Faster is better, right? The faster you can see your patients, the more patients you can see, the more money you can make, etc., right? However, where does the balance lie when our patients are in our office? Too fast and the impression may be your office doesn’t care. Too slow and you may lose out on possible sales because the patient is crushed for time. Then, add in the variable that every patient is different on their preference for expedience versus valued time spent, and how can you know what’s working well?
I do think this varies geographically, and demographically. However, literature exists that analyzes patient time spent in office and its correlation to sales in all areas, not just optical. It seems there are varying opinions, but the “ideal” time falls somewhere around 45-60 minutes. Anything longer than that, and sales seem to decline. So, what will you do in that time? The fact remains that doctors need to be efficient and wise with how patients spend their key decision-making time in the office.
In my office, we have done analysis on how we spend our time with patients: total time, and time spent in each specific area from the moment the patient walks in the door. We thought, before tracking, we were doing a pretty good job at moving patients through in 35-45 minutes. Reality showed it was actually closer to 50-55 minutes, and that data certainly has made us closely examine each step in the patient exam experience. Although we are still working on this, here are a few observations:
Entrance activities. This area is a HUGE time variable. Established patients can move through this more quickly, but even a small change such as sharing new insurance benefits can alter that. Additionally, new patients who have not bothered to follow our advice in filling out forms before they arrive add anywhere from five to fifteen minutes. What we’ve done to countermand some slow-downs is to ensure we are not repeating questions amongst staff. We’ve added tablets for signing documents that can then automatically upload into our EMR. If we are still noticing slow-downs, we have a protocol for pulling new patients back sooner into pre-testing if they are struggling to fill out forms.
Testing and exam. This area will vary most amongst doctors depending on delegation and style of exam you like to deliver, but there certainly exist opportunity for efficiencies. Something as simple as having the technician pull all pictures and networked tests forward so they are ready to show the patient by the doctor can save 1-2 minutes per patient because the doctor isn’t fumbling. If you see 20-30 patients per day, this can add up significantly. Making rules, or a protocol, about who is dilated when and with what mydriatic drop heads off a lot of questions by my techs. Additionally, you should really reflect if you HAVE to autorefract the established patient who hasn’t had a major prescription change in many years. That saves an additional minute or two.
I also invite you to look at what tests you have your techs do versus what you do. For the sake of efficient data gathering, but also accurate results, you may find it’s actually quicker for you as the doc to check VA’s, in example, as you can head off all those unnecessary comments and observations my patients (ahem engineers) like to make during this test. I have several screening scans and pictures many patients opt in on. If you know the quality won’t be great until the end-of-exam dilated pupil-state, it may be faster for you as the doc to bring them into the testing room, take the image, explain quickly rather than page a tech, have them do it, return the patient to the exam lane and then find you to explain it. We are continually looking at testing and exam flow for greater proficiency.
Doctor hand-off/optical. Our observations in this area for my office center around the dilation of patients’ eyes. Such an integral portion of the exam is critical for my practice’s standard of care yet can really kill a sale in optical due to blurry vision and thus slower decisions or no end sale at all. We’ve attempted to improve this area’s "time" by encouraging browsing before the exam, or the use of daily disposable contact lenses when browsing (not a full fitting, placed on eye by staff and removed by staff). We also encourage patients to schedule a return "eyewear consultation" so they can finalize their purchase.
There are many areas of a practice that can be analyzed when it comes to time analysis. Time studies of our own time spent as doctor (doer) versus CEO (designer) versus delegator (which sometimes turns into decision-helper) are extremely useful, as well. I invite you to first look at how your patients spend their time with you, and then move to your own activities. Being productive doesn’t mean you have to be busier and do "more." It just means you do well with the time you have. Extend this same grace to your patients, and all will win.
Gina M. Wesley OD, MS, FAAO owns and practices at Complete Eye Care in Medina, MN. Accolades include Minnesota's Young Optometrist of the Year in 2011 and the Early Professional Achievement Award from The Ohio State University College of Optometry in 2013. She is a member of the American Optometric Association, a fellow in the American Academy of Optometry and enjoys practicing, writing and lecturing in the industry. For questions or comments about this article, please contact firstname.lastname@example.org.