If your practice has struggled to find and keep good ophthalmic assistants, you are not alone. Consultants in the eye-care field say it’s a long-time problem that has been exacerbated in recent years. To overcome it and find the kind of people you can rely on to help your practice run smoothly and keep your patients happy, you may have to get creative.
THE SHORTAGE CONSENSUS
What the data show
The ophthalmic tech shortage “is a ubiquitous problem across practices from Alaska to Florida and from New York to San Diego,” says Cynthia Matossian, MD, founder and medical director of Matossian Eye Associates, a multispecialty practice with offices in Doylestown, Pa., and New Jersey.
Her pronouncement is backed up by ophthalmic consultant Jane T. Shuman, MSM, COT, COE, OCS, CMSS. She says the need for techs has been a constant during her 30 years in the field but has grown worse over the past 5 to 7 years. She attributes that, in part, to the aging baby boomer demographic requiring eye care. Another factor, cited by both Ms. Shuman and Dr. Matossian, is the lack of public awareness of careers in eye care.
Brad McCorkle, who runs Local Eye Site, an eye-care-specific job board based in North Carolina, compares the problem to another medical specialty. “If you look at the position of dental hygienist, for example, I would liken it to the role of an ophthalmic tech. Somehow, dentistry has done a good job of making dental hygienist well known. I don’t know why it’s happened this way, but I do know the position of ophthalmic tech does not have the awareness from the general public that it deserves.”
Mr. McCorkle offers some perspective on the dearth of ophthalmic technicians as well. His website lists roughly 25 eye-care positions, and 28% of the jobs posted are for ophthalmic techs — the second highest percentage for any one position in a list that includes optician, practice administrator and optometrist. In his experience working with approximately 8,000 eye-care practices nationwide, practices struggle the most with filling the tech positions.
And the shortage may get still worse. “The surveys communicate that people in the field are approaching retirement age or are past retirement age,” says Ms. Shuman. “So, they will be leaving the workforce soon.”
The International Joint Commission on Allied Health Personnel in Ophthalmology (IJCAHPO) is trying to get a comprehensive picture of this problem. The group’s CEO, Lynn D. Anderson, PhD, notes it was founded in 1969 in response to the insufficient number of physician extenders to help meet the patient demand for care. “It’s really hard to get a handle on how many people are coming into the field,” she says. “Our best gauge is the number of people we certify each year. So, we know there are 1,000 to 2,000 new every year.”
To bring the situation into clearer focus, the commission will launch a survey, either late this year or early next, asking practices the number of technicians currently employed, the number the practice would like to employ and the difficulty in filling vacant positions. And, to help combat the shortage, IJCAHPO is developing an initiative to grow awareness of ophthalmic assisting careers. “We are working with medical assistant training programs and talking to the military about career transitioning, or spouses of active military,” says Dr. Anderson. “We’re also active with a group called Health Occupation Students of America, a club for students interested in medical careers.” IJCAHPO has also developed a career website.
The hunt for a practice administrator
Just as the search for good technicians has gotten more difficult, so has the hunt for a practice administrator equipped to manage the modern eyecare practice. Marla Galasso, the recruiting support services manager at BSM Consulting, says, “The pool of candidates who have the expertise our clients are looking for is more limited than ever. Where before we had hoped to fill a leadership role within 30 days, today it’s really more of a 60-, 90-, 120-day process.”
Before beginning the search, Ms. Galasso recommends conducting a needs assessment with the key stakeholders to determine the practice’s strategic imperatives. “Do you want to grow the practice? Increase staff morale? Do you want to improve efficiency?”
Beyond creating a job description that outlines the position’s duties and requirements, Ms. Galasso says to consider “seven core competencies” that an ophthalmic leader should possess:
- Health-care practice management experience
- Leadership experience. “Someone who has actually led a multi-physician practice, because a multi-physician practice is scalable,” she says.
- Financial management and reporting acumen
- Expertise in business development
- Clinical operations knowledge
- Human resources background
- Regulatory and compliance proficiency
“Prioritize which core competencies are important for the strategic imperatives,” Ms. Galasso says.
Marketing the role is crucial as well. This process may require an attitude adjustment on the part of the practice. Given the current low unemployment rate, job seekers have the luxury of choice. “Today, employers have to sell the position, show what’s in it for the applicant,” Ms. Galasso says. “We give them tips on how to market the position, how to use technology, differentiate the ad visually. Because if you’re not appealing to the ‘what’s in it for me’ factor, you just look like everyone else.”
Impact on patient care
Not only does too few techs mean extra stress for everyone, but it can impact patient care as well, notes Dr. Matossian. “As a field, we are depending more and more on diagnostic tests on which to base our treatment plans. We need that objective data. It also helps patients to become believers in their disease when they see objective data, especially if some of their symptoms are very mild or nonexistent, such as dry eye disease. Also, some of these treatments are cash or have an out-of-pocket component and copays, etc.”
Again, data make patients more willing to pay for treatment. And this diagnostic testing is tasked to staff. “Staff now have to be more educated, more able to adhere to protocols and do the testing properly, enter the diagnostic data into EMRs, be detail-oriented,” Dr. Matossian says. “And we are so short on staff. As a result, sometimes we are unable to do all the testing we were hoping to do.”
