To Grow or Not to Grow – That Is the Question

By Dr. David Anderson,

In 2011 we were faced with this question.  I had been in my practice for seven years and was really busy.  My wife had joined our office three years prior and was also becoming quite busy.  My partner, Dr. Keith Basinger, had been seeing patients at our office for over 13 years, and his schedule was packed.  We were faced with a choice — get busier or risk being out of business.  Neither sounded attractive.  I felt I was working hard as it was, and I didn’t want my seven years of hard work to be lost as decreasing payment for services and pressures all around were taking hold.  We had seen a dramatic increase in the number of patients with managed care plans; therefore, fewer patients were paying full price for our services and products. We had not seen an increase in reimbursement for services since I joined the practice. Expenses were going up, but our fees for service were not rising accordingly.  So we had to find a way to increase revenue to overcome a potential decrease in overall net profit.

Simply adding more patients to our schedule was not the answer.  I did not want to compromise patient care by having to hurry through a patient visit in an effort to stay reasonably on time.  Besides, with the layout of our office, there seemed to be a daily bottleneck at the pre-test room.  Often people would be worked up and ready to see the doctor but then had to spend time waiting in the reception area because all the exam rooms were full.

We had not yet implemented EHRs into our practice.  The wheels were in motion, but we really did not know how we could do this with our current patient flow.  We thought we would have to see fewer patients or stay later to finish records because of the extra time to input the information in the EHR.  

At a business meeting, the speaker raved about incorporating scribes in the exam room.  He discussed benefits, including improved patient care and a better experience for the patient.  This resonated loud and clear – “better experience, better care.”  We saw a way incorporate scribes when we switched to EHR and possibly grow our practice by getting busier.  If I could perform an eye exam and trust a scribe to record the visit in the EHR, it would free up some of my time.  If I became more efficient, I could see more patients in the same amount of time.

After two months we realized the concept worked.  We had enough patient flow to get busier by seeing more patients per day.  We saw more medical patients, such as glaucoma follow-ups or eye emergencies throughout the day.  There was more time to add a contact lens fit into the schedule.  We did not use specific time slots for these items but simply worked these patients in throughout the day between scheduled exams.

Our staff costs went up, but our revenue went up to more than compensate.  Soon after we made this change, we realized our office was too small, our parking lot was too full and our patients had no room in our office.  We needed more space to accommodate this change.  Again, the question arose – “To grow or not to grow?”

We chose to grow and built a new office, expanding from 3800 square feet to 7400 square feet.  Most importantly, we now have ten patient care rooms and two pre-testing rooms.  The up-front cost was a challenge, similar to adding one additional staff per doctor to be their scribe.  However, there are many days during the week when all patient rooms are full and two other patients are being pre-tested.  Having each patient already in the exam room and ready for the doctor increases our efficiency and helps keep us on time.  We no longer have to waste time waiting for a patient to be pre-tested or moved into an exam room from the reception area.

To grow or not to grow – we chose to grow.  We currently have enough space for patient care with room for future growth.  We have 16 full-time and three part-time employees.  Our schedules are booked ahead for over one month.  We are seeing over 700 patients a month without adding any doctor hours compared to four years ago.  We have maximized our schedule, delegated to our highly trained staff and added space to handle the work load.

We have grown because we chose to grow.  With the assistance of our scribes, we easily managed the more difficult requirements for Meaningful Use 2.  When the ACA went into effect, more patients with medical coverage were seeking care.  This had a positive effect as we were ready to increase our patient volume.  In the foreseeable future, as diabetic patients and an aging population need medical care, we will be poised to meet these challenges.

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