Five Questions with Drs. Carmiencke and Scott

Today, the Eye Physician Network is really excited to have our five-question series with the two primary doctors of a great practice in Bend, Oregon. The senior partner is Dr. Kit Carmiencke, OD who founded the practice, Integrated Eye in 1976.

The junior partner in the practice is Dr. Kirsten Carmiencke Scott, OD, MS. Dr. Scott joined the practice in 2008, after serving as a doctor in the U.S. Navy for 3 years. They represent different generations, and each has so many talents that complement each other.

We should also mention that they are a father-daughter team! Keep reading to learn more about these two great doctors!

  1. Someday we will have the COVID crisis behind us. What changes have you made that you see continuing after it’s behind us?

Dr. Scott: One of the biggest things is that we instituted appointments for optical, frame shopping, and adjustments. So instead of just dropping in, patients are scheduled to our optical.

It makes it more of a boutique feel and gives the optician the opportunity to spend more one on one time with the patient along with preparing for their visit.  It’s made their flow better and it’s also been great for our staffing.

Dr. Carmiencke: Do you see this continuing the same or some kind of a hybrid going forward?

A hybrid retaining some COVID protocols but returning to some of our unique values. Continuing our discussion of optical; patients now expect that all our frames on display will be sanitized after each “touch”.

By scheduling time with our opticians, it places more perceived value on our staff’s professional skills and patients are excited about the one-on-one care.  For us, it really makes the optician in charge of frame selection. They can discover the patient’s lifestyle and needs and choose a selection for them based on this.

During our first month of our reopening to limit the number of patients in the office at one time, we did do parking lot delivery of glasses, so we could not personally fit the new glasses. This was something that was tough for us since we’ve always believed delivery of new glasses with a professional fitting and detailed care instructions was an important step and we hated skipping it. We have gone back to the scheduled dispensing of the new glasses to properly adjust and dispense the new glasses, reinforcing the value of their purchase.

Dr. Carmiencke:

Before we leave what we have learned from COVID, I would like to discuss what we re-learned that is as business owners we need to take care of our staff.  While it seemed as if only we were under pressure after being closed for 7 weeks, we forgot the increased stress each member of our staff was under.

They were unsure if our office was a safe place to return to, given our close working environment with patients. Plus pressures at home with children away from the classroom and then they were unsure if they would have a job and the financial unknown for all of us.

Staff stress level got so high that one day we had one doctor schedule the entire day for staff interviews with every single staff member.  We spent time speaking to them about work concerns.

They did not know what COVID really meant and if they were at a higher risk for contracting it. We also spent time talking to them about their time outside of work. We really wanted to let them we know were concerned about them and we were there to help when we can.

  1. Have you seen anything in the past that compares with the disruption you’ve experienced with COVID?

Dr. Carmiencke:

Unfortunately, we have been through “a perfect storm” in 2009 and 2010.  First, we were in a financial recession that hit our state and especially our tri-county area hard with an unemployment rate that was well over 20%.

At the same time, we had previously made the decision to drop VSP, Vision Service Plan, which was our largest insurance source of patients.  They provided 22% of our patient visits but this resulted in 13% of our revenue.

We could see this trend increasing and we knew we needed to go a different direction. Then the third leg of our “trifecta” was the loss of an excellent employed doctor who left to start her own practice.  The huge loss of our patient base and revenue was not as sudden as with the COVID shut down, but it was terribly similar financially.

Dr. Scott:

At least with COVID, we were able to apply for government programs such as PPP, so we were able to supplement the income loss. During our “trifecta”, we just had to take the time to rebuild the practice base.

  1. What new technologies have you recently embraced that you’ve found particularly useful?

Dr. Scott:

Within the last 3 years, our purchase of the Maestro OCT has really helped us in terms of diagnosis and patient education. It lets us monitor chronic conditions like glaucoma and epi-retinal membranes.

That has really revolutionized what we can do and what we can follow in our patients.

