What's the patient flow to optical like in your offices?

[KrystleClear]

I would like to gather some intel on how other offices run before going to our MD/owner and management with some ideas/suggestions for improvement.
This is mostly an issue with patients who see the MD, but... our wait times are reeeeeally long. A patient here for a complete dilated exam can expect to be here for at least two hours, sometimes 3 or four. Most of the time is spent waiting to be seen by the doctor in the dilating lobby after being "worked up" techs. Our EMR software tracks the time between each step. One patient on Tuesday had been dilated for two hours. Start to finish they were here for 3.5 hours. As you might expect, many patients get really upset by this. Sometimes they just walk out in a rage. By the time they are done with their exam, they're too tired/hungry/grumpy to even think about ordering glasses. I have asked time and time again for the techs to send the patients who get refracted out to optical to browse the frames while they dilate - it distracts them from getting made about the long wait and we can get most of the glasses ordering stuff out of the way - which also shortens their total time spent in our office. Instead, I end up stuck here past 9:30 at night for the last patient who could have taken care of it during the 2 hour timespan they spent sitting in the dilation lobby staring at the wall. I hate to just tell them to come back during our "normal hours." <br>

What's the patient flow like at your office? Ours is - check in, maybe browse optical if they're early, tech takes them back for workup, refraction, & dilation, they go to the dilating lobby (where they sometimes wait for over two hours, sometimes even for nondilated appointments like IOPs), then see the doctor, then checkout, then they come to optical (if they want to). Again, I offer to them to come see me during dilation, and the techs say they are offering it to them as well, but the patients seldom take us up on it. I guess they want to see what the doctor says before getting too invested in glasses? <br>

Do you guys have a limit for how much time should be spent at each step of the patient flow?<br>

For the docs on here, do you try to keep your chair time to a certain limit, barring more time consuming emergencies of course. How long do appointments take at your offices?

Do you let people dilate for longer than 30 minutes?<br>

How many patients per day is reasonable to you?<br>

Do you have set hours of operation that you actually adhere to? We never know when we will close for the night because it depends on when the doctor(s) finish up, which varies. Some (rare) days we close at 5PM, sometimes it's nearly 10:00PM. <br>

We are desperately understaffed right now (like everyone) and I am going to be the only optician here in a month when my coworker leaves. They don't like to pay us overtime here, so I can only assume there will be a whole day where the optical shop is unmanned (we work really long days - 7am to whenever we finish, which is sometimes almost 10 pm). I'll take whatever wisdom you all have to offer. I want to be able to get the patients while they're here and avoid them coming back on a day when I'm not here.

[IIxIPariahIxII]

Krystle....those are some pretty lengthy wait times. Dilation probably 15-20 minutes max. Doc brings them out to look at glasses and get fitted while they dilate. Then come grab them to check while we look over insurance. Typically here no longer than an hour total. Our hours are set in stone and we have signs on the door posted that we close for lunch for an hour. We lock the door for it, and lock the door right at 5pm. We'll stay a little longer to catch up on optical stuff, but always out by 6pm at the latest. Some patients may take a little longer in the room because of medical circumstances, our doctors don't rush. But 3 hours is a bit much. lol

[optical24/7]

Do you really work in Pa, not Texas? There are a lot of similarities to the practice I retired from in 2020. ( great year by the way for an Optician to retire!)

Long wait times? Check.

No browsers while waiting for the “next step?”..Even when encouraged by staff? Check.

Long hours waiting for clinic to finish?…..Ah….No way…

1st, I had a great job, ran 3 locations, paid great, treated as a professional, but there’s no way I would work even one day for those kind of hours. Especially without OT pay…Period. Give me reasonable hours or I’m gone, I got a life. Good, heck, even mediocre Opticians are in high demand, take advantage of the job market!

Similarly, Techs were good at suggesting browsing while waiting, front desk sucked. But, very few would come look unless they knew
they were buying new. Keep the pep talk up with the front desk and techs, but don’t expect there to be some big up tick.

The absolute, biggest thing I did that really brought them back to the optical was a $100 discount card for a complete pair of glasses. Disclaimers about not applying to insurance, ect. ( we didn’t accept any insurance plans) (we encouraged out of network filing for those that had insurance). They religiously gave them out at check out. Even if they didn’t stop by after the exam, ( yes, exhausted, hungry, tired, ect), they would come back the next day or so.

if it was lens only, we honored half that. We went from 27% retention to 49% retention. With 5 dr’s, that was a tremendous boost in patients using us instead of walking. ( with 70% of patients having eye wear insurance, and not accepting any, I considered this a success.)

