“How can I see more patients in a day?”
This is a question that many dermatologists ask themselves- especially now that insurance reimbursements are down and dermatologists feel pressure to increase the number of patients per day. I am here to argue that it is the wrong question. The right question is “How do I maximize each patient’s visit to my practice in a way that improves patient care and increases my income?”
The best-selling business book Good to Great, which talks about how good companies became great companies, discusses how Walgreens beat Eckerds Pharmacy in the walk-in pharmacy wars. Basically, Eckerd Pharmacy tried to get more customers to walk thru the doors, while Walgreens tried to get each customer to spend more money while in the store.
You can learn from this model and improve patient outcomes and the patient/physician relationship. Follow what Walgreens already showed is the answer- don’t see more patients but instead increase your revenue per patient. I believe the answer is to offer retail products to your patients that will enhance patient care while increasing your practice income. Of course you want to take an ethical approach and not tack on products and services that patients do not need. Offering them the option to purchase a tube of hydrocortisone, a bottle of selenium sulfide shampoo, or an antifungal cream saves the patient time, ensures they chose the correct product and helps increase your income. Increasing your income allows you to make improvements to your practice and this is a win/win for everyone.
First lets consider the possibility of doing both- increasing the total number of patients and increasing the amount of income generated per patient. These are the mental steps you should go through when planning your strategy.
Is My Medical Practice Efficient Enough?
The first question to ask yourself is “Do I really want to get more patients into my medical practice?” The best way to answer this question is with an assessment of how long your wait list is. If it is too long (longer than a month), then you should not try to get new patients until you can accommodate the ones you have more efficiently and shorten your wait list. Your goal should be to get more patients to move more quickly through the office.
How many minutes does the patient spend in your office from check in to check out?
In order to understand your practice’s level of efficiency, calculate how many minutes each patient spends in your office and find a monthly average. We use Nextech which calculates this for us. You could do it manually with a sign in and sign out sheet. Once you know that the average patient spends X number of minutes in your office, you then need to determine where in the patient process cycle that time is spent.
Your time is limited
You need to know how long YOU spend with the patient.The average in general dermatology is about 3-5 minutes, but in cosmetic dermatology, it is more like 15- 20 minutes. Procedure oriented practices may have 30-45 minute patient visits, while surgical practices may have longer. Use Nextech or a manual system to calculate the average number of minutes you spend with a patient. If you discover that you spend an average of 15 minutes a patient, then assuming you take an hour for lunch, you can only see 28- 30 patients a day. I have worked with dermatology practices that see 90-120 patients per provider per day! I believe that you should be happy in your work and provide great care to your patients and we all go at different speeds. Once you figure out how many minutes you spend on the average with patients, experiment with timing and see what you are most comfortable with. I have a cash based cosmetic dermatology practice.
When I first did this analysis, I found that I liked to spend 30-45 minutes with new patients (they usually get injectable procedures) and 15-20 minutes with follow-up patients. My skincare follow up visits took about 15 minutes of my time.
The next step is to figure out what you are doing during that time and see how you can streamline it. On new patients, I was spending 10- 15 minutes hearing their skin care issues, medical history and past skin issues. It seemed to take this long for the patient to tell me all they wanted to tell me about themselves and for me to feel like I had a good understanding of their skin’s issues and what skincare products, medications and procedures they needed. I was spending another 5 minutes explaining the skincare and medication instructions to them and at least another 5 minutes consenting them. This meant that i had spent about 25 minutes and I had not even done the injection procedure yet. Obviously I needed a methodology that sped things up but did not compromise patient care or the patient/ physician relationship.
Consider space requirements and number of exam rooms you have
Before you can decide on a strategy you need to look at your office and see if you can maximize patient interaction space. The number of exam rooms and patient interaction areas will affect the number of patients that you can see a day. When derms analyze their income levels, they often look at the amount of net income per exam room per hour. Most insurance practices that I have seen (through my Skin Type Solutions Franchise System business) have a net profit of $150/exam room per hour while cosmetic dermatologists have a net profit of $300-$400/ exam room per hour. This implies that you can increase your income by increasing the number of exam rooms. This strategy only works if you bring in physician extenders and standardized methodologies to maximize your time.
Standardized Methodologies To Lower the Amount of Time You Spend with the Patient
The goal is to decrease the amount of time that YOU spend with the patient without compromising patient care or outcomes. These are a few methods that I adopted in my medical practice to speed it up that have been implemented in over 50 derm offices that have adopted my Skin Type Solutions Franchise System.
The consult process begins in the waiting room with a self administered tablet-based 3-5 minute questionnaire. The receptionist hands the patient a tablet while they are waiting to see me. The scientifically validated questionnaire asks the patient historical questions about their skin’s issues and current concerns. (You have to admit that we ask the same questions over and over so why not use a standardized methodology to streamline the process?) The quiz diagnoses the patient as one of 16 distinct Baumann Skin Types and gives the doctor a list of patient concerns. The questionnaire has four main purposes:
To collect historical and current data
To help the doctor better understand the patient’s skin phenotype and narrow the possible diagnoses
To cause the patient to think about their habits and how they can affect skin health
To generate a predetermined treatment plan that includes a skincare regimen, medications, instructions, and disease specific educational material for the patient
Once the patient is in the exam room, the physician looks at the Baumann Skin Type Diagnosis, examines the patient, and clicks a few boxes to customize and approve the treatment plan. This can save the physician 10-15 minutes of time. Because the treatment plan instructions are in the software system and constantly updated as necessary, the physician can delegate the explanation of the treatment to a physician extender. The Skin Type Solutions System trains your staff so that they can provide consistent and accurate instructions to your patients. This allows you a few extra minutes to actually talk to the patient and get to know them! This luxury is a game changer and will help you improve the patient/ physician relationship. If you determine that the patient would benefit from a procedure, you have more energy and spring in your step when you are doing the procedure which allows for better concentration and outcomes.
Using video consents for procedures in another way to save your time in the exam. By using videos rather than a verbal process, you are controlling what the patient is told and making sure that they are consistently told the same thing each time. (Of course your staff will still have them sign a consent form after watching the video.) I noticed that after using video consents, I never have the issue of a patient saying “No one told me that…” statements such as “No one told me that Botox would only last 3-6 months” or “No one told me that it would leave a scar.” It seems that when patients see it on a video they remember much better than when they just sign a consent form. Skin Type Solutions Franchise Systems is working on making these videos available to all franchisees so that they do not have to create their own.
In Summary
Using standardized methodologies, moving patient interactions such as the history taking process to areas other than the exam room and harnessing the power of physician extenders by improving their education can help you increase the number of patients seen per exam room per day. If you choose to follow the Walgreens example, the solution to increasing income is to retail skincare products in an ethical and scientific manner. Combining the Eckerd and Walgreens mentality to increase the number of patients at the same time that you increase retail sales is the quickest path to increasing your income while improving outcomes and the patient/ physician relationship. For more practice management tips for your dermatology practice and guidelines to selling retail products in your practice, be sure to check STSFranchise.com daily.
Developed by world-renowned dermatologist, Leslie Baumann, MD, the Skin Type Solutions® Franchise System is an educational, science-based skincare store that implements a simple and reliable system to maximize skincare product sales and improve patient compliance and results.
Based on Dr. Baumann’s patent-pending Baumann Skin Typing System, this first-of-its-kind retail model provides dermatologists with the scientific methodology, training, and education necessary to prescribe effective, customized skincare regimens utilizing multiple brands of products that have been independently tested and approved by Dr. Baumann. To learn more about what Skin Type Solutions can do for your dermatology practice, visit the STS site here.