Dr. Carmiencke:

After 50 years in optometry, I’d have to say that OCT is definitely the most amazing eye care technology I’ve seen. Although the wavefront analyzer combining aberrometer, topography, and autorefractor is certainly in a league of its own for optical care as well.

We have not purchased any new technologies because of COVID but as we look back through the different stages of this crisis, from shelter-in-place to gradual reopening, I’d say we have been well positioned with the technology investments we’ve made over the last 5 years.  Having cloud-based electronic medical records allowed our doctors to respond quickly and effectively to every eyecare emergency call and then triage while at home. Without the complete patient record in front of us at home, this would not have been possible.

With regards to reopening and attempting to maintain “social distancing” our continued investment in electronic refracting systems allows us to complete this portion of our refractive exam at 6+ feet.

  1. Have you found a creative solution or system that you’ve put in place during the pandemic?

Dr. Scott:

I think one of the big ones we put into place initially, was realizing that we had to quickly get in touch with our patients and cancel or push out their eye appointments to an unknown date.  While we ultimately closed for seven weeks, we didn’t know then when we would be able to re-open so we canceled patients in batches.

First, we were able to capture through RevolutionEHR the list of patients who we needed to re-schedule.  Second, we developed a questionnaire that patients could use to assess their unique needs for medical eye care and optical issues like loss or broken glasses, etc.

Then, we kept track of those patients in a spreadsheet and when it was time to re-open, we had triaging results for several hundred patients so we knew what patients we needed to get in first, who were most urgent, and those we could push back maybe a month after we had opened.

Dr. Carmiencke:

That was a temporary solution, but we realized we potentially could have had as many as a thousand patients attempting to contact us by phone immediately when we finally re-opened and there was no way we could handle that.

Dr. Scott:

This gave the front desk staff the ability to personally contact the patients.  One thing we are proud of is we had a live person who contacted them for the re-appointment and answered when the patients called.

That really helped with our efficiency. We have stopped the triage questionnaire now that we are caught up on those patients, but it was a good solution for those couple of months.

  1. A practice with a father and daughter at one time was unusual. I can’t remember one case of that early in my career. At most, it was pretty rare.

Dr. Carmiencke, practicing with your daughter must have some real benefits. Are there any that come to mind?

Dr. Carmiencke:

Sure, there are lots. We are both doing primary eye care, but we still complement each other.

There is not a day that goes by that I don’t ask her at least some questions. “Are we on the right course here? What do you think about this treatment or these findings?”

Because she teched here before OD school, she knew the flow, knew our values, and knew our pledge to deliver an out-of-sight eye care experience.

Dr. Scott, practicing with your father must have some real benefits. Are there any that come to mind?

Dr. Scott:

Being able to glean as much both clinical information from his experience along with his practice management experience. It’s been wonderful to be able to ask questions about different types of patients and clinical conditions but then also about running a business.

As he said earlier, he’s practiced for fifty years; that’s a lot of great clinical cases he’s come across. When I’m concerned about which direction to go, it’s always nice to have someone right there to ask.

On the business side of things and community side of things, he’s been such a fixture in the community for so long that it’s nice to be able to pick his brain about certain things. Because most of the time when an issue comes up, he’s usually dealt with it in the past.

Now, my mom would probably say there are some pros and cons. Like our dinner discussions tend to be a lot about optometry and eye care so she can get a little frustrated by that.

But it’s never a dull conversation at dinner when you get to practice with your father.

Thank you both for being here with us today. As you know, I’ve had the opportunity to be in your practice many times over the years, both on the business side and as a patient.

Also, as you know, I’ve been into a lot of practices around the country. You really do have a premier practice. I think just one of the reasons is that you are always asking, “what are we doing to adapt to changing situations?”. COVID was an immediate thing.

Practices have had to deal with many things in the past and I’m sure there will be ones in the future as well. The advice you’ve shared with us is very valuable.