THERE IS much divergence in the net incomes of similar optometry practices, even if per-patient revenue is equal. How is this so?

Let’s say that two optometrists (Doctor A and Doctor B) decide to see 16 patients a day for comprehensive eye exams. As a result, both doctors staff for the patient flow, incur the cost of the facility required to handle this desired patient volume and have the same ancillary costs associated with patient volume. That said, at the end of the month when both O.D.s examine their practice metrics, Doctor A’s reveal she saw all 16 of her scheduled patients each day, while Doctor B saw 80% of her 16 scheduled patients each day, or about 13 patients per day.

Doctors A and B have the same per-patient revenue, which is $300. Doctor A grossed $3,900 on her first 13 patients ($300 x 13 patients). So did Doctor B. Both Doctors netted $858, or 22%, of their gross on the first 13 patients. Dr. B ended the day there.

However, because her staff was laser focused on maintaining a full schedule (16 patients), Doctor A saw three additional patients, which added $900 to her gross production, now $4,800. In addition, Doctor A has an air tight grip on her cost of goods, which amount to 20% of the gross income. So, Doctor A nets 80% on her last three patients, or a net of $720 ($900 x 0.8).

What is the difference in net income between Doctors A and B?

• In one day, Doctor A netted $1,578, and Dr. B netted $858. (OK, Doctor B cut herself.)

• In one week (4.5 days), Doctor A netted $7,101, and Doctor B netted $3,861. (Maybe Doctor B just has a flesh wound?)

• In one month (18 days), Doctor A netted $28,404, and Doctor B netted $15,444. (Perhaps the bleeding is a little worse than thought for Doctor B?)

• For the year (or 216 days in this example), Doctor A netted about $340,000, and Doctor B netted about $185,000. So Doctor A took home $155,000 more than Doctor B did this year, even though both doctors began each day with a full schedule. Doctor A earned 83% more than Doctor B. (Doctor B may need a blood transfusion!)

• Multiply this by 30 years, and Doctor A nets $10.2 million vs. Doctor B’s $5.5 million!

Now that you know how much difference actively managing one’s patient schedule can make, let’s discuss the key components required to maintain a full schedule.


It is important to identify the time required to complete each phase of the examination and understand the factors influencing the time, so you can determine how many patients you can see daily.

For example, how long does it typically take for patients to traverse from the reception desk through the pre-test sequence, arrive in the exam room and be ready for you, the doctor? If the required time in the pre-testing sequence is even one more minute than the time spent in the exam room, you will need multiple pre-testers to keep your patient schedule running smoothly.


Schedules either work for or against you, so it is important to know how many patients you want to see each day for comprehensive examinations and your emotional and physical capacity for dealing with people.


It generally makes sense to save your high-demand times for more comprehensive examinations. You want to utilize your non-high-demand appointment slots for follow-up appointments, as these patients tend to be more amenable to working with your schedule because you’ve already established the value of the appointment at a previous visit.


Now, that you’ve identified how many patients you can provide exceptional care to and your high-demand appointment slots, it’s time to create value for your patients to arrive on time. Doing so helps reduce the risk of “action paralysis” (when staff is unsure whether to wait for a late patient or to move another patient into the late patient’s time slot). It also reduces a practice’s risk of having multiple patients entering the comprehensive exam workflow at the same time, which can create chaos.

To create appointment value, have your receptionist explain to patients what, specifically, will happen when they get there and the value of these steps. This way, patients are more likely to arrive on schedule and won’t assume the doctor is 20 minutes late for their appointment. (The latter will make them re-think arriving on time in the future.) The following sample script explains the steps taken during the visit and their value:

“Hi Drew. So, your appointment is scheduled for Feb. 3 at 10 a.m. When you arrive, I’ll introduce you to one of our pre-testers, who will perform some preliminary tests whose results are very valuable to the doctor in assessing the health of your visual system. For this reason, it’s very important you arrive on time. At 10:20 a.m., you’ll see the doctor. Sound good?”


Now, create a system to help keep your schedule full and operating efficiently. This may require a number of schedule alerts that cover patient requests or partiality for specific slots. (See “Scheduling Systems,” above.)

One successful practice kept a running courtesy list of patients who were amenable to moving ahead in the schedule. The practice’s receptionist also noted patients who had time constraints, so that staff members did not waste their — or the patient’s time — trying to reschedule an appointment.

If a change in the schedule, such as a no-show or late patient, occurred, the practice’s staff immediately contacted one of the patients who were amenable to moving ahead in the schedule and offered the appointment to him or her.

The practice effectively created a sliding schedule, which consistently moved openings farther away from the immediate time, increasing the odds of the staff’s ability to fill the appointment. Also, the practice staff created and kept a number of updated patient lists that they worked through when replenishing an opening. Its usual order of accomplishing this was:

1. Move a presently waiting patient into the opening.

2. Peruse the day’s schedule for other patients who want to move ahead in the schedule.

3. Contact patients who are on the “Courtesy list.”

4. Peruse the next few days of the schedule for patients who are scheduled around the same time of day as the opening and who have an alert identifying them as willing to move ahead in the schedule.

5. Create lists of patients who missed their appointments and have not been subsequently seen or rescheduled, and peruse those lists to fill any remaining openings in the schedule.


Although these tips take time, they also increase your practice revenue: Doctor A made substantially more money than Doctor B by having her staff stay on top of no-shows and appointment cancellations. OM