William (Bill) F. Goss, DC, DACS, uses innovative methods to minimize patient waiting time

William (Bill) F. Goss, DC, DACS, likes to keep busy. The Michigan chiropractor logs 2,400 patient visits per month at his main office alone, plus another 800 at a satellite facility about 20 miles away. (Those numbers translate into monthly collections of $110,000 and $40,000, respectively.)

Goss says his formula is simple: Always do what’s best for the patient.

In Goss’ estimation, among the things not at all best for the patient is making him or her languish in a waiting room. But that never occurs in Goss’ practice. Why? It’s because he has no waiting room. He has gone to great lengths to structure his Sterling Heights office and the satellite in Rochester so that patients aren’t forced to cool their heels before seeing him.

“We’ve designed our procedures, our scheduling, our systems, our entire office around the goal of getting patients right in—and then right back out,” he says.

Once they arrive and sign in, patients are ushered to an adjusting room or to a seat directly outside one. The chairs are color-coded, signifying whether a patient is new and the degree of urgency of clinical attention needed.

“Take new patients, for example. The color-coding allows me to know instantly, at a glance, without having to stop what I’m doing and ask the staff how many new patients are lined up,” Goss says.

Lunch Rush
Goss does not work alone. He is aided by four other DCs whose techniques and practice styles closely mirror his (thus permitting a form of standardization of care, which abets efficiency of delivery). At least one doctor is on the floor in each office at all times during business hours, which start at 9 am and continue nonstop until 7 pm on Monday, Wednesday, and Friday; then from 10 am to 7 pm on Tuesday and Thursday; and from 10 am to 1 pm on Saturday (plus after-hours direct call-in to the doctors, seven days a week).

“Some doctors close their offices at lunch—some for up to 3 hours—and that’s a big mistake because all it does is erect a barrier that contributes to the patient not wanting you as his or her doctor,” Goss says. “In my practice, we don’t close for lunch because that’s the time of day when most people want to come in to be seen by a doctor. At lunch hour here, this place rocks, while all the other chiropractors in town are closed.”

It should be clarified that the Goss Chiropractic Clinics doctors do eat lunch, and that they’re not condemned to fast all day.

“We stagger our lunch breaks,” Goss explains. “One doctor takes an hour for lunch at 1 o’clock, while the other remains on the floor to see patients. When the first doctor returns, the second goes to lunch.”

Notice, too, that lunch breaks don’t start until the noon hour ends; that’s so at least two doctors are available for the crush of patients beginning at the stroke of 12.

Keeping the Wait Down
Here are some other Goss Chiropractic Clinics techniques for preventing waits:

• Not necessarily taking patients in the order in which they arrive. Says Goss, “The patient who was first to sign in may not be first seen if we know him to be a person who likes to take his time, have a cup of coffee, hang around for a while and talk to the staff. If the person who signs in after him is someone with no time for socializing—a busy businessman with a cell phone practically glued to his ear who stopped in only because he was driving by, for example—that’s who may be more likely to be seen first. To be able to do this, you have to know who it is you’re taking care of.”

• Requiring new patients to attend orientation during which the operations of the office are explained. This makes patients somewhat responsible for keeping things moving smoothly, Goss offers.

Pictured from left are chiropractic assistants Amanda Dubyk and Shelley Wolny; William (Bill) F. Goss, DC, DACS; and chiropractic assistant Tara Ryniak.

“We tell them, ‘If your time is important, then we need your cooperation to help us honor and respect it,’” he says.

As part of the orientation process, the new patient is given a guided tour of the office and is shown the location of everything, from the restroom to the coffee machine, so they won’t take up staff time having those things pointed out on future visits. New-patient orientations are conducted four times per week and take place in a room designated exclusively for that purpose. (The room seats 15.)

• Discouraging development of exclusive relationships. Goss prefers patients to accept being seen by whichever doctor happens to be on the floor at the time of the visit.

“If someone wants to be seen only by one doctor in particular, then what happens is they won’t come in on days when that doctor isn’t here, even though they have an appointment,” Goss says. “We don’t want our patients missing any appointments, because that disrupts the functioning of the office and interrupts the health progress of the patient. Besides, it shouldn’t matter which doctor treats a patient, since we all use similar adjusting techniques and hold to the same philosophies of care.”

