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Many of my management tips focus on ways to make a practice busier, but what if your practice is already very busy... how do you keep growing? Let's also suppose that the practice is already delegating many clinical, optical and administrative procedures to qualified staff members. The practice is at capacity and booked a couple weeks in advance.
First and foremost, let's acknowledge that this is a wonderful problem to have!
There are many ways to manage a practice at full capacity, such as possibly raising fees and reducing the participation with discounted managed care plans. But one of the first thoughts I have when I see a practice that is booked solid is to bring in an associate optometrist. When you think about it, an appointment schedule that is booked well in advance is like cash that is continuously sitting out in the future. If you could collapse that backlog of demand, your practice will generate much more income. Obviously, you must see more patients per day to achieve this, and if the present doctor and staff are doing all they can, then another doctor is needed. A bonus benefit of reducing the backlog is that patients will be much happier, because scheduling appointments becomes more convenient for them, and patient service may even improve because stress in the office will be reduced. This results in even more referrals.
It is a big step to add another doctor to any practice, but there are many potential rewards. Here are a few thoughts:
If you don't have enough office space for another doctor, I'd consider moving in order to allow the growth. With this successful of a practice, you should consider owning the building.
One way to make the existing facility work is to expand office hours into evenings and any weekdays that are currently non-clinical. Of course, more staff will be needed, but the increased production makes that a minor point.
I recommend at least 2 exam rooms per doctor working, so a patient can always be ready in the other exam room and the doctor simply moves between the two.
There are some nice economies of scale in multi-doctor practices, since the building, equipment, inventory and staff can serve more people.
I've had success bringing in a new graduate right out of school, and having that person work as a technician for the few months between graduation and licensure. That allows the new doc to learn the ropes better than any other method - and the knowledge of dispensing, pre-testing, insurance paperwork, etc. proves invaluable. The new doctor also bonds with the staff.
Since our practice uses scribes, the new doctor learns even more by observing the senior doctors in the exam room. How often do we ever actually observe other optometrists at work? There are many great ideas in each of us.
If the new doc's ego causes him or her to balk at this temporary tech work, I'd wonder if I had the right associate.
Associate optometrists may be on a partnership tract or may be employees. Both methods have advantages and disadvantages, so be open-minded and consider both.
Here is a commonly believed myth: to attract a top-notch OD, with excellent people skills and clinical skills, you must offer some type of practice ownership. In fact, there are many excellent ODs out there who don't want to own a practice at all. They want to be clinicians and don't want to be businesspeople. They want a good salary and benefits and a professional workplace with good staff and equipment.
I'm not convinced that incentives or commissions really cause an optometrist to produce more. I've seen many practices where an OD with a straight salary has the same prescribing rate and revenue production per patient as the OD owner. If there is not a true cause and effect relationship between the incentive and the goal, why do it?
Doctors who are on a partnership tract would naturally be expected to work harder at building the practice, and they should want to do so. Involvement in the community, staff management, practice administration and marketing are important tasks for junior partners to be involved in.
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.