Efficiency 101

Boost your practice with scribes, extra exam rooms and (yes) fewer days.


Efficiency 101

Boost your practice with scribes, extra exam rooms and (yes) fewer days.



Neil B. Gailmard, O.D., M.B.A., F.A.A.O., provides invaluable practice management advice in OM’s “Management Tip of the Week” e-newsletter. For this article, we’ve collected some of the e-newsletter’s recent guidance on how to increase productivity.

For more information or to subscribe to the e-newsletter, visit

Add scribes.

To see the value of scribes, analyze how much time you spend writing in a record (paper and pen or EHR software). You’ll see that it adds up to a large block of time. If you could save that time and still have excellent records (maybe even better than they are now), you could see more patients, leading to much greater income. If you don’t have a patient backlog, you could grow your practice with marketing projects and staff training, or take a couple more days off per week and enjoy life.

To utilize chairside assistants, invent the process as you go along by doing what feels natural. Tell your staff not to worry about the mechanics of recording, as you’ll review everything afterward and teach them as you go.

Developing an exam form also makes it easy for your techs to record data. Review this with them before you start the scribing procedure. Techs know most optical terms and abbreviations, and your staff is familiar with your records. Don’t throw difficult medical terms at your assistant at first; understanding that you may take the exam form and make a few notes yourself from time to time.

Also, you may not want to verbally reveal medical findings for the patient to hear until you are ready to discuss it with them. For example, you may want more data before stating that you see pigment clumping in the macula.

Cross-train your staff.

In most U.S. eyecare practices, separate staff work in the optical dispensary and the clinic. These staff members have different training and different skills. In my practice, the optical and the clinic are both served by one staff group, as pretest technicians are also trained as opticians. This allows flexibility for staff to go where they are needed during rush periods. Customer service improves, and wait times decrease because more staff can do the job.

Start by changing the job description for new hires in the future. If the norm in your practice is for technicians to work in both the clinic and optical, job applicants won’t view it as a big deal at all. It will be rare for you to find job candidates who have experience in both areas, so hire the best person, and train for the skills that are missing.

Also, ask your present staff whether they have any interest in learning the other skill. Many employees view this as an opportunity to grow in their career. You may find some resistance and decide on a “grandfather clause” that allows staff to stay with the job they were brought in to perform.

Reduce your patient care days.

Eyecare providers have considerable control over exam length and, therefore, daily productivity. Sadly, many don’t see any value in speeding their schedules up because they don’t have enough patients. They feel they would just run out of patients with no increase in revenue.

These docs are missing out on one of the most efficient management strategies: See the same number of patients you currently see per week, but in fewer days. For example, if you generally see patients four-and-a-half days per week, see that same number in three-and-a-half days. Yes, this could require an investment in another employee and possibly in additional instrumentation, but there is no investment that will produce a greater return.

Restructure your appointment schedules to see more patients per day by reducing the length of each appointment slot. Make appropriate changes in your exam routine so you don’t run behind schedule. Start by looking for ways to delegate, shorten, speed up or eliminate some of the exam procedures you usually perform (See “It’s the Right Time for Exams” on page 20 for specific tips.)

If you reduce the number of patient care days, I believe you should still keep the office open on the other weekdays during normal business hours. It’s best if you still come into the office for administrative work, but your staff should keep it open even if you’re not present.

This could leave you with valuable free time to work on building your practice and management and marketing projects.

Use multiple exam rooms per working doctor.

Given that you can buy a nice chair, stand, phoropter, slit lamp and digital acuity chart for less than $15,000, consider adding an additional room now. Unless you are a new start-up practice or otherwise have severe cash flow problems, you should be able to lease, finance or buy the equipment.

Consider these factors to use the room to the fullest:

▸ The extra exam room can increase patient flow in pre-testing if you train your pre-tester to only perform the tests on the major automated instruments and no more.

▸ Some additional less expensive tests can be duplicated and performed in any exam room, which allows the pretest room to open up sooner for the next patient. Train staff to get in and out.

Our pre-test room tests include auto-refraction and keratometry, non-contact to-nometry, visual field screening and lensometry (if we did not make the habitual glasses). Also, acquire screening retinal photos, corneal topography and macular pigment density tests in pre-test areas.

The technician continues with these tests in one of the exam rooms: case history, visual acuity, stereopsis and color vision.

Then, she dials in the starting point for the refraction and uses an alcohol swab on the phoropter and slit lamp. The retinal and corneal images are displayed on the desktop computer. Staff offers to play a 3D digital video clip about the patient’s eyecare needs until the doctor arrives.

The doctor should be aware when the next patient is ready. This can be accomplished by using a simple silent pager device, an office light system, a message on the computer system or any other method. I like the doctor to be flexible with the exam routine and make an effort to stay on schedule.

As for the needed space, I’ll bet you have an 8’ by 12’ space, such as:

A storage room. Move the junk to the trash, or rent an off-site storage unit.

A file room. You can free up space with e-records.

A contact lens dispensing room. You don’t need a dedicated room for this simple task. Move the trial lenses to a shelf, possibly in a wide hallway.

Unfinished adjacent space. 20’-long exam rooms can be reduced to 12 feet.

Increased practice profit

Follow these tips to improve your efficiency, allowing you to boost revenue by seeing more patients. OM


Dr. Gailmard offers consulting services to eyecare professionals through Prima Eye Group; information is available at Send questions and comments to, or e-mail