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 By Neil B. Gailmard, OD, MBA, FAAO, Editor February 27, 2008 - Tip #317 
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Delegation in Contact Lens Practice


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One of the fastest and easiest ways to increase your profitability in contact lens practice is not the most obvious way. It's not increasing fees or decreasing acquisition costs. It's reducing the doctor time spent in the fitting process. As we examine the profitability of any service in an eye care practice, time is an important factor. We don't just care about income; we care about income per unit of time. We may track gross revenue per month, but that is with an understanding of how many hours per week are spent seeing patients. We also find that tracking gross or net revenue per doctor hour or per staff hour are very valuable statistics.

How does delegation help profit?


Let's assume a hypothetical practice has a mean net income per contact lens fitting of $200, and the average doctor time spent per case is one hour. Let's further assume that through maximum staff delegation, the doctor time was reduced to 30 minutes. The profitability doubled in this example, even though no fees were changed. The thirty minutes saved per case were either not worked by the doctor or they were used to generate additional income.

Delegation is one of the most powerful tools in practice management. I've long contended that it's vastly underutilized in optometry, but I find it's even less utilized in contact lens practice. In most optometric practices today, the doctor handles most contact lens fitting procedures.

What to delegate

Here are some aspects of contact lens practice that you could easily delegate to a qualified technician. Assume the eye care practitioner has another exam room available and can see other patients while the contact lens work is proceeding.
  • Educate the patient about contact lens types, disposal options and fees.
  • Perform keratometry or corneal topography tests and any additional measurements needed.
  • Insert and remove all diagnostic contact lenses on the eye.
  • Perform a diagnostic workup over the diagnostic lens, including visual acuity at near and far, auto-refraction over lenses, and evaluation of patient comfort.
  • Depending on the doctor's judgment and state law, additional evaluation steps could be performed, like subjective over-refraction (often spherical only) and slit lamp evaluation of fit.
  • Assist with many aspects of a follow-up exam, including case history, visual acuity and any other aspect of the exam deemed appropriate.
I should be clear that I believe a licensed contact lens fitter should still examine, prescribe and fit the contact lenses. That may be a doctor or a certified contact lens technician in some states. Any type of licensed fitter can benefit from delegation.

These procedures are commonly delegated, but review them just to be sure they haven't become doctor responsibilities in your office.
  • Training patients in contact lens care and handling.
  • Ordering, receiving and verifying contact lenses for patients.
  • Maintaining inventories of trial lenses and sellable lenses.
Why don't your delegate more?

The answer probably is because your practice is not set up to do so. You don't have the right staff member handy. You haven't trained your staff to do that kind of work. Your appointment schedule is not set up to take advantage of it. Your exam rooms are not set up for it. It's easier to just do it yourself. It's cheaper to just do it yourself. None of the prior statements are valid in my opinion, by the way. If you could double your profitability in contact lenses, it would be worth a great deal of time, effort and expense to make it happen.

More next week on how to adapt your practice for maximum delegation.

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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