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Editor: Neil B. Gailmard, OD, MBA, FAAO
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Empty Appointment Slots: A Love-Hate Thing for Owners
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May 11, 2016
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I talk to doctors quite often about how many patients they see per day. I’m not judgmental about it because there are many factors involved and it is really something each doctor must decide, but my focus on this point led me to an interesting discovery that could help you with your practice goals. I think most ODs have a love-hate relationship with holes in their appointment schedule. At their core, doctors know that empty appointment slots hurt the business, but on any given day, especially when life is busy (when isn’t it?), we might be secretly glad there are some empty slots. It will give you some breathing room. You might even tell the front desk to not fill them.
On a day-to-day basis, this may not feel like a problem, but when you do this over a period of years, it limits the production of your practice. Read on for a deeper look at the impact of this and what to do about it.
Don’t make it personal
When I talk with an optometrist about how many exams she does per day, I don’t want it to be personal. We should talk about how many patients the practice sees per day, not the owner personally.
A great test for how you feel about exams per day or empty appointment slots is to pretend you have an associate doctor who is seeing the patients and not you. And pretend that you employ the doctor on a straight salary basis. Take yourself out of the equation and ask yourself how many exams a really good associate OD should see per day, with plenty of support staff, instrumentation and exam rooms. Also ask how you feel about appointment slots that did not get filled, no shows and last minute rescheduling that leaves holes in the day.
Patient demand is a huge factor
We need many metrics to successfully operate a business and one of them is some measure of patient demand. Many important business decisions depend on this metric. Patient demand is an expression of how many patients want to receive services from your practice. At its simplest form, it can be stated as how far ahead you are booked with appointments. But that factor must be qualified because being booked ahead for three weeks is different if the doctor only sees 10 patients per day, three days per week. Compare that with a doctor who sees 25 patients per day, five days per week and is also booked ahead for three weeks.
It is not enough to simply look backwards at how many patients (or exams) were seen per day or week or month in the past. What if doctors limit their schedule to 10 patients per day, but are booked out solid for weeks? That doctor is seeing a low number of patients per day but has a lot of patient demand.
Decision making with patient demand
There are many business decisions that should be made with an eye on patient demand, but I’ll highlight three main ones here:
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Vision plans. Vision plans make sense if there are a lot of vacancies in a doctor’s schedule. Even a lower profit is better than zero profit if you have openings. If you have holes in your schedule on most days, but actually prefer it that way, you will reject vision plans even when it would help your bottom line. Of course, only you can decide how hard you want to work, but growing patient demand can lead to a strong income and the ability to hire an associate. And seeing more patients per day does not have to be more work if you delegate more.
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Hiring an associate. This is one of the best strategies for practice growth there is, but it won’t be successful without lots of patient demand. That is how you can afford to pay the associate’s salary and still make some profit for yourself.
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Preappointing. I know many practices that do very well with preappointing, but it is quite common to have many no shows and last minute cancellations and reschedules. The schedule in advance can look like it is full, but when you look backward at how many exams each doctor actually performed, it is disappointing. You may like the days that are bit more slow-paced while kidding yourself that the schedule is full.
What to do about it?
So, what should you do if you realize that you have been holding your practice back because you don’t want to see more patients per day? I think the most important thing is to be aware of it. Then you can reassess your goals and decide if revenue production is that important or not.
I think the best strategy is to increase patient demand so you can hire more staff, move to a larger office and hire associate ODs.
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