EyeNet Magazine

Practice Perfect: Human Resources
Boost Practice Efficiency, Part Seven: Ensure Techs Fulfill Their Potential
By Chris McDonagh, Senior Editor

To make sure your technicians are able to work productively, you should review how duties are distributed within your practice and be on the lookout for unnecessary bottlenecks.

Allow physicians to devote their time to diagnosis and treatment. If there is one task that can save the ophthalmologist more time than any other if delegated to a technician, it is refractometry, said Kenneth E. Woodworth Jr., COMT, COE, the chief operations officer for Kentucky Eye Institute, a practice with 13 offices throughout Kentucky. “If your state law allows nonphysicians to perform refractometry and retinoscopy, then all your techs should be trained to perform those tasks. Also, dependent upon CPT code requirements, physicians can confidently delegate basic skills such as history taking, visual acuity, muscle balance testing, pupil testing, tonometry and confrontation visual fields,” said Mr. Woodworth. This frees up physician time, which can then be spent on tasks that techs aren’t trained to perform.

“Time-consuming tasks are the most important,” agreed Jane T. Shuman, COT, COE, president of Eyetechs, a Boston-based firm that provides technician-training and consultancy services. “But before delegating any task—in addition to checking state law—someone must verify the tech’s level of competency to confirm the tech can perform to the practice standard. A doctor must feel comfortable with work that a technician performs on his or her behalf,” said Ms. Shuman.

How to distribute duties between techs and other staff. “While I don’t personally feel there is any task that a tech should never have to perform, the following tasks would, routinely, be handled by nontechnicians: appointment making, surgery scheduling, billing and collections, accounts payable, accounting, scribing and secretarial tasks, including transcription,” said Mr. Woodworth. “However, though it is generally an inefficient use of technicians’ time to have them routinely perform nontechnician tasks, there are many small practices that use them in that way.”

And given how difficult it can be to fill technician vacancies, Ms. Shuman suggests you give nontechnicians some work responsibilities that might encourage them to rise up through the ranks. “A great place for them to begin is with diagnostic testing (particularly fields), IOLMaster, the Epic System and scribing. The latter task will often pique their intellectual curiosity and drive them to learn to tech.”


Are You Slowing Your Techs Down?

There are many ways a practice might inadvertently stymie its technicians’ productivity, said Ms. Shuman. Doctors, for instance, may be disappearing into their offices between patients. So you should evaluate your processes from the technician’s perspective.

Do your techs share instruments? If they’re waiting in line to use, say, a centrally located lensmeter, then verifying the power of spectacles will be a bottleneck to patient flow. “Ideally, each technician exam lane should be equipped with basic instruments,” said Mr. Woodworth. “One technician who persuaded her physicians to implement that one tip told me that they increased patient throughput by 20 patients per day—just by putting a lensmeter in each technician exam lane.”

Do techs have to use substandard equipment? “Throughput suffers when equipment is not in good repair. If, for example, the phoropter’s cylinder wheel keeps sticking, that will slow down refractometry,” said Mr. Woodworth.

Do techs have to switch lanes? “It is much more efficient if technicians are each assigned one exam room,” said Mr. Woodworth. They will become more familiar with their room and its equipment, and, more important, they will avoid a lot of unbillable walking back and forth.

Do techs escort patients around the office? During the course of each day, a significant amount of time will be spent escorting patients to and from the clinical area. And this is particularly true for ophthalmology, where—because of its patient demographics—patients’ use of canes, walkers and wheelchairs is not uncommon, said Mr. Woodworth. “If techs escort all patients from the waiting room to the clinical area, tech time is wasted and patient throughput suffers. If patients are brought to the technicians, perhaps by a less-skilled, lower-paid individual, technicians will then have more time to work with patients, thus increasing throughput.”

When physicians won’t let go. “Suppose you notice there are long periods of time throughout the day in which techs have nothing to do, yet the physician is struggling to keep up with patient volume. This may indicate that the doctor is unwilling to delegate the most time-consuming tasks,” said Mr. Woodworth.


Cross Training and Certification

The danger of narrow specialization. “While hiring highly specialized technicians may, on the surface, seem less costly, in the broader scheme of things, it can come back to bite you,” warned Mr. Woodworth. “If, for instance, a practice hires and trains a visual field technician, who will perform the visual fields when that person isn’t in the office?”

The value of cross training. “The bottom line is that, even though technician ‘generalists’ are difficult to find in certain areas of the country, and difficult to train in all areas, patient throughput increases with cross-trained technicians,” said Mr. Woodworth.

Similarly, the practice will benefit if the nontechnical staff are cross trained. It allows the office to function seamlessly when members of staff are out, and it makes it easier for people to help each other out when the practice is running behind. “How far should you go with cross training? This will depend on the individual circumstances of your practice and the extent of physician buy-in,” said Ms. Shuman. “The efficient practice will attempt to cross train among pods, among clerical and clinical staff, and among departments. It takes many months to reach fully cross-trained status, but it is well worth the effort. The patients benefit from staff who are knowledgeable in all aspects of patient care, members of staff benefit from a better understanding of why patients are scheduled the way they are, and phone triage is more consistent.”

The value of certification. Both Ms. Shuman and Mr. Woodworth, who is a former president of the Joint Commission on Allied Health Personnel in Ophthalmology, are vocal advocates for certification. “The techs in my practice are fond of quoting something that I have told them over and over, ‘It’s not the initials after your name that make you a better person—it’s the process you go through to get those initials,’” said Mr. Woodworth.

“The level of confidence is increased tremendously once the initials are earned,” added Ms. Shuman. “And often, once people are certified, they discover that they’re committed to a career rather than just a job. Many certified personnel have a desire to learn more as they progress. In this age of increasing technology, diagnostic testing and new treatments, there is a greater demand for qualified personnel. As an administrator, if all things were equal, I would prefer to hire someone who has made this commitment than someone who has worked uncertified in the field for the same number of years.”


Further Reading

For further productivity tips, visit www.aao.org/practice_mgmt/boomer.cfm and download three white papers describing three different practice models—physician only; physician with technicians; and physician with technicians and optometrists.

To read an article by Mr. Woodworth, “Efficiently Using Ophthalmic Medical Personnel” (Techniques, March 2008), visit www.aao.org/aaoe and then select “Newsletters.”

To read more on techs, visit www.eyenetmagazine.org/archives for tips on when to add them (March, 2008), how to hire them (May, 2008) and how to train them (June, 2008).


The AAOE program in Atlanta features several sessions devoted to practice efficiency. These include:

Conquering Patient Flow (Sunday, Nov. 9, from 3:15 to 4:15 p.m.; search the Online Program for event code “250”).

Designing Medical Office Space: How to Create Efficient, Effective and Patient-Friendly Office Space (Tuesday, Nov. 11, from 10:15 a.m. to 12:30 p.m.; “575”).

FIND OUT MORE. Visit www.aao.org/2008 for the full program.


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