Don't rely on one-size-fits-all standards; analyze YOUR practice's space needs.
Q: Now that I have begun searching for a new location for my practice, I must determine how much space I will need. I continue to hear about the recommended statistical guidelines used to determine the appropriate space for each room and the entire office. I don’t agree with some of the resulting data. What do you recommend?
- Bob Jones, DMD
A: Dr. Jones, I find those statistics misleading. Take, for example, an ergonomically designed patient chair that sports the latest technology in its thin back, plush upholstery, and articulating headrest. It’s probably great for the masses, but if you stand a lanky 6 feet 6 inches or portly 5 feet 2 inches, that chair might not be the best one for proper ergonomic function.
Because this will be one of the most significant investments you will make during your career, it deserves a thorough analysis before you make any long-term projections. I, too, have heard that for each treatment room you need two seats in your waiting area. How can that be accurate unless it has been qualified and quantified by a more in-depth analysis? If you own a family dental practice that focuses on restorative treatment and treats children, adolescents, and seniors, you’ll likely need more seating. Adolescent patients often come with parents and siblings. Likewise, elderly patients often arrive with drivers or companions. Conversely, if you operate a cosmetics practice, you probably serve a demographic of self-sufficient 30- to 60-year-olds.
Less obvious factors also affect seating and traffic. A hygienist who uses a prophy jet instead of manual polishing can reduce patient chair time by 20 to 30 percent. In the same context, more cosmetic dentists are working on one quadrant or arch for an extended appointment that could last from one hour to an entire day. So, where hygiene may increase volume, long appointments likely reduce volume. Do you overbook your schedule and typically run on time? If not, regardless of the demographic you serve, you probably need to accommodate more people in your waiting area.
If you need the following, you'll need more space:
Vestibule - If the facility that you are considering has direct exterior access, like that in a strip mall or stand-alone building, you will probably need a vestibule to protect those in the waiting area from the elements. Depending on the layout, you will likely need around 35 square feet to meet Americans with Disabilities Act guidelines. Consider the impact on the remaining space for accessibility and function.
Gasses - Fewer practices are using nitrous oxide. If you intend to provide hard-plumbed nitrous and oxygen to treatment rooms, you will need 5 to 8 square feet to store the tanks and manifold. Although it’s not a lot of space, the space juxtaposition, door swing, and delivery access easily can create the need for ancillary, peripheral space.
Film processing - If you use analog film, you will need a darkroom for a dip-tank or automatic processor (other than a Peri Pro). A typical film-processing room will consume up to 21 square feet. If you use direct digital or phosphor-plate imaging, you will need a workspace for the CPU and monitor, as well as a scanner with the latter. A typical workstation can consume as much as 15 square feet. In the case of the scanner, you must be able to reduce ambient light. Location (not near a window) is critical and could impact your floor plan.
Administrator - Practices that employ an administrator to manage the practice experience greater financial success. If you don’t foresee hiring one, you can save approximately 90 square feet.
Dental utilities - Many office buildings offer ancillary (storage or utility) space that can be used for dental utilities. If it is not available, you will need approximately 24 square feet for the compressor, suction pump, and amalgam separator.
Building utilities - Although most professional office buildings provide rooftop or basement HVAC systems, it is common for each suite to have its own system. Depending on the overall size of the suite and number of zones needed to heat and cool the space, you might have to accommodate as much as 35 square feet, providing the units will be accessible from a common area. If that isn’t the case, you may need as much as 20 additional square feet to accommodate service personnel.
Patient charts - Two factors influence this need, or the lack thereof. First, if you produce digital films and scan aged films for digital storage, you will significantly reduce the thickness of each chart by eliminating panorex, bitewing, and FMX films. Second, if you run a virtually paperless office in which patient records are stored digitally and scheduling is done on a PC, you keep few hard records. Otherwise, you will need anywhere from 36 square feet to 60 square feet for an average, two-practitioner office. This defers to your type of practice - family practice, higher volume; specialty practice, lower volume.
Consultation - Although many practitioners prefer to do case presentations or consultations in their treatment rooms, the trend is to provide a non-clinical, nicely appointed space in which patients will be more relaxed and potentially more receptive to presenters. You will need approximately 100 square feet to create a reasonably comfortable environment.
Private office - Most practices use a small area for private activities and phone calls. Doctors often share the space with their partners or associates. Consider two things: First, if more than one practitioner is going to share an office, the space will need to be sized adequately to afford each a reasonable desk space with potential privacy screens. If each practitioner prefers his or her own space, each will need approximately 80 square feet to be comfortable.
Staff lounge - I think it is a mistake not to invest in personal space for employees, but many doctors refuse. It is becoming the norm to provide an eat-in staff lounge, kitchenette, staff lavatory, and staff lockers. Staff members often use the lounge itself secondarily for meetings and continuing education. That noted, offices typically allocate anywhere from 100 to 500 square feet for a staff lounge, another 10 square feet for lockers, and 50 square feet for a lavatory.
Ordering - A dental supplier-provided PC is common in a dental office. Practices that use that service prefer a segregated area where there is sufficient space for the computer, texts, and catalogs. A minimum of 15 square feet will suffice.
Panorex - Many general practices have a panorex, so accommodation comes down to two options: 1) An analog unit will need approximately 16 square feet. 2) A digital unit will require a minimum of 25 square feet to accommodate a panorex and computer. If you use phosphor plates, you will need additional space for your scanner.
X-ray - It is not common, but I have provided rooms exclusively for taking periapical films. These rooms often feature an inexpensive, barber-style chair or dental chair. With comfort considered, a reasonable accommodation is 80 square feet, although less space might suffice.
