At the 2026 ASOA meeting at ASCRS, Rod Solar, cofounder of LiveseySolar, and Patti Barkey, COE, strategic advisor with Bausch + Lomb, presented "Building and Keeping Top Surgical Counselors." Here, they share key takeaways with Ophthalmology Management. The below transcript has been edited for clarity.

Rod Solar: Hi, I'm Rod Solar, and I am the scalable business advisor for LiveseySolar. We're in the business of doubling the revenue of refractive and cataract surgery practices and tripling their profits in 3 years or less.

Patti Barkey, COE: I'm Patti Barkey. I am here today with Rod on this particular topic about counselors and premium IOLs and capture and leads and all the great things that help us look wonderful as practices. And I am currently with Bausch + Lomb as a strategic advisor for practices.

Rod Solar: Patti, what I wanted to really stress during that presentation was that the counselor role is a revenue-producing role. And, a lot of times, I think people don't quite get it right, in the sense that they either promote people who were never intending to look at the product being judged by their productivity as a revenue producer or perhaps just landed into that role because they were good secretaries. Do you have any comments on that? Have you experienced that in the field?

Patti Barkey: Yeah, absolutely. I think sometimes practices tend to take the strongest clinical supervisor and put them in this role because they know the technology the best. And you and I both know that it's not just about the technology, it's about what we're delivering results-wise. Obviously, you have to have somebody that's comfortable with discussing the money portion of this, because with upgrades comes a price, a fee. And so many times those same technicians do not want to be in the game of sales. They don't want to have anything to do with upgrading or promoting or selling things to patients. But we're selling ourselves every single day, so that is the biggest piece of it.

Rod Solar: A hundred percent. So, have you noticed any type of traits among the very best surgical counselors that you have encountered? If you were to see a new applicant or somebody inside the practice, have you ever seen a trait where you'd say, yeah, for sure that person would make a good counselor?

Patti Barkey: Yeah, absolutely. And like we talked about in this program, I think finding people that work in jewelry stores, people who have worked in the customer service industry, waitresses, but you need both a professional appearance, you need empathy, you need to be able to read the room, you need to be able to talk about and expect excellence and high levels of outcomes. All of those things make up a well-rounded person. You can't have somebody just come sit in the role that's pretty. You also can't have somebody come sit in the role that's just super clinical. There's a combination of those attributes that really make this work.

Rod Solar: Yeah, absolutely. I've actually also noticed that coachability is a critical component. Somebody who doesn't have all the answers but has better questions, and also somebody who is very good at following instructions. So my personal belief is that the job of communicating to others and to enhancing the variables so that more people say yes is actually more about process than it is about personality. Would you agree with that?

Patti Barkey: Yeah, I think so too. And I think process is so critical because at the end of the day, we're doing surgery on a patient too, and the details matter. To get to the outcomes, you have to not only know what the patient wants in an outcome, but how you and your team are going to deliver that outcome. So yes, following a process, following instructions, dotting the I's, crossing the T's, the details matter.

Rod Solar: I want to talk a little bit about what we spoke about when it comes to interviewing and finding the right people, because that's where it all begins. I kind of see the process as less of an interview and more of an audition. So what I often do with people is put them into role-play situations where I act as the patient and I have the questions or I have the obstacles that I want to present to the counselor, and I try to see how they act on their feet. I also try to give them scripts and see how they go about reproducing those scripts and taking feedback from me,  if I were to say, "Hey, say this a little bit differently or put a pause in here or make that question sound better." I know there's a lot of perhaps controversy around scripting and things like that. We've talked about that before. But yeah, how do you handle interviews for surgical counselors and things like that?

Patti Barkey: Yeah, and I think about it the same way. It is like an audition, and isn't that what an interview is?

Rod Solar: Absolutely.

Patti Barkey: You're auditioning yourself. And I think for these particular consumers, when anybody walks into the room with a consumer that you want to close and you want to sell, if you will, and capture, it is about putting on that hat of being that person that the consumer needs you to be. It isn't about you personally, it's about who that person is. And when you talk about the behaviors and the processes, there's several AI products out there that are looking at this. And I used to not be a big believer in all of the artificial intelligence stuff, but I'm coming to a point too where I do think some of the artificial intelligence things can help drive a superior communication platform, if you will, to take these individuals to the next level with reminders, prompting, and making sure that we don't forget the details. Making sure we've covered all the bases compliance-wise, risk-wise for the consumer, because it's not just selling a procedure. It's medicine at the same time.

Rod Solar: Yes, anything that prompts us. The earliest form of prompting would've been a form that we would fill out with the patient as we're interviewing them. Then it evolved into a CRM, perhaps, that we have an electronic record that we're even ticking off on an iPad. And I suppose AI is just more of a checklist. But also it takes into account what's actually being said in the moment—which is super exciting, because while you might have a linear process that you might go through, like a checklist, the AI is actually able to respond to what's actually being said in the moment, which is fascinating. And I haven't seen yet how good people might be at responding to that, how hard it is to get whispered in your ear about what to say next, and that might be challenging. But yeah, I'm very, very open to exploring those areas.

Patti Barkey: So, what do you see as the difference between the United States and London, and the different areas you get to work, in the quality and qualifications of candidates that we, as practices, are finding available to us, and how well we can onboard that person? How long [is it taking] to fit somebody into the mold you will want for the supreme capture percentages, right?

