I have written many times about the need for optometrists and their staffs to be more efficient with eye exams. I know that concept can spark a negative response because it may seem like quality of care will be sacrificed or the doctor and staff will be stressed. That is simply a misconception, however. Neither of those factors has to be true. If you want to increase practice profit in this era of managed care and vision plans, let’s find a way to work faster, not harder.
Start by changing the appointment template
There are dozens of good ways to design your appointment schedule and if you have a system that works for you, lets you see about 25 patients per day, and you stay on schedule the vast majority of the time, then stick with it. But many doctors waste a tremendous amount of time because they have appointment systems that are outdated.
It is likely that you will need to change some aspects of your exam process to be more efficient, but the quickest way to do that is to start with the end in mind. If you change the schedule and you have shorter time slots for each patient, you will figure out what needs to be done. It usually involves more delegation, it may mean hiring more staff and you may need to eliminate or shorten some of the testing and talking. Don’t worry, we can do that and still deliver great care and still make patients love your practice.
My practice has four optometrists and we work with an appointment system that is amazingly simple, which is the main reason I like it. Every slot is 15 minutes long and we don’t care what kind of exam it is. That is about it! But there are some details that may help you implement this system:
While the appointment slots are only 15 minutes long, we insert block outs at several points throughout the day that allow us to stay on schedule and even handle emergency squeeze-ins.
With the block outs considered, we actually have about 20 minutes per patient. We could just have 20 minute slots with no block outs, but I prefer the shorter slots. It makes me think in shorter terms with each patient.
I like the psychological aspect of more appointment slots with some blocked out. These empty slots give my staff some place to enter additional patients if needed.
We only schedule doctor time, not technician time. The patient may be in the clinical area of our office for 45 minutes or more even though they only have a 15 minute slot with the doctor. We have plenty of clinical technicians who do pretesting and also scribe. I hire the right number of staff to keep their part moving.
I find that with ample delegation to a great staff, a comprehensive eye exam does not take any more doctor time than a follow-up visit or a contact lens check. Fifteen minutes is plenty of time, even with a dilated fundus exam (DFE). Of course, some patients are more complex and may run over the 15 minute time slot, but some are very easy and take less than 15 minutes. The block out slots allow you to catch up when some patients run longer.
The doctors in my practice dilate about 90% of their exams, even though we have an Optos. In most cases, a technician just works the patient back into any available exam room after dilation and the doctor completes the exam fairly quickly. This DFE is not actually scheduled.
Having all the slots the same helps my staff to fill last minute cancellations because they don’t have to find just the right patient type. See the section below on specialty exams.
You can’t control all aspects of the appointment schedule, so just fine tune it with block outs placed at strategic points during the day and let it work itself out. Some patients arrive early and some are late, some are easy and some are difficult. Work on perfecting the average for your practice. Doctors can stay on schedule if they are flexible with their routine and what order they do various procedures. It is critical for the doctor to be aware when the next patient is ready to be seen. We use silent pagers for this, but light systems would work as would an online popup message.
What if you can’t fill the new schedule?
I would set up the fast template anyway, even if it has empty slots. It is better to actually see the full capacity of what your schedule should be and not get lulled into a slow-paced routine. I would also close off some full days or half days in order to group patients together on days when you can see patients efficiently. This also frees up those other days and helps you manage your time better. Here are some thoughts
Use those days for practice management. Since you need more patient demand, marketing would be a good topic to focus on, but there are many more projects that need the owner’s leadership. What could be improved in your practice?
Work in another practice or see patients in nursing homes.
Become involved in the community or with civic groups.
Enjoy some of that time for your personal life.
In this new appointment model, your practice appears to be quite successful and busy on the days you see patients! Patient notice this and the perception of your practice improves.
There can be some exceptions to the 15 minute appointment slot, namely specialty work like low vision, orthokeratology, binocular vision and developmental vision. You can train your staff on the proper appointment time needed for this work, what days to offer this care and how many of these appointments you can see per day.
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.