Physician Offices and Outpatient Clinics: Key Space Allocation Factors

There is significant variation in the amount of space planned to accommodate a specific number of annual outpatient visits to a physician office or outpatient clinic. In some cases the department gross square feet (DGSF) may be more than double for the same workload — even when the types of patients seen and physician specialties are similar.

PHYSICIAN PRACTICE MODEL AND OPERATIONAL ASSUMPTIONS

Physician practice space typically consists of a patient reception/check-in desk and a waiting room (intake area), a large number of identical exam rooms, a smaller number of office/consult rooms and procedure rooms, and associated support space. The size and configuration of the space vary depending on the medical practice model and operational assumptions. Physician practice space may be located in a medical office building (either freestanding or connected to an acute care hospital), co-located with diagnostic and treatment services in a comprehensive ambulatory care center, or part of an institute or center of excellence organized along a specific clinical service or product line ― such as a sports medicine center, heart center, cancer center, or geriatric center. Physicians may own their office space, lease their space, or be employees of a healthcare system or other entity.

Some specific examples include:

  • A large multispecialty group practice with a common (or distinct) patient intake area, shared staff/administrative space, shared diagnostic and treatment facilities, and co-located exam rooms.
  • A teaching clinic affiliated with an academic medical center with medical residents serving as the primary providers but supervised by faculty members.
  • A traditional community-based primary care practice with limited diagnostic services.
  • An institute or center of excellence developed around a specific service line or medical specialty ― including related diagnostic and treatment services and short- and extended-stay patient care units.
  • A comprehensive primary care (medical home) model focused on health maintenance and prevention, patient education, and extensive utilization of non-physician providers — such as nurse practitioners, physician assistants, behavioral psychologists, social workers, and nutritionists.

EXAMPLE OF SPACE ALLOCATION FOR 20,000 ANNUAL VISITS

As an example, the space required to accommodate 20,000 annual primary care visits at a university clinic may be over twice that planned to accommodate the same workload for a private physician office as shown below.

Key factors that impact space allocation include:

  • Annual visits per exam room. In the private practice space, there are typically four physicians seeing patients, five days per week, 50 weeks per year. Each of the four full-time physicians sees about 90 patients per week resulting in 4,320 annual patient visits each based on 48 weeks (allowing for vacation and holidays). When on-site, each physician uses two exam/treatment rooms and a dedicated office/consult room and generally sees 20 patients per day while rotating between the two exam rooms. The balance of the 20,000 annual visits (2,720) is made up by visiting part-time physicians and a nurse practitioner who cover for the full-time physicians when they are on vacation or at conferences. This results in an overall average of 2,500 annual visits per exam/treatment room. The university clinic is staffed by residents who are supervised by a faculty member. Each resident is assigned a single exam room on the four half-days a week that he/she is on-site. Because this is a teaching clinic, each patient visit is scheduled for an hour so that each exam room may be used for only three to four patient visits per day. Due to the nature of the patients, there is a large number of “no-show” visits that also negatively impacts optimal utilization of the exam rooms. The university clinic is staffed 42 weeks per year due to resident rotations and the research and education responsibilities of the faculty. As a result, each exam/ treatment room accommodates an average of 1,428 annual visits.
  • Number of exam/treatment rooms. The private practice space has a total of eight exam/treatment rooms. At the same time, the university clinic requires 14 exam/treatment rooms. This accommodates the peak weekdays when there are 14 residents in the clinic at once.
  • Additional procedure rooms and ancillary treatment spaces. In the university clinic, there is a dedicated procedure room that is used for teaching and two consult rooms that are used occasionally by allied health students. The private practice space has no additional consult or procedure rooms.
  • Number and types of administrative offices and workstations. Each of the four full-time private physicians has a dedicated administrative office that is also used for patient and staff consultation. Another shared office is available for part-time providers. In addition to the reception/check-in desk, there are four central charting workstations and three administrative workstations (off-stage).
    There are significantly more staff working in the university clinic with seven central charting workstations, seven physician/resident workstations, and an office for the clinic manager. In addition, there are four private and two shared faculty offices and five workstations for ancillary staff in an adjacent office suite.
  • Typical exam/treatment room size. The “standard” exam room size in the private practice space is 100 net square feet (NSF) with charting performed outside the exam/treatment room. The exam/treatment rooms in the university clinic are typically 130 NSF to accommodate a desk and a computer workstation as well as the exam table and sink/supply cabinet.
  • NSF to DGSF factor. The private practice space has a single main corridor connecting the patient intake area to the exam/treatment rooms with a secondary corridor leading to the physician office/consult rooms. Due to the larger number of exam/treatment rooms and other patient care spaces, the university clinic was designed with multiple corridors resulting in a proportionately larger amount of corridor space.
  • Average visits per DGSF. The throughput of the private practice space averages 5.5 annual visits per DGSF compared to the university clinic with 2.6 annual visits per DGSF.
  • Average DGSF per exam/treatment room. Using another metric of space efficiency, the private practice requires 453 DGSF per exam/treatment room while the university clinic requires 560 DGSF per exam/treatment room.
20,000 Annual Visits Private Practice University Clinic
Annual Visits Per Exam Room 2,500 1,428
Number of Exam Rooms 8 14
NSF Per Exam Room 100 130
Total Department Net Square Feet 2,680 5,410
NSF to DGSF Factor 1.35 1.45
Department Gross Square Feet (BGSF) 3,620 7,840
Annual Visits Per DGSF 5.5 2.6
Average DGSF per Exam/Treatment Room 453 560

EVOLVING MODELS

Physician practice space was traditionally planned assuming two exam rooms and an office/consult room for each physician. The space was dedicated for use by the specific physician regardless of the hours per week that he/she was present. Because of the competing responsibilities of most physicians ― seeing inpatients, performing surgery and other procedures, seeing outpatients in other locations, attending conferences ― only a portion of the physicians used their allocated exam rooms at a given time. This has led to the development of time-share clinics in some regions where physicians schedule exam/treatment rooms when needed and share common patient and staff support services and space. The variance between peak- and low-volume days is even more pronounced in academic medical centers where medical faculty also have teaching and research responsibilities that further reduce (and affect the scheduling of) their time in outpatient clinics.

Telemedicine usage surged at the peak of the COVID-19 pandemic as patients and providers sought ways to safely access and deliver healthcare services. This rapid shift, borne out of necessity, was enabled by increased patient and provider willingness to use telemedicine and regulatory changes enabling greater access and reimbursement. During this spike, it is estimated that on average one-third of office and outpatient visits occurred via telemedicine. Since that time, telemedicine utilization has stabilized and varies by specialty. However, it is now an integral part of the healthcare delivery model as it improves healthcare access, outcomes, and affordability. Physicians may conduct telemedicine visits via a phone call or a video conference which can occur in their office or home. Dedicated telemedicine rooms may also be provided within their practice space or clinic. These rooms are designed to allow a more extensive patient evaluation involving a multidisciplinary team and enhanced technology. Detailed information on designing and equipping telemedicine rooms can be found in the FGI Guidelines.

See related post: Case Study: Planning a New Outpatient Clinic.