Staffing Your Ophthalmology Clinic and Practice

By Jane T. Shuman, COT, COE

Congratulations! You have just completed your residency in ophthalmology and perhaps even a subspecialty fellowship. You have joined an existing practice, agreed to succeed a retiring ophthalmologist, or are about to hang out your own shingle. You have been busy credentialing with the various health insurance plans, buying office equipment and other bare bones necessities. Now it’s time to turn your focus to staffing your clinic.

As you know, ophthalmology is different in many ways from much of medicine. The responsibilities given to ophthalmic assistants are one such variation. Not only do technicians take vital signs (vision and pressure), but a detailed history and accurate ancillary tests will help the ophthalmologist diagnose or monitor progression of eye disease. In many practices, the eye care provider also reviews and issues the manifest refraction performed by allied health personnel. Over time, the ophthalmologist learns to trust the data in the record and finds himself repeating tests less frequently.

According to the Census Bureau, the population is aging as the Baby Boom generation reaches maturity. It is predicted that there will be over 46,000,000 seniors (age 65 and older) by 2015 and over 54,000,000 in the year 2020. Not only do we need additional ophthalmologists and other doctors to address the increase in health problems, but those eye doctors will need additional staff to work up this volume of patients in an efficient manner.

To date, there are approximately 30,000 ophthalmic specific allied health personnel in the United States, half of whom hold certification as an assistant, technician or medical technologist. There are a limited number of accredited programs in Ophthalmic Assisting. Currently, there are no mandates regarding certification or licensure as clinical staff works under the license of the ophthalmologist. Your signature validates the findings documented by your staff.

Because of the increasing shortfall of experienced personnel, more and more practitioners are training staff personally. This is the time to do so since it is unlikely you will have a full patient load from the get-go. Although this will require a great deal of effort and planning, the rewards are numerous: loyalty and appreciation cannot be measured. The new hire is taught “your way”; there is no need to unlearn or relearn bad habits. If you hire someone with the interpersonal skills and other attributes for which you are looking, he or she should be able to learn the skills necessary to perform.

So how and where do you find this person? Ideally, you want to hire someone with health care experience. It might be a medical assistant, LPN, or a receptionist with outstanding follow through and attention to detail. If you are in an area with a community college or other educational institution, speak with the Career Services Department. At some point in time you might even consider becoming an internship site for medical assisting students. Craiglist.org and other internet resources seem to draw a greater number of respondents than traditional want ads. They are usually more economical, as well. If computer expertise is an important factor (i.e., the integration of an electronic medical record), the online postings will likely satisfy that requirement.

Once you have hired the trainee, assume they know very little about eyes and begin with the foundation. It is helpful to provide him or her with a copy of “the Ophthalmic Assistant”, available through the American Academy of Ophthalmology. This is also the recommended text for the Home Study test, a precursor to certification. Use three-dimensional visuals to demonstrate physiology and pathology.

The new hire should be provided with a list of commonly used ophthalmic abbreviations, so you and he/she can speak the same language on paper. She needs to become familiar with the forms you use and ocular triage before she can begin helping you. Once you are ready to begin, assuming the patient load is still light, work together. Just as in medical school, you watched before you performed and later instructed, the processes in the office should be similar.

Once you are satisfied with her histories and vision, progress to ancillary testing. Provide the rationale for the various tests, such as confrontational fields, Amslers and pupils. Verify that she is performing them accurately before you allow her to “go solo.”

Your new clinical staff may need encouragement to ask questions. Don’t forget to close the loop and explain interesting cases, particularly those she participated in. Have her look in the slit lamp as you progress. After all, a picture is worth 1,000 words.

Together, you will grow your practice and she is likely to instruct future new hires.

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Jane T. Shuman, COT, COE
Eyetechs
71 Commercial St
Box 277
Boston, MA 02109
p: 617-314-6400
f: 617-367-5964
http://www.eyetechs.com/

Jane T. Shuman, C.O.T., C.O.E., President of Eyetechs, Inc., is a nationally recognized authority on clinical flow, scheduling and technician education. She worked in a high volume ophthalmology practice for over fifteen years and founded Eyetechs Inc. in 1999.

During her work as an Ophthalmic Technician and Clinical Manager, Shuman has seen first hand the many important issues confronting today’s busy ophthalmology practices. Based on her past experiences, she has learned the importance the proper schedule and competent technicians have on efficient patient flow and practice revenue.

Jane has taught countless seminars on the integral aspects of today’s busy ophthalmic practice including at many annual conferences of both the American Academy of Ophthalmology and the American Society of Ophthalmic Administrators. Jane is the current Director of the Nursing and Allied Health Program of the Royal Hawaiian Eye Meeting and has served as the Director of the Massachusetts Society of Eye Physicians and Surgeons Technician Training Program, helping to earn the 2002 AAO Star Award for Programs for Ophthalmic Administrators and Technicians. She has served on the Board of Directors of the American Society of Ophthalmic Administrators.

She has published numerous articles can be found in many publications such as Review of Ophthalmology, Administrative Eyecare, Ophthalmology Management and Eyeworld. JCAHPO approved online courses can be found on the Allergan Access website at http://www.bsmconsulting.com/.