• Practice Perfect

    Ophthalmic Technicians, Part 1: Tackling the Tech Shortage

    Written By: Leslie Burling, Contributing Writer, interviewing Andrea Brown, Sanjay D. Goel, MD, Adeline Stone, COT, CRA, CDOS, and Natalie Loyacano, COMT, ROUB, OSA, OCSR, (f)ATPO

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    Your practice’s use of technicians can be key to improving effi­ciency, but many ophthalmolo­gy practices struggle to recruit enough of them. A solo practitioner and three seasoned practice managers discuss the position’s role, and share tips on recruitment.

    Techs Can Play a Key Role

    Ophthalmic technicians can be integral to an efficient ophthalmology practice.

    Helping physicians provide better care. Technicians play a vital role in gathering and managing the data neces­sary to treat your patients. “The infor­mation that technicians gather enables ophthalmologists to put together the puzzle pieces of what is occurring with their patients and provide more robust eye care,” said Adeline Stone, COT, CRA, CDOS, at the Oregon Health & Science University (OHSU) Casey Eye Institute and Portland Community College, both in Portland, Oregon.

    Enabling physicians to see more patients. By performing routine tasks for the physician, technicians signifi­cantly reduce the amount of time a patient spends in the office.

    Why Techs Are Hard to Find

    A nationwide shortage. With fewer than 60,0001 ophthalmic technicians to serve more than 19,000 practicing ophthalmologists in the United States, finding and retaining trained personnel can be a challenge. The fact that de­mand outstrips supply can put techni­cians in a strong bargaining position. “Many certified technicians demand higher salaries, and practices—partic­ularly smaller ones—simply cannot afford that rate,” said Natalie Loyacano, COMT, ROUB, OSA, OCSR, (F)ATPO. 

    Lack of training programs. “Another obstacle we face is the lack of ophthal­mic training programs, which are lim­ited nationwide,” said Andrea Brown, at the Casey Eye Institute. She noted that Oregon has only one such program. Some practices have collaborated with local colleges to increase the supply of certified candidates, but this isn’t an easy process (see “If You Build It, They Might Come,” EyeNet, January 2019).

    The Optimal Number of Techs

    Each practice is unique. Determining the ideal ratio between ophthalmic technicians and physicians “essentially revolves around the practice patterns, patient volume, and complexity of cases seen within a practice,” said Ms. Stone. Practices that treat patients with more complicated cases “typically have lower patient volumes and will likely need fewer technicians,” she said. This contrasts with “practices that manage straightforward cases and annual exams, which usually have a higher patient volume and would generally require a greater number of technicians for support.”

    Sharing techs between two loca­tions. Sanjay D. Goel, MD, is a solo cataract and refractive surgeon who opened two new offices in 2021. He found that having three technicians who travel between both locations is a good fit for his practice. Each tech­nician is cross-trained to answer the phone and schedule appointments. As a result, he found that having a dedicated front desk staff person was unnecessary. “If someone is away from the office for paid time off, the other two can jump right in and fill the gap,” said. Dr. Goel, who practices in the Baltimore region.

    A solo vitreoretinal clinic. Ms. Loya­cano, who is the practice administrator for a solo vitreoretinal clinic in Biloxi, Mississippi, has found that four or five technicians per physician is optimal: two doing workups, one doing testing, one who is a floater, and, if the physician likes to have a scribe, then one more to scribe. “The testing technician facilitates continued flow without disrupting the workup technicians from preparing patients; and the scribe documents the exam and takes any additional history,” she said. “This system eliminates the need for the physician to obtain and document any information throughout the exam—thus allowing the physician to concentrate solely on the patient.”

    Attitude and Aptitude: What to Look for in a Technician

    Personality is key. Personal disposition is at the core of a quality candidate. Ms. Stone said that an individual who is a “positive team player, has empathy to­ward patients, and is customer service oriented tends to excel in this role.” Dr. Goel agreed, and added, “We are a very patient-centric practice. I like my staff to take their time with patients and get to know them, so I look for someone who is friendly and outgoing and who enjoys interacting with others.”

    Certification is important. “Most physicians and administrators see certification as a value to their practice because these technicians usually have much more ophthalmic knowledge and higher skill levels than those who are not certified,” said Ms. Loyacano. “They also tend to be dedicated to the profession because they took the time to learn, study, and take the standard­ized test.”

    The basic, intermediate, and ad­vanced levels of certification are Certi­fied Ophthalmic Assistant (COA), Certified Ophthalmic Technician (COT), and Certified Ophthalmic Medical Technologist (COMT), respectively.

    Is Your Next Tech Already on Staff?

    Ms. Loyacano has found that promoting her front desk staff to technician can be more efficient than hiring from the outside.

