Space Needs and Office Layout

Opening a practice means more than choosing a city and hanging a sign in the location you like best. In this article, we'll deal with the nuts-and-bolts aspects of planning your new office.

Determining How Much Space You'll Need

Start by taking into consideration where you're going to practice, and what you're going to offer. If your philosophy involves limiting your practice to manipulation (adjustments) only, you're going to need less space than someone whose practice is going to include other forms of treatment. Similarly, if you're going to practice in a rural area, a high-tech-appearing office may appear too intimidating and ostentatious, whereas such a facility might be perfectly at home in a more urban setting. Assess your base of potential patients, and rely on your common sense and good judgment.

In most cases, 800-900 square feet, appropriately laid out, will be adequate space for everything a new doctor wants to accomplish. As your business takes root and begins to grow, the size of your office can grow as well. And the space you acquire should comprise your entire facility, which would include two treatment rooms, a front office, doctor's space, a reception area, and a restroom. A reliable rule of thumb is that 800-900 square feet can accommodate 150-180 patients per week, or six to eight patients an hour.

One of the largest allocations of space in many chiropractic practices is the X-ray facility and darkroom. But, it may not be necessary to offer on-site X-ray services, especially if you’re a new doctor. Besides, the cost—upwards of $25,000—can often be better allocated to other areas. It may be better to designate that space—and the money—for other purposes, and send patients who need X-rays to a radiology facility or the local hospital.

Deciding How to Configure Your Space

To help get you started on configuration ideas, we've included several sample office floor plans at the end of this article. Whether or not you’re starting from scratch, studying these plans could help you generate some basic ideas. Many doctors will start with a piece of graph paper and sketch possible layouts to scale. You don't have to have an architectural background to do this; allow yourself adequate time and a supply of pencils, and get started.

TREATMENT ROOMS

Begin with your treatment rooms. Ideally, each should measure about 8' x 10' unless you want to offer modalities; in that case, each room should measure slightly larger, say 10'x 12', or even 12' x 12'. Plan for each room to include a table, a counter or small desk and chair, a few shelves, and a cabinet or two for supplies. You can add interest to the rooms by hanging your diplomas on the walls. Art prints or personal photos, tastefully matted and framed, are also perfectly acceptable treatment-room decor.

DOCTOR'S OFFICE

Many doctors allow themselves too much room for a personal office, an action that results in square foot upon square foot of wasted area. All most doctors really need is a cubby space, or ledge, carved out of a wall in the central hallway. If that's not possible, a closet- or restroom-sized office, with a stand-up desk or ledge, will suffice. The most important objective in terms of your own space is making sure you have room for, and have easy access at all times to, your own computer, which must link to the computers in your front office.

How much time will you spend in your own space? If you're busy treating patients, not much. And chances are you won't use the hundreds of books that line the shelves of most doctors' offices; choose the reference manuals that you use most often and place them in the front office or on a shelf above your workspace.

FRONT OFFICE

The front office is a space that deserves as much attention as you can give it. The configuration of that space will determine the shape and layout of the front office, but as a rule of thumb, the office should always accommodate three people comfortably—more if you're planning to employ a larger staff. Even if you plan to employ two people in the front office, the space should accommodate three because you'll likely be moving in and out of the area throughout the day.

One section of the front office should be designated as a billing area; ideally, that aspect of office management should be handled by only one person, and his or her desk should be separate from the front desk. New patients should be informed immediately that this person who handles financial matters.

RECEPTION AREA

Many doctors allow too much space for their reception area; usually, comfortable seating for six people is more than adequate. The layout of the space will determine exactly how it's configured, but one thing is certain: You must create privacy between the reception area and the business office and treatment areas. Especially in light of new HIPAA regulations, patients shouldn't be privy to any information about other patients, regardless of whether that information deals with treatment, diagnosis, finances, or any aspects of a doctor/patient relationship. Whether the privacy is created by actual space or by divisions, such as screens or partial walls, it must be established immediately, and be respected throughout the life of the practice.

The ambience of the reception area is vitally important to the comfort of your patients. Comfort is a concern; although you want your office to project a professional ambience, you want your patients to feel welcomed as soon as they walk in the door, and while they wait to see you. Consider warm earth tones for your decor; choose furnishings that are professional and comfortable at the same time, such as oak or oak-look chairs with comfortable cushions in pleasing colors. And make sure your chairs have arms—a "must" for patients who are having trouble standing or sitting.

