"If you have the right design that emphasizes efficiency, you won't need to add staff. Good design can dramatically increase staff productivity and that's a key thing to consider when looking at real costs," he said.

While no two projects are alike, David said that doctors can expect that a complete re-design, depending on whether it includes reconstruction or new construction, can range between roughly $30 per square foot to about $50 per square foot.

"Going in, you need to understand that a medical office design firm, an architect or your local contractor, probably doesn't have experience with a chiropractic office. That could result in much higher costs. These don't have to be $200,000 projects, but they can be far more expensive than necessary."

Look and Feel

Dr. Koelling, whose new office opened in April 2009, said his facility is now more like a hub then a rail car.

"The new office flow has helped us, there's no question about it," he said. "When a patient walks in the door, the first thing they see is 'command central'; the front desk module where the CA can coordinate everything from one spot," he said. "She can get to everything quickly with very few steps, to the rehab area, adjusting rooms, and so on."

As part of the design, Koelling's two adjusting rooms have three spacious changing rooms that feed into the work areas. "What the patients love is that when they are ready, they flip on a switch that indicates they are ready, and we see that."

Koelling said electronic patient records are available in the treatment room, reducing staff steps to retrieve them. Digital X-rays are also available in the rooms, yet another step-saver for staffers.

"People come to this office and they're blown away, excited to be there," he said. "The image is professionalism and because we're efficient, the image gives them a confidence in the care. All of it has helped up with retention and referrals."

Caratozzolo said that correcting the workflow problems that were an "impediment" in his old office was a key part of the design.

"All of us had to go way too far into the building to get into an exam room," he said. "Now, it's no more than 10 steps to either an exam room or and adjustment area."

Another problem was that there was too much visibility of areas that were never intended for patient views, specifically the finance billing office.

"It may sound small, but our people can close that door and get work done."

A Real-World Clinic

A major goal of Parker College's new clinic is to give students a "real world" experience. To that end, it incorporates a radical new idea: faculty who work there will eventually be taken off school salaries and earn what they make from providing care. "A campus clinic is not a reality-based experience," Stolar said. "Faculty are on salary, and that doesn't necessarily give students the experience of what they'll find out in the field where you eat what you earn."

One won't find a large numbers of interns in a "normal office," but this particular facility had to accommodate that reality.

"With so many people in the same space workflow patterns are great importance," Stolar said. "You don't want people running into each other or waiting around in large groups. (The facility) had to be operational but without impediments to moving people around quickly."

This required that the rooms in the clinic be multifunctional. For example, the facility will have four different "adjusting pods." These rooms can be rapidly modified to be used for seminars or meeting with patients.

There will also be five multi-purpose private rooms that can be used for patient consultation, follow-up exams, massage therapy and nutritional consultation.

Lively Environments

Efficiency is absolutely crucial to a successful office design, but ambience is just as important. It sets the tone for the entire experience.

Koelling said, "A lot of people says that when they've been in other places, they didn't seem very modern or very clean. In truth, the practice may be very clean, but if it's dark, the impression is negative. And they'll remember that."