Optometric Management Tip # 158   -   Wednesday, January 26, 2005
Quiet on the subject of delegation?

I generally receive quite a bit of email from readers, which is great, but I didn’t receive any this past week on the subject of delegation. I’ve seen this silence before on delegation, but I’m not sure why. My theory is that optometrists who already delegate are happy with it and those who don’t delegate too much either can’t or don’t want to. It’s hard to change anyone’s mind on the concept. But that won’t stop me from making my case. I think ODs in the first group would likely still benefit from taking a step up on the delegation scale, and the latter group could make some changes in their procedures and realize huge benefits.

Usual excuses for not delegating

I think most of the reasons optometrists cite for not wanting to delegate more are listed below. Examine your philosophy and see if you agree with any of the following sentiments. By the way, I believe all of the following are myths.

• Patients want the doctor to do the tests
• Patients would perceive the quality of my service as less
• I can’t afford to hire more staff
• I can’t find any good help
• More staff just means more headaches
• Technicians can’t do the task as well as I can
• I don’t want to see patients faster – it would be too rushed
• I don’t want to work any harder
• I don’t have the physical office space
• I can’t afford the additional pre-testing equipment
• I practice in a state that prohibits delegation by law
• I wouldn’t net any more income anyway, any gain would just go to payroll
• I would feel like my exam fee is out of line if I didn’t do all the testing

Take a step up on the delegation scale

I suggested an assignment last week, which was to list all the tasks that your practice currently delegates to non-doctor staff members, and to make a second list of the tasks that could be delegated. It is up to you to prioritize the “could” list, with an eye on ease of implementation and financial return. Then hold a staff meeting and discuss the concept. Don’t present a change in procedures as an edict, but rather let staff participate in the plan. They often see things that doctors don’t. Most staff members welcome the idea of a growth opportunity in their career, and optometric practices often lose good staffers by not fostering growth.

Here are just a few tasks that might stimulate you to take a step up on the scale.

• Start having a technician perform more pre-testing. Make a list of the tests that all eye exams should include and check off the ones a technician could perform. Let the tech do some tests in a data collection room and then do more in the exam room. Purchase or lease automated instruments such as an autorefractor, field screener, NCT tonometer, digital retinal camera and topographer.
• Do you always have a tech available to perform lensometry on the habitual Rx? Can all techs perform manual lensometry on an unknown pair of glasses, and spot and mark progressives?
• Let your tech take visual acuities by working with the next patient in the other exam room while you're in the first exam room.
• If you order contact lenses yourself, that’s a delegation red flag. A good tech can do it perfectly.
• Can all your technicians insert trial contact lenses for a new wearer with ease? Leave the exam room and let the tech do this task and return later to check the fit.
• Teach a technician to do Goldmann applanation tonometry.
• Does your tech instill mydriatic drops and explain the process?
• Do your techs complete all the coding, fee charges, billing, spectacle/CL prescription and recall paperwork?
• Have your technician stay in the exam room with you and scribe.

Delegation is one of the most important keys for success, because it dramatically raises productivity, and does not have to reduce quality. Be careful if your plan is to build a practice that is totally dependent on yourself… you might just get it.


Best wishes for continued success,

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