Reducing Overhead by Expanding Your Schedule
by Keith Borglum

Many practices look at the cost of rent as a fixed expense, when in fact –in relationship to income– rent is a variable expense. As with any expense, the cost of a particular item of overhead is not as important as its relationship to the budget and income. For example, a rent of $3,000 per month is 6% of $50,000, but only 3% of $100,000. Splitting the rent between two $50,000 practices reduces the cost by $1,500 each.

Most practices only use their exam rooms 8 hours per day at most, and often 6 hours or less, typically between the hours of 8:00AM and 5:00 PM. A full-time office-visit schedule for most physicians is 36 hours per week, and even less for specialists and surgeons with in-patient schedules. At the same time, patient demand is highest before their work hours, during lunch, after work, and Saturdays. We find that many patients will accept appointment hours between 7:00 AM and 9:00 PM, a total of 14 hours per day or 70 hours per week. 70 hours per week is almost exactly the schedule of two full time physicians in office visits. Therefore, a physician can cut their rent costs in half by alternating their schedule with another physician in the same space.

Example for a 2 or 3 exam room office:
7:00-2:00 Dr A B A B A
2:00-9:00 Dr B A B A B

As a few practical and operational details: - Each would have their own medical assistant, who could handle return calls and filing during non-patient hours - The practice would be open during normal lunch hours Staff stagger lunch schedules to keep the office open through lunches.

  • The first and last hours of the day would likely be for longer visits like physical exams, so that the office could be staffed with only 1 or 2 support persons.
  • The business office staff could work normal business hours. The skeleton staff would collect paperwork and co-pays during the early and late hours for the business staff.
  • The staffing schedule would be more attractive to recruiting staff and physicians with children, as the early shift could be home in time to greet children returning from school.
  • The "off-duty" physician can still use their desk during the "on-duty" physician's schedule to do paperwork and phone calls, or to do rounds or out-of-office visits or procedures.
  • After-hours on-call interruptions are reduced because there is a physician available late to take call in the office.
    An perhaps most importantly, each physician has some hours free during the day, either early or late. In 20 years of practice management consulting to doctors, I have never had a client return to "normal" hours after experiencing this format of split-shifts, as it provides a better daily life-style for the doctor.

Author Keith Borglum is a consultant, author, appraiser and practice broker with Professional Management and Marketing, 3468 Piner Road, Santa Rosa California 95401. Phone 1-707-546-4433 for consulting information. Keith is one of the few consultants in America to have been accepted as a member of all of the following; National Society of Certified Healthcare Business Consultants, Society of Medical Dental Management Consultants, National Association of Healthcare Consultants American Medical Assoc's ConsultantLink©, American Academy of Family Physician's Network of Consultants, American College of Physicians Consultant Network, American Academy of Ophth Executives' Consultant Network, American Academy of Dermatology Residents' Faculty, AAAAI Practice Management Faculty, California Association of (Licensed) Business Brokers, and the Institute of Business Appraisers,

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