WHAT YOU CAN DO
Think outside the box
For ophthalmologists who have been grappling with finding the right people to fill vacant staff positions, try hiring for personality rather than resume — and looking in unlikely places. “I’ve had doctors tell me they feel they can train for the skills but that the person’s attitude, customer service skills, personality — you can’t train that, you can’t buy it. It has to be the right kind of person,” Dr. Anderson says.
Douglas A. Katsev, MD, practices at the Sansum Clinic in Santa Barbara, Calif. In that upscale area, an ophthalmic technician’s salary will not pay the rent; the commute from more affordable communities, he says, is at least 45 minutes. When staff find something closer to home, they leave. “To find quality people who live here is really difficult,” he says. His solution: “If I meet someone around town at the AT&T store or someone who is really friendly or a waitress in a restaurant — they are good candidates because they are used to doing more than one thing at time — I’ll take their number and give it to my practice, because the more people they get who stay in Santa Barbara, the better my life is.”
Dr. Anderson recommends taking a look at your own patient base for good candidates. “We know from our research that the number one reason people come into this field is they have a family member who has an eye problem. That’s why we say patients are a good place to look. They come in with their family member, and they fall in love with the field.”
Ms. Shuman agrees that practices should not focus too much on the candidate’s professional background, noting that she started out as a French teacher. “You need a bright, inquisitive multitasker who is willing to learn on her own time as well as on the job,” she says.
Long-term strategies, plus
Given that staff shortages are a nationwide issue for eye care, a nationwide response to the problem is in order. “There needs to be an aggressive campaign to raise public awareness that ophthalmic assisting exists,” Mr. McCorkle says.
Dr. Matossian has formed a coalition with a group of practice administrators dedicated to increasing such awareness. The group plans to invite industry to partner with them as well. After all, she points out, the shortage of staff to perform the increasing number of diagnostic tests can inhibit the purchase of new equipment. She also sends her practice’s HR person to local high school and community college counselors to inform them of ophthalmic assistant opportunities for appropriate students.
Ms. Shuman says she has seen some grassroots efforts achieve success, but “I think you have to have people who are dedicated to building it.”
Formal education for your current staff can help as well. IJCAHPO offers an accredited training program, which includes certified ophthalmic assistant (COA), certified ophthalmic technician (COT) and certified ophthalmic medical technologist (COMT) certifications. In addition, the Association of Technical Personnel in Ophthalmology, or ATPO, offers continuing education.
Practices can also explore other local opportunities. Fifteen years ago, Ms. Shuman created a community college course for ophthalmic assisting. While it is not accredited, it does provide an introduction and foundation in the field, she says. Ms. Shuman makes it clear to both the students who attend the class and the practices that call her looking for possible employees that the students will still need training, “but they have dedicated one night a week for one or two semesters to learning this field. They know the cornea from the retina, and they have had a little hands-on experience,” she says. Many of her students have gone on to obtain certification.
Ms. Shuman also recommends practices develop a training program of their own “so that there are clear expectations and the new employees can be productive early with the easier tasks. The new hires must understand why they are doing what they are doing, what an abnormal result may be and must be thinkers,” Ms. Shuman says.
She further recommends that if they do not learn to scribe as an entry-level position, they should at least sit in on the doctor’s examinations. “That’s where they are going to close the loop between what they do on the front end vs the patient’s final outcome.”
How to keep them
The ongoing tech shortage combined with current “full employment” means that employers may well have to offer a higher salary than they’d like to get good staff members — and retain them. However, a less-than-impressive paycheck is not the main reason techs leave a practice, according to JCAHPO’s Dr. Anderson. “The number one reason people leave their current job is their employer. It’s not about the money — it’s that they are not happy with their supervisor.”
So, while a competitive wage and competitive benefits help, that nebulous concept of “practice culture” needs to be addressed. What can ophthalmologists do to develop a good culture? One way is to make it clear that their input is important, says Dr. Katsev. When one of his techs offers an idea that improves efficiency or patient care, he makes sure to thank them and to do it in a manner that is clearly not perfunctory. “I praise their good idea, telling them how much it has helped a patient, for instance. That reward they receive when they have done a good job not only helps retain staff, but it incentivizes them to work harder at their job; it tells them their performance matters,” Dr. Katsev explains.
Dr. Matossian believes it is important to “empower” employees by giving them opportunities to learn and accumulate more skills — which justifies higher pay. Her multispecialty practice offers opportunities to rotate within various subspecialties within ophthalmology: glaucoma, cataract, cornea and oculoplastics. “So, it’s not the same thing every day for them,” she explains.
On a more practical note, Dr. Matossian points out that most ophthalmic assistants are women of childbearing age. After maternity leave, they may not want to return to work full-time. “We want them to stay with our practice, so we try to provide them with flexible schedules,” she says. “Some work three days a week or four hours a day.”
Another way to help retain staff is to create a convivial atmosphere. Dr. Matossian’s practice offers quarterly team-building events as well as birthday parties and baseball games. Dr. Katsev hosts a party for the whole practice at his home. He also has one pretty spectacular trick up his sleeve for holding onto staff: He takes them to the annual Hawaiian Eye Meeting. “I rent a larger place for the group to stay and then I pay for half their airfare. They do have to pay something; it’s not free. But the idea that they can go is really important. It’s my way of showing my group that they are special.”
However, if you can’t manage that feat, fear not. Staff “want to feel wanted and respected, that they are actually contributing something to the overall good of every patient and to the practice,” says Dr. Matossian. Showing appreciation for your employees will go a long way toward combatting turnover. OM