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May 2008

Practice Perfect: Coding & Reimbursement
Boost Practice Efficiency, Part Four: A Good Tech Is Hard to Find
By Barbara Boughton, Contributing Writer

For more than a decade, there has been a shortage of ophthalmic technicians in most cities in the United States. Indeed, it is estimated that there’s a need for an additional 6,000 ophthalmic medical personnel, according to the American Academy of Ophthalmic Executives. So these days you must be increasingly creative in order to find and retain the best technicians.

Where to Find Candidates

How do you track down those hard-to-find ophthalmic technicians?

Ask your current staff. “I’ve hired a few people through ads, but one of the most successful ways I’ve found to recruit personnel is through referrals from techs who already work in our office,” said Traci Fritz, COE, administrator of the Fite Eye Center in Detroit, and a board member of AAOE. “Our techs know who’s really good—and they’ll know of people coming back into the field after an absence to raise children, for instance, or those who are moving to a new city.” An employee referral program with rewards for those who refer successful job applicants can be helpful, but you need to promote it openly to all your employees.

Advertise online and at professional meetings. Ms. Fritz has found that newspaper ads tend to attract a lot of applications from those who aren’t qualified. “Trade associations, such as the Association of Technical Personnel in Ophthalmology (ATPO), offer job listing services to employers around the country,” said Lynn Anderson, PhD, as does the AAOE (go to and select “Professional Choices”). Openings can also be posted during the AAOE, JCAHPO and ATPO annual meetings in November or at regional continuing education programs. Other alternatives include Internet job boards, like Craigslist, said Ms. Anderson, who is executive director of the Joint Commission on Allied Health Personnel in Ophthalmology (JCAHPO). “Younger people are attuned to looking online for jobs,” agreed Richard H. Lee, MD, who is in private practice in Oakland, Calif. “And it is far more cost-effective than advertising in the local paper.”

Write a job ad that sells the position. When you write a job ad, give it an attention-grabbing headline or introduction. Briefly describe the work as well as the “must have” skills, but keep in mind that an exhaustive list of job responsibilities or necessary skills may scare off potentially good applicants. If you can teach some skills, then mention that in the ad—learning these skills then becomes a job “perk” for applicants. Describe company benefits and any positive aspects of the work environment, such as flexible work hours or interesting and challenging work. In other words, your job ad should distinguish your position from the competition, said Ms. Anderson.

Consider the candidate who isn’t yet qualified. Students enrolled in ophthalmic training programs may be able to work part-time. You can offer them an increase in pay when they finish their academic programs. Medical assistants who have prior work experience within a medical setting may also be good candidates for ophthalmic technician jobs, although they’ll need to undergo specific ophthalmic training.

How do you know that the time and effort invested in training a medical assistant will be worthwhile? “One strategy is to hire people who recently finished a medical assistant program and put them in front office positions,” said Dr. Lee. “Then you can see if they have the skill levels and other abilities to make a good ophthalmic tech.”


Look to the Front Office

Is your next tech already on staff? “If techs come up from within the ranks, they understand the needs of the practice from the beginning,” said Steve Robinson, a senior consultant with Advantage Administration in Dallas. As chief operating officer of a practice in Dalton, Ga., he found that some of the best techs were those he promoted from front office staff.

Character traits to look for. Mr. Robinson always looked for several qualities in candidates for cross-training. These traits include natural curiosity, a willingness to learn new skills and, since techs deal with the public all day, an outgoing personality.

Invest time in training. It can take a year or more before someone in the front office staff is ready to work independently as a tech, said Ms. Fritz.


Selecting the Right Candidate

Once you have a pool of candidates to choose from, the next step is to use interviews to winnow down the ranks. Here, your task is to speak positively about your practice and the job of ophthalmic technician, and to assess the candidate’s skills with some tough questions. Questions should center on education and training, certification and licensure, and previous ophthalmic employment. You should also ask the candidates about their capabilities in handling ophthalmic equipment and what kind of patient experience they’ve had.

Ask three types of questions. During an interview, questions should be informational, behavioral and introspective, according to Ms. Anderson. Informational questions are those that center on the candidate’s experience. Behavioral questions are those that ask the candidate about how they’ve handled job certain job situations in the past. Introspective questions give you a sense of the candidate’s strengths and weaknesses, as well as his or her personality. Questions that Ms. Anderson would ask include: How would you deal with a difficult person during an eye exam? What are your long-term career goals?

