A machine is only as efficient as the sum of its parts. Like a machine, an ophthalmologist’s practice needs many moving parts to work together to effectively and efficiently diagnose and treat its patients. From the patient’s first contact with the front office, to the technicians who help diagnosis and treat whatever issues might arise, an ophthalmologist must know what to look for in his or her staff to streamline efficiency and create an excellent patient experience. A first-rate staff makes an ophthalmologist’s life easier, taking away stress and bettering his or her business to create a well-oiled machine.

In this article, we’ll discuss what to look for when hiring staff who will help improve your practice, as well as how to retain and reward that staff once you’ve assembled it.

Where Practices Go Wrong

Perhaps the best place to start is to analyze the missteps of some medical practices. Ravi Goel, MD, an ophthalmologist from Cherry Hill, N.J., identifies what he believes to be the biggest mistakes practices make when hiring or training staff. “I think the key is expectations—what a job entails and the demands that come with it. That’s the biggest mistake or area for improvement,” he says. “You need to be clear about your expectations right away, or you’ll end up hiring someone who’s not qualified, or not prepared for what you expect of them. If we’re hiring, we want someone who’s going to add to a clinical team and be happy there. Ultimately, we want them to enhance the team and make care more efficient for patients. If they’re not making your practice more efficient, they’re not worth hiring.

“The bigger issue is how efficiently practices run because that directly impacts patients,” Dr. Goel continues. “You absolutely need a team that provides an excellent patient experience.”

For most practices, the patient experience starts with the staff on the “front line”: the staff members who interact with patients every day, greet them, answer phones, set up appointments, file insurance claims, and generally help an ophthalmologist aid as many patients as possible. An invaluable staff will contribute something that’s almost intangible to your practice and remove stress and roadblocks.

 “Giving great clinical care and being a smart physician is assumed,” Dr. Goel says. “Your patients assume that you are a good doctor, so you need to focus on the other areas they’re exposed to. You need to give them an experience that leaves them happy and coming back. It’s all about what the patient’s experience is, and a lot of that is dependent on your team—your colleagues.

“The patient experience starts when they call you or look you up online. The most important person in your practice is the one who answers the phone. If that person doesn’t treat a patient well, it’s over. They’ll go somewhere else,” he says.

Dr. Goel has some thoughts on how to achieve this environment. “It has to be patient first,” he says. “You want to create an environment where patients have excellent clinical care, and they ultimately leave the office that day feeling like they’ve had a great experience. Everyone who interacts with the patient that day
affects the patient’s attitude about the visit. I find that a lot of negative reviews are because of billing issues or issues with the front office that often have nothing to do with clinical care, and have more to do with the experience of the visit.”

John Pinto, an ophthalmology business advisor, also weighs in on where practices can go wrong. “At the top of that list is poor selection, poor orientation/training and poor ongoing supervision,” he says. “If you’re not clear, you’ll get undue perfectionistic expectations and oversights that’ll result in stress and higher staff turnover.” However, in terms of compensation, Mr. Pinto claims it actually isn’t a huge issue. “Surprising to some, wages are way down on the list of factors that increase staff turnover.”

Mark Packer, MD, FACS, president of Mark Packer MD Consulting in Boulder, Colo., highlights a different issue practices struggle with. “The biggest issue is losing staff to a competitor,” he says. “Not necessary someone you view as a direct competitor, but it could just be someone in the region who has a more attractive package. It’s not just financial—not just about the dollars. I’ve seen practices lose their most valuable technicians because something about another practice was more attractive, whether that’s a potential for advancement, a lifestyle change, etc.

“The cost of losing a valuable tech is so much higher than it seems because getting someone to that level of skill and training them in the way you want things done is time-consuming,” Dr. Packer adds. “There’s a morale issue, too. Say someone you perceive as a leader leaves. There’s going to be a certain level of morale exhaustion for those who looked up to him/her. So there are intangible losses too.”
An Invaluable Staff

Avoiding these pitfalls and hiring the people that best fit your practice helps to  create an efficient and invaluable staff. In regards to the traits of an invaluable staff, Dr. Packer says, “The number-one value is someone you can trust. It’s the tech who comes up and says, ‘Mr. Jones is here and he has this problem.’ It’s invaluable when you know they’re absolutely right in what they’re saying. They have to have the clinical experience and skills to make that call, obviously, but once they do, the trust will come almost naturally.” Dr. Goel agrees. “Trust is a must—being able to entirely trust your techs when you see a patient takes the pressure off of you, making your life that much easier,” he says.

“There’s also a personality thing sometimes,” Dr. Packer says. “Some people like to dramatize or minimize, and you want them to be in sync with you, so when a tech comes and says, ‘You’d better see Mr. Johnson right now,’ you know there’s some real urgency behind it, not just an emotional or overreaction. That’s so valuable. That kind of trust gets built up over a long period of time, which is also why it’s a blow to lose someone you entirely trust. All those moments when they make the right calls and correct suggestions build toward that trust.”

In an article discussing how to best build an eye-care team, authors Thulasiraj Ravilla and Gnanasekaran Chinnathambi state, “The selection process should probe not just the candidate’s competency but also his or her motivation. The reality is that technical skills can be developed and improved over time, but it is much more challenging to change fundamental beliefs, attitudes and behavior. Thus the recruitment and selection process should ensure both competency and the right fit for the organization’s values, but with a greater emphasis on the values (which are reflected in the organization’s mission and vision).”1  
However, sometimes staff turnover happens, and both Drs. Goel and Packer admit that while it is often a blow to the practice, there are some positives. “When people leave to go on to do something with research or at a different level (working in research when the company that sponsors the study hires them to be a clinical research associate, for example)—okay, you lost someone,” Dr. Packer says. “But you can look at it as if you’re a training ground for people who want to go on that path. That’s encouraging to staff. That can be a positive thing because it inspires people to do better where they are.

