IN SOME cases, offices can be made more efficient by adding an additional exam lane. Office efficiency, though a concept we all strive to achieve, is a difficult task for many eye care providers to fully understand, as large portions of our day are spent in the exam room. This is true of many businesses where the owner works in the business and may not take the time to work on the business.

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“That fatal assumption is: If you understand the technical work of a business, you understand a business that does that technical work,” according to “The E Myth Revisited: Why Most Small Businesses Don’t Work and What to Do About It,” by Michael E. Gerber.

To determine whether to add an additional exam lane, take a step back. First, analyze practice time to understand where wait, or waste, time may occur. Then, assess the return on investment (ROI) of adding another lane and, finally, if you decide it makes sense for you, map out the process before implementing into your practice.


Know when patients are made to wait. Evaluate this on a consistent basis to assess the efficiency of your business; I recommend quarterly.

You can build a spreadsheet for whatever time increments make sense for your specific office flow. The ultimate goal is to understand where the wait is, for example before pre-testing, and how long it takes to get patients through the exam. My goal is 45 minutes, but an hour at worst.

Now that you understand how long and where patients are spending their time in your office, assess why they are spending that time in each area. For example, did Patient 2 wait for 10 minutes after check in because pre-testing equipment was not available? Did Patient 3 wait 20 minutes because a technician was not available to take her through pre-testing? Did Patient 4 have a 10-minute wait because you, the doctor, were backed up with Patient 3?

To identify the specifics, ask your office manager or another staff member to follow the flow and provide an explanation for any wait time longer than five minutes.

If you determine patients are waiting for pre-testing equipment availability, staff members or an exam lane, change is necessary to fix these issues. Any of those wait minutes would be considered wasted time and uneven patient flow. If there is a consistent wait for an open exam room of more than five minutes, it is time to add a lane.


Now that you recognize wait time is negatively effecting office efficiency and a lane addition is a possible solution, it’s time to determine the ROI of adding a lane. At some point, you’ll see diminishing returns, as you, the doctor, are only one person. But you can expect to see as many or more patients in a more condensed time frame when operating out of multiple exam rooms. Consider a surgeons’ schedule. Most surgeons now work out of multiple surgery rooms. The nurses and technicians prep the patient in the next room while the surgeon completes a procedure in a different room. This streamlined approach to patient care creates a positive perception from the patient’s point of view, as he or she doesn’t want to spend a long time in your office.

Let’s take a hypothetical situation and compare working out of one, two or three exam lanes and starting with 14 patients a day through five days a week (40 doctor hours). (See “Lane Comparison.”)

The highest efficiency jump and increase in patient volume occurs when working out of two exam lanes, 70 patients per week at one lane as compared with 90 patients per week at two lanes, but 80 patients per week at three lanes. Two lanes seem to be the minimum number for most eye care providers to maintain an efficient flow. When opening a third exam lane, an increase in patient volume may occur because of your increased capacity to see patients. But you may also find yourself seeing the same number of patients in less doctor hours, the excess of which could be spent on administrative tasks, as seen in the scenario outlined above. In this case, an associate doctor may have the opportunity to build his or her patient base.

To analyze lane comparisons specific to your office, consider your exam slots and how you schedule patients. Specifically, if there is an opportunity to increase your staff utilization, to increase patient care and to streamline your approach, it is time to add another lane. It does not take a big increase in patients seen in a given period for the ROI make sense. If you can provide as many exam slots as you currently do, in a more condensed schedule, you will find some extra time to use as needed.

Patients seen and doctor hours are only one part of the ROI equation. Some of the needs of a new lane include a slit lamp, phoropter, chair stand and VA chart; minimal upfront costs for all these items could be around $25,000. Being conservative with revenue per patient ($300), it would take less than two months to break even on a new lane. 

There also could be extra costs with your specific situation to be added in, such as construction costs. Be sure to account for these when calculating ROI.


If you’ve decided adding an extra lane makes sense for your practice, it’s time to determine how you’re going to do it with your space. Consider remodeling an area or even splitting a larger exam lane into two lanes through the use of technology.

A basic exam lane package and a high-end exam lane with automated equipment obviously differ. You can rationalize space usage with high-tech diagnostic equipment that has higher cost, but lower footprint. For example, a high-tech exam lane may cost 2x to 3x more, but may greatly improve your efficiency and even take up less space. Analyze the cost-benefit of these various options when mapping out your new exam lane.


Adding an exam lane is one step to improving patient flow and practice profitability. The ROI of doing so is strong. It also may provide you with more time to work on your business. Consider the possibilities for that extra time and what it could mean to your business. OM