o.d. to o.d.

Time and Motion

If you measure surgeons based on the speed with which they complete procedures, then how do you grade optometrists?

BY WALTER D. WEST, O.D., F.A.A.O. chief optometric editor

A recent discussion with a friend in the healthcare management business gave me a perspective of things to come in healthcare management, facility management and ultimately, patient care. I guess it's telling that patient care came last in the series of three topics I just named; at least I think so.

My friend works for a company that uses existing hospital systems to monitor doctors while they practice in the surgery suites of their client hospitals and ambulatory surgical centers. A few of the variables that are captured by the healthcare system are as follows:
► the doctor's identity
► the surgical procedure being performed
► the cost involved, including the required support staff
► the amount of time the procedure takes.

We all recognize that there is a "table cost," if you will, for surgeons just as there is a "chair cost" for optometry. The fixed expenses involved in staffing the operating suite, providing utilities, making instruments available, necessary support services, as well as the time of other physicians involved (although not performing the procedure).

Surgery with a stopwatch?

Here's what I found interesting, are you ready or this? Surgeons are now being rated on time efficiency and it's effect on hospital profitability. They are being compared with their peers. Based on this information, the healthcare management companies are building performance profiles that include means and medians.

Here's the clincher: some surgeons' privileges to use certain surgical facilities has been revoked because they are too slow. I wonder how any of us would feel knowing that the surgeon operating on us had one eye on the clock.

Time is of the essence, but …

The reason I relate this story is to make a point that many in optometry, including myself, have tried to make for decades. Time is valuable; we are in the business of providing healthcare and our profitability depends on our ability to provide as much healthcare as possible per unit of time. But, and this is a big but, not at the expense of the patient's care.

One issue that has always created limitations for optometrists in their earnings potential is that the practice of optometry is very labor intensive and if the only person laboring to provide optometric care to patients is the optometrist, it's also less profitable or in some cases, not profitable.

An advantage that optometrists have is that much of what we do can be delegated without negatively impacting the level of patient care that we provide. In fact, I would argue that by delegating clinical data gathering we often enhance the level of patient care we provide. This is because we now can focus our attention on interpreting the data and generating recommendations and prescriptions — all without the time-consuming distraction of gathering data. Also consider that if most of your time is consumed in gathering data, you will become better at gathering data. However, if most of your time is spent in interpreting data and making recommendations and generating prescriptions, then you will become better at these tasks.

Take the time for patient care

So, where someone else has the surgeons I spoke of watching the clock, in optometry we have good reason to watch it ourselves. And in so doing, we can become more efficient, more profitable and better able to ensure an appropriate level of care for our patients. OM