• Circular floor plan. The 3,600-square-foot main office is laid out as sort of a “clinic-in-the-round” (and none of the adjusting rooms have doors) so that doctors and staff can see everything from anywhere. This is the same at the 2,000-square-foot satellite.

“This avoids the problem of doctors mistakenly thinking the flow of patients arriving is light when in fact it’s the opposite,” Goss says. “Because they can see from any location in the office what’s happening with the flow of arrivals, they’re not going to be moving along at a pace that’s too slow. It’s crucial that the doctor be able to anticipate what’s going to hit him 20 minutes out.”

Allowing patients to glimpse the hustle and bustle of the office in this manner helps too. Mainly, it dissuades them from tying up doctor time with extended pleasantries or with questions having little or nothing to do with the problems at hand.

“That’s one of the reasons we don’t have doors on the adjusting rooms,” Goss says. “They can see how busy we are, and that gives them the message that the doctor doesn’t have a lot of time to waste.”

Taking the Public’s Pulse
Goss Chiropractic Clinics launched in 1988. The offices see all types of cases and in all age groups.

“Whatever problems people are having, we want them to be brought here; we don’t shy away from the difficult cases, the ones a lot of other chiropractors won’t handle—such as acute disc problems and acute neuropathies,” says Goss, who, like his colleagues, is a full-spine osseous adjuster who relies on multiple techniques to get the job done.

Goss insists on offering services in a manner preferred by the community.

“Once we know what the public desires, we shift our delivery system accordingly,” he says.

Goss explains that he gauges community needs simply by keeping his eyes and ears open. He also amasses knowledge of trends in the world of service and service delivery by attending as many major customer-care training seminars as possible.

Most new patients come to the practice by referral. Existing patients who convince friends and family to be seen by Goss and his colleagues earn as a reward free movie tickets and become eligible for raffle prizes.

“When we do a raffle, we don’t just give away a couple of prizes; we give away 15 at a time—expensive ones, too,” Goss says, indicating that first prize in one of those fairly frequent drawings is a Super Bowl party kit in which the winner receives $300 worth of food, beverages, and decorations so that he can host a gathering at home while the professional football championship game airs on television; second prize is a color television on which to view the game.

Twenty-five percent of the practice’s patients pay for visits with cash. Fifty percent are covered by some form of managed care. Medicare patients make up 20% of the mix, while workers’ compensation and personal injury together account for 10%.

In times past, Goss saw the majority of patients himself, with the other doctors on hand to back him up. Now, they handle most of the cases, while Goss serves as team supporter. This arrangement allows him to spend more time with his family.

However, the activity that consumes most of Goss’ time away from practice is his leadership position with the Michigan Chiropractic Association (MCA).

“I want to help make chiropractic bigger and better—in my state, in the nation, and throughout the world,” says Goss, an MCA board director as well as chairman of its legal action committee who last year traveled to China under the organization’s auspices to help establish that country’s first chiropractic clinic.

Entrepreneurial Bent
Goss developed a love for science as a kid in his hometown of Warren, Mich, so it was pretty much a given that he would end up in a field like chiropractic—although he originally planned on a career in dentistry.

“In college, I changed my mind about becoming a dentist after spending some time studying with dental-school students who were a year ahead of me,” he recalls. “All they did was moan and complain about their field—they hated it, and they hadn’t even yet started practice. It made me wonder what I was getting myself into.”

Goss was well-suited to chiropractic for another reason beyond affinity for science: He was an entrepreneur. Need proof? Try this: As a young adult, he acquired an ice-cream truck and drove the rig 7 days per week, sometimes as many as 10 hours per day, to pay his way through college. Goss completed his chiropractic college prerequisites at Spartanburg Methodist College (Spartanburg, SC), then entered Sherman College of Chiropractic (Class of 1988).

Following graduation in 1988, Goss joined the practice of Joe Lupo, DC.

“I wasn’t ready to go solo,” he says. “I wanted to learn as much as I could about both the clinical and business aspects of being in practice.”

Goss was with Lupo less than 1 year before he felt ready to open an office of his own.

“Dr Lupo was a great mentor and still is. He made it look so easy that I was convinced I could do it, too.”

Rich Smith is a contributing writer for Chiropractic Products.