If your practice is always in need of an extra pair of hands, but there already seems to be too many people on your payroll, a second look at your use of trained ophthalmic technicians may be in order. In this article, a pair of certified ophthalmic executives explain how they manage ophthalmic technicians to maximize both patient and physician satisfaction and benefit the bottom line.

The Situation
The demand for quality health care at a reduced expense has driven the need for well-trained technicians in ophthalmology practice, explains Steve Robin-son, COE, vice president and chief operating officer for Professional Eye Associates, a practice with three locations in northwest Georgia. "With the assistance of a good technician, the phy-sician is not fragmented; he can focus on care," says Mr. Robinson. "The ideal role of the technician in the office setting is to be an extension of the physician," he says. "The workup prepared by the tech can help the physician digest data more rapidly."

Ophthalmic technicians may be a better staffing choice than ophthalmic nurses, Mr. Robinson proposes, because nurses currently come at a premium, and their additional skills are not usually needed in the general ophthalmology practice. Technicians, on the other hand, are perfect for day-to-day diagnostic tasks and patient relations, since, he says, "They specialize in doing just a few things well."

Professional duties of the technician might vary, depending on practice size and management style. At Minnesota Eye Consultants, P.A., the ideal situation is to have technicians cross-trained in all areas, says Candace Simerson, COE, ACMPE. As president and chief operating officer, Ms. Simerson has revamped the staffing situation at Minnesota Eye in the four years she has been there. "By changing things around, looking at what makes sense, combining positions, and having people travel among our four offices, we have been able to cut our staff by 30 percent," she reveals. Cross-training, which is often a given in smaller offices, made this type of efficiency possible for Minnesota Eye. "We do a whole host of things here," says Ms. Simerson, "from research to lasers to a fellowship training program. We can't have someone who doesn't scrub in for surgery, for example. Our technicians have got to be able to do everything."

Patient Education
"There are two opportunities for the technician to participate in patient education—before and after the exam," says Mr. Robinson. "Initially, the technician could provide information that might help the patient's vision concerning their behavior or their eyewear. For example, the tech might see that a patient's contact lenses are not clean. She should ask if the patient is having problems with the cleaning regimen, or discuss the products that are being used. A technician might notice that someone's glasses are leaving deep indentations on the nose and could recommend an adjustment to the nosepads that would increase comfort." Mr. Robinson points out that this type of assessment should be the limit of the technician's interpretation of what she sees in a patient. "The technician is not diagnosing or treating a condition," he explains.

Following the exam, the technician's role continues. "The technician comes back to the patient to review what the doctor said and find out if there are additional questions. She may also prepare the patient for the next visit or give instructions concerning medications," adds Mr. Robinson. In this way, he says, the doctor can exit the encounter without leaving the patient stranded.

At Minnesota Eye Consultants, "We try to make sure that our technicians are educated not just in what they do, but that they have an understanding of the bigger picture," offers Ms. Simerson. "By giving them a broader base of knowledge, they are better able to explain what they are doing to the patients."
She says that the physicians write up "cheat sheets" for the techs on each new technology brought into the office. One example was the introduction of wavefront technology. "They learned what its capabilities are, when it is indicated, et cetera," she says.

Clinic Flow
Observant technicians are invaluable in controlling clinic flow, says Ms. Simerson. They recognize what kind of testing is done more often, then try to direct patient flow based on how busy certain machines are and when rooms may be empty. "We don't have techs walking patients all around the office, and no one is left in the hallways," she says. It is ideas like this that allow Minnesota Eye to work smarter with 30 percent less staff, according to Ms. Simerson. Technicians also have input on where a new piece of equipment will go, based on where it will fit physically and be the most accessible.

Clinical Tasks
Clarity on task assignments can help eliminate physician/technologist re-dundancy, states Ms. Simerson. Be-cause technologists at Minnesota Eye try to manage the testing preferences of nearly a dozen ophthalmologists and 13 optometrists, they prepare a guidebook that lays out which tests each doctor requires for each disease or problem. "If one doctor has a corneal evaluation, the technologist will know what tests the doctor wants done on that patient before he or she even sees them," says Ms. Simerson. "If this patient has X problem and she is seeing Dr. Hardten, the protocol's in the guidebook." There's no wasted time while the doctor sends the pa-tient off for testing, she points out. Study of this guidebook is part of the training for all new staff.

Telephone Triage
At Professional Eye Associates, Mr. Robinson explains that technicians share the responsibilities of telephone triage. They are also available for questions, especially for follow up from a patient who may have met them on their visit to the office. Patients calling back to speak with a technician "is entirely appropriate and does happen frequently," says Mr. Robinson, who considers availability by phone just another part of good pa-tient care.

Technicians work the phones on an outgoing basis as well, says Ms. Sim-erson. "Our technicians serve as backup to our staff nurses, who usually make the calls for post-surgery or to check on compliance with treatment regimens." She says Minnesota Eye's technicians are ready to step in because they are well-versed in the clinical functions outside of those that are solely the physician's territory.

The Paper Trail
According to Mr. Robinson, the ophthalmic technician should be prepared to handle any patient paperwork that has to do with patient care other than financial matters or office business, such as appointment scheduling. Ms. Simerson too, cautions giving a trained technician too much work that is strictly administrative. But, she says, "I'm sure that in a smaller office the technician also would be prepared to chip in at the front desk."

The ophthalmic technician will routinely act as a liaison with other practices, says Mr. Robinson. At Professional Eye Associates, technicians handle gathering paperwork that follows a patient to a subspecialist, as well as preparing the patient for that outside visit. They will explain to the patient what the subspecialist will do, why the visit is necessary and even prepare a map to the new doctor's office, he says.

Acknowledging that the list seems unending, Mr. Robinson states that the ophthalmic technician should be prepared to wear just about all of the hats in the practice. For this reason, he encourages professional certification and advancement of technicians based on their interests and abilities. Ms. Simerson agrees, noting that Minnesota Eye attracts individuals who are proactive and want to learn new things. They have an in-house training program for new employees and to instruct current employees on new technologies. "We want everyone on the same level," says Ms. Simerson. "Not to have someone good at this, but not at that." In addition, Minnesota Eye teaches certification courses on-site every year. "We give enough courses that our technicians don't have to go outside if they don't want to," she adds. "We do so much teaching in this practice that it's just part of the culture." She says this non-stop training has a positive effect on the employees because, as the manager, she is able to recognize who is doing well and move people up the ladder.
"We do push our technicians," she says, "but they appreciate the opportunity to learn new things all of the time and to do something different every day." 

Contact Candace Simerson at cssimerson@mneye.com; Steve Robin-son at steve@professionaleye.com.