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 By Neil B. Gailmard, OD, MBA, FAAO, Editor February 14, 2007 - Tip #265 
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What To Do If You Are Booked Far In Advance


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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, it's a little rare in our profession, but it does happen.

Is it a problem?

What's wrong with owning a practice that's booked three weeks solid in advance? Isn't 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.

Associate ODs

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 won't 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 don't 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 sells.
  • It's not fair in my opinion to expect a partnership mentality from an employed associate. You can't 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 don't expect him or her to be entrepreneurial or to have extensive administrative duties.
  • The best way to help fill the associate's appointment schedule (and you do want it to be full - 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 doc.
  • If you are not sure if you want to move "your" 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,

Read Past Tips Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week


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Send questions and comments to neil@gailmard.com.

Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.

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