“They need to feel that they’re on a path that is leading somewhere that they want to go,” Dr. Packer adds. “It’s intangible how you actualize that, but you can, by just talking to them about both your and their expectations, so their job isn’t just a grind.”

Like Dr. Packer, Dr. Goel says that although sometimes staff retention is tough to maintain, there are sometimes positives that come from it. “Retention is tough, but in my practice, I teach everyone the skills they need to be excellent techs, even knowing that they become more competitive and valuable in the job market,” Dr. Goel says. “It really comes down to, would I rather have a tech that’s highly skilled, but has a risk of leaving? Or would I rather have a tech who is not as skilled and wants to stick around? You want people who want to learn. They make the best staff. And sometimes it’s not the worst thing if they leave. You shouldn’t be afraid of someone leaving. What’s worse is being afraid of someone staying who doesn’t have the skills or the drive to learn those skills.

“On the flip side, when we acquire a tech from another practice, they’re a gold mine,” Dr. Goel continues. “We ask them what can we do to make things more efficient, what they liked most about their last practice, etc. If you use them as a resource, you’ll often get some great advice from them, on not only what they did right, but also what to avoid. Tell me what we’re doing wrong. How can we constantly improve our practice?” he asks. “Mr. Chinnathambi and Mr. Ravilla also agree that losing a member of staff is an opportunity to learn. “Employee retention should be a major concern for any organization,” they state. “Individuals, once well trained and effective, may opt to move for better prospects. In that case, a formal exit interview is useful to inform management about her or his experiences within the organization and what might be improved. Above all else, the organization has to be concerned about employees’ physical, mental, social and spiritual well-being.”1

Keeping them Happy

So how do you retain your staff and keep them happy? According to Dr. Goel, it’s about giving them a voice in your practice. “I find that the staff often want to feel like they’re contributing to something. Oftentimes, they would rather take a lower wage as a trade-off for experience and the feeling that they’re contributing to something and making a difference,” Dr. Goel says. “Members of your team are happier if they’re given a voice—if they feel they can contribute something to a practice to make it run more efficiently or improve the experience for a patient. They’re more likely to stick around if you listen to them and value their clinical input. They feel a sense of investment in the practice, which is a very positive thing.”

Corinne Z. Wohl, President of C. Wohl & Associates, a practice-management consulting firm, offers her advice on how to keep your best staff happy. “High morale and staff happiness are generated when employees feel respected for their work effort, appreciated as a team member and experience positivity in the workplace environment,” she says. “Thorough communication from management and physician-owners via meetings and written announcements also adds to employees’ confidence that they know what’s happening in their organization. It’s just another form of sharing, respect and teamwork that creates a happier work setting.

“Practices that prioritize building fun into their routines find increased staff happiness, too,” she continues. “Things like playing email bingo, holding holiday-related contests, and  providing thank-you lunches after a challenging clinic day are just a few ways to generate a positive team spirit and show sincere appreciation.”

Dr. Packer
also provides some concrete advice on how to facilitate a welcoming work environment to cultivate an invaluable and happy staff. “First of all, the compensation has to be competitive. You’re not going to get good or happy people if you’re paying them less than everyone else and working them harder,” he says. “I know a lot of doctors are bottom-line-oriented and concerned because it’s their livelihood, but you really can’t afford to cut costs there if you want a reliable team that you can build a relationship with. That’s the foundation.

“I think promoting people from within is huge,” Dr. Packer continues. “In our practice, people from the front office have become techs, because they see what the techs do each day. Not everyone may have that ability, but it’s worth exploring. Advancing through the practice can be a big morale boost for everyone.

“Beyond that, ask yourself, ‘Is it exciting for these people to come to work every day? Do they like the environment? Do they feel there’s potential for advancement? A future here? Can they learn more skills to achieve a higher level of compensation?’ Some of that can be done through certification,” Dr. Packer notes. “By continuing education, you can reward them for keeping their certifications active.

“They have to feel like they’re part of something worthwhile. It’s not just a job. They’re not someone who could be replaced by a robot tomorrow,” he says. “There’s something about being there that’s exciting and fun, whether it’s the collegiality, working toward a common goal or being involved in clinical research.

“I think, intrinsically, most technicians give the doctors the benefit of the doubt—they trust and respect their expertise,” Dr. Packer says. “I think they come in with a pretty positive attitude. It’s yours to lose, but you don’t have to. You can build on that. My favorite things are the new technologies, and training staff to use them. That can be exciting for everyone because you get to teach all of the new things you can use this technology for with your patients.”

Advice from Your Staff

It’s one thing to ask a doctor what staff value in a practice, but it’s another to get the opinion of the staff directly. A staff member from an ophthalmology practice in Maryland discusses her experience at multiple practices. “I think it does start with the compensation, because that’s how you’re actually being valued,” she says. “But I’ve never had a real problem with that. I think most doctors know the value of their staff and wouldn’t try to cut corners there.

“Beyond that, it’s nice to have some affirmation that what you’re doing isn’t going unnoticed—you’re appreciated somehow,” she continues, “whether it’s recognition from the doctors themselves or the patients who are thrilled with their visit. That’s probably the best feeling.”

In terms of her previous practices, she says, “I recently left a practice because of a flexibility issue. I have to drop my son off at school on the weekdays, so I needed my hours to start at 10 o’clock, and the practice couldn’t make it work. It’s no one’s fault, really, but I think being accommodating to your staff (up to a certain point) definitely goes a long way. The other practices I left were mainly due to lifestyle things—I moved back home for a year, and another year, after I got married, my husband and I bought a house down here. So there’s another move and a new practice.”

In another conversation with a staff member from an ophthalmology