A second exam room has a huge impact on the productivity of the practice. In fact, when we look at the relatively low cost of basic exam equipment, it may be the best bang for the buck one can get. If you already have a second (or third or fourth) exam room, this tip will give you some ideas on how to use it to the best advantage. If you are currently working out of one exam room, I'll present some strong motivation for finding space and equipping it now.
As I discuss your options below, keep in mind that I'm referring to multiple exam rooms per working doctor. If you have two docs in your practice who work on the same days and three exams rooms, you don't have two exam rooms per doctor and you could gain efficiency if you added one. While the second room gives the biggest jump in efficiency, a single doctor can find even more benefit from three or more exam rooms. Working patients back into the flow after pupil dilation is much easier with three rooms.
Have the space but not equipped
Many ECPs have a second exam room in the office that is not equipped yet and they are not sure when to take the plunge. Given that you can buy a very nice used or brand new chair, stand, phoroptor, slit lamp and digital acuity chart for less than $15,000, I would do it now. Unless you are a new start-up practice or otherwise have severe cash flow problems, you should be able to lease, finance or just buy the equipment outright. The return on investment is very big and I'll cover that in detail below.
Don't wait for a sign that the time is right. Equip the room now and you will immediately be more efficient. Even if you don't yet have a lot of patient demand, you can see your current volume of patients in far less time and you'll position your practice to grow. With an inefficient, slow schedule that spreads a few patients across a whole day, the doctor and staff members become accustomed to that pace. The schedule appears full with twelve patients. You must make a proactive change to that mentality.
Would like to equip but no space
I'll bet I could find an 8 by 12 foot room in at least half the offices that think they have no space for another exam room. Of course, something has to give, but office space that can produce revenue should take precedence over other uses. Here are some places to look for space to convert to a second exam room:
A storage room. Move the junk in there to the trash or rent an off-site storage unit.
A file room. You can free up space with electronic medical records.
A contact lens dispensing room. We really don't need a dedicated room for this simple task anymore. Move the trial lenses somewhere else; possibly on shelves in a wide hallway.
Unfinished adjacent space.
20 foot long exam rooms can be reduced to 12 feet, creating some new space so you can move things around.
If you really can't find any additional space for a second exam room, you should consider looking for new office space. Space limitations can hold your practice back and prevent growth.
How to use the second exam room
The key to making the second exam room pay is to allow you to see more patients in a shorter period of time. Recognize that the act of moving patients in and out of the exam room consumes a lot of time. If the doctor can move back and forth between two exam rooms and if the staff always has the next patient ready so the doctor does not have to wait, you can realize a huge increase in productivity. Consider these factors to use the room to the fullest:
Let clinical technicians use the exam rooms. I would not make the rooms doctor only. Read below for more on this.
The extra exam room can increase patient flow in pretesting if you train your pretester 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. We train staff to get in and get out of the pretest room with little chit chat.
Our pretest room tests include auto-refraction and keratometry, non-contact tonometry, visual field screening and lensometry (if we did not make the habitual glasses). We also perform screening retinal photos, corneal topography and macular pigment density test in pretest areas.
The technician continues with these tests in one of the exam rooms: case history, visual acuity, stereopsis, and color vision. She then dials in the starting point for the refraction and uses and alcohol swab on the phoroptor and slit lamp. The retinal and corneal images are displayed on the desktop computer. We offer to play a 3D digital video clip about eye care on the computer until the doctor arrives.
I think it is important for the doctor to 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.
If the doctor is available when a technician is working in an exam room, the doctor may just walk in on the tech and patient. I would just say hello to the patient and wait for the tech to complete the current test. We train our technicians to turn the case over to the doctor after completing the current phase of testing. Any uncompleted work may be finished later.
Multiple exam rooms provide a great return on investment.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
Dr. Gailmard's new book, Practice Management in Optometry: A Blueprint for Success Based on the Optometric Management Tip of the Week, is now available on Amazon.