Tech Crisis! Hiring and Retaining Staff in a Pandemic-Altered World

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“Staffing is the no.1 problem for everyone,” said Daniel J. Briceland, MD, in solo practice in Carefree, Arizona. Indeed, in a recent survey of ophthalmologists in Utah, 53% of respondents agreed that they have faced increased challenges in hiring and retaining technicians since the start of the COVID-19 public health emergency, said Jacqueline Pullos, COMT, OSC, CTC, who sent out the questionnaire. In ad­dition, 67% of respondents have been continually or frequently understaffed in the past two years. “I think you might find similar results in a national survey,” said Ms. Pullos, a technician trainer at University of Utah Moran Eye Center and past president of the Association of Technical Personnel in Ophthalmology (ATPO).

The technician shortage is likely to be ongoing. While hiring technicians has been a particular challenge for many years, the pandemic exacerbated the problem. And it appears that the shortage will continue. One projection estimates that the number of U.S. ophthalmic technician jobs will increase from 60,900 in 2020 to 69,600 by 2030.¹ With technician turnover now endemic, what can your practice do to stay fully staffed?

Retaining Staff Has Gotten Harder

Maintaining a settled roster of technicians has, for several reasons, become even more difficult over the last couple of years.

Pandemic’s onset caused staffing turmoil. When COVID-19 broke out, some technicians changed jobs or retired because of the uncertain­ties and stressors that accompanied the pandemic, said Bansari Mehta, MHA, director of operations at Eye Associates of Southern Indiana, which has multispecialty locations across Indiana and Kentucky. Others gave their notice because of, for example, difficulty in finding childcare during that time. Now, with many people less fearful of the disease as vaccines have become available, other factors have come to the fore.

Pay is increasingly an issue. Because of the overall labor shortage in the United States, em­ployers in many industries have increased wages to fill positions, even in traditionally lower-paid types of employment. Consequently, some oph­thalmic technicians are quitting their jobs to make more money in a different line of work. “We’re competing with fast-food chains,” said Bradley S. Henriksen, MD, with Excel Eye Center, which has locations throughout central Utah.

Furthermore, ophthalmology offices sometimes have a hard time retaining employees if larger medical facilities can offer more in the way of pay and benefits. “Salary is the most common reason why people leave,” said Shawn Carter, OSC, COE, administrator at F.J. Sauerburger, MD, PA, in Waldorf, Maryland, which is within commuting distance of major hospitals and medical centers in Washington, D.C. Those large health care systems can pay employees a significantly higher wage than her small practice can, she said.

Some people have reset their priorities. During the pandemic pause, some technicians realized that they would prefer to change careers—or to stay home and care for children or other family members. Ms. Carter recalls one former employee who, after the office shut down for two months at the beginning of the pandemic, elected to stay home with her 1-year-old.

When Hiring, Cast a Wider Net

Given a tight labor market for technicians, prac­tice managers are considering candidates with a broader range of prior experience to expand the pool of potential applicants.

Consider applicants who are looking for a change in medical vocation. Ms. Carter looks for people with medical training who can easily shift to ophthalmic technician work. Among her hires have been a former veterinary technician and a certified nursing assistant who worked at a nurs­ing home, both of whom wanted to stay in health care but not at the jobs that they then had.

Consider those who’ve excelled in the service industry. One of Ms. Carter’s hires was a waitress, who had demonstrated in her previous job a tal­ent for multitasking. Likewise, said Dr. Henriksen, “We look for people who can handle a fast-paced environment and have experience in the service industry,” adding that basic skills like showing up on time and being responsible are also vital.

Look for those who will put your patients at ease. Said Ms. Carter, “We hire more for per­sonality.” Being comfortable talking to people—especially senior citizens, who are typically the majority of ophthalmologists’ patients—and tak­ing time to answer a variety of patient questions are important qualities to look for in potential employees, said Dr. Briceland.

Tap Into Current (and Past) Employees

Important avenues for hiring include identifying current staff members who are interested in mov­ing to an ophthalmic technician job, along with keeping out the welcome mat for past employees.

Promote from within. If an employee is inter­ested in becoming a technician, they can job-shadow to see if it appeals to them and if the job would be a good fit, said Ms. Mehta. “This has been extremely successful for us,” she said.

Why it works. Current employees are already familiar with the language and lingo of the office, which is helpful in their technician training, said Ms. Mehta. “You can almost always tie something you’re teaching to whatever the employee was doing before,” added Ms. Pullos. “For example, schedulers already know a little about history-taking; surgery schedulers know something about ocular conditions; and opticians can speak the language of optics.” And knowing the office culture is a plus all by itself, she said.

