Article Date: 2/1/2002

View From The Top
The Delegation Debate
Revisiting common arguments made against delegating.

Here's a one-word, surefire way to start a verbal brawl at the next optometry meeting: Wait until it's quiet. Then, stand up and say, "Delegation." Watch as the oratory wrangling and the games begin!

What's the big deal?

The delegation debate started the instant an optometrist hired the first optometric technician. Even if that technician's only task was to answer the phone, the concept of delegation had been born into the optometric world.

Today, delegation refers to much more than clerical front office tasks and now crosses over into the clinical care of our patients. As this spectrum evolved, so did the depth and voracity of the debate over what we should delegate. Let's put on our analytical hats and look at both sides of the debate by examining some of the major arguments.


"Patients pay for me to examine them. They want to see a doctor, not a technician. Patients don't like it when they see a tech for 45 minutes and a doctor for only five."

False: Surveys show us that patients care less about who examines them and more about getting solutions to their problems. True, they want the doctor's intelligence, experience and endorsement, but they don't really care who collects the data. I've never found a measurable correlation in a client's practice between the amount of doctor time spent with a patient and the patient's perception of clinical care.


"There are subtleties that occur during an exam that only a doctor can recognize as important."

True: And once you get a firm grasp on what those subtleties are and how important they are, they shouldn't be delegated. But don't throw the baby out with the bath water and deny the other things that you can delegate.


"What's the rush? I'm not that busy anyway and patients like when I spend a lot of time with them."

False: You may not be in a rush, but many of your patients are. I've performed hundreds of patient exit interviews for my clients. Patients often tell me that they were in the doctor's office longer than they anticipated.

Patients also tell me (and will never tell the doctor) that while it was nice that the doctor engaged in non-clinical small talk, they could've easily survived without it. They needed to get the grocery shopping done before picking the kids up at school. They have a life after their eye exam and we need to be sensitive to that.

Another major practice management problem that relates to this point is that most of us reserve the frame selection process (that part of our practice that typically generates 70% of our income) as the last step in the patient's visit. By then, patients can be so burned out that they just want a break and want to go home -- and eventually buy their glasses elsewhere.


"Delegation allows me to see more patients in less time and that makes me more money. I can spend more time making clinical decisions and less time collecting data."

True: If you're busy enough that patients are declining your services because it takes too long to get an appointment, then that's probably correct. This must of course be balanced against the increased labor costs incurred when you delegate more tasks. Generally speaking, with regard to labor costs -- delegation pays -- it doesn't cost.


"Anyone can push the auto-refractor button as well as I can."

True: Hard to dispute that one. You can delegate virtually anything that's labeled "auto."


"If I learned to refract, so can a technician."

True: I saved the best for last. It's been said that an accurate whole body/holistic/lifestyle refraction is what defines optometry. For this reason, many argue it should never be "given away."

For those of you who already delegate refraction, you have no doubt grown comfortable with the distinction between "refracting" and "prescribing." For the rest, if it doesn't work for you -- don't do it. But again, don't deny patients the benefits of having other tests and procedures delegated. Let's not forget our patient's perspective on refraction. Truth be told, most don't care who does it.

Find some common ground

When choosing to delegate -- or not -- distance yourself from the knee-jerk reactions of what you feel to be true versus what we know to be true. Stay within your clinical comfort zone but recognize that what's comfortable for you might not be so for your patients.



Optometric Management, Issue: February 2002