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An inefficiently run office can lead to frustrated physicians, staff, and patients. Over time, this can lead to physician burnout, staff turnover, and loss of patient revenue. Since efficiency levels play a large role in a practice's ability (or inability) to consistently run according to schedule, adjustments in this area often result in marked improvements.


Practices looking for efficiency solutions that will allow them to consistently stay on schedule should consider these tips:

Set an expectation that physicians and staff arrive on time. Physician(s) and staff members should be held to a degree of professionalism in which they are expected to consistently arrive on time to work. In most practices, this means getting to the office before the first patient's appointment because the patient's scheduled time is the time in which they will be seen by the physician—not the time they are brought back to an exam/procedure room.

Scheduling should reflect this. Arriving before the patient enables staff members to have the room and patient ready to be seen at the appointed time. It also allows physicians an opportunity to review the schedule, make any necessary follow-up calls, and settle in for the day. When staff or physicians are late and this does not occur, the practice risks running behind for the entire rest of the day.

Encourage and facilitate patient promptness. Patients are more likely to arrive on time when they understand how important it is to the practice. Emphasize this point in new-patient information and reiterate it every time a patient makes an appointment. Ideally, ask patients to arrive 15 minutes prior to their appointment. To facilitate patient promptness, be sure the practice's address and phone number are provided when leaving reminder messages. Additionally, check the Internet to see if the practice is locatable via GPS or similar. If it is not, take the necessary steps to change that.

Offer online registration forms. Patient registration is expedited when online forms are filled out in advance. If possible, add patient registration forms to the practice website so that new patients can complete the forms prior to arrival. This will ensure that patients are ready to be seen when they arrive at the office. If forms are to be completed in the office, check to make sure that they are easy to understand and that there is no redundancy of questions.

Work to reduce phantom patient interruptions. Phantom patients—those patients who call the office frequently with pre- and post-visit questions—do not produce new revenue for the practice, yet they take up valuable staff time. Interactions with these patients often result in an interruption to the practice's usual workflow. To reduce the time a practice devotes to phantom patients, have staff work toward setting appropriate patient expectations.

Accurately communicate outcome timelines from a product or service to eliminate patients from prematurely calling with questions. Additionally, review all pre- and post-treatment instructions periodically to make sure that they are thorough and up to date. This, too, eliminates unnecessary calls to the office.

Create emergency/walk-in appointment slots. Adding daily emergency/walk-in appointment slots to a practice schedule prevents patient-flow interruptions caused from patients being “squeezed in” throughout the day. Determine the appropriate number of these slots for the practice by averaging the number of emergency and walk-in patients seen in the past four weeks. Use this information to approximate the number of daily emergency/walk-in appointment slots needed.

Manage the “Oh, by the way” patients. Patients who begin asking questions about conditions unrelated to the original reason for their visit always threaten to derail a practice's effort to stay on schedule. These individuals are often referred to as the “Oh by the way” patients. Here's why: A physician completes his/her assessment of a patient and provides the recommended course of treatment. As the doctor attempts to leave, he/she hears the words, “Oh, by the way ….” Handling these patients when other patients are waiting can be tricky. Train support staff (medical assistants and nurses) to intervene by telling the patient that they would be happy to discuss the additional issue(s). This gives the physician permission to move on to the next patient without appearing to be rushed or uncaring.

Establish systems that direct physicians. For optimal efficiency, systems should be in place to direct physicians to their next patient priority. When a system does not exist, physicians often waste time looking for and asking staff where they should go. Many systems exist and are effective. Practices can choose from a sophisticated light system, a flag system, or a sticky-note system. It's a matter of what works best for the practice.

Utilize medical assistants (MAs). Practices can utilize medical assistants to help optimize the physician's time with patients. It is recommended that an MA accompany the physician at all times and be prepared to help out when necessary; for example, an MA can help by anticipating the physician's needs and having appropriate items pulled and ready for use. Additionally, make medical assistants responsible for stocking exam and procedure rooms with items like necessary supplies, patient forms, and patient education material; leaving the exam room to search for these items is inefficient and a waste of valuable physician time.


A well-run and efficient office that is able to stay on schedule will result in a pleasant work atmosphere for physicians and staff. These benefits directly translate to the patient experience and help increase patient retention and word-of-mouth referrals. The cherry on top is more revenue for the practice.

Vicki Guin is a management consultant with the Allergan Practice Consulting Group of Allergan, Inc., a specialty pharmaceutical company based in Irvine, California.

Ms. Guin consults with dermatology and plastic surgery practices in the areas of financial analysis, practice valuations, human resource issues, internal and external marketing, leadership training and team building, sales training, compensation, and cosmetic practice development. She has more than 25 years of consulting, sales, sales management, and training experience. Prior to joining the Allergan Practice Consulting Group, Ms. Guin served as a Botox Cosmetic Development Manager in New Orleans.

Before that, she worked as a sales specialist in multiple health care disciplines, including ophthalmology, surgery, and anesthesia. Ms. Guin is a frequent speaker at various health care organizations and hospitals. She earned her bachelor of science degree in marketing from the University of Tennessee, Knoxville.

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