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 By Neil B. Gailmard, OD, MBA, FAAO, Editor June 6, 2007 - Tip #281 
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How many patients per day?

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Additional Information

One of the fastest ways to increase your income is to increase the number of patients examined per day. With your fixed office expenses already met, any increase in sales volume per day will fall to the bottom line and into your pocket. If your average sale per exam is $350 (that is realistic) and if we allow 30% for cost of goods, you will net $245 for each additional exam seen per day. If you see two more patients per day for five days a week and you work 48 weeks per year, you would net an additional $117,600 per year. Let me be clear that we are talking about net income. Pretty amazing, really.

Can you see more per day?

I often meet some resistance from doctors and staff when I propose the idea of changing their office procedures to see more exams per day, but when you consider the incredible financial potential, the interest level always goes up. Now that I have your attention, let's consider the changes you would have to make to see two more full exams per day.

  • Change the appointment schedule. Unless you want to work longer hours or skip lunch, you will need to shorten the standard appointment slot that you currently use for an exam. If you are adding two exams and if an exam takes about 20 minutes of doctor time, you need to find 40 minutes. If your schedule currently allows 30 minutes for an exam slot, and if you have 10 of those per day and if you shave 10 minutes off each one and make it a 20 minute slot, you will have created 100 minutes. That is much more than you need, but you could insert a few block out periods into the schedule to be sure you run on time. I find that every practice is different and it is best to fine tune and customize the schedule based on actual operational experience.
  • Hire an additional technician. You can certainly test the new schedule first with your present staff, but be prepared to hire an extra employee quickly if you want to maintain staff morale and if you want to continue to deliver high quality eye care. You have the potential to increase your net income by over $100,000; you can certainly handle the additional payroll cost.
  • Increase your delegation. The amount of delegation that exists in eye care varies tremendously, so I can't be very specific here, but be sure you are delegating effectively. Increasing daily production is the ideal time to take a major step up in delegation so you can save more doctor time per exam. The goal is for doctors to spend more time on high level physical exam procedures and on patient communication and less time on data collection. Be sure you're delegating tasks that do not require new instruments, such as case history, visual acuity, lensometry, stereopsis, color vision, and blood pressure.
  • Invest in automated instrumentation. An autorefractor and a tech-friendly tonometer are great places to start. Add a visual field screener and a digital retinal camera for screening photos and you are well on your way to an efficient practice.

Additional thoughts:

  • Review your exam routine. Every way that you can save a few minutes in your exam matters. A five minute savings per patient adds up to an hour and 40 minutes if you see 20 patients per day! Retinoscopy and Goldmann tonometry on every patient requires more much more time than that.
  • You need not limit your goal to an increase of only two extra patients per day. How many patients per day can an eye care professional see with excellent staff support, and still provide excellent patient care?
  • Don't worry that you will have to work harder with the new schedule. Seeing 25 patients per day is no more work than seeing 10 if you have enough help. In fact, the shorter visit with each patient is actually easier because you can eliminate having to perform boring and repetitious tests and concentrate on diagnosis and treatment.

The biggest challenge to higher production

There is a fly in the ointment, though, when it comes to this ambitious plan. Many practices simply do not have enough patients to increase the number examined per day. You could consolidate the existing appointments into fewer days as I've described, but most practices will quickly run out of patients and would simply see holes in the schedule. I strongly encourage you to do it anyway, even if you don't have much patient backlog! Compress the appointments you do have into fewer days and practice more efficiently on those days. The benefits are still huge even if you have some unfilled slots.

  • You and your staff learn how to work efficiently so you can quickly absorb more business as it develops in the future. You will be ready.
  • Your practice looks more impressive. Patients see a busy, high- functioning practice instead of a slow, sad one. Patients who are impressed refer others much more often.
  • Your time is managed better, allowing you some free days without interruption so you can concentrate on building your practice.
  • You have appointments available sooner for people who call and want to be seen quickly.

Practice now as you mean to go.

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.

Please Note: The views expressed in Management Tip of the Week do not necessarily reflect those of the sponsor.

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