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 By Neil B. Gailmard, OD, MBA, FAAO, Editor October 31, 2012 - Tip #556 
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Can You Examine Patients Faster?

  Sponsor: AIR OPTIX® AQUA Multifocal Contact Lenses

Some optometrists act slightly insulted when I ask them that question. I mean no offense, but the economics of eye care are changing and seeing more patients per day is one of several strategies that can help increase profitability. The technology of eye care is also changing. We can deliver care much more efficiently than we did years ago. Let's take a fresh look at what would happen if you tried to perform eye exams in less time.

Why do it?
The obvious reason to see more patients per day is to generate more revenue. The median gross revenue per comprehensive exam is about $307 according to a major study. You can do the math, but if you see more people per day, the increased revenue is significant. Some optometrists may respond that they would see more patients per day if they had the demand, but you may have to change your scheduling routine first. After all, I'm sure you have some patients booked throughout the next week. Some of them may have come in sooner if you offered the appointments.

There is another reason you should consider faster patient flow, but it is hard for some ODs to comprehend: your patients might like it better. Optometrists tend to view the time patients spend with the doctor as a valuable commodity; many of us justify our exam fee with ample doctor time. The truth is that a little bit goes a long way. Many patients would like it better if the exam were shorter; assuming they received a good exam. I believe we can deliver an excellent exam in less time than most optometrists now spend.

How can you do it?
You can deliver a quality exam by delegating more and by analyzing how you spend time. I can offer suggestions, but if you start with the goal of a 15 minute average exam time, what would you do? Let's say you can leave the dilated fundus exam as an additional procedure that is worked back into one of your exam rooms and we won't even count that. This may be a different clinical model than you are used to, but if you concentrated on reviewing the case history (not taking it), performing a subjective refraction, a slit lamp exam and a brief discussion of the patient's diagnosis and treatment, you could have time to spare. That would take a lot of delegation, but it is quite possible.

Will quality suffer?
In my opinion, faster eye exams do not have to mean any loss of quality. Well-trained technicians and advanced instrumentation provide very accurate data. The doctor still analyzes the data but does not have to collect it. The problem oriented approach to eye care means you do not run tests that are not actually needed for that case. You may have to update your clinical routine and break some old habits. Your technician can take visual acuities and you don't need retinoscopy or phorias in most cases.

Will you have to work harder?
Seeing twenty patients per day is no harder than seeing ten if you have enough good help. I actually find the faster pace more enjoyable because I dislike doing tests that are just routine and boring. I prefer to spend more time talking with the patient and making decisions for patient care.

What will patients think?
Faster eye exams do not have to give an impression that you are rushing. There is still plenty of time for the personal touch and for friendly conversation with patients. Even with less doctor time, patients still spend a fairly long time in the office with pretesting, the exam and optical dispensing or contact lens work. I maintain patients would like to make the whole visit a little faster anyway.

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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