We haven't talked about delegation for quite a while. My articles in the past
on this topic have mostly focused on what procedures to delegate and how go
about it. Delegation is so poorly utilized in eye care that I would like to take
a more fundamental approach in this article to illustrate why it is so important
to practice growth.
For the purposes of this article, I will assume the following:
- You want to build a practice that is busy and generates a high net
- You are currently not busy enough. If you had more patient demand (at
reasonably good fees), you could find a way to see the patients.
I would estimate that this describes about 90% of optometric practices in the
What can you control?
We know that delegating duties to staff is a key requirement of the
practice described above. There is simply no way to generate a large net income
if the practice has a small staff and the doctor performs most tasks herself. Of
course you can't begin with a large staff right away, so how do you get there?
You begin with a mental approach that embraces the concept of delegation because
you know it must be in your future. You must continually look to delegate more
and more to your staff and try to seek ways to make your staff larger.
It may seem like you can't control the patient demand aspect of your
practice, although you do have some indirect control and I'll cover that below.
But I understand the feeling that for the immediate future there is not enough
demand and it's growing slowly. You can, however, control how much delegation
goes on in your office. If the dream practice uses delegation, then your
practice should also.
Your practice operations and your staff must reflect the current level of
demand. That means the doctor/owner performs many tasks that she would not do in
the dream practice. That's perfectly fine and the doctor/owner should take on
those roles temporarily, but I believe it becomes permanent in most practices
and that freezes the practice into a non-growth mode. The doctor/owner comes to
accept that she must do these things and that no one else can do them well
enough. It just seems easier and more practical to do them yourself. It can even
seem economical; like doing some tasks yourself is saving the cost of another
employee. That is false economy and it could be stopping you from reaching your
Growth must occur in a step-by-step fashion for most practices. Stretch
as much as possible to invest in your practice in ways that you feel will help
the most. You must have a vision of what you want your practice to look like and
then make it look like that as much as possible.
It's fine to have a plan for delegation, but actually much of it will occur
on a trial and error basis. Who does what in your practice will evolve until you
have developed a good system that maintains high quality service and protects
your financial interests.
Here is an oversimplified example of what I mean by step-by-step growth.
- You might begin by delegating all optical dispensing and pretesting
duties to a technician and optician.
- You raise your fees as you add additional instruments and tests.
- Then you shorten your appointment slots and see more patients per day.
- You hire more staff with the increased revenue from the extra
appointments per day.
- The increased staff allows you to delegate more tasks, giving you more
time to train staff and work on customer service. The increased staff also
helps customer service because there are more people to take care of patient
- The improved customer service results in more referrals and better
retention and gross and net revenue increase.
- You raise contact lens fitting fees and optical prices.
- You remodel and expand the optical and increase your frame inventory.
- The new optical creates more revenue.
- You hire more staff.
- You move to a larger office and equip more exam rooms, allowing you to
be more efficient.
- The larger office signals to the community that your practice is a
strong player in the local eye care market. More patient referrals occur.
- You hire an associate OD and take yourself out of the appointment
schedule one day per week, which you spend on management. The new associate
works two evenings per week plus Saturday mornings, which fill with
appointments very quickly.
All this will take a few years, but it is fantastic model for growth and it
all depends on delegation.
Delegation is not just optical and clinical
As you look at delegation and the role of staff members, look at the
administrative aspects of your office as well. Try to design a system for your
practice that does not depend on the doctor / owner. This will require a good
office manager who can handle virtually all administrative duties. The practice
owner can and should have close control over the practice finances, but that
doesn't mean she must make the bank deposits and print all the checks to
suppliers personally. It takes time to train and trust an office manager, so the
tasks you delegate will evolve, but set a goal to transfer the duties.
Here is a list of some of the duties to work on transferring to the manager
or other staff.
- Ordering supplies and products
- Fixing and installing things around the office
- Arranging for contractors
- Accounts payable
- Interviewing and hiring employees
The end result of all this delegation to others is increased productivity.
You are able to see far more patients and generate far more income when you have
multiple people doing it. And ultimately, this process allows the doctor/owner
to spend time on practice development; researching and thinking about what to do
What about building patient demand?
The only way to build patient demand is to provide great service. How
does a restaurant become the place that is always packed with people? Great
food. In our field, we must provide exam and treatment services that are
different from the pack, outstanding experiences with contact lenses and
eyeglasses and fantastic customer service. If you and your staff do that, word
of mouth referral and patient loyalty will cause demand to increase.