If you can win the battle to get all staff, especially the doctors! to recommend your optical, you’ve accomplished a lot!

Good luck if you stay. You got yourself a very hard working challenge!

[drk]

There's no quick fix for that situation. It would require a massive re-tooling of how things are done.

Is the bottleneck the number of exam rooms? MDs? Under-delegating? Over-scheduling? Taking too many emergencies? Too many diagnostic tests being run same-day? Too much patient education by the physician? etc.

Maybe you need a big-screen TV with Matlock, coffee and cinnamon buns in the dilation room.

[mervinek]

In my experience I have found that appointments in ophthalmology practices vs optometry practices always take longer. OMD schedules are much more full than OD. I suspect some major over booking. When possible, patient should always start the frame selection process while dilating. (In our office the optical is a separate office from the Dr office so it's not possible). Even at the craziest practice nearby (not ours, thank God), their hours long appointments are pre-op cataract evaluations. They tell people they could be in the office for 4 hours and actually tell them to pack a lunch! 2+ hours for a routine visit is out of control. There is no reason for that unless some kind of emergency takes place. Another thought is testing... is there a lot of testing being done that takes up the time? Or is this just a routine visit with dilation and refraction? If testing is done and it takes that long, then I would definitely tell the patient that they will have to come back to select glasses another day because today is just a testing day. Who would want to pick out glasses after an exam that just took hours! All I'd want to do is go home!

[mervinek]

There's no quick fix for that situation. It would require a massive re-tooling of how things are done.

Is the bottleneck the number of exam rooms? MDs? Under-delegating? Over-scheduling? Taking too many emergencies? Too many diagnostic tests being run same-day? Too much patient education by the physician? etc.

Maybe you need a big-screen TV with Matlock, coffee and cinnamon buns in the dilation room.

+1

[drk]

[optical24/7]

It was some time ago, but I remember reading in an OMD mag that the average time a patient was in for a complete exam was like 2:05. MD offices have always had longer visits. Partly from doing a bunch of test on them same day, instead of scheduling them separate (as drk mentioned). There’s also the over booking issue and not setting some time aside for emergencies.

But one of the big issues in a busy office is that patients want to “talk” to the Dr about things unrelated to their eyes/vision. Thousands of times I’ve walked past an exam room and hear the patient going on and on about their little Johnny’s baseball team, or their latest vacation ( even showing pictures) and every other subject under the Sun…

It’s the same in any tightly scheduled Dr’s office…Any. I developed a habit years ago that I’ll only schedule my own Dr visits early in the morning. I want to be the 1st or 2nd patient of that day, even if I have to schedule further out on the calendar. By mid day, the dr is already backed up just from the blabber. When patients complained in the dispensary about their wait time I would pass on my advice.

[Uncle Fester]

We are desperately understaffed right now (like everyone) and I am going to be the only optician here in a month when my coworker leaves. They don't like to pay us overtime here, so I can only assume there will be a whole day where the optical shop is unmanned (we work really long days - 7am to whenever we finish, which is sometimes almost 10 pm). I'll take whatever wisdom you all have to offer. I want to be able to get the patients while they're here and avoid them coming back on a day when I'm not here.

My wife was in an often crazy busy hospital dispensary and after a merger had management taken over by bean counters who didn't know beans about our craft but knew a lot about numbers and profits. The hospital provided Davis Vision to the thousands of employees and their families in the hospital. They also had a significant number of medicaid patients.

There were 3 full time opticians. When one left, she and her manager could manage by working like dogs. When one or the other was out however, they kept up by doing what you are, so management put off ""for another month" any new hire. After 6 months her manager/optician announced his retirement she said enough and gave her notice after 20+ years there.

We lucked into a friend of mine hiring her and haven't regretted the decision for a moment.

My advice is polish the resume. They won't appreciate what they've got until it's gone.

fwiw- I think MD's and most businesses for that matter are looking at the profit per square footage of dispensary space and are trying to maximize profits speculating the "what if" something other than a retail optical dispensary was there. As we know all too well managed care has killed eye wear profits (playing by the rules) at our level and those not in the trenches do not understand that.

