Optometric Management Tip # 276   -   Wednesday, May 02, 2007
Are Scribes Practical?

I listed the use of scribes (or chairside assistants) as one of my top practice management misconceptions a few weeks ago. The practice of having a technician record data for the doctor in the exam room seems quite common in ophthalmology practices, but almost unheard of in optometry, so I must draw the conclusion that most ODs donít feel there is much to gain. In my experience, using scribes results in one of the largest increases in clinical efficiency that Iíve ever seen. It is indeed practical and I encourage any eye care practitioner who is fairly busy to adopt the procedure.

Delegation as an income producer

Iíve utilized scribes in my practice for 20 years and Iíve helped many clients add them to their clinical routine. The whole point of delegation of any clinical duty to a staff member is to save doctor time, and doing so allows the doctor to see more patients per day. Scribing is no different; itís simply delegation of a very time consuming task. Regardless of whether the record is on paper or electronic, if you added up all the time spent on record keeping in one day, it is quite significant. Saving 10 minutes or more per patient would allow doctors to compress their schedules and see many more patients per day, without working any harder! Nothing increases gross and net income faster than seeing more patients per day.

Even if a practice does not have a great backlog of patients, it still makes sense to adopt maximum delegation techniques because doing so allows the practice to see all the patients it has in fewer days of the week. This advanced time management allows the doctor to have large blocks of time free to work on practice management projects and build the practice.


In addition to the major benefit of increasing revenue through delegation and efficiency, there are many more advantages that you might not have thought of:

Just do it

Of course it helps to do some planning and training before asking your techs to scribe for you, but in the end itís really much easier than you might think. Just reassure your staff that you know their skill levels and you wonít embarrass them or throw very advanced terminology at them that is over their heads. You can still reach over to the record and make a drawing or jot a down few notes that you donít want to speak out loud. I found it was helpful to redesign the exam form to assist technicians with recording and to allow me to see the pretest data. It also helps if your exam routine is fairly fast.

If scribing works for you it is very likely that you will need to hire more staff members, but the increased revenue production will greatly exceed any additional payroll cost. I remember when I first tried the technique in my practice my office manager was worried that we might run short of technicians to start workups or to dispense eyewear. I didnít let that stop progress; I just told the manager that if she ever really needed a tech, she knew where she could find one Ė in my exam room! I said, ďjust knock and the door and call her out; Iíll be fine by myself and Iíll understand that you needed help.Ē It was hardly ever necessary.

Best wishes for continued success,

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