By Cheryl G. Murphy, OD
August 31, 2016
Like long-distance runners, optometrists set their own pace for patient flow to optimize their own unique performance. However, ODs who try to adapt to a practice’s established schedule when it is not what they feel comfortable with are doomed to fall behind.
There is a diversity of the pace at which we see patients that exists in optometry. I have filled in at many practices, worked at more than a handful, and interviewed dozens across the nation for optometric trade magazines. I have noticed is that there is no universally accepted way to schedule and intake patients. How can you find the pace and workplace that is right for you?
It may have a lot to do with where you started working early in your career. When we graduate optometry school, if we have had no heavy influence on patient flow elsewhere (like being a tech prior to graduation or having a relative or family friend who is an optometrist), then the first place we accept a job may help to mold us into the optometrist we later become.
I was lucky enough to choose a job where the owning optometrist and I shared a lot of the same values and preferences for patient care. He was big on patient education, building relationships and rapport with families, as well as providing each patient with a full comprehensive eye exam each year. There was a supportive staff available to help smoothly transition patients in and out of their appointments. This included an office manager, and one-to-three techs, depending on whether there was one or two doctors seeing patients that day. Exams were scheduled on the half hour with contact lens checks, emergencies, office visits or follow-ups scheduled at the top of each hour. Contact lens insertion and removal training was delegated to highly skilled and confident techs, as was pre-testing and case history. This pace allowed for plenty of time to get to know each patient and build trust, which, in turn, led to referral of friends and family. This slow, yet relationship-building, pace helped to secure the practice as a staple in the community through the years.
No Single Formula
I do not think that there is one formula or magic schedule that will guarantee a wildly successful business and content, yet productive, employed ODs. However, I do think that each one of us knows what we are comfortable with when it comes to pace. I recently accepted a position in which I started seeing patients every 20 minutes. At first they agreed it would be two full exams and a “follow up,” so the pace seemed to be similar to what I had experienced before. However, the third follow-up slot became filled with “regular” exams at times, which was fine, until it wasn’t. Part of the reason it didn’t work was that these “regular” exams were anything but regular. They were complicated cases often consisting of keratoconic patients who needed to be fitted for contacts, macular degeneration patients who were struggling to gain each line and letter they could and post-surgical patients who did not get the results they expected post-surgery, and were now to be fit with hard lenses to try to optimize their vision yet again.
Additionally, at this new practice, I no longer had my strong support staff of technicians. I was on my own when it came to collecting pre-testing data, taking case history and insertion and removal training for new contact lens wearers. Seeing three patients for eye exams an hour, with some of them complicated contact lens fits, or new contact lens wearers, who required training from me, was just not something I was comfortable doing. It is not that the pace was hectic. Like many optometrists, I often like a hectic schedule when all goes smoothly, and with the right support staff, as it makes the day fly by and fills me with a sense of pride. It was just that the pace of three (often complicated) patients an hour without any techs there to help me gather data made it impossible for me not to fall behind in the day’s schedule.
Avoid the Feeling of Panic
Falling behind leads to its own sense of panic. At first you feel you’ll just catch up with a no-show, or a shorter-than-expected appointment, but on those days when everyone shows up, the schedule is packed, and unanticipated complications arise, you might find yourself drowning in a sea of angry patients who haven’t even met you yet. This does not make for good rapport, let alone provide an interaction that is conducive to building trust or the proud referral of friends and family to the practice.
So, when you can’t handle the pace, you have to speak up. Talk to those in charge, whether it be the office manager or the owning optometrist(s) or ophthalmologist(s). Hiring a tech, or asking those who are free, to step in and do lensometry, autorefractor, case history, insertion and removal training, and anything else you may need help with, could save you from feeling overwhelmed and stressed. It will also provide for a more pleasant experience for patients and less waiting.
If nothing can be done about the pace because the practice needs to see a certain number of patients per hour to be “profitable,” and cannot hire a tech, or additional staff is unavailable, then that is fine. If you are an employed OD, then you are not the business owner and may not know the overhead and expenses that they are up against coupled by lower reimbursement rates and online competitors eating into their profit margins over the last decade. However, having said that, if you feel uncomfortable, truly uncomfortable, not just challenged or “busy,” but truly stressed by the pace, and nothing can be altered or added to provide you with much needed support, then it may be that the practice is not a professional match for your practicing style and preferences, and it is time to move on.