Support staff training. In addition to on-the-job-training, Ms. Mehta said that her practice works with technicians to help them become cer­tified (see “Technician Training”) and will also pay for the necessary classes and tests.

Keep in touch with ex-employees. It always makes sense to stay on good terms with former employees, said Ms. Mehta. Employees who retire or change jobs may find they miss their work at your practice. Ultimately, they could come back and decide on re-employment.

Nine Tips for Publicizing Vacancies and Contacting Applicants

Some practices are getting creative in finding potential hires, but long-standing methods such as job websites are still important.

1. Use your waiting room to publicize job op­portunities. Cards and flyers posted in the waiting room have proved to be a surprisingly good way of finding applicants, said Ms. Mehta. “Patients have friends, children, or grandkids who may want to apply for a job.”
2. Encourage staff to put the word out. Word of mouth, while less effective than it used to be, is still another viable option, said Dr. Henriksen. Typically, this is informal and involves staff mem­bers reaching out to friends and acquaintances, added Ms. Pullos.
3. Use your practice website to advertise vacancies. Dr. Henriksen said that his practice is adding a careers page to its website to provide in­formation on job opportunities and to encourage people to apply, and search engine optimization (SEO) criteria can make those job listings easier to find in internet searches, he said.
4. Find applicants online. Posting jobs on social media and taking part in virtual job fairs are among the ways Ms. Pullos and others in her clinic have been seeking out potential employees, though they also still attend in-person job fairs.
5. Make a video to promote your practice as a great place to work. Ms. Pullos said that Moran Eye Center has been making recruiting videos. These are primarily used on social media, but they also run on monitors in the background at job fairs.
6. Explore your options for placing advertisements online. Job search websites include the following:

• The Ophthalmology Job Center (ophthjobs.aao.org/), which is supported by the Academy and the American Academy of Ophthalmic Executives (AAOE).
• General job search sites, such as Indeed (www.indeed.com), ZipRecruiter (ziprecruiter.com), and regional employment websites.
• Career Connection (https://atpo.org/library/career-connection), which is a partnership be­tween ATPO and Local Eye Site.
• Career Center (https://www.jcahpo.org/careers/for-employers), which is run by the International Joint Commission on Allied Health Personnel in Ophthalmology (IJCAHPO, formerly JCAHPO).

When using Indeed, Dr. Henriksen suggests paying an additional fee to make advertisements more prominent. (You pay this fee when people click on your advertisement, and you can limit how much you pay each day.)

7. Ask training programs about their newslet­ters. Contact colleges and universities that offer medical assistant programs and see if you can place job listings in their email newsletters.
8. Decide whether to call or email a job candidate. Dr. Henriksen noted that younger job seekers are less likely to answer phone calls, so he suggested emailing them after they apply, rather than calling.
9. Consider starting with a remote interview. “We set up Zoom meetings for the first interview,” said Dr. Henriksen. “The response rate [of people showing up for the interview] is much higher.” If that initial interview goes well, an in-person interview is the next step.

Technician Training

In addition to in-house training, some practices pay for additional technician training and classes. Ms. Carter is at one such practice, and she said that technicians are also urged to attend meetings held by the local eye society to glean information that will be useful on the job.

The significance of certification. Certification is extremely important, since it provides proof of a minimum standard of education, said Ms. Pullos. She quoted Sergina Flaherty, COMT—a technician who lectures on tech train­ing—as saying, “Certification doesn’t make you a tech, but it tells people you are a tech.”

Three levels of technician certification. The certifications are as follows:

• COA—Certified Ophthalmic Assistant (basic)
• COT—Certified Ophthalmic Technician (inter­mediate)
• COMT—Certified Ophthalmic Medical Tech­nologist (advanced).

The certification exams are overseen by IJCAH­PO (www.jcahpo.org). Ms. Carter said her practice works with staff who want these certifications and reimburses them for their expenses.

Getting started with certification. The Academy offers an ophthalmic medical assistant text­book and online exam (see “Training Resources”) that can serve as a prerequisite for IJCAHPO’s COA exam. For more on technician training, including the importance of cross-training, see “Ophthalmic Techs, Part 2: Training and Retain­ing” (EyeNet, June 2021).

Boost Recruitment, Reduce Turnover

Practices are turning toward incentives to hire and retain ophthalmic technicians, including increases in starting pay.

