Office design that works

When internist Henry Walters in Statesville, NC, commissioned a new office a few years back, he said, "Make it bigger."

"I wasn't looking for a Taj Mahal, but I wanted something that would make me more productive," says Walters, a member of the 80-doctor Piedmont Healthcare group who practices in a solo facility.

Walters' practice has indeed become more productive, and extra space is a big reason why. He and his nurse practitioner Cathy Wayand now share six exam rooms compared to five in their old quarters. And they see eight additional patients a day between them. A procedure room allows Walters to perform more tests-treadmill, pulmonary function, and bone density-as well as other ancillary services.

"I like the way the office flows," says Walters, who paid for his new digs out of his own pocket. "It's a fun place to work."

Medical office design encompasses everything from the science of healing colors to the privacy considerations of exam rooms (never install the table so that the patient's feet-and blush-producing body parts-face the door). These days, design must also consider this issue: How do you spread out without wearing out?

The space race stems from a variety of sources. Outside of Medicare-heavy practices, primary care doctors generally need at least three exam rooms apiece to maintain a steady stream of visits, says practice management consultant Keith Borglum in Santa Rosa, CA. Yet many doctors are stuck with only two rooms, says Borglum. "They're cooling their heels while they wait for a room to turn over." Want to add midlevels? They'll require two or three exam rooms apiece as well, depending on their patient load. And ancillary services-important income-boosters in primary care-often require their own dedicated areas.

Then there's the fact that clerical staffs have grown larger in direct response to insurance-company rigmarole. The head count per full-time doctor in internal medicine practices, for example, rose from a median 3.7 to 4.2 between 1995 and 2004, according to the Medical Group Management Association. "More bodies translate into more space," says medical architect Richard Haines, whose firm in suburban Atlanta designed Walters' office.