August 2018


To the point: simple practice tune-ups for complex times
Arresting the thieves of your valuable time

by John B. Pinto and Corinne Wohl, MHSA, COE

“Anything that is wasted effort represents wasted time. The best management of our time thus becomes linked inseparably with the best utilization of our efforts.”
—Ted Engstrom

“I wasted time, and now doth time waste me.”
—William Shakespeare

Every eye surgeon has but three things at their disposal to sell: their brains, their hands, and their time. By the time you graduate and practice for a few years, the brains and hands you have for every patient are pretty well established for better or worse. But for the balance of your career, your time is absolutely under your control.
Of the 3.5 million minutes the typical ophthalmologist spends in the course of a full and satisfying career, at least a few hundred thousand are wasted. At the current reimbursement levels, that’s a lot of dollars worth of your time up in smoke.
Wasted time can never be completely banished. But it can be coaxed into relative submission. Here are eight ways to do so.
1. Reduce excessive no-show rates. In the typical general/geriatric practice, 5% of your patients will not appear for their scheduled appointment. This falls to 3–4% in subspecialty practices and practices in the upper Midwest. It can rise to 6–8% in urban practices, practices with a higher Medicaid population, and practices focused more on primary care. If your no-show rates are higher than these typical figures, it can cost as much as $15,000 in lost profits per year per doctor for every excess percentage point. Check to ensure that appointment reminders are going out religiously (calls, texts, emails, letters, etc.). If after this check your no-show rates are still excessive, consider doubling down (even tripling down) on reminders, and combine communication channels—a text plus an automated call and a final live call to non-responders. If these efforts fall short, consider that you may have customer service and “patient experience” gaps that need to be addressed.
2. Be sure staff are well trained and well supervised. Staff training should include the importance of a rapid tempo during the inevitable times when patients back up, and supervisors should be aware that one of their key missions is to constantly be on the hunt for ways to increase patient volumes while preserving quality care.
3. Use scribes (whether or not you use electronic health records). If a scribe can help you see just under two extra patients per clinic day, they pay for themselves—and if they can help you see three extra patients, you are way ahead of the game. The secondary gain, even if you don’t wish to see more patients in a day, is that you are less fatigued. And the questions of especially curious patients can be handled by an assistant, leaving you more time to give the clinically neediest patients in your care.
4. Skip going to your personal office between patients. This habit, which commonly develops during a surgeon’s slower, early years, can condition you for a lifetime of under-performance in economic terms. When weighing in on new facility designs, we urge clients to place the physician’s personal office suite as far as possible from the clinic floor.
5. Keep patient doors open. It’s a small matter, but the act of fully closing and reopening a lane door for every patient visit takes time when multiplied times 40+ encounters per day. Very little of what happens in ophthalmology obliges closed-door privacy. If a patient brings up a sensitive issue, the door can always be closed. The added benefits are that staff can get a sense of where you are in your exam, they can slip in and out as needed without disruption, and the physician who might be scribe-less from time to time can be assured that patients are less likely to raise issues of uncalled-for doctor-patient contact.
6. Delegate rooming your patients and more. A generation or two ago, eye doctors picked up a chart at the front desk, called the patient from the waiting room, conducted the tech-level exam, the doctor-level exam, and escorted the patient back to the front desk. In a few practices, all of these exam stages are still performed by the doctor. If this is the way you practice, and you like it this way, then don’t change a thing. But if you are running behind—temporally or economically—then delegate exam elements that others can perform for you.
7. Is technology robbing your time and productivity? The software programs driving your computer and cell phone are addictive by design. Unless you are closing on a new house or caring for an ailing family member, and especially if you have a low impulse threshold and must “check in” often, your technology should live off the clinic floor.
8. Avoid excess socializing with patients. We include this last pearl advisedly. For the best doctors—the kind of providers we all want as our personal physicians—medical care is supposed to be about caring. Connecting with patients through social banter is fun, makes the day go faster, binds patients to providers, and increases the odds that your recommendations will be followed. But absent the periodic VIP patient or personal friend, excess socializing should be limited. How much is too much? The guideline we share with clients is that 20–30 seconds at the start of the encounter and a similar half minute or so at the end of the encounter is enough to satisfy (even delight) most patients. But take your own counsel on this one. We’re less worried about the jovial surgeon who runs chronically 20 minutes behind than the wooden clinical robot who moves efficiently but joylessly from room to room.
In a 40-patient day, saving just 1 minute of time per patient allows the typical general ophthalmologist to magically generate 40 free minutes. This in turn is more than enough to see about three or four patients, which can potentially work out to a personal pay raise, staff raise, technology upgrade, etc. It might even allow you to get home on time more often.
Of course, some of the time you spend distracted from your core job as a physician, surgeon, and business owner is not wasted:
• Time spent with staff in the breakroom now and then catching up on their lives, families, and triumphs
• Time spent walking a circuitous path from your parking spot to your personal office, checking out how maintenance is doing on tidying up the grounds
• Time spent wandering over to the billing department to thank your clerks for their special efforts this month
• Time spent checking out competing websites for ideas that could help your practice round out patient services
• Time spent with your administrator coming up to speed on last month’s financials and preparing for the next board meeting
• Time spent in refreshing power naps and midday meditation, energizing the pace and output of the rest of your day

About the authors

Mr. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in San Diego. His latest ASCRS•ASOA books, Simple: The Inner Game of Ophthalmic Practice Success and the fifth edition of John Pinto’s Little Green Book of Ophthalmology, are now available at He can be contacted at or 619-223-2233.

Ms. Wohl is president of C. Wohl & Associates Inc., a practice management consulting firm. She earned her Masters of Health Services Administration degree at George Washington University and has more than 30 years of hospital and physician practice management experience. She can be contacted at or 609-410-2932.

Arresting the thieves of your valuable time Arresting the thieves of your valuable time
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