Keep clutter to a minimum by anchoring as much to the walls as you possibly can: magazine racks, toy shelves, and shelves for drinks or refreshments. Make sure your reading material is desirable, varied, and even educational. It won't hurt to place chiropractic-related materials within reach. (Also, your reception area isn't the place for publications that can incite controversy, either with questionable content or objectionable photos.)

RESTROOM

Make sure your restroom is clearly marked and pleasant to visit. Keep tissue well-stocked, empty wastebaskets regularly, and stock up on disposable air-freshener cartridges. Set your hot water to a temperature that's not high enough to scald patients' hands, and make sure disposable towels are plentiful.

Fitting Front-Office Furniture and Administrative Equipment Into Your Floor Plan

Consider obtaining furniture of a modular nature that can be utilized in several ways rather than a committing to major pieces of equipment with singular uses. You'll want furniture that's attractive and comfortable, but it's most important to make sure your furniture can adequately support your office equipment. As you're looking at office furniture, plan for the following equipment:

Several computers - to perform electronic billing and keep patient records and appointments – will require a modem and a dedicated phone line. So plan for multiple phone outlets.
A phone system that is multi-line so patients and potential patients never have to encounter voice mail, except for after hours. Extensions should be cordless and should be able to accommodate headsets for maximum comfort and ergonomic stability.
Wifi to facilitate internet connectivity and email capabilities - which your insurance staff must have for verifications with managed-care companies and approval of treatment plans.
A fax machine.
A multi-purpose printer/photocopier. A tabletop printer/photocopier is fine -- but remember that you get what you pay for. A bargain-basement machine will not do the job you need it to do.

And don't forget to pre-wire for electricity with ample plugs for the various pieces of equipment you might use, most certainly your computer and its components. Wiring in the floors is convenient, safe, and aesthetically pleasing—you can "hide" outlets, cords and plugs under the desks.

Deciding Whether to Lease or Purchase Your Space

The vast majority of D.C.s lease, rather than purchase, their office space. Here are some things to ascertain before you sign your lease. (Before signing any legal document, including an office lease, make sure your attorney reviews it.)

Make sure the lease includes:

A warranty to practice chiropractic
A description of the facility and layout
Warranty and condition of the facilities
A permission to alter the facilities without having to restore them to their original condition at the end of the lease
Any guarantees of services to be provided by the landlord—these should be specified
The amount of rent payments to be made each month, the day of the month by which rent payments should be made, and where the payments must be remitted
The condition of the premises—especially if the space is not completed
A provision stating a warning will be granted before eviction
A termination of the lease and a suspension of rent obligations if the building is damaged
A clause stating the landlord will be responsible for maintenance and repairs
A provision relieving the tenant of fire liability

The following should be provided, if at all possible:

Option to renew and an option to terminate
Escape clauses: death and/or disability
Leasehold improvement allowance
A right to sublease the premises
A right to share space

Avoid the following provisions:

Escalation provisions in taxes, utilities, operating expenses, and cost of living
Any clause that relieves the landlord of liability for damage due to falling plaster, broken pipes, or plugged drains
Any clause that continues the tenant's liability after the lease has expired
Any clause that automatically renews the lease unless the tenant gives notice
Unlimited viewing of the premises by the landlord; limit this to the last 30 days of the lease

Construction of Your Office Space

If your office involves new construction or a major remodeling project, allow ample time —six to eight weeks—and, if possible, hire a professional contractor. Make sure it adheres to all local building codes and ADA (Americans with Disabilities Act) mandates. Ideally, your builder or remodeling contractor should take care of this, but it never hurts to follow up with your local officials at City Hall. Not only will doing so give you peace of mind, but it will enable you to "meet and greet" influential individuals in your community. Check to see if your local codes require more than one restroom, and make doubly sure plumbing and electrical components conform to code requirements. Make sure your outdoor signage meets local code requirements, also. You might have erected the most attractive, eye-catching sign in the world, but if it's too large, too garish, or placed too high, chances are it will have to come down.

Sample Floor Plans

Take a look at these sample floor plans to give you ideas on setting up your office space.

720 square feet Floor Plan (sample start-up office)
900 square feet Floor Plan (*John D. Hickey, D.C. - Design #55)
800 square feet Floor Plan (*John D. Hickey, D.C. - Design #56)
900 square feet Floor Plan (*John D. Hickey, D.C. - Design #58)
1,200 square feet Floor Plan (*John D. Hickey, D.C. - Design #41)

These floor plans are from "The Chiropractic Office - A Guide to Contemporary Office Design" by John D. Hickey, D.C., PrimeWord Publishing.