Managing a practice can be difficult, and it’s harder if you have a lot of staff turnover or run into trouble hiring good people. Having a well-established team of technicians, managing partners, administrators and desk staff members can help improve a practice’s overall efficiency and profitability. Here, experts in ophthalmic practice management share their tips on how to properly hire, train and retain staff.


Bringing People In

“Having the mission, vision and values clearly defined allows new people in your organization to feel connected to something, which then promotes satisfaction and, hopefully, retention,” says Laura Baldwin, senior consultant at BSM Consulting, an ophthalmic practice management firm based in Reno, Nevada. “The mission, the vision and the values of the organization—those need to be clearly defined so employers can articulate, ‘Why would someone want to come work for me?’ People coming into employment want to know that there’s meaning behind the work, that they’re going to work with good people, that they’re going to be valued and they’re going to be able to deliver value,” she says.

There are many systems for hiring staff, but recruitment has gotten more difficult over the years. “A couple of years after the pandemic, the difficulties have been paramount, and we’re just now beginning to see in our clients some softening of that difficulty,” says John Pinto, president and founder of J. Pinto & Associates, an ophthalmic practice management firm based in San Diego. “The typical smart administrator is spending more time than they had in the past trying to develop a candidate pool, both through online routes like Indeed, and also through encouraging the existing staff to refer their friends and community contacts to the practice.” 

Training employees to retain them is always good practice. According to a 2021 AAO survey, 20 percent of employed technicians were trained as Certified Ophthalmic Assistants, 6 percent were trained as Certified Ophthalmic Technicians, 36 percent were trained in various certifications, 20 percent were trained but not certified and 18 percent have no training or certification at all.

For lists of ophthalmic job openings, societies such as the American Academy of Ophthalmology and the American Society of Ophthalmic Administrators post job boards online. According to their websites, job postings are only available to organization members, but all website visitors can freely create a profile, apply to the posted jobs and monitor recent applications.

Experts say that practices need to be accepting of individuals with little to no health-care experience for certain office positions. “I always tell clients, ‘If you’re at Starbucks and you get really great service from a barista and it’s somebody you want to work your front desk, then you can train them on the skills,’” says Ms. Baldwin. “Hire them for personality and attitude, train them for the skills.”

Erica Jahnle, the chief operating office and practice administrator for Jahnle Eye Associates, a suburban Philadelphia practice with a staff of 40, says that prospective employees are often interested in a higher salary and some way to help achieve a work/family balance. “Salary requests have gone up a lot,” she says. “They’ve increased about 20 percent over the past two to three years—it’s remarkable. This applies even to our starting salary, for people with no experience in an ophthalmic, optometric or even a medical office. We want to hire nice, kind people who want to do the work and show up, but don’t necessarily have experience or a certain degree.

“One thing that’s the hardest for both current staff as well as those coming in is balancing childcare with work,” Ms. Jahnle continues. “That’s one of the reasons people sometimes leave or go part-time. We generally try to accommodate that need, because if we like someone, we want them to be here. However, it’s hard to balance, because we simply need staff when patients are coming in for their appointments. Sometimes that means hiring additional staff if someone has to cut down their hours. Unfortunately, we’ve lost some fantastic staff because we can’t help employees a lot with this, but it’s something they’re looking for. I wish the U.S. would change the system so providing childcare wasn’t such an extraordinary cost.”

In 2021, the AAO surveyed 9,000 ophthalmologists about their practices. Of the results, one-third of participants experienced physician burnout. This was due to individual challenges and unexpected burdens from the COVID pandemic. According to the survey, physican burnout impacted solo practices (23 percent) less than group practices (27 percent) and practices in larger patient concentrations (health systems, hospitals, multispecialty facility; 51 percent). 

Retaining Good Staff

After employing new staff members, the next step is to train them. Mr. Pinto says, “The average practice 20 years ago didn’t have, for example, an operating manual describing, ‘How do we answer the phones?’ Or ‘How do we escort a patient down the hall and put them in Room 3?’ There’s an awful lot of work that’s been done to manualize practices, write down the standardized operating procedures and review those procedures. Those written manuals are not only useful as training guides, but also as a process of maintenance documentation, a kind of accountability document to ensure everyone works the way they’re first trained.”

