There are many good ways to design your appointment schedule. Part of that decision depends on the optometrist’s clinical philosophy about eye care and how much time they need to perform an eye exam that meets their standards. However, with the increasing dominance of managed care, many ODs are trying to find ways to be more efficient. This is a very smart strategy and it can definitely increase your profitability.
Contrary to popular belief, seeing more patients per day does not have to be stressful for doctors or staff members. It does not have to reduce quality of care. It does not have to take away from the patient experience. And it does not mean that anyone must work harder.
An important question in your effort to increase patient flow is if you have any more patients to see. If you have lots of patients wanting to be seen, the change in your routine is fairly easy and very rewarding. If you don’t have tons of patients, increase your flow and efficiency anyway. If your average number of exams per week is 50, see them in three days instead of four or five days. Use the newly created free time to market your practice.
Here are some key factors to work on.
Many optometrists are stuck in an old exam process. Step out of the box and think about what you could delegate if you had the staff and the exam room set up that would make it work. There are a few high level procedures in the eye exam that only a doctor can perform, but not many. How about visual acuity measurement or routine tonometry? Pick some things and make it happen.
To achieve higher delegation in your clinical setting, you may need more instrumentation or a change in your pretesting room layout. That’s fine; go ahead and decide on what you need. It is a smart investment.
Always observe the laws of practice in your state or jurisdiction.
Many times, the toughest part of implementing change is what to do first. I find one of the best first steps is to hire another employee. Don’t worry about increasing your payroll cost; it is almost a certainty that your productivity will increase and you’ll bring in more new revenue than the employee costs.
Multiple exam rooms per doctor
The baseline for efficiency, unless the practice is a new start-up or very small, is two exam rooms per working doctor. More than two per doctor is even better. If you are adding a second OD and you will both see patients on the same days, you need four exam rooms. If you can’t find the space to convert, you will have to look for larger office space, but be creative. Meet with a contractor and ask if he can move a wall or two, add a doorway, take out a closet, or repurpose that outdated contact lens training room.
A technician can use one of the exam rooms to complete the pretesting before the doctor comes in. That can free up the pretesting room quicker so another technician can bring the next patient in.
If you have a room that is too small for an exam room, consider making it a dilated exam room with an exam chair and slit lamp. But if you can put those items in there, why not add a phoroptor and a mirror for the acuity chart and make it a full-function room. Automated refracting systems are designed to work in very small spaces, but you need to add a slit lamp to most of the designs I see.
The need to dilate is a professional judgment only you can make, but consider if adding an Optomap could reduce your dilation percentage. Or consider dilating in advance of seeing the patient or when you first meet the patient.
Another form of delegation, but having a technician record your exam findings is a huge time saver. How much time would you save if you did not have to record any data in your EHR system?
OK, I’ll come right out and say it. It is possible that you talk too much. I know your patients love you and they enjoy the chit-chat and it is important they understand their eye conditions. But it might not be as interesting as you think. Slightly less talk could be a good thing. Most people want to get on with their day.
Be on the lookout for ways you and your staff waste time. A doctor who must walk patients in from the reception area or out to the optical is a big waste of time. Those few minutes add up!
As you implement your new efficient approach, design a new appointment template that will keep you busy, but not running behind. Three exams (a mix of all types, but most are comprehensive) per hour is a good goal. Consider having some technicians start their work day 15 to 30 minutes before the doctor officially starts his/her schedule. The same could happen with your lunch breaks. Have staff get started with pretesting so the patient is ready when you start work. But don’t be late.
These changes do not have to make you rush or act crazy. In fact, the time you save with delegation or by eliminating waste can be used for the important things that only you can do.
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.