Why practices don't grow

Optometric Management,  May 2000  by Gailmard, Neil B

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Temporarily shedding your white coat can do wonders for your practice. Learn how this strategy and others can lead to success.

Most optometrists would like to increase patient demand for appointments and increase gross and net income. But why is it that many practices grow steadily when they're small to medium in size, but stall as they grow larger?

By studying my own practice, and many other practices nationwide, I believe I've come up with one of the main reasons why practices stop growing, or grow very slowly Also, hidden within the solution will be a second, powerful practice-building tool. You could be the answer The reason practices don't grow is that no one is managing the firm. Reread that sentence. It's deceptively simple. In most practices all over the country, the optometrist primarily takes care of clinical duties. Sure, he also does some managing, but let's face it if no one is examining patients, there would be zero production.

This is a quandary because managing and leading a business is actually a full-time job on its own. Many doctors employ office managers because they know the practice needs more management attention than they're able to provide.

At first glance, this seems like a smart strategy. The flaw in it, however is that most office managers don't have high-level management skills. And even if they do, they're not given the full power and authority to really lead the practice. Furthermore, many O.D.s aren't paying the kind of salaries that would attract highly trained and qualified managers. And although office managers are still very necessary and important, I maintain that only the doctor/owner has the leadership potential and the motivation to effectively lead the practice.

My theory can probably be proven in your own office. Management guru Tom Peters referred to "management by wandering around" in his landmark book In Search of Excellence. How many problems would you find in your practice if you wandered around the office during business hours and really looked... really listened?

If your office is like mine, you'll find countless things that could be better:

* telephone calls that aren't handled effectively

*accounts receivable that are too high and too old *when promised

* staff members with attitudes * patients who have to wait too long in the reception room

* insurance claims that don't get filed * frames and contact lenses that aren't returned for credit.

I could go on, but you get the idea. In the big picture, solving these management problems is more important than seeing patients. Customer service deficiencies can keep a practice from growing.

Starting to manage

One of the best ways to grow your practice is to remove yourself from the appointment book at least 1 day per week. I know that this probably is the last thing you'd think you have time for in your busy schedule, but it's necessary if you want to focus on success. Bear with me.

If your patient care schedule is currently at 4.5 days per week, reduce it to 3.5 days. You'll use this extra day as an in-office management day. If you already have a management day, you'll now have two. You shouldn't look at this as a free day, but rather a workday with no patients scheduled. What will you do? Manage.

Start by making a priority list for your practice. Conceptually speaking, where is your practice now? Where do you want it to go? Get input from your entire staff and write a business plan. Here are some suggestions:

* Do a SWOT analysis (strengths - weaknesses - opportunities - threats).

* Design a written marketing plan.

* Remodel your facility. Re-engineer your policies and operations.

* Provide staff training in both technical skills and people skills.

You could do all of this, if you. create the time. You'll find advanced management a fun diversion from daily clinical practice. Won't there be a loss of production?

You're thinking this sounds good, but that taking yourself out of 1 patient care day per week will surely reduce income. How's that good management? Notice that I didn't recommend that you see fewer patients per week, only that you practice 1 less day. You should see the same number of patients per week, more if possible, in the remaining days. You'll simply change your scheduling practice to see more patients per day. This will be easier than you think. Let's look at some steps to take:

1. Reduce the appointment time allotted for each full eye exam. Make sure your appointment book can handle the new time slots and tell your staff when to start doing it.

2. To stay on time with the new schedule, look at your exam procedures and see where you can save time. Delegate as many tests as possible to technicians. Eliminate some tests if they aren't needed. Realize that patients don't really want an eye exam to take a long time. Doctors equate length with quality, patients don't.

3. Hire an additional technician right away and possibly another receptionist. You may even want to invest in a new automated instrument. The benefits will far outweigh the costs.