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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
Alternatively Dr A could take all first shifts and Dr B all second
shifts.
Adding a Saturday increases the week by two shifts, which could
be split between three physicians at 4 shifts each ( but at only
28 hours per doctor, or some uneven mix).
As a few practical and operational details:
- Each would have theirown 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,
Permission is granted to reprint or quote any portion
of this article provided that the author, firm, phone, domain name
(PracticeeMgmt.com), and city are named and two copies of the quoting
journal are immediately mailed to the author at 3468 Piner Road,
Santa Rosa CA 95401. |
