As a consultant, I talk with a lot of optometrists. My goal is to help them to be more productive and profitable. I love to find the low hanging fruit first, which are the easy things to change that will produce a dramatic increase in revenue. In many cases (certainly not all), optometrists simply take too long to perform an eye exam.
There are many factors in your practice that are difficult to change, but the time you spend on each exam is directly within your control. You may be surprised to read that spending less time could be good for your practice, but read on.
I know the eye exam length is a sensitive subject. Your exam is part of your professional philosophy and it is completely in your domain. I respect that, and I realize that in the end, the decision is completely yours to make. But I have found there are many misconceptions about what patients really want and what constitutes high quality eye care.
Times have changed drastically since many of us graduated from optometry school. Diagnostic technology has greatly advanced and collected revenue has not advanced due to the increase in managed care. These are two very good reasons for us to look at the time we spend on an eye exam. Why should our eye exam procedures be the same as they were ten years ago?
Factors to consider
Eye care economics. Let's consider the fee you are actually paid for an eye exam. Most ODs define routine vision exams differently than medical eye exams and the fees reflect that. Vision plans typically pay between $40 and $70 for an exam. When you consider the expenses of running your practice, this fee does not support a high amount of doctor time.
Patient perception. What makes us think patients want an eye exam to take a long time? They don't. It may seem like your patients love spending lots of time in your exam room, but patients are naturally polite to their doctor. You're the expert and they are paying you for your service. They are not going to tell you they wish you would speed it up. But their experience may actually be somewhat unpleasant.
How do you measure quality? Patient surveys? Percentage of eyeglass remakes? In my experience, in my own practice and in working with many other high volume practices, the quality measures are as good or better as in slow-paced practices. Patients love their doctor and staff members in the high volume practice. Patients tell these doctors that their exam was the most thorough they ever had.
Allow more time for contact lenses and glasses. When you take a long time for pretesting and the eye exam, the patient will want to rush the dispensing aspect of the visit because they have other plans for their day. Many ODs tell me they do not bring up contact lenses to many patients because they just don't have the time. What a shame! Contact lenses can be very financially rewarding even with vision plans because many provide an allowance and you can collect the balance from the patient.
Create more dedicated time for practice management. Working faster allows you to create large blocks of time for non-clinical tasks. If you can see the same number of patients you see now in fewer days, you can use the time saved to work on your practice. Use it for marketing projects, staff training and for improving the patient experience.
If you work five days per week and produce $600,000 of gross revenue, it would be possible to produce that same amount in half the time. Why not compress the patients and be very busy when you are in your clinic?
Change something! Take control! For many ODs, the procedures that have been in use for many years have not proven effective. The result is not likely to change unless you change something. If you want big results, change something big.
Always follow local laws and contractual obligations. Your exam should meet the medical standard of care, insurance plan mandates and regulations by the state board of optometry.
What if the practice is not that busy?
One of the major reasons that ODs provide long eye exams is because they are not that busy anyway. You may reason that the patient will be impressed with the extra time provided and the thoroughness. I actually think they will be more impressed if the exam was efficient and they were allowed to be on their way. I also think that the slow approach leads the doctor to develop bad habits. The doctors and staff become accustomed to the slow pace and eventually can't see any other way. My advice is to be quick and delegate as much as you can based on the size of your staff. A small practice can't afford a huge staff, so the doctor must do more, but work toward growing the practice and becoming more efficient over time.
How can you do a faster exam?
It is best if you figure out how you can do a high quality exam in less time, but I'll provide some general guidance.
Delegate more. What can you do to save doctor time? Even highly delegated practices can usually delegate more. How about scribing or technician refraction?
Some small talk is good for the patient relationship, but let the staff handle some of it.
Learn how to politely stop a patient who talks too much. Take control.
Don't do tests you don't need. They do not impress anyone.
Make the subjective refraction fast and easy.
Limit the patient education and treatment options. Patients generally want just the simple highlights. Recommend the best option; don't provide the whole list of options.
Reduce the patient's waiting time, such as waiting in the reception area, too much paperwork, waiting for the doctor and waiting for the optician.
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.