Aligning with providers for scaling: To successfully scale your clinic, it’s essential to get on the same page with your providers. Communicate that it’s unrealistic for any one provider to manage 1,000 patients individually. There are simply too many tasks involved, and relying solely on one provider would be inefficient. The solution lies in leveraging your entire team. By doing this, you ensure smoother operations and the ability to handle more patients without compromising care.

Question about transitioning follow-ups to non-providers: Over the weekend, I received a question regarding how to transition follow-up visits from providers to RNs or other non-provider staff members. This is one of the most critical steps to scale. The question involved key considerations like appropriate verbiage, addressing patient concerns, and managing scheduling. To implement this change, you’ll need to clearly communicate how follow-ups will be handled by staff other than the primary provider, without affecting the quality of care. Setting these expectations with both staff and patients is crucial.

Overcoming the bottleneck in clinics: One of the major obstacles to scaling is the belief that the provider must see every single patient, every single time. While it’s true that a provider must sign off on treatments, there’s no need for them to personally see the patient for every follow-up or routine check. For instance, after the initial consultation, follow-ups can be delegated to other team members, allowing the provider to focus on new patients or more complex cases. This shift is critical to increasing efficiency and capacity without overburdening the provider.

Patient flow at Genesis Lifestyle Medicine: At Genesis, when patients come in, they first interact with front desk staff, the clinic director, or even the sales team—often not the nurse practitioner (NP) or physician assistant (PA) writing prescriptions. The support staff handles the initial stages of the consultation and sales process. All staff members, from medical assistants (MAs) to sales representatives, are trained to understand our services and products. They can answer basic questions and conduct pre-consultation tasks before involving the provider, who reviews the patient's chart and approves or denies treatment based on medical guidelines.

Asynchronous visits and the provider’s role: When handling non-controlled substances, asynchronous visits can be utilized, where the patient doesn’t need to be seen in person by a provider. The provider can review the patient's chart, medical history, and initial consultation data, then approve treatment before payment is taken. This approach is common in areas like weight loss therapy. Providers are responsible for reviewing and signing off on care, but the in-person visit isn't always required after the initial consultation.

Support staff managing follow-ups: Follow-up visits, such as those for weight loss programs or treatments, can be handled by trained staff like MAs or phlebotomists. These visits often include routine tasks like weighing the patient or discussing treatment progress. For example, staff may ask if the patient needs any boosters, such as a B12 shot. If any medical questions arise, they notify the provider, who signs off on the procedure. This process ensures that the provider remains involved in medical decision-making while delegating routine follow-up tasks.

Long-term prescriptions and approvals: Providers often write prescriptions for 3, 6, or even 12 months, especially for non-controlled substances like weight loss medications or treatments for hair restoration (e.g., finasteride or minoxidil). For significant weight loss cases, where patients need to lose over 100 pounds, providers may write year-long prescriptions, knowing that the process takes time. If any changes to medication or dosage are required, the provider must approve those changes, ensuring continuity of care without unnecessary in-person visits.

Protocols for medical decisions: It’s important to establish that support staff, such as RNs or clinic directors, cannot practice medicine or make changes to a patient’s treatment plan without the provider’s approval. While staff can answer general questions related to protocols or services, any concerns related to the patient’s health or medication must be escalated to the provider. Clear documentation of all interactions is essential. If a conversation isn’t documented, it’s as if it never happened, so detailed record-keeping is a non-negotiable part of the process.

Follow-up visits without a provider: Many follow-up appointments don’t require the provider to be physically present, which allows clinics to manage patient load more effectively. For treatments like CoolSculpting, weight loss follow-ups, or hormone therapy reviews, where the treatment plan has already been established by the provider, follow-ups can be managed by support staff. These staff members ensure that the plan is being followed, and the provider’s role is simply to monitor the patient’s progress over time.

Scaling through delegation: One of the biggest mistakes clinics make is having the provider handle every aspect of patient care, from initial consultations to follow-ups. By allowing trained staff to manage consultations, medical history reviews, and sales processes, the provider is free to focus on the most critical aspects of patient care—such as signing off on new treatment plans and making important medical decisions. This is a common model used by larger companies in the industry, like Ideal Image or LaserAway, where the initial consultation is handled by the sales team, and the provider only steps in to approve the treatment.

Telehealth and legal considerations: Telehealth, including asynchronous visits, is a powerful tool for scaling operations, especially when managing non-controlled substances. Companies like Keeps, Hims, and Roman have successfully used this model to provide treatment via telehealth consultations. Although there are still regulations regarding controlled substances, telehealth for non-controlled medications is perfectly legal and effective. It’s also critical to comply with FDA regulations and ensure that the provider's involvement meets all legal and medical standards.

Presenting the strategy to staff: When presenting this approach to your team, emphasize that the key to scaling lies in delegating tasks while maintaining the provider’s oversight. Support staff should be empowered to handle follow-up consultations and routine patient management, but the provider must remain responsible for all medical decisions. This teamwork will not only increase your clinic’s efficiency but also exponentially grow your business. As long as you ensure the provider signs off on every major medical decision, you can scale effectively without compromising patient care.

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