Physician Offices and Outpatient Clinics:

How Many Exam Rooms?

By Cynthia Hayward
Originally printed in the
SpaceMed Newsletter
Spring-Summer 2014
www.spacemed.com

BACKGROUND
Physician practice space typically consists of a patient reception (intake) and waiting area, a number of identical exam rooms, several office/consultation rooms, one
or more special procedure rooms, and associated clinical and administrative support space. Physician practice space may be located in a medical office building
(either freestanding or connected to a hospital), co-located with diagnostic and
treatment services in a comprehensive ambulatory care center, or part of an institute or center organized along a specific service line such as a Sports Medicine
Center, Heart Center, or Cancer Center.
Planning space for physician offices and outpatient clinics begins with determining
the number of exam rooms required. The need for other clinical space such as
procedure rooms will depend on the specific medical or surgical specialties seeing patients at the facility. However, the sizing of patient intake, administrative, and
support space is generally based on the number of exam rooms.
PHYSICIAN-DRIVEN APPROACH
When planning space for a private practice or when the anticipated schedule and
staffing pattern have been firmly established, the number of exam rooms can be
estimated simply by assuming a ratio of exam rooms per physician (or other care
provider) during the peak weekday shift or clinic session. Two exam rooms per provider are typically planned, although high-volume, quick turnaround specialties
such as dermatology or surgery follow-up visits may effectively use three exam
rooms per provider.
WORKLOAD-DRIVEN APPROACH
Exam rooms were traditionally assigned to specific physicians regardless of the
hours per week that he/she was present. In larger clinics, the number of exam
rooms was typically driven by the demand on the peak half-day during the week.
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 total physicians may use their allocated exam rooms at a given time. This results in significant variance in utilization
of the exam rooms during the week. 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.
With an emphasis on reducing capital and operational costs today, most organizations strive to increase the utilization of exam rooms and minimize the overall footprint of the space. This has led to increased scrutiny of exam room throughput and
the development of more efficient operational models. By co-locating groups of exam and consultation rooms, they can be used by other provider teams during periods of low utilization. Interest in time-share clinics is growing where physicians
schedule exam/treatment rooms only when needed and share common patient and
staff support services and space rather than owning their space.

2014.7.2

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Physician Offices and

Outpatient Clinics:
How Many Exam
Rooms?
Continued

An analysis of the utilization of an existing physician practice or outpatient clinic

begins with collecting data on the annual number of visits and weekly hours of operation. Dividing the annual physician visits by 50 weeks per year (allowing for holidays) results in the average weekly visits. Based on weekly hours of operation, the
portion of workload expected to occur evenings and weekends can be subtracted
for space planning purposes. The average daily visits per exam room can be derived by dividing the average weekly visits occurring during the primary weekday
shift by the number of exam rooms.
For example, 400 visits per week (Monday through Friday, 8:00 a.m. to 5:00 p.m.)
with 24 exam rooms results in an average of 3.3 visits per exam room per day. If
patients are typically scheduled two per hour in a particular clinic, a utilization factor
of only 21 percent results. In this case, alteration of the planned scheduling pattern
should be considered (i.e., so that fewer half-day clinic sessions per week are
scheduled) resulting in the potential reassignment of the exam rooms to another
provider team during other times of the week.
It should be noted that there may be other care providers in addition to the physician such as physician assistants and nurse practitioners who see patients
independently in an exam or consult room. Providers typically schedule a range of
one to four patients per hour depending on the specialty and the proportion of new
patient visits (which take longer) versus return or follow-up visits.
An exam room utilization factor as high as 90 percent can be assumed for private
practitioners who do not have a high number of no-show patients. Teaching clinics, where care is provided primarily by residents supervised by academic physicians (who together spend longer times with patients) and where there is a large
number of no-shows, typically see the fewest number of patients per provider. In
this case, an exam room utilization factor of 70 percent may be used for planning
purposes.
Well-planned physician practice space/outpatient clinics provide sufficient flexibility
to accommodate sizable deviations from workload forecasts. This is accomplished
by creating spaces that can be used interchangeably for various types of visits; by
understanding the relationships among workload, visit times, and staffing to respond to unexpected surges in workload; and by accommodating a wide range of
patient visits in a single flexible exam/treatment space.
Cynthia Hayward, AIA, is founder and principal of Hayward & Associates LLC.
.

2014.7.2

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