Can you afford to pay more? Until recently, the pay scale for technicians had not changed for quite a few years, said Dr. Briceland, with the result that the average starting wage was not attractive to many potential employees. His small office raised its starting pay for technicians earlier this year.

(Nationally, wages for technicians in 2021 ranged from $13.90 to $28.12 an hour, according to data published by the U.S. Bureau of Labor Statistics last March.²)

Do you offer a competitive benefits package? Ms. Mehta said that her large practice, which has 20 doctors and about 200 employees, has a com­petitive wage and benefits package that includes a health care plan, among other benefits. Dr. Henriksen added that at his practice, which has 15 offices, employees are offered health and dental insurance, as well as a 401K, profit sharing, and a pension plan.

Do staff receive recognition throughout the year? Technicians at Dr. Henriksen’s practice are rewarded with pay increases when they earn certifications. In addition to rewarding staff for sharpening their skills, some practices plan special events and extras for their employees, ranging from recognizing birthdays and other milestones to special outings for staff members, such as day trips. “Our doctors are great about holiday celebrations and thank-yous to employees,” said Ms. Carter. “We also have a staff appreciation day.”

Did COVID disrupt practice cohesion? Dr. Henriksen said that because COVID shut down a lot of the usual morale and team-building activities for employees, office cohesiveness has suffered. He said that his practice has been work­ing to recreate that sense of unity among its 100 employees. “We’re trying to be more conscious of that … if we’ve had a busy day in the clinic, we’ll give an incentive (lunch, gift card, etc.) to every­one. We want to reward them for working really hard in stressful situations.”

Are you fostering a supportive work environ­ment? A supportive work environment is essen­tial, said Dr. Briceland. It can improve teamwork, boost morale, and “is critical to keep people happy,” he said. In a small team, where staff all interact with each other each day, it can be easier to foster and maintain such an environment. “But the more people there are in the office, the more challenging it is,” he said.

Can you cultivate a happy patient–happy staff virtuous circle? Dr. Briceland noted that there’s a feedback loop between the way patients are cared for and employee satisfaction. If patients are not happy with their time at the ophthalmologist’s office and they complain, that affects the attitudes of the staff. And the way staff are treated and get along with each other will affect patient satisfac­tion, he said.

Are you supporting your technicians’ career goals? Savvy practice managers can earn techni­cians’ loyalty by helping them to advance on their career path by, for example, encouraging them to take courses and pursue certification. Even if a technician intends to someday enter a differ­ent field, it’s worthwhile to be supportive, said Dr. Briceland. His current part-time technician intends to go to nursing school classes at night and eventually become an RN. However, since this is years in the future, Dr. Briceland feels that by being understanding and appreciative of her career goal, he will have a loyal employee for as long as she is still in nursing school. “If you have great employees, you encourage them to follow their dreams,” he said.

Do You Know If Your Staff Are Happy?

Last but not least, it’s worthwhile to address employees’ sources of discontent before they start looking for alternate employment.

Touch base with technicians frequently. Pe­riodic reviews are important not only to discuss job performance, but also to ascertain whether technicians are still content in their work, said Dr. Henriksen. If they need additional challenges or would like to learn a new skill, “it’s important to have a sense of that before they look elsewhere,” he said.

Maintain an open door. Communication with employees is all-important in the office setting, said Ms. Mehta, and she makes sure her door is always open for anyone to come in for a chat if they are having issues. “We’re extremely big on happiness,” she said.

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1 https://www.bls.gov/ooh/about/data-for-occupations-not-covered-in-detail.htm#Healthcare%20practitioners%20and%20technical%20occupations. Accessed Aug. 15, 2022.

2 https://www.bls.gov/oes/current/oes292057. Accessed Aug. 15, 2022.

Meet the Experts

Daniel J. Briceland, MD Solo prac­titioner in Carefree, Ariz. Relevant financial disclosures: None.

Shawn Carter, OCS, COE Adminis­trator at F.J. Sauerburger, MD, PA, in Waldorf, Md. Relevant financial disclosures: None.

Bradley S. Henriksen, MD Pedi­atric ophthalmologist with Excel Eye Center, which has locations in central Utah and Utah County. Rel­evant financial disclosures: None.

Bansari Mehta, MHA Director of operations at Eye Associates of Southern Indiana, which has loca­tions in Indiana and Kentucky.Relevant financial disclosures: None.

Jacqueline Pullos, COMT, OSC, CTC Tech trainer at University of Utah Moran Eye Center in Salt Lake City. Relevant financial disclo­sures: None.