometer here)
But the difference between the machine that pays for itself twice over and the one under the towel comes down to about ten questions, most of which have nothing to do with the machine.
We have put together a calculator here to help you compute the numbers.
Here is how I’d work through it.
Start With Your Diary, Not the Brochure
The question is never “is shockwave any good?” The question is “how many patients walked through my door last quarter that I could have treated with it, and how many of them would have paid?”
Go and count. Actual presentations from actual notes, not a vibe. If you’re looking at shockwave, count your insertional Achilles, plantar heel pain, greater trochanteric pain and lateral elbow. Say you find eight a month. Say half of them take a course of four sessions at £75. That’s £300 a patient, so £1,200 a month of new revenue, and you now have a number to put against the finance payment instead of a feeling.
If the count comes back at two a month, you have your answer. Buying the machine first and then going looking for patients to justify it is how clinics end up treating people who didn’t need treating. That’s a clinical problem before it’s a business one.
What Else Could That Money Do?
Nobody frames it this way (specially not that very sleek salesperson). The comparison is not “machine versus no machine”. It’s machine versus the other things £18,000 buys.
£18,000 is a part-time associate for the best part of a year, and an associate generates revenue from week one and doesn’t depreciate (they might even appreciate!). It’s a year of serious marketing spend. It’s a second treatment room kitted out. It’s a receptionist who actually converts enquiries instead of taking messages.
Run the machine against those honestly. Sometimes it wins clearly, particularly when it lets you charge for something you currently can’t offer at all. Often it doesn’t, and the reason people don’t like doing this exercise is that they’ve already decided.
Can You Afford It Beyond the Deposit?
The sticker price is the easy bit. Look carefully at what comes iit every single month.
Consumables and applicator heads. Service contracts, typically somewhere between £500 and £1,500 a year once the warranty lapses. Electrical safety testing. Insurance. Software licences and subscriptions, which are increasingly how the expensive machines are priced nowadays. The finance payment itself, which on a five year term turns £18,000 into something closer to £22,000 once you’ve paid the interest.
Add it all up and work out your genuine monthly break-even in patients, not pounds. “I need eleven treatments a month for this to wash its face” is a number you can actually manage against.
See our Equipment Purchase Calculator here.
Does the Evidence Stack Up?
You are a clinician. You are skeptic by nature. Apply the same standard you apply to anything else.
Is there decent published evidence for the indications you’d actually use it for, or is the evidence for something adjacent that got stretched in the brochure? Is it UKCA or CE marked for that use? Do the major insurers recognise the treatment, because if you’re seeing a lot of insured patients and they won’t pay for it, your revenue model just lost a leg.
Ask the rep for the papers, not the case studies. A good supplier will send them over without flinching. If what comes back is a glossy PDF of before and after photos and a testimonial from a clinic in Florida, you’ve learned something useful about the supplier.
And be honest about the machines where the evidence is thin but patients love them. That’s a legitimate commercial decision, but make it with your eyes open, and don’t let your marketing claim more than your evidence supports.
Get Your Team in the Room Before You Sign Anything
If your clinicians weren’t part of the decision, they won’t use it. Not out of spite, just because they have a way of working that already gets results, and a new box in the corner is friction. They’ll mean to use it, and then they’ll have a busy Tuesday, and then it’ll be three weeks before they use it again.
Involve the two or three people who’d actually be delivering the treatment before you commit. Let them ask the sceptical questions. If your most experienced physio thinks it’s snake oil, you either change their mind with evidence or you don’t buy it, because their opinion will leak into every consultation whether they mean it to or not.
Borrow It Before You Buy It
Almost every supplier will do a demo, a trial period, or a short hire. Take it. A fortnight with the machine in your clinic tells you more than any amount of research: whether it fits the room, whether the workflow is clunky, whether patients respond, whether your team reaches for it.
Then find three clinic owners who already run one. Not the references the supplier gives you, the ones you find yourself through your own network or a peer group. Ask them two questions: how many times a week do you actually use it, and what do you wish you’d known before you bought it. The answers are usually blunt and always useful.
Read the Boring Bit
Finance and lease agreements on clinical equipment are written by people who do this for a living, and you are not one of them.
Check the term and what happens at the end of it, particularly on a lease where you may own nothing at all after five years of payments. Check whether it’s a genuine lease or hire purchase, because the tax treatment differs. Check for personal guarantees, which turn a company liability into a claim on your house. Check the early settlement terms, the minimum contract on any software subscription, and whether the service contract is optional or bundled in perpetuity.
Get your accountant to look at it before you sign, not after. Half an hour of their time is cheaper than five years of a bad agreement. It can be expensive to be cheap sometimes!
