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How to Handle Growing Pains

If your practice's pace is too busy, consider these efficiency solutions.

Richard S. Kattouf, O.D., D.O.S.

Q In less than four years, my practice has grown to a point at which I have more patients than I can handle. My staff is stressed and disorganized. Patients are scheduled one month out, and I'm sure some are leaving the practice due to these issues. What can I do to correct them?

Dr. M.R. Karp
via e-mail

A: Congratulations on your practice's rapid growth. Here are solutions regarding physical plant and scheduling. (Note that these solutions may apply to “under-booked” practices as well.)

Maximize physical plant

Work out of multiple exam rooms. Many O.D.s equip only one exam lane due to costs, but you'll need at least two fully equipped exam lanes to accommodate your patients.

► Eliminate inefficient tasks. Stay out of the front office so you don't get caught up in patient payment issues. These take time you don't have.

Also, delegate the “transporting” of patients to and from the exam room to techs, stylists or opticians. This can save you enough time to schedule at least one or two more comprehensive exams per day without inflicting further stress on your practice.

► Train and test all staff. Develop “in-house” training for all employees and, as part of a check-and-balance system, test staff knowledge. Testing assures you can delegate at a high level. Techs must be empowered to take visual acuities, perform entrance tests, take medical and ocular history, use diagnostic medical instrumentation and possibly refract. Note: A tech refraction with an O.D. refinement can save you at least five minutes per patient. So, if you see 15 exams per day, you've created a 75-minute savings, enabling you to schedule two-to-three additional patients per day.

Schedule wisely

Schedule visits that require a high level of doctor expertise and skill first thing in the morning and first thing after lunch. This allows you to be productive while ophthalmic technicians work up other patients.

► Bundle certain types of visits to save time. For example, historically, Medicaid patients exhibit a high percentage of “no shows.” So bundling this group at “non-peak” times enables the entire practice to render excellent care in a very efficient time frame. Normally, the consultation and optical styling time is reduced for this group. The end result? You see more patients in less time without “giving up” prime-time scheduling slots.

Another example: contact lens follow-up evaluations. Bundle the procedures, and delegate the majority of them to ophthalmic techs. You'll save seven minutes per patient. Have the techs collect all the information, which you interpret. If you schedule six follow-ups per day you'll save 42 minutes (at least two additional patient visits).

Finally, maximize your medical licensure, and you'll have numerous return visits for medical reasons. It is possible to schedule an entire morning or afternoon of follow-up visits only for glaucoma work-ups and dry-eye work-ups, among other ocular abnormalities. These visits have a small refractive component. That is, do not perform comprehensive exams at these visits. If you and your staff are prepared, these visits will be efficient, productive and profitable. OM