Assess the candidate’s know-how. How do you determine each candidate’s knowledge of ophthalmology and level of technical skill? Ms. Fritz often asks technical questions about biometry measurements to assess the candidate’s skill. She’ll also ask a job candidate to undergo testing in the office. She may ask one to do measurements for a cataract lens implant, for instance. Or she’ll ask the candidate to perform a refractive exam. “I like to ask them to do a refractive exam on me because I have mild nearsightedness with astigmatism. If they can capture my prescription correctly, I know they have some of the skills necessary,” said Ms. Fritz.

Encourage the candidate to ask questions. You often can assess their skill and knowledge level through the questions they ask, Ms. Anderson said.

The candidate should have more than one interview and more than one interviewer. The most difficult issue to assess is the candidate’s personality and whether he or she will fit in with the rest of the office staff. “That’s why multiple interviews with different people in the practice are important,” Ms. Anderson said. “Different people can see different sides of a candidate.” Multiple levels of interviews can also help you tease out those candidates who simply look good on paper from those who truly will be an asset to your staff, she said.

Put the candidate’s pros and cons on paper. Before the hiring decision is made, it’s good to do a written evaluation of each candidate, said Ms. Anderson. Two good ways to do that are a narrative evaluation and a critical factors evaluation. In the narrative evaluation, you summarize the highlights of the candidate’s skills and how well he or she measures up to the position. In the critical factors evaluation, you score each candidate in several categories. Totaling up each candidate’s score can provide a systematic means for summarizing how well the various candidates match the job requirements.


Retaining the Right Candidates

Once the best candidates are hired, however, the question becomes how to retain them for the long term. Although there’s a perception that there’s a large amount of turnover among ophthalmic technicians, the opposite is actually true. The ATPO recently performed a survey of almost 2,200 ophthalmic technicians. Eighty-four percent of those who received a survey responded. The survey found that responders had spent an average of more than 15 years in ophthalmology, eight years in their current position, and more than eight years with their current employer. Still, it is crucial to retain good employees, and our experts had some advice on that.

What employees want. A recent survey of 1,200 U.S. adults—not specifically techs—found that pay was not as important (it ranked 10th) as health benefits (first) and other less tangible benefits such as working in an office that has clear procedures (third) and that has a flexible, family-friendly environment (fifth). Other top concerns included the retirement plan, job security, being able to get quick decisions, being able to work with talented managers, and being creative and intellectually stimulated. This survey was performed by Princeton Survey Research Associates International.1

What you can offer. One of the keys to retaining good employees is to make sure they understand that they’re really contributing to the success of the practice. Several of the most important employee retention strategies for ophthalmic techs are a competitive salary and benefits, and a good relationship with the supervisor and MD. For some ophthalmic technicians, career advancement is important—so large practices are more likely to meet their needs. Written policies and procedures that make the office worker-friendly are also crucial, Ms. Anderson said. In the end, it’s important to hire an ophthalmic technician who will be happy in your office, as well as one who has the right skills, our experts agreed. “You need to establish that they ‘click’—that they’re the right fit for your particular office,” Ms. Fritz said.

1 Go to, select “News” and see the Jan. 3 news release.

Further reading. For more tips and resources on hiring techs, look for the AAOE’s Allied Health Recruitment & Training Tool Kit at

NEXT MONTH: Part five—On the job training for the tech-to-be.


Meet the Experts. The AAOE program in Atlanta includes four Instruction Courses presented by this month’s interviewees.

Ms. Anderson will present “On the Job Training Strategies for Your New Ophthalmic Assistant” (Tuesday, Nov. 11; search the Online Program for event code “540”).

Ms. Fritz will present “Staff Training for Efficiency” (Monday, Nov. 10; “462”) and “Meeting the High Expectations of Today’s Patients” (Tuesday, Nov. 11; “559”).

Mr. Robinson will present “Pay, Bonuses and Evaluations: A System That Works!” (Monday, Nov. 10; “343”) and “Is It Possible to Train People to Give Outstanding Customer Service?” (Monday, Nov. 10; “391”).

Find out more. The program will be online by the end of this month at Course tickets go on sale to AAOE and Academy members on June 21.