Photography - I have provided a room exclusively for extra-oral photography. Because it doubles as a patient- education space for the hygiene staff, it is worthy of consideration. In that isolated case, we provided approximately 100 square feet.
Laundry - According to current mandates, scrubs and smocks must be laundered professionally or processed in-house. Assuming you choose the latter, you will need anywhere from 7 square feet for a stackable unit if accessed from a space such as a lounge or lavatory. When washing, drying, folding, hanging, and storing are considered, then we have provided laundry facilities that consume 30 square feet.
Handicapped lavatories - Although regulations vary regarding size and occupancy, gender-specific, handicapped lavatories usually are required. In some areas, an additional lavatory for staff might have to be adaptable - which means that it must be the same size as an accessible lavatory, but will not require accessible fixtures and accessories such as grab bars. So, if you have a space that will accommodate two practitioners and two hygienists, likely you will need both. If you choose a private lavatory for clinicians and a private lavatory for staff, your total need for lavatory space will be approximately between 180 and 195 square feet. At the minimum with a single, unisex lavatory, you will need between 45 and 49 square feet.
If you need all of the aforementioned spaces and calculate that need by the worst-case need factor, you will have to increase your space requirement by 1,535 square feet.
Size matters - Personal needs in essential spaces equally influence need. Consider the following:
Hygiene - It is becoming more common to find hygiene assistants who perform numerous tasks, including four-handed function for procedures such as sealants. In these cases, we typically provide a room that is identical to an operatory, or approximately 20 square feet larger than a conventional hygiene room.
Lab - This is probably the room that creates the most disparity in need among practitioners. With the advent of overnight mail and courier services, many practitioners are doing little more than taking impressions and forwarding them to commercial labs. Several practices have insisted on creating commercial labs in-house, the largest of which measured more than 500 square feet. How you use your lab has a significant impact on how much space will be required.
Treatment - Although ergonomically, the space between the patient and the adjacent support (cabinets, counters, instruments) should remain the same with any size room, many practitioners embrace larger treatment rooms. The greatest increase I have witnessed is approximately 12 square feet - not a lot of space until you multiply the additional space by the number of treatment rooms.
Charts - You might also consider the need for greater confidentiality, as well as patient perceptions. We created separate rooms for charts long before HIPAA regulations to avoid patients feeling like numbers when they enter reception areas and face wall-to-wall banks of charts.
Space - Space for the sake of space is an effective tool in creating a relaxed environment, diminishing audible communications, and enhancing professional image.
The considerations regarding size can have impacts equal to those determined by need or the lack thereof. Those few aforementioned items could increase the need factor by 700 or 800 square feet.
Just when you thought you had considered everything, you find the things you overlooked.
Form and access - These are the most overlooked considerations in calculating space needs. Form refers to the partitions that define and separate the spaces within a suite. With a nominal thickness of 5 inches, an average office can demand as many as 150 square feet consumed by partitions alone. Access refers to the passageways that provide access to all areas within a suite. Again, with consideration for a code-compliant width, an average office can need as many as 500 square feet. Typically, we allow for between 20 and 30 percent of additional space for form and access.
Leaseable vs. useable - This is a simple necessity when looking at a potential space. Assuming you are certain of your space requirement, you must ask the lessor or seller to define the useable square footage. According to the Building Owners and Managers Association, the proposed square footage being offered may include one half the thickness of the perimeter walls. This can be substantial. A new client expressed interest in a suite for the entire second floor of a professional office building that boasted 5,000 square feet at a reasonable $16 per square foot. However, after eliminating the perimeter wall measurement, the two stairwells, elevator lobby, elevator, and elevator machine room, we discovered that the useable space was actually about 4,000 square feet and $20 per square foot.
Obstructions - The critical components described for leaseable space notwithstanding, other considerations should be investigated. Look in the ceiling above the suite, the ceiling or basement below the suite, or perform exploratory demolition of existing partitions. So, what are you looking for? Heating and cooling ducts, pipe and wire chases, columns or structural masonry, and roof drains, to name a few. Many of these can be relocated, but likely the expense to perform those tasks will be your responsibility.
Storage - Besides form and access, storage is the most commonly overlooked space. How you address the need will aid in defining the amount of space for this area. Assuming you have the conditions that would support either option, consider the difference between a storage room and walkby storage. The former will require enough space for a person to enter and bend to reach the lowest shelves. The latter will consume only the amount of space needed for the depth of each shelf because the storage will be accessed by either a bifold or sliding door in a passageway. In either case, consider a minimum of 20 square feet for a growing practice.
The office space planning process may be tedious, but I assure you it will pay substantial dividends.
Editor’s Note: If you have a design question, feel free to drop an e-mail to the author at [email protected]. Your e-mailed question may serve as the basis for one of Ludwig’s future articles in Dental Economics®.
Garrett Ludwig founded Diversified Design Technologies Inc. in 1971. The company has specialized in the design and construction of private-practice, health-care facilities since 1975. During that time, he has designed more than 250,000 square feet of professional office space. He has a U.S. patent on his emergency services “crash cart” design. Ludwig has shared his experience in dental office design in numerous trade publications, and continues to lecture on the subject throughout the United States. He can be reached at (800) 622-5563, and [email protected]. Visit his Web site at www.profitbydesign.us.
BEYOND the basics, three categories influence space evaluation -
1) Everything you need that exceeds basic function
2) Sizes of the spaces based on function
3) Areas commonly overlooked