Rod Solar: That's a great question. So, to be honest with you, I don't see a tremendous amount of difference in terms of the caliber of people applying for these kind of roles, as long as you are very clearly communicating what it is you're looking for and what it is that you aren't. I think where most practices get into trouble is when they try to fit round pegs into square holes and try to make the best of what they've got, as opposed to literally going out there and saying, "I'm looking for this type of person, and I will go through and sift through people to find the right person." So, I don't see a big difference there. In terms of the onboarding, we recommend a 90-day onboarding [process] where day 0 to 14 is shadowing—so they're observing, they're watching consults or telephone calls, they're learning scripts.

We have a very specific way of learning how to do a script. Essentially, we take a big script where they read it, and then they black out a word and then they read it again and they try to remember what's in the blackout, and then they read it again and black out another word. Eventually, they've blacked out every single word until such time they know the whole thing. And, basically, you do it as many times as there are words in the script, and that's how you learn and memorize a script so well that it actually never feels robotic anymore, because you've said it so many times, it actually feels like you and I talking about things we really, really know. We don't have to rehearse because we've talked about them so often. And so it feels like that. So that's 0 to 14 days.

Day 15 to 45, I want them to start handling parts of the consult with somebody else. I want them seeing somebody else do it and then handling a part of it. So that part of it, and you can only handle parts of it if you actually know how to break it down, which we got into during the talk. And then day 46 to 90, really, I want them owning consults and I want them hitting numbers. And really, I think one of the biggest challenges that people have when it comes to determining whether or not they've got the right person is they don't measure them. They don't evaluate how well they're doing. And so I have a very specific list of metrics that I shared at the presentation that ensure that we have a scorecard for every single counselor and we rank them on that. So that's how it stays.

Patti Barkey: Yeah. I also think they tend to plug and play. We train, we plug, and then we walk away. We're not measuring, but we're also not auditing. Somebody may have great capture rates. I used to work with an optician [who] could sell anything to the wall, and the highest-end glasses. But the problem was more of those came back unhappy.

So, once we get through the process, the greatest counselor, the greatest person that's in this role, also has produced the most satisfied patient experience with outcomes that the surgeon provided and the team provided. So, we get to the end of the whole process and then we start all over again with the next patient. I think, again, this particular course was just so important because I think many, many, many practices—as you know in your business—are trying to figure out this sweet spot. So we hope that everybody that was part of this program was able to take away some very important tidbits to put into practice when they get back and that everybody's capture rate goes up based on this.

Rod Solar: Yeah, absolutely. Now, one of the things I talked a lot about during the session was how to keep people. But we didn't have as much time to get into your own personal perspectives on how you keep people. I just laid out my framework. What are the things that you would do to retain? Because one of the biggest challenges I think surgeons have and owners or practices have is they think, oh, if I train these people, if I invest in these people, then they go away. What happens then? So, what have been your discoveries and your experiences, and what keeps the best people?

Patti Barkey: Well, I think picking the right person to begin with and figuring out early on what motivates them, because many of us are motivated by success, and the better we get at something, the more motivated we are to become even better at it and to see the results of what we produce. What you don't want is somebody that is so motivated that once they achieve a certain level, they're like, "Well, I'm done with this. It's now time to go somewhere else," because we need to consistently repeat and repeat to get the great captures and great outcomes. I think keeping staff—and I've been very fortunate to have a very low turnover in my particular office that I was just a part of—is transparency, it's respect, it's letting people own the role that they're responsible for and feeling proud about it, seeing the patient's outcomes, going full circle [from the] beginning of the patient experience to the end of the patient experience, and knowing that your particular role in that gave patients better vision, gave patients a better lifestyle.

And I think when people get to participate all the way through the process, they own the role and they become very satisfied in the role. When you exclude them from those KPIs or the numbers or where we're celebrating and where we're doing great, and at the other side of this, if we're not compensating them at the level for what the purpose is of this particular role—this is a very important role, and the compensation should match their ability to produce. They should be rewarded for what they bring to the table. They become very valuable.

Rod Solar: Yeah. I mean, very talented people have many options. And unless we see these people as one of the central employees in our organization and reward them in the way that makes them want to stay, I mean, it's not all about money, it's about progression, it's about recognition, it's about all sorts of aspects. Also a big part of this is having some kind of stated career ladder where people see not only where their role fits into the organization with all these different positions, but also a progression from where they are now, what tier they're at now, and what comes next, so that they can feel like there is a next step. Imagine if you were in a room with no door to an exit, you'd get a little bit frustrated and you'd think, "I want to jump out the window." So the idea here is, there's a door here and there's another room.

And once you're in that room, there's another door to another room and these rooms have greater and greater challenges, but they also have greater and greater rewards. And I think that's a good way to keep people motivated about the long term and sticking with your organization for a good long time.

Patti Barkey: Yeah. And a final point on that is I do think consistency, locking down the process, following the process, tweaking it along the way [is important]. People tend to become very frustrated with processes that constantly change or constantly changing mindsets: today we're doing this, but tomorrow we're going to do this. So, it's important to go back full circle to where we were that the role is defined really well. The process is in place. Yes, this person wants to have a little input into their day-to-day, but they don't have the input into the lenses this physician's going to use. They don't have input into maybe the laser the surgery center has. They need to know those areas, but you’ve got to have some consistency in behaviors, expectations, and presentations. And again, back to the scripting that keeps it clean, we're offering the same thing to every patient every time and nobody feels like they were not informed, so they could make a good decision.

Rod Solar: Yeah, that's what it's all about. Sounds great. I think that kind of wraps it up. Yeah, I think that's been a great summary and also a few additional talking points to some of the things we talked about, which I think just further enriches the conversation we had on stage. So thanks again so much for participating in this with me. It's been great.

Patti Barkey: Thank you. It's great to work with you on it.