Optometric Management Tip # 265 - Wednesday, February 14, 2007
What To Do If You Are Booked Far In Advance
A recent email from a reader asked me this question and I thought it would make
a great topic for a tip. The doctor who posed the question admitted it was a
great problem to have. It really is and sadly, itís a little rare in our
profession, but it does happen.
Is it a problem?
Whatís wrong with owning a practice thatís booked three weeks solid in advance?
Isnít that what we are all working hard to achieve? The biggest problem to me is
that this practice has untapped revenue sitting in the appointment book. If we
could collapse some of that backlog and move more patients to the present day,
the practice would gross and net much more money.
A second problem is that the lack of appointment availability is stifling
patient satisfaction and growth. A convenient and quick appointment is a primary
patient want and need, and if our goal is to maximize the practice, we must
satisfy this need.
Why is the schedule so full?
What action to take when a practice is too busy depends on how it got that way.
Simply put, there are two ways a significant appointment backlog can occur:
1. The practice has a small staff and the doctor performs most clinical duties
and relatively few patients are seen per day.
2. The practice is efficient and enjoys tremendous patient demand.
Of course, most practices fall somewhere in between these two extremes; there
are degrees of efficiency.
If a practice is close to example number one above, I think the first step is to
change the operation so it is not so dependent on the doctor. This occurs by
acquiring larger office space, automated instrumentation and more staff members.
These changes obviously represent an increase in expenses, but that will be
easily offset by a much greater gross income. Profits will be realized.
If a practice is already highly delegated and the doctor is seeing patients at a
fairly busy pace, say 25 or so in an eight hour day, the next step is to bring
in an associate OD. In this case, if the practice is booked solid even one week
in advance I would be entertaining the idea of an associate.
The good news is that either of these scenarios has great potential to increase
gross and net revenue quickly. I think it would definitely be worth any growing
pains that might be experienced as the changes are implemented.
Hiring an associate OD does not have to be a painful experience at all, although
I readily admit that finding candidates can be challenging. But the caliber of
graduates from optometry school today is so good that you wonít need a huge pool
to draw from.
- Associate ODs do not have to be partners. There are many excellent ODs
who do not want to own a practice or manage a business. They are clinicians
who want to provide patient care in a professional practice environment and
go home to their family life at the end of the day. Nothing wrong with that
in my book.
- Bringing in an employed OD is much easier to do than finding a partner
and much easier to separate from if things donít work out.
- Associate ODs do not have to be paid on a percentage basis or be placed
on an incentive plan. In my experience, good old fashioned salary and
benefits work just fine if you have developed a good staff and a system that
- Itís not fair in my opinion to expect a partnership mentality from an
employed associate. You canít have both. I would not expect the associate to
build his or her own practice within mine, beyond providing excellent
service to each patient. I donít expect him or her to be entrepreneurial or
to have extensive administrative duties.
- The best way to help fill the associateís appointment schedule (and you
do want it to be full Ė right?) is for the senior doctor to reduce his or
her patient schedule by one day per week. That day can be used as a
management day, which will further grow the practice. The increased backlog
for the senior doc will facilitate more patients switching over to the new
- If you are not sure if you want to move ďyourĒ patients over to the
associate doctor, then I think you want a partner who will build his or her
own practice or buy half of yours.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management