Counting pennys is just as important for medical businesses as it is for any other.
My friend had a bunch of old, mostly orange and green chairs. I jokingly asked him if they cost him $10 a piece. He said, "less. Actually we bought 20 desks for $500 and got all these chairs for free." A marketing company was selling its fixed assets and they furnished their several thousand square feet of office space for almost nothing.
His office space is close to the railroad tracks--"the closer you are to the tracks, the lower your rent" he says--and he pays only $0.39 per sq ft per month -- about 1/3 of what everyone else I know is paying. The space was actually quite decent.
He pays $1,000 per month for a billboard to recruit potential web developers. That seems like a lot of money, but compared to the $23,000 he spent employing one developer who wrote poor code -- none of it could be used -- the $1,000 per month to improve his talent pool is a great investment.
He sends out tons of direct mail. He calculated that it would be cheaper to use a one-window envelope with the mailing address printed on the letter inside than a two-window letter. But rather than pre-printing his envelopes with his logo, he found it far cheaper to buy an envelope printer and print his return address. He got a $4,500 envelope printer on eBay for $500. He saves hundreds or thousands of pennies everyday the way he does his direct mail. That adds up to hundreds or thousands of dollars a year.
He found a source for ink toner where he pays $10 for recycled instead of $200 for a new toner cartridge.
Once he wanted to use a photo of a well-known person for an advertising campaign. The person's agent wanted about $2,000 per month. But my friend found a stock photo of the same person on rubberball.com for $59.00 -- a one-time fee for unlimited use.
If you're looking for free voip service, check out www.Voipbuster.com. Voipbuster is a great barebones solution, with some limitations. The free calling requires a nominal deposit (around $3)), and is only free to landline phones within some countries (free in the U.S.--for now). Calling a mobile phone costs $0.01/minute. Oh yeah, and you can only make outgoing calls.