My 2 cents.

[DanLiv]

I am on the outside of this issue, we are all optometry but also do medical visits for diabetic, glauc, MD, pre/post cat and LASIK, etc. We book eye exams every 30 mins, max 14 per doctor per day, and a few medical visits as needed on the quarter hours in between. We do not overbook, we stay on time. 15 mins pretesting, 10 mins by the time doc gets to pt, doc spends 20 mins with pt, if they are shopping page optical, customer is selecting eyewear within 60 mins of their exam time. If a patient is in clinic for more than an hour, we're behind. 90 minutes and something is completely off the rails. This is different from your issue Krystle because we are optometry and the docs know optical and contacts drive the business, that's what we are all really there for. Our optical and contacts lens revenue is 65%+ of our business, and the office flow is geared toward that.

There's no quick fix for that situation. It would require a massive re-tooling of how things are done.
Is the bottleneck the number of exam rooms? MDs? Under-delegating? Over-scheduling? Taking too many emergencies? Too many diagnostic tests being run same-day? Too much patient education by the physician? etc.

As you say your massive delays are all the "waiting for the doc" part. Your docs (the problematic MD at least) don't seem concerned with the value of patients' time, and don't prioritize optical in their business model. That's fine if their intention is to run a tiny optical, with one overworked optician, capture less than 20% of their refractions, only need optical/CL revenue to comprise 10-20% of the business, and are content with exam and insurance revenue comprising 80-90% of the business. Is that what they want? I presume if queried they would say not. But they work as if prioritizing clinic/optical 90%/10%, so it is only reasonable for them to expect revenues in line with that 90/10 priority.

It sounds like you are a heavily medically-driven practice, and it is understandable that docs fall into the rut of thinking like clinicians instead of business owners. But it doesn't have to be like that. There are several large multi-MD/OD practices in my area that heavily prioritize optical, have as many opticians as doctors, claim 80% capture, and have optical revenues alone that eclipse our entire annual practice revenue. The docs have to want that business model, and be willing to change their habits to reflect that priority.

[DanLiv]

fwiw- I think MD's and most businesses for that matter are looking at the profit per square footage of dispensary space and are trying to maximize profits speculating the "what if" something other than a retail optical dispensary was there. As we know all too well managed care has killed eye wear profits (playing by the rules) at our level and those not in the trenches do not understand that.

Yes I agree. Optical is not profitable just by existing. The whole practice needs to work to make it so. If they're not interested, might as well tear it out and put in more exam lanes and issue Rxs with a smile while their pts go to Warby, Costco, LC.

[drk]

It was some time ago, but I remember reading in an OMD mag that the average time a patient was in for a complete exam was like 2:05. MD offices have always had longer visits. Partly from doing a bunch of test on them same day, instead of scheduling them separate (as drk mentioned). There’s also the over booking issue and not setting some time aside for emergencies.

But one of the big issues in a busy office is that patients want to “talk” to the Dr about things unrelated to their eyes/vision. Thousands of times I’ve walked past an exam room and hear the patient going on and on about their little Johnny’s baseball team, or their latest vacation ( even showing pictures) and every other subject under the Sun…

It’s the same in any tightly scheduled Dr’s office…Any. I developed a habit years ago that I’ll only schedule my own Dr visits early in the morning. I want to be the 1st or 2nd patient of that day, even if I have to schedule further out on the calendar. By mid day, the dr is already backed up just from the blabber. When patients complained in the dispensary about their wait time I would pass on my advice.

Amen, brother. Schedule first thing in the morning and then show up early to beat the next guy scheduled first thing in the morning.

[drk]

I am on the outside of this issue, we are all optometry but also do medical visits for diabetic, glauc, MD, pre/post cat and LASIK, etc. We book eye exams every 30 mins, max 14 per doctor per day, and a few medical visits as needed on the quarter hours in between. We do not overbook, we stay on time. 15 mins pretesting, 10 mins by the time doc gets to pt, doc spends 20 mins with pt, if they are shopping page optical, customer is selecting eyewear within 60 mins of their exam time. If a patient is in clinic for more than an hour, we're behind. 90 minutes and something is completely off the rails. This is different from your issue Krystle because we are optometry and the docs know optical and contacts drive the business, that's what we are all really there for. Our optical and contacts lens revenue is 65%+ of our business, and the office flow is geared toward that.



