ne of the most significant milestones in any new doctor’s practice is the process of actually opening the office. This process may occur in any number of manners, depending on the doctor and the situation. Opening an office in a multi-specialty practice differs from a free-standing sole practitioner setup vs. an associateship or partnership. What I’d like to talk about today is the actual physical office setup. It may sound mundane, but I found this aspect of practice to require more thought than I had anticipated. |
by Jarrod Shapiro, DPM
Joined Mountain View Medical &
Surgical Associates
of
Madras, Oregon July 2008
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When I first started practice two years ago, I went from residency to an established practice, as an associate. This office had been created 28 years ago and was well established. Little of the office structure was going to change. My recent move to Oregon involved getting a podiatry practice started in a multi-specialty practice that had previously focused on primary care. They had no existing structure for a surgical specialist, much less a podiatrist. So, it came down to a bit of extra legwork (footwork?) on my part, to guide the practice administrators in regards to my anticipated needs. I’ve been very lucky to have staff that is receptive to my needs and is willing to share my vision of podiatric practice. This could have been a much different situation were they not as accommodating.
The first step to setting up the office was to figure out how many rooms I’d need. The amount of initial stock and supplies depends on this, as well as anticipated patient volume. We decided on two rooms to start, with an overflow/procedure room (already present at the practice). Two rooms are sufficient for a new practice, as long as it’s possible to expand. From experience, I knew I can see up to 20 patients in a half day with two rooms. Yes, it can get hectic, but with a little planning it is possible.
The next step was figuring out which vendors to buy supplies from. For those of you thinking of opening your own practice, this is a good exercise to help figure out some of your costs. First came the chairs. We bought two refurbished podiatry chairs from a company in California at a reduced price. I don’t think it’s necessary to spend $5000 or more on a chair, unless you have the money to burn. Next, the instruments and supplies. I spent quite a bit of time comparing prices and products from various companies. Most of the podiatry suppliers have websites where you can request a catalogue. I chose a different company for the instruments than the general office supplies, based on price issues. I made a list of every office product I could think of, asking various questions such as “What would I need to do a P&A?” or “What would I need for postop patients?” The initial supply cost (excluding the chairs) was about $6,100, which is on the low side, since I placed a second order soon after starting. One quick note here; since I have two practice locations, I ordered supplies for the equivalent of a four room practice (the second office already has functional chairs).
Once the supplies arrived (which took longer than anticipated) it was time to set up each room. I enjoyed this part more than I would have thought. It was not a chore that had to be done. Rather, I was creating the environment in which I would be spending much of my time. I chose to stock each room identically, to decrease wasted time during direct patient care. I also created a stock template, so the staff could easily and automatically restock the rooms. I did not delegate the room setup to staff because I wanted to control how the rooms would be set. This was also the real test of my original stock order. I found quite a few items during the actual setup that I needed, but missed.
The final step of the process was teaching the staff the office procedures, including rooming patients, procedure setups, etc. I wrote out every step I wanted my MA to do without leaving anything for guesswork. For example, here’s an excerpt from my orientation manual that I gave to my staff:
Rooming Patient
- Bring the patient into the appropriate room.
- Seat the patient in the exam chair. Do not leave the room until the patient is in the chair with both shoes and socks off.
- Ask for the purpose of the visit and document any important information.
- Ask for any new test or imaging results (ex. MRI).
- Obtain vitals (height, weight, and oral temp, BP).
- Prepare the patient’s feet for specific planned procedures. Specific instances:
- Calluses or nailcare: place gauze or cotton with 3WEA on the affected areas. Have gloves, nail nippers, dremel burr, and face mask ready.
- Postoperative dressing change: remove cast or dressing as appropriate. Set out dressing supplies for redress.
- Leave patient exam room door closed after leaving, and mark the appropriate flag.
With all my pre-instruction and discussion, having everything done to my expectations is very much a work in progress. It takes constant readjustment to make sure everything will be done my way. Setting up the office is an expression of the individual. For those of you who have the opportunity, take advantage of it. It’s another learning experience in a long line of learning experiences. Best wishes with your office setup.
Jarrod Shapiro, DPM
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