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 By Neil B. Gailmard, OD, MBA, FAAO, Editor May 11, 2011 - Tip #481 
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Questions and Objections about Scribes


  Sponsor: Center for Patient Insights

My latest series of tip articles about scribes has produced a lot of interest from readers so I'll conclude the topic this week by answering some questions I've received.

Three scribes per doctor
I mentioned that I schedule three scribes per working doctor, but I phrased it as "scribes/technicians/opticians" and that was a bit confusing.  I meant that to be read as one job title that is cross-trained for all those duties, not three separate people.  To sum it up better, we have three technicians per working doctor and each tech also acts as a scribe and frame stylist as well.  On a three-doctor day, we try to have nine technicians.

The technicians do not stay with a specific doctor but they go wherever they are needed most.  They may be paged to the optical area to do an eyeglass dispensing or they may take the next patient into the clinic for pretesting.  In addition to the three technicians per doctor rule, we have receptionists, an office manager, insurance coordinator and lab technicians to make glasses.  We also have two full time opticians who always remain in optical and do not perform pretesting or scribing.  These opticians take care of walk-ins and are available to take a handoff from technicians if the clinic side is very busy and we need the techs back for patient care.

Every practice is different and those exact staff requirements may not work in every practice.  Having the technicians cross-trained in optical gives us many resources that we can move to any part of the practice that gets busy.  It allows a high-level of customer service in optical because that side of the practice is not by appointment and we can get a rush of people at times.

Should smaller practices also use scribes?
No, probably not, but I would recommend the practice owner set a goal to use scribes in the future.  I also believe ECPs can use scribes sooner than they might think.  Let's consider the extreme of a new startup practice.  This practice may have only one employee and that person is primarily at the front desk, but may also be cross-trained for some optical dispensing.  The doctor in this situation must perform many tasks that I would eventually recommend delegating.  But in the beginning, with limited cash flow and a small number of patients, it is best for the doctor and staff member to handle multiple tasks. 

Over time as the practice grows, the doctor should delegate more and more duties and scribing would be one of the more advanced tasks.  The point is for the ECP to continue to push for more delegation.  This should be accomplished even before there is an obvious need to delegate.  Don't wait for the practice to be extremely busy before delegating at a high level; put delegation into effect first and the practice will become busier.  How?  If you compress patients into fewer days of the week, you create free days or half-days when the practice owner can be scheduled to work solely on practice management.

Cross-trained scribes may not be good at optical sales
I've heard the concern before that clinical technicians may not be stellar at optical sales.  The thought is that the cross-trained super-technician might not be as good at selling as a dedicated optician.  In over 25 years of using scribes, I have not found it to be a problem and in many cases, the clinical techs surprise me at how well they sell.  Consider these points:

  • The power of the doctor recommending optical products at chairside and having the technician in the room to seamlessly make it happen goes a long way to boost sales.  This advantage elevates the average technician to a level on par with a very good salesperson.
  • I still employ opticians who are great at selling, but I really can't find enough of them.  I need more staff to keep our patient flow at a high level.  We ask our best sales staff to train our clinical technicians in the art of selling and they learn by observing.
  • A great optical dispensary is a huge aid to sales.  After investing in beautiful frame displays and extensive inventory, our approach is to educate each patient about optical products and to ask them verbal questions about their lifestyle.  When we do all that, we sell a lot of products. 
  • I don't really want a slick, high-pressure sales approach.  We sell more by keeping optical under our healthcare umbrella and not making it feel too retail-oriented.

Dilation and contact lenses
A question was asked about how I handle pupil dilation with the contact lens fitting process that occurs on the same day as the comprehensive eye exam.  We use full dilation in about 90% of comprehensive exams, but it really does not present a problem with contact lens fittings or frame selections.  We are simply a little creative about when we instill the drops with the goal of managing all aspects of eye care. 

In the case of all new contact lens fittings and many refittings, we are scheduling a follow-up visit in one week.  This visit is included in the fitting fee.  Unless the patient had signs or symptoms of a serious eye health problem during the initial exam, we just perform the dilated fundus exam after the contact lens follow-up one week later.

Another approach would be to just delay the drops until the technician or doctor has performed most of the contact lens procedures.  I can still evaluate the fit of a basic soft lens with a slit lamp even if the pupil is dilated.  Vision can be evaluated before the drops are instilled.  A big advantage of having the visit managed by a technician instead of the doctor is that more time can be devoted to a patient without disrupting the appointment schedule.


Best wishes for continued success,

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


A Proud Supporter of

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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