Bottom Line
Edited by Dennis Shepard, MD, FACS
by Paul N. Arnold, MD, FACS
In our busy surgical office, physician time is at a premium, so anytime
I perform a task that someone else could perform, the economics of the entire
practice suffer. That's why in addition to hiring certified ophthalmic technicians,
we have hired four registered nurses in the roles of "scribe/counselors."
Like COTs, they are capable of performing most diagnostic tests and also
doubling as surgical nurses in our ambulatory surgical center on OR days.
Additionally, their training enables them to knowledgeably discuss diseases
and treatment options with patients, saving me a significant amount of time
in the exam room. Here's how we use them and how you may be able to benefit
from them, too.
As I mentioned, we use our ophthalmic registered nurses for all of the tasks
normally performed by COTs. This includes visual fields, A-scans, corneal
topography, and also pre-op prep, circulating nurse work and immediate post-op
care in our on-site ASC on surgical days. Our nurses also serve as scribes,
documenting my assessment and treatment plan.
We find that nurses' formal medical training allows them to perform a broad
variety of tasks which might otherwise require my time. For one thing, nurses
can translate layperson language into medical terminology. Thanks to this
capability, I can speak entirely in lay terms to the patient during my exam.
The nurse can then convert my words into medical terminology for the record.
Also, with training, nurses are fully capable of counseling patients without
my help. Once the exam is finished and I've discussed the assessment and
plan and covered any specific questions, I disengage. The scribe/counselor
stays to answer other questions. This saves me at least an hour and a half
each day.
You might think that patients would resent this methodology, feeling that
they received "short shrift" from the physician. In fact, we find
just the opposite. The quality of counseling is first rate; a scribe/counselor
can counsel cataract, corneal transplant or glaucoma patients as well or
better than I can. Continuity of care is also better, because the same person
who answered the patient's questions also walks the patient to the check-out
desk and is always available via telephone. In fact, some patients visit
our practice and expressly ask to see their scribe/counselor and not the
doctor!
Now, it's true that registered nurses cost a little more than certified
ophthalmic technicians. Across the country, the average RN earns around
$35,700, somewhat more than COTs, who average around $31,000.1 However,
for us, the additional cost is clearly worth it.
If you are interested in trying this strategy, my advice would be to make
sure the person you're considering is truly cut out for ophthalmology. Although
RNs in general are more broadly knowledgeable than COTs, some are less capable
with the precision required in ophthalmology. To get the best person for
the job, we give potential employees three small tests:
A personality profile to determine their basic demeanor;
A brief "intelligence test" of simple math and word relationships;
and
A practical exam to see how well they operate, or can learn how to operate,
common instruments. Though this seems simple, it can actually be telling,
since some nurses are intimidated by technology.
Sometimes you have to spend money to make money. In my experience, personnel
is one such area. Though an RN costs more than a COT, the increased productivity
at least in our practice makes it all worthwhile.
Dr. Arnold is in private practice.