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 didnít receive any
this past week on the subject of delegation. Iíve seen this silence before on delegation, but
Iím not sure why. My theory is that optometrists who already delegate are happy with it and
those who donít delegate too much either canít or donít want to. Itís hard to change anyoneís
mind on the concept. But that wonít 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.
Take a step up on the delegation scale
- Patients want the doctor to do the tests
- Patients would perceive the quality of my service as less
- I canít afford to hire more staff
- I canít find any good help
- More staff just means more headaches
- Technicians canít do the task as well as I can
- I donít want to see patients faster Ė it would be too rushed
- I donít want to work any harder
- I donít have the physical office space
- I canít afford the additional pre-testing equipment
- I practice in a state that prohibits delegation by law
- I wouldnít 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 didnít do all the testing
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 ďcouldĒ list, with an eye on ease of implementation
and financial return. Then hold a staff meeting and discuss the concept. Donít present a change
in procedures as an edict, but rather let staff participate in the plan. They often see things
that doctors donít. 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.
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 yourselfÖ you might just get it.
- 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
- 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, thatís a delegation red flag. A good tech can do it
- 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
- Have your technician stay in the exam room with you and scribe.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management