It’s the Right Time for Exams

Increase exam efficiency without sacrificing quality, and promote sales.


It’s the Right Time for Exams

Increase exam efficiency without sacrificing quality, and promote sales.




“How much time should an exam appointment take?” Patient expectations, the desire to provide/receive quality eye care and declining health insurance reimbursements beg this question. As doctors, we typically arrange our schedules in one-hour blocks. As patients, we commonly expect doctor appointments to take an hour from the time the doctor walks in the door. Yet in speaking with colleagues, who also define an exam’s start by when a consumer enters their practice, the typical exam appointment time is more than 75 minutes, not including the optical visit.

Consumer intent-to-buy decreases once the appointment hits the 32-minute mark, says recent data from consulting group O.D. Lean. Considering cell phones, the Internet (sales of contact lenses, glasses and soon-to-be eye exams) and round-the-clock cable news reporting have created consumers who expect quality in the most efficient time frame possible, this makes sense. In fact, many, if not most, brick-and-mortar chain practices demand from their doctors a high volume of through-put to build their retail optical sales. That said, going too fast could result in a significant drop in sales as well. In fact, one practice that was able to reduce comprehensive exam appointments to an average of 19 minutes and further cut them to 12 minutes discovered doing so resulted in a sales drop of almost 20%. For practices that function in the high-end arena, for example, frame selection can take 45 to 60 minutes, including digital measurement for lenses. This is because the shopping experience requires a strong optician-patient relationship.

Here, we describe how you can slowly and steadily improve your exam time efficiency while maintaining quality eye care and capturing sales.

1 Determine your current exam times.

Pick one day of the week, and have the check-in person write when each person arrives and checks out. Also, have the check-in person write the type of exam (e.g. contact lens check, medical visit, comprehensive vision exam, etc.) for which the patient presented to the office.

Determine the average length of each exam. This should include data collection (if any), clinical examination/procedure time and how much face-to-face discussion time is needed for the different patients you encounter. For instance, if your practice is largely refractive, with little or no disease, and a large number of simple contact lens fits, doctor time should be no more than 10 minutes for the initial encounter.

At day’s end, determine the average length of each type of exam. (You may even want to repeat this for a few days to get a stronger sample.) These averages are your “real” baseline. No assumptions, just facts. It is a place to start.

2 Find out workflow processes.

After you calculate the doctor time, extrapolate from there the encounters the rest of the staff has, which also vary with type and complexity of patient. Specifically, hand a notecard or piece of paper to everyone in your office, and ask them to write every step that occurs from the time a patient calls for an appointment through their check-in process and up to when they are ready for the pre-test person or you, the doctor, to take them to the clinical examination area.

Put these steps in chronological order, and discuss each of these steps with your staff. To simplify, discuss one step each day with the appropriate staff members, and write the results of that discussion.

This written workflow protocol is going to become your new workflow; one that everyone in the office understands and complies with.

3 Re-evaluate workflow processes.

Re-assess the workflow a few steps at a time, and determine whether each step helps to educate, promote or sell one of the products or services available in your office. If steps don’t do one of these three things, they don’t need to be done when the consumer is in the office.

Saving one minute at each part of the process (check-in, pre-test, examination, contact lenses, optical and checkout) can save six minutes per exam. That doesn’t sound like a lot, but if you multiply that by the 10 to 15 exams most practices see in a day, you have 60 to 90 minutes of “new found” time to schedule additional patients, work on your business operations or even go home early.

4 Start over.

Review the first step every six months, and repeat the second step a few times a year to enhance your efficiency without sacrificing the value and service you provide to your consumers. This is a never-ending process of office improvement, both in efficiency and quality of care. You can track this by either watching revenue per encounter, average patient encounter time or both.

Enhancing the process

Expediting exams requires a tremendous amount of training, task delegation, technology and a never-ending mission to provide quality care efficiently. But it’s all worth it, as your patients will appreciate your consideration for their time, and you’ll be able to schedule additional patients. Now that you have your plan to get there, do something about it. It’s your move. OM


Dr. Morris is chief optometric editor for OM. He is the director of Eye Consultants of Colorado, the founding partner of Ocular Technology Solutions, Inc. and managing partner of Morris Consulting Associates, a full-service business management consulting firm. He is also a co-founder of the National Student Practice management symposium. E-mail him at


Dr. Choate is in private practice and vice president of Market Development of Optometric Medical Solutions, which seeks to promote the medical model in optometry. Also, he is an adjunct professor at Southern College of Optometry, the University of Missouri - St. Louis School of Optometry, and the University of Alabama Birmingham School of Optometry. In addition, he is an FDA investigator and a consultant for contact lens-related products and equipment, a fellow of the American Academy of Optometry and a charter member of the American Optometric Association’s Contact Lens Section. E-mail him at, or send comments to