    Has a current employee demonstrated tech potential? “The ability to mul­titask is key at the front desk. After spending two to three years in this capac­ity, they learn a lot about ophthalmology, the practice, and the terminology involved,” said Ms. Loyacano. “It is therefore merely a matter of teaching them the technical skills because they have already demonstrated the aptitude and personality to master our practice’s procedures and protocols.”  

    Peer support can smooth the transition. When you train an existing staff member to be a technician, “the work relationships with their coworkers are already established, which can significantly increase the team’s support during the training period—an underlying factor that can foster a successful outcome,” said Ms. Brown.

    Provide training resources. The Academy and AAOE have developed vari­ous resources to support the training process, including:

    • Ophthalmic Medical Assisting: An Independent Study Course,
    • The Ultimate Coding Compliance for Super Scribes and Technicians, and
    • Dictionary of Eye Terminology.

    Purchase these resources at aao.org/store.

    Support those who support you. There is not much room for advancement in Ms. Loyacano’s small practice, so promoting from within is an ideal way for staff to move up. Such internal recruitment can help promote a higher level of commitment from staff.

    Where to Find Candidates

    Go online. The Ophthalmology Job Center (ophthjobs.aao.org) is a clearinghouse for physician and staff positions. It is supported by the Acad­emy and the American Association of Ophthalmic Executives (AAOE). Other options include ZipRecruiter (www.ziprecruiter.com), which Ms. Loyacano uses.

    Network. Ophthalmology is a close-knit community, and communicating with colleagues in the field is a reliable way to both reach out to potential candidates and announce that you are searching for staff. Ms. Brown refer­enced the many social media options available (LinkedIn, Twitter, Instagram, for example) and specifically suggested participating in Facebook groups for “staying abreast of what is occurring in the field and connecting with candi­dates.” Another option is the AAOE’s e-Talk listserv (aao.org/practice-management/listserv).

    Partner with schools. Although oph­thalmic training technician programs are limited nationwide, vocational schools and community colleges can provide an opportunity to tap talent and make students aware of the oppor­tunities within ophthalmology. Con­tacting the program director is the first step for developing a relationship, said Ms. Stone. “Reach out to this individual and ask about any opportunities for students to participate in the clinical environment.” Such clinical experience may be a requirement of the student’s program, and you can invite students to “work in tandem with your team, in a hands-on basis,” said Ms. Stone. “At the end of their clinical experience, you can directly recruit from the program and hire them—a win-win for everyone.”

    Now Is a Good Time to Recruit

    COVID-19 has had an inverse effect on the availability of ophthalmic technicians. Some practices were able to main­tain their staff by securing Paycheck Protection Program loans; others are slowly rebounding; and many permanently reduced their staff due to the sudden decline in patient load that resulted from the uncertainties and restrictions related to the pandemic. As a result, more ophthalmic technicians are looking for work, noted Ms. Stone. “Our applicant pool has been larger than we normally would see. There have been more trained and certified techni­cians looking for work in the last year than we have previously experienced.”

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    NEXT MONTH. Tips for training and retaining ophthalmic technicians.

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    1 www.bls.gov/oes/current/oes292057.htm. Accessed March 15, 2021.

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    Ms. Brown is director of clinical operations at OHSU Casey Eye Institute in Portland, Ore. Relevant financial disclosures: None.

    Dr. Goel is a solo practitioner at Goel Vision, which has two locations near Baltimore. Relevant financial disclosures: None.

    Ms. Loyacano is the practice administrator for a solo vitreoretinal clinic in Biloxi, Miss. Relevant financial disclosures: None.

    Ms. Stone is the practice manager for the comprehensive eye care division of OHSU Casey Eye Institute and a part-time faculty member at Portland Community College’s ophthalmic medical technology program. Relevant financial disclosures: None.

    For full disclosures and the disclosure key, see below.

    Full Financial Disclosures

    Ms. Brown None.

    Dr. Goel Carl Zeiss Meditech: C.

    Ms. Loyacano None.

    Ms. Stone None.

    Disclosure Category

    Code

    Description

    Consultant/Advisor C Consultant fee, paid advisory boards, or fees for attending a meeting.
    Employee E Employed by a commercial company.
    Speakers bureau L Lecture fees or honoraria, travel fees or reimbursements when speaking at the invitation of a commercial company.
    Equity owner O Equity ownership/stock options in publicly or privately traded firms, excluding mutual funds.
    Patents/Royalty P Patents and/or royalties for intellectual property.
    Grant support S Grant support or other financial support to the investigator from all sources, including research support from government agencies (e.g., NIH), foundations, device manufacturers, and/or pharmaceutical companies.