I am not talking about moving on from one bad day or even a few over the course of a month. Everyone knows that back-to-school and the end of the calendar year are some of the busiest times in our appointment books, but if you are consistently falling behind the appointment book and feel mounting pressure or even anxiety each day when you pull into the parking lot at work, you might want to look for a position elsewhere.
Before working at a practice, here are questions to ask to evaluate its exam pace.
How many patients are typically seen per hour? And what are the appointment types? You may find that up to four appointments per hour is achievable with the right support staff there for you to transition the patient in and out of the exam room, conduct pre-testing, complete case history and handle things like insertion and removal training for new wearers of hard and soft lenses. However, if they tell you that you’ll be doing pre-testing, case history and insertion and removal trainings on your own, you may want to ask for less patients scheduled per hour or extra time blocked out in the schedule if the patient is a new contact lens wearer.
What types of insurances do you take? Practices that accept insurances that have very low reimbursement rates may expect you to do more exams per hour to make the practice profitable. Practices that are self-pay (a true rarity nowadays to find, but they are still out there) and do not accept insurance are probably less concerned about doing as many exams as they can per hour because they are more concerned with patient satisfaction to ensure the patient returns year after year and that they get that ROFF (referral of friends and family.) Find a practice that is “in between,” meaning it takes a broad spectrum of plans, but isn’t afraid to leave some of the low reimbursing plans out. Remember these are delicate questions, so you may not feel comfortable asking them during the interview, but may find out more information through a casual conversation with the office manager, medical biller or other staff. It may not be until you start working there that you find out things out, and that is also OK.
What sort of support staff do you have in place? Who is there to assist me? Some of the best practices I have interviewed acknowledge the fact that you need a well rounded team of people around you to do a job right. Some practices do not stop at having office managers, techs and billers, they may also take the time to promote staff enrichment by having their techs become officially certified. They might also pay for staff education and trips to industry events like Vision Expo to further educate and inspire staff. They may even have not only techs but scribes in office who help enter patient data into the EHR while the doctor sees patients. This is a welcomed change in today’s world, as instead of turning their back to the patient to enter information into the EHR, or staring down at a digital device, they still make eye contact and have that friendly connection to their patients. Think about it. We have enough people outside of the exam room in the real world with their heads down and their eyes glued to their smartphones. Patients may not want their doctors during a medical examination doing the same thing.
How are appointments made? What is asked during the booking of an appointment? This question seems irrelevant, but it affects the doctor and their pace. When patients call or come in to schedule an appointment for contacts, it is crucial to know whether they have worn lenses before and also whether they have been properly trained on insertion and removal by a doctor or a doctor’s office before. I have had patients who have worn contacts before but somehow they were never properly trained on how to clean and store lenses. Simple rules like changing the solution in the case each day, changing their case every 6-8 weeks, no swimming without goggles on over the contacts and the importance of using the proper contact lens cleaning solution (which to their surprise is not saline) have somehow never been told to them.
When booking appointments patients should be asked if they are a new or existing patient to the practice (if the information isn’t obvious already). Do they want a contact lens examination or re-evaluation, and if so, are they a previous wearer of contacts or a new wearer (never worn before)? Also, tell them to bring the boxes of the contacts they currently wear to the exam, so if the doctor feels they are still an appropriate fit and would like to keep them in those lenses, there will be no guessing game as to which lens brand and size it was.
Finding out more about how a practice paces patients during the interview process, or by talking to doctors or staff who already work there, will help you decide if that pace is a good match for you and one at which you feel comfortable working. Remember, there are optometric practices out there that book one patient every 45 minutes and there are optometric practices out there that see 7-8 patients an hour. Finding a productive and profitable happy medium, or the pace that suits you, is a way to ensure your longevity and happiness working there.
How many patients do you see an hour? Why do you think the pace of appointments varies so widely among some optometric practices? How did you find the practice that was right for you and what clues did you look for to make sure you’d feel comfortable keeping up with the pace that already existed there? Is it ever OK for an employed OD to ask a practice to change its pace of patients? How can the best compromise between profits and rapport/patient education be achieved?