As you say your massive delays are all the "waiting for the doc" part. Your docs (the problematic MD at least) don't seem concerned with the value of patients' time, and don't prioritize optical in their business model. That's fine if their intention is to run a tiny optical, with one overworked optician, capture less than 20% of their refractions, only need optical/CL revenue to comprise 10-20% of the business, and are content with exam and insurance revenue comprising 80-90% of the business. Is that what they want? I presume if queried they would say not. But they work as if prioritizing clinic/optical 90%/10%, so it is only reasonable for them to expect revenues in line with that 90/10 priority.

It sounds like you are a heavily medically-driven practice, and it is understandable that docs fall into the rut of thinking like clinicians instead of business owners. But it doesn't have to be like that. There are several large multi-MD/OD practices in my area that heavily prioritize optical, have as many opticians as doctors, claim 80% capture, and have optical revenues alone that eclipse our entire annual practice revenue. The docs have to want that business model, and be willing to change their habits to reflect that priority.

^^this man could be a consultant. Excellent

[KrystleClear]

Thank you everyone who has responded so far! DanLiv - I wish I could hire you to "counsel" our MD (owner). He's a lovely person, a great surgeon, but terrible at business and managing staff, and terrible at decisions. The thing is - we all know the big problems are rooted there, but no one is brave enough to lay it out bluntly for him, or if they do it doesn't seem to sink in. He signs the paychecks, you know? We have been without a real manager/practice administrator for going on three years! I actually quit in 2021 because the angry patients really started to get to me. I was working the checkout desk then. I actually left and went to a completely unrelated field - a warehouse that processed used smartphones. I love it. Pay was so so, but it was stress free. Then the main optician here passed away suddenly. The MD had been asking for me to come back since I left, but when my predecessor passed (very sadly and unfortunately) he made me an offer I couldn't refuse. So, begrudgingly I came back. So far, my stress level is MUCH lower in the optical than the front office side, and I had done this before at a different office. I don't want to quit again. I want to be able to have a real conversation with him on why so many staff quit, why we have so many patients walking out, and how fixing these issues can eventually lead to more profitability. I know he cares about that because we are often told we aren't profitable enough - which is frustrating because I can't just pull people out of thin air - I can only sell to people who come in to the optical.

We used to have coffee and snacks for patients, but it did not go well. Mostly older patients... coffee... Let's just their there was an uptick in bathroom incidents.

I am hoping to get some anecdotes from you all so I can say with certainty that while, yes, ophthalmology runs longer typically, 3 to 4 hours for a visit is not normal. I may be met with a brick wall, but at least I tried. Sometimes I am so busy I never get a second to breathe, and sometimes I feel like a tumbleweed is going to blow through the optical. I'm going to be the sole optician soon, so I am trying to also streamline things. (I'm not confident that they will hire a replacement for the other optician who will be resigning. I know how things work around here, so...)

[Uncle Fester]

Krystle- You should consider printing Dan's excellent observations and finding a sympathetic higher up to have read.

When you find yourself alone shortly you must insist on more compensation.

Just be honest with them or you will continue to be used by them.

[drk]

How about YOU being the office manager, Krystal?

[KrystleClear]

How about YOU being the office manager, Krystal?

They couldn't pay me enough to do that! They don't last long for a reason.

[mervinek]

I know what it's like to be an only optician in a busy practice. The last practice I worked at was 2 ophthalmologists and 1 optometrist. They had about 150 appointments on a busy day (which included testing). Optical was walk in. At any given time I had a line of 6 patients waiting for me. I had no one to help and several times when I asked off for vacation I was told no because there was no one to cover for me. It got so bad that I couldn't go to the bathroom. I would close for lunch but even then, it would back things up more because people would be waiting for me when I got back. I would get home and be shaking from the stress. Gave my notice and moved to another practice that is soooo much slower. (really, the opposite problem) While this practice has it's problems too, at least I get the opportunity to pee! Sad that it came down to that. My health is way better now that I left and I will NEVER let myself get in that position again. I would recommend a serious heart to heart talk with the owner. What's he going to do? Fire you? Nope. And if it's that bad...let him. Just prepare for the meeting and approach it in a helpful way and not in a mean way. Also... our owner OMD never wants to meet with you unless you have solutions. Maybe you don't want to be an office manager, but think like that and give him something that a good one would recommend.