It’s best to understand the impact staff training has on a practice and how it can be used to retain staff in the future. “Nowadays, staff training puts more burden on a practice because you’re bringing in people who are new to the specialty or in some cases new to eye care,” says Ms. Baldwin. “Therefore, it’s not just about the initial training. It’s about ongoing training and development for employees who’ve been there for a year or two, and who’ve become proficient at their jobs. What are you doing to continue to grow and develop that employee so that they see value in staying with your organization and see the opportunity for perhaps a career path in your organization? You train to retain.”

Ms. Jahnle says that her staff’s ability to move into a new role can help keep people engaged and refreshed. “In performance reviews, we ask if there are additional things a staff member is interested in learning,” she says. “We’ve had some who’ve moved to different departments: For example, two individuals started out as receptionists but then became billers after many years. A receptionist became an optician, and we’ve also had receptionists graduate to becoming ophthalmic technicians. Sometimes, people come in thinking they want to do just one thing here, but after a while they think, ‘Maybe I could do the other thing instead.’ ”

In order to successfully train staff members, practices need their physicians, managers and administrators to become experts in leadership. “Employers really have to understand the motivation of each team member and how to coach, mentor, teach and train them to get the best out of them,” says Ms. Baldwin. “They’re not only having to deal with the operational leadership of a practice, but most importantly the human leadership of the practice, the unique generational differences within organizations, and what motivates somebody who may have been in the workplace for 30 years versus what motivates somebody who’s just coming into the workplace.”

Ms. Jahnle says one of the keys to retaining staff is communication. “I think the thing that I value, or most staff members seem to value, is being willing to listen to them,” she says. “They should feel that they can come to me if they have a problem with another staff member or a patient, or even a personal problem. For some managers, sometimes it’s easier to avoid things, but I feel it’s better to take things head on. For instance, this morning we had a meeting from 8 to 10. Before the meeting, we asked everyone if there’s a concern or something they want to address at the meeting. We spent a lot of time letting staff discuss tips for other staff and their concerns. It helps everyone feel that they’ve bought in on what we’re doing.

“I also keep them in the loop on how the business is doing,” Ms. Jahnle continues. “What are our goals, and what’s the product we’re selling?”


Ongoing Challenges

Of course, there are instances in life that may affect staff retention. In 2020, many staff members were furloughed due to the pandemic and individuals weren’t seeking positions in ophthalmology. According to the Bureau of Labor Statistics, 58,600 technicians were employed in the United States in 2019. In 2020, due to the pandemic, there were 57,310 ophthalmic technicians in the United States. Due to this drop, BLS projected that approximately 65,700 technicians would need to be employed by 2030. According to recent BLS data, 66,060 technicians were employed in 2022, filling the projected total of ophthalmic technicians in the United States.

“I would say one of the most important things that the average practice leader learned from the pandemic was to not sweat the small stuff,” says Mr. Pinto. “We used to think that losing an important staff member or losing your leads or having a doctor who’s productive give their notice was a major crisis. In light of, and in comparison to, what COVID inflicted, those things are just kind of a walk in the park. Leaders gained a new appreciation for how they could manage in the face of any number of other crises that occur.

“I tend to not catastrophize, and I suspect that even if we had another COVID pandemic like the original version and the incidents and severity was equivalent to the last round we had in 2020, that not only will the national public health response be different, but also the individual clinic response will be different,” continues Mr. Pinto. “There’ll be less of a ‘run for your lives’ feeling, and more of an appropriate proportionate response.”

If a practice needs help recruiting, retaining or managing their staff, then investing in a practice management firm specializing in ophthalmology can be beneficial, since they’ve seen many of the problems that you’re just experiencing for the first time. “Think about this in clinical terms,” says Mr. Pinto. “For every patient that a doctor sees, they’ve seen thousands of other patients with exactly the same presenting condition. When you now look over on the other side of the aisle, and that same doctor, or even the administrator, is looking at their business problems, they probably only looked into one or two practices for recommendations over the course of their entire career.”

In the end, everyone manages their practices differently, but times are always changing. “Physicians should be open to the talent that’s out in the workplace,” says Ms. Baldwin. “It may look different, sound different and not have the same experiences as it used to, but people have great attitudes, great motivations, and great desire to come into your workplace, and when given the right opportunity, can end up being one of the best employees you’ve ever hired if you’re open to it. We’ve got to look at the world differently.” 


Mr. Pinto is President and founder of J. Pinto & Associates, an ophthalmic practice management firm. Ms. Baldwin is Senior Consultant at BSM Consulting, a practice management firm specializing in ophthalmology, optometry and other medical specialities. Ms. Jahnle has no financial interests to disclose.