Adding an associate optometrist to your practice brings great potential for growth, but it is best to analyze and prepare the practice well in advance for this change. Once a new doctor begins work in your office, your standard operating procedure becomes the norm. It becomes the office policy, even if it is not written down. Associate doctors tend to accept the procedures that are in place when they start employment, but it can be difficult to change office procedures afterward. Here is a list of important factors to consider well in advance of hiring a new doctor.
It is very important to have strong patient demand in the practice before a new OD is hired, especially if the goal is to be able to fund the compensation of the associate without decreasing personal income to the current practice owner. I generally recommend that doctors begin to seek a full time associate OD when the practice is well delegated and seeing a high volume of patients per day. A rule of thumb is to be booked ahead with appointments at least one week solid. Of course, a part time doctor may work well if patient demand is less than that.
In my experience, bringing on an associate with the hope that the new doctor will grow the practice does not work out very well. Certainly some growth will occur if the new doctor does a good job, but it is generally not fast enough to cover the increased payroll cost. Most practice owners will want to avoid a situation where they are paying an associate to see patients that the senior doctor could have seen.
Delegation and patient flow
The single biggest factor affecting profitability for the associate is how many patients they see per day. If the senior doctor normally sees patients at a slower pace and does not utilize high level delegation with clinical technicians, then that pace becomes the policy for the new doctor as well. That is the normal routine and it will be very hard to change after the associate works for a few months. Associate doctors, especially those who are paid on salary or per diem, do not typically want to see more patients per day. It is viewed as more work and who wants that? You could provide a financial incentive of some kind, for the associate to see more patients, but that could lead to paying more than the going rate.
The best advice is to hire enough staff and delegate actively before adding an associate doctor. The existing doctor(s) should work at their highest level of efficiency first because hiring technicians is more economical than hiring a doctor. And it sets the policy for patient flow at the right level so when a doctor does join, he or she will have proper expectations.
In the earlier phases of practice development, it is often not possible to have the office open for extended hours. The doctor/owner may not want to work excessively long hours and may prefer to not work evenings or Saturdays. That is very well, but one of the benefits of adding another doctor is to be able to offer more convenience for patients. Expanding the hours not only provides more production in terms of number of patients seen and eyewear dispensed, but the convenience factor results in a better patient experience and more word of mouth referrals.
I recommend that the work schedule for the new doctor be designed by the practice owner and based on the needs of the practice. If the work schedule is presented during the interview process and it includes two evenings (until 7pm) and Saturdays (9am to 1pm for example), the candidate will most likely agree. After all, she wants the job offer. If the salary is based on a 40 hour work week, a schedule like that will provide the needed hours but also allow a full day off during the week. The doctor may not like working evenings and Saturdays, but it is nice to have a day off in the middle of the week in addition to Sundays off.
Office design and space
A nice jump in revenue is realized if the new doctor allows the practice to see more patients per week, but one must also consider if there is enough physical space to handle more patients at the same time.
Additional staff members will be needed and they need a place to work, when they are with patients and for behind the scenes work as well.
If two doctors are working at the same time, four exam rooms are needed for maximum efficiency.
Additional pretest rooms may be needed if patient volume is greatly increased.
Consider how you will handle frame selections for more people at the same time. You may need additional dispensing tables and more room in the optical.
You will have some time to create this additional work space, because a new doctor is not usually busy immediately, but it is best to have a plan in mind for where the space will come from.
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.