Optometric Management Tip # 157   -   Wednesday, January 19, 2005
The Delegation Scale

Unfortunately, most optometrists underutilize one of the most powerful tools for practice profitability and growth: delegation. In my experience, there is a wide range of delegatory practices in existence in eye care, from the very low level to the extremely high level. I call this range the delegation scale, and I firmly believe that at least 80% of ODs could benefit from taking a step up on that scale, from wherever they happen to currently be. I admit that delegation can have a downside, if itís not managed properly, but it is far too important of a management principle to shy away from based on that fear.

Resistance to delegation

In my practice management lecture seminars, I often feel some resistance to delegation from doctors in the audience. There are various reasons (I think theyíre excuses) cited for why they donít like it. Iím not really sure why optometrists are slower to delegate than our counterparts in medicine and dentistry Ė although I acknowledge that our professional training does not teach us to embrace the concept. But there are lots of things we learn to do outside of optometry school, and delegation is one of them.

Productivity and expense reduction

Most docs who delegate at the higher end of the scale do so because theyíve seen the great benefits of higher production. Production in terms of number of exams per day, boxes of contact lenses dispensed, pairs of glasses ordered, or any other revenue producing item you want to look at. If you are one of my many colleagues who have not taken a step up on the delegation scale for a long time, however, perhaps looking at delegation from the expense side, rather than the revenue side, will entice you. You are losing money by under-delegating. No practice owner willingly pays more than they need to for office supplies, rent, staffing, inventory or any other expense. Yet, thatís what you do when you perform many tasks in your practice that could be delegated.

CEO vs. doctor

Think of your practice as a separate entity, a company. You are the CEO. Consider your doctor persona as a separate individual whom you hired for the job of optometrist. Consider the doctorís skill level in eye care and his or her annual personal income. It would be wasteful to assign simple, repetitive tasks to this person, when a technician could be hired to do them. Using the proven philosophy of each person working at his or her greatest potential, even fairly technical tasks should be shifted from the doctor, assuming techs can do the job as well (often using special instrumentation). A CEO who does not staff properly is guilty of poor management.

Itís not that the doctor is too good to do the menial tasks of changing light bulbs or ordering contact lenses or taking entrance visual acuity, and from a practical standpoint, this might have to happen for a while. I understand growth phases in a practice when staffing is not optimum Ė yet. But the distinction between a growth phase and poor management occurs when the assignment moves from temporary to permanent in the mind of the CEO. It becomes a problem when the doctor does menial tasks for years and there is no longer any effort to move away from that role.

Staff problems?

Many practitioners feel they canít increase delegation because they would have to hire another staff member. Exactly! Whatís stopping you? The expense? But we just discussed how itís really more expensive to do it yourself. After a new technician is hired, and you gain some breathing room, you can experiment with a new clinical and optical process. You can reorganize your appointment schedule and rearrange some exam rooms and equipment. It will not take much for the gained efficiency to pay for the salary of the new employee. Grow into your new level on the delegation scale and repeat the process.

An assignment for next week

This topic of delegation is so important to successful practice that Iím going to continue with it next week. In the meantime, take a pad of paper and jot down on the left side all the tasks that you currently delegate in your practice. Give this some thought, and include tasks from office administration, clinical services, optical dispensing, and optical lab. Then jot down on the right side all the tasks that your practice currently performs that could theoretically be delegated to properly trained technicians and assistants. Put a check mark next to any tasks on the right side that you know could be delegated, but you would not personally feel comfortable doing so.

Weíll meet back here next week.


Best wishes for continued success,

Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management