Patients are not just a backlog of impending revenue

July 15, 2008

Although it may seem like it, a waiting room full of patients doesn't mean a physician is sought after and bringing in a lot of profit. It is actually just the opposite, and on top of that patients grow increasingly unhappy, finding other physicians with more availability. Like cans of corn in a warehouse, it causes no money to be brought in, the process just becomes more and more backlogged.

Since I joined ophthalmology in 1981, how we view medicine and patient care has changed drastically-to say the least! And if you are a specialist in demand, the changes can almost take your breath away.

Working first in a trauma center/county hospital, then in the VA system, and now in a private practice, I have had the opportunity to work with a large number of attending doctors, as well as our own staff physicians. This has allowed me to see a number of the ways that patients are viewed in these systems. And, if this is the way you view your patients, some of these insights might be risky for you and your practice.

A successful practice will often measure its success largely by its schedules-and how far out those schedules are. The further out you are, the more in demand you are. Although on first blush this may make sense, those people waiting to see you are not revenue, or even potential revenue, they are simply backlogged people trying to get into your clinic. They are now: cans of corn!

Therefore, we dubbed Sam, "Can of Corn." We would smile at him and nod knowingly during our management meetings when he discussed backlog. He thought he was getting through to us. We were praying that if we appeared to agree, Sam would focus on one of the other clinics he managed, and not ours.

In another life, Sam had worked for a very large company that dealt with agricultural sales. In particular, cans of corn and peas. The chief executive officer (CEO) of this large company expected an up-to-the-minute warehouse count of the pallets of corn and peas they had in storage. And then Sam would have to project how much revenue that equaled to the company.

The CEO would be gleeful at the future windfall that his company could reap.

Sam, on the other hand, was beside himself!

He tried for years to help the CEO understand that cans of corn in the warehouse were not revenue-they were simply cans of corn backlogged in the warehouse. The only time they would become revenue was when someone bought those cans of corn at the grocery store. Those cans were not even future revenue. They were simply filling pallets taking up space. Actually, they were costing the CEO money because he had to pay to keep them warehoused.

Now, you may ask, what does this all have to do with ophthalmology? Try this-change "cans of corn" to "patients."

Patients (cans of corn) stuck in your warehouse (clinic schedule 3 to 4 months out) are not projected revenue. They are simply patients stuck in your system waiting to be seen.

Ten or 15 years ago, that was the way all of us practiced. There was little concern regarding "backlogs" in the system because patient backlog was the definition of a busy, in-demand physician. This risky practice phenomenon progressed from the can of corn analogy to the "They'll Wait To See Me Syndrome"!

"They'll wait to see me" became a standard sentence I heard daily from a number of different physicians-be they ophthalmologists or primary care physicians. It didn't matter if we were talking about clinic wait times or backlogged appointment schedules. How could they think that patients would wait for them was a true statement? Because of the Captive Audience Syndrome (CAS).