By Gina M. Wesley, OD, MS, FAAO 
Before adding an associate, calculate your scheduling wait time and space requirements—then compute the additional services and revenues that a new doctor can bring to your practice.
Adding an associate doctor is not a decision to be taken lightly. After all, it means considering whether your patient volume and annual revenues are high enough to warrant the addition, along with deciding whether your office space can withstand another doctor. You also may need additional staff to support the higher patient flow expected. Here is how I went about deciding and then preparing for the addition of my new associate doctor, Kelly Minnich, OD, after working as a solo doctor for years.
Does Your Patient Volume Warrant Another Doctor?
My staff and I noticed patient demand increasing, and our busy appointment times were booking out three to four weeks ahead of time, if not more. It’s hard to predict whether you can “afford” another doctor unless you can absolutely guarantee their schedule will be full from day one of starting. I expect it will take a good six months or so for the doctor to pay for herself, and then, assuming that her schedule is mostly filling up and/or she’s producing at a higher level, we will start to see profits.
Gina M. Wesley, OD, MS, FAAO, and her associate, Kelly Minnich, OD, as they appear in their biographies on the homepage of Complete Eye Care of Medina’s web site.
Calculate Finances–How Will You Pay for the New Doctor?
Take the percentage net you average over a whole year. Whether that’s 20 percent, 25 percent or 30 percent of gross. Then, determine what a fair amount of pay per day is for your doctor. For instance, $375 for a day’s work. Then, work that backwards to figure out what gross receipts would need to be brought in on a day the new associate works to pay for him or herself. So, in this case, $375 is 20 percent of $1,875. That’s the receipts needed that day for the doctor to break even for the practice. I don’t count staff wages for that day because it was a day they were already working in my practice; we now just added a doctor. These numbers are for illustration only and don’t represent exactly what I’m paying my doctor, but it’s close.
Now, that’s what I’m doing for the first six months she’s working for me. After that, she will be paid on production. So, she gets a percentage of what she brings in. There is a guaranteed minimum (that would be up to the doctor hiring to determine what that is; I think half of what a “normal” day would bring them is fine). So, her pay is now based on performance and how effective she is at billing, prescribing and working with patients to pursue more services if needed.
How Will the Associate Impact Your Schedule?
I had compressed my schedule up to this point in seeing all our patients per week in only 2.5 days. I’ve now expanded to four patient days per week, and have her doing two and myself doing two. I now have a complete full day for CEO tasks/administration. We had gotten to the point we were plateauing with the number of patients we could see per week/month with my schedule, and I didn’t want to add clinic time. I spend two days per week at home with my son. So, now we have her to not only meet our new demand but grow even more. I also want her to incorporate low vision into our practice, which was what her residency was in part focused on, along with ocular disease.
Do You Have the Office Space Needed?
My office space required no additional rooms or resources because I wasn’t fully staffed in the doctor portion before (only seeing patients a couple days per week). All we needed to do was add doctor days each week. If I was adding her on to see patients while I was also seeing patients, then that would require possibly other exam rooms and additional staff to support such as a technician.
Ready to Prepare for Your New Associate?
I had Dr. Minnich train with me for about three full days before she started seeing patients. Now we are continually training. As she moves forward, I am able to be here for one of the days per week she sees patients, so we have a constant dialog about patient care, how to enter data into our electronic records, patient hand-off and how to handle different patient situations. She already knows how to be a doctor; I’m now just focusing on how our processes and office policies work, as this is what has made us successful. I want her to keep on that path and not have to learn the hard way from mistakes as I did.
Introduce Associate to Staff
My staff has played an integral part in helping Dr. Minnich train as they also familiarize her with our office flow and our EHR system. They will learn as we move forward the personal style she has with patients. I will continue to evaluate our staffing needs as we move forward, as I anticipate we should be able to handle more patient flow adequately, since we weren’t full time to start with, but that remains to be seen.
Introduce Associate to Patients
We announced Dr. Minnich’s arrival via e-blasts to our patient base, as well as on our practice Facebook page. In addition, we are doing a flier campaign in the newspaper in our area about our new associate. We will also be arranging some public appearances and speaking events focused on Dr. Minnich. We plan to put both of our pictures out front in the reception area so patients can see and distinguish which doctor is which if they don’t already know. We currently have Dr. Minnich’s photo and biography on our homepage along with my own.
Implement 90-Day Probationary Period
I am doing the same 90-day probationary period for Dr. Minnich that I do for all other new employees. I was very specific in her job contract as to my expectations of daily duties, as well as her responsibility to market herself to bring in new patients and to build up her portion of the practice. Dr. Minnich knows she’s being monitored carefully during this probationary period allowing both of us to see if this practice is a fit for her.
Carefully Observe the New Associate
I will be closely monitoring patient reception to Dr. Minnich, as well as my staff reports about her interactions and productivity and efficiency. I also will be monitoring her records to ensure thorough record-keeping which will give me an indication of the level of care she is providing patients.
Be Open to the Associate’s New Ideas But Remain Practice Leader
At this point Dr. Minnich is so new that the main focus is to get her up to speed on how we do things. Then, as we move forward, I am open to suggestions or ideas. However, I did discuss in the interview with her that there may be times I don’t necessarily incorporate suggested changes, and she needs to be OK with that to work here. Time will tell how that balance works.
Preparefor aNew Associate: Action Plan
Evaluate your patient flow and demand and modify your schedule to help meet those challenges. When you’ve determined what you need outside of what you yourself want to do, those are the times the associate doctor can fill in. For example, there may be cases that you would rather pass onto an associate than handle yourself.
Be upfront about your expectations for job performance–and put it in writing. This way, there is no confusion about what that associate doctor should be doing in his or her job and overall. I specified in my associate’s contract what is expected of her: daily duties, patient recruitment, training of staff and education, among other tasks. I wanted to be perfectly clear about her responsibilities. Doctors may think associates “know,” but they may not. I really wanted to be specific about her bringing patients to the office, as I will certainly help her build her own patient base, but will not be fully responsible for it.
Plan your training accordingly to give the maximum amount of attention to what the doctor needs to know. I sent my new associate a file of paperwork from our office beforehand so she would be familiar with certain aspects of the clinic before even coming here for on-site training. Before she started, I sent her all of our patient forms, our major policies, who I refer to, price lists, and other materials.
Related ROB Articles
Analyze Your Finances to Determine When to Add an Associate
Become Practice CEO: Create an Office that Runs Without You
Be Comprehensive in Orientation for New Hires
Gina M. Wesley, OD, MS, FAAO, is the owner of Complete Eye Care of Medina in Medina, Minn. To contact her: drwesley@cecofmedina.com.
