In last week's tip article, I focused on the usual excuses doctors give for not delegating more. I hope I demonstrated that delegation of clinical testing to qualified technicians is a key factor in practice success. This is especially important for practices that see a high percentage of patients with vision plans. The best strategy is to begin to delegate even before it feels like it's actually needed.
The amount of delegation varies widely among practices today, but whether you are a minimal delegator or more advanced, nearly all practices can find new procedures that could be delegated. Increased delegation generally converts to increased profitability.
How to improve your delegation process
Let's start by looking at some clinical tests that are often not delegated, but easily could be. See if you delegate everything on this list and if not, speak with your staff and begin a plan to make it happen.
Visual acuity. This one is so basic, yet many optometrists take visual acuities on all their patients. OD, OS, OU, with Rx, without Rx, far, near... it takes time! If you average four minutes for the whole process and if you see 15 patients per day – you're losing one hour per day! You could easily see three more comprehensive exams each day. Multiply that by the $307 median revenue generated per exam and your gross increases by over $20,000 per month! So why don't most ODs delegate acuity? Is it because the acuity chart is in your exam room? Come on, you can change that. Is it because you think only the doctor can discern the quality of the responses? I'm not buying it; my technicians use pluses and minuses after the Snellen notation and I think I get it. Try it.
Tonometry. I understand the need for the doctor to perform applanation tonometry on glaucoma patients, but on the 90% or so that are normal I want a reliable test that is easy for any technician to perform as a pretest without anesthetic or disruption of the cornea. The new generation of gentle and quiet air-puffs fills the bill for me. They provide readings that are very close to Goldmann. Patients like to joke about the puff, but most really don't mind and if someone does, then do Goldmann.
Insertion of trial contact lenses. The insertion process actually takes a lot of time, starting with retrieving the trial lenses from inventory, opening the lens packet, inspecting, rinsing, setting up, inserting, letting it settle, removing to rinse again if needed, and waiting again. And that was just the right eye. If you had a technician available you could just advise her about which lens you want to see and leave the room to see another patient or return phone calls. When you return, you simply have to check the fit. If you used scribes, you'd have a technician available.
Over-refraction of contact lenses. Delegating more contact lens procedures to technicians is a great way to increase profitability by reducing chair time. After the technician inserts both trial lenses, she could take acuity and perform a spherical over-refraction. Most over-refractions do not require cylinder and how hard is it to just fog up and bring down to BVA?
Case history. Of course the doctor should review the case history with the patient, but do you have to be the one to write it down?
Scribing. Most ODs have not tried this technique but it's actually very practical and affordable. There are many advantages to having the technician stay in the exam room and record your test results and observations, but a major one is the time it saves.
What steps to take next?
As you formulate a new delegation plan, consider these factors for your office.
Equipment. You might need multiple instruments or new technology. Whatever additions are needed, you will easily be able to afford them due to the increased productivity. Invest in your practice.
Use of rooms. Let the technician use an open exam room and let other rooms have dual functions. How can you use your space more efficiently? Even if it takes minor construction, the investment will pay off.
Technical training. Teach your technicians to do more tests. Let them practice on each other during non-busy times.
What to say. Tell your staff what you want them to say when they do each test. Keep it simple and just explain what each test does.
Recording data. Show your technician how to record data. Taking some of the EMR data entry burden from the doctor saves time.
More staff members. You may need to hire another employee or two, and that is if all goes well! Hiring more staff means you are operating a higher level and you are much more efficient. You won't feel the payroll cost; instead you'll notice a higher net income.
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.