Everything Is Negotiable, Especially in the Last Week of the Quarter
Reps have targets. Manufacturers have quarters and year ends. Trade shows exist to close deals, which is precisely why you should not close one at a trade show, and precisely why the week after is a good time to ring them.
Ask for the obvious things: a lower price, a longer warranty, free consumables for the first year, training for the whole team rather than one person, service included for three years.
Then ask for the things they’ll say yes to more readily, because they cost them nothing and are worth a lot to them. Many manufacturers will discount meaningfully in exchange for a case study, social content, a video testimonial or being listed as a reference site. Some will fund co-branded marketing for the launch. If you’re going to be posting about the machine anyway, get paid for it in the purchase price.
The worst outcome is they say no and you’ve lost nothing.
Ask Who Fixes It, and How Fast
A machine that’s broken is a machine that’s costing you the payment and earning nothing, and a service engineer three weeks out is a very long three weeks when you’ve got a course of treatment half delivered.
Before you buy, get it in writing: who services it, what’s the typical response time, is there a loan unit while yours is away. Ask what happens if the supplier is a UK distributor for an overseas manufacturer and that relationship ends, because it happens more than you’d think and it can strand you.
Training Isn’t a One Hour Handover
Installation day training is the supplier showing your team which buttons to press. That’s not training, that’s a demonstration, and by Thursday half of it is gone.
Plan around growing the team’s competence. How do you get new starters up to speed six months from now? Is there a refresher course? Does the supplier provide protocols by indication? Are your consent forms and record keeping updated for the new modality? Check your professional indemnity covers it, and that everyone using it is covered individually.
Confidence is the whole game here. A clinician who isn’t sure of the protocol will quietly steer the patient towards something they are sure of, and your machine goes back under the towel.
Paying It Off Is Not the Goal
This is where most clinic owners stop thinking, and that is the bit that matters most.
Covering the finance payment is break-even. Break-even is not success, it’s survival with extra admin. The purchase only makes sense if it produces profit (
) on top of the payment, and that comes down to pricing and to what it does to the rest of your patient journey.
So price it properly. If you price a course of shockwave at £55 a session because you’re nervous, you’ve spent £18,000 to be busier at the same margin. Price on outcome and on what it replaces for the patient, not on what the machine cost you. Look at whether it lifts your average patient value across the board, because a new capability often justifies a review of your whole price list, and clinics chronically underprice.
Be wary of the supplier’s revenue projection. It assumes a full diary and a 100% conversion rate, and yours will not be that.
“But surely the machine pays for itself?” Only if you use it and charge properly for it. A machine used four times a week at a price you set out of nerves is a slow, expensive way to stand still.
See our Equipment Purchase Calculator here.
Nobody Books a Machine They’ve Never Heard Of
You can have the best kit in the county and it means nothing if the only people who know are the patients already sitting in your waiting room.
Launch it properly. A dedicated page on your site targeting the condition rather than the machine, because people search “heel pain treatment near me”, not “shockwave therapy”. Email your existing list, particularly anyone you’ve treated for a relevant condition in the last two years, and a fair number of them are still in pain. Brief your GP and consultant referrers. Get your team to say one consistent sentence about it in consultations. Put something in reception. Post the first patient outcomes, with permission. You can even ask the manufacturers/distributor for some promotional material you can put in your clinic.
“I don’t want to look like I’m flogging a machine.” Then don’t. Talk about the problem it solves. Nobody wants a laser, they want to walk the dog without their heel hurting. Lead with that and the marketing stops feeling like selling, because it isn’t.
Put a Review Date in the Diary Now
Before the machine arrives, put a note in your calendar for six months and twelve months out. Track two things from day one: how often it’s used, and what happens to the patients you use it on.
At six months you’re asking whether utilisation is where you projected and which therapists are and aren’t using it, because that’s usually fixable with training or a conversation. At twelve months you’re asking the harder question: is this thing earning its keep, and if not, do I sell it?
Selling equipment isn’t failure. Sitting on a depreciating asset for four more years because you don’t want to admit the purchase was wrong is. Second-hand clinical kit holds value reasonably well, and the sooner you make the call the more of that value you keep.
Do your Homework, Avoid Buyer’s Remorse
Most equipment regret we see doesn’t come from buying a bad machine. It comes from buying a good machine to solve a problem the clinic didn’t have, and then quietly building the clinical justification backwards from the purchase.
Luckily for you, we have put together this calculator to help you project the numbers: here.
If you’ve done the count, run it against the alternatives, got your team behind it and priced it honestly, you’ll do well and will make a great business investment.
Buy it because your patients need it and the numbers hold up. In that order.
If you want a second pair of eyes on the numbers before you commit, or help getting a new service in front of the right patients once you’ve bought it, get in touch. We’ve watched a lot of clinics make this decision and we know that investing in the right piece of kit at the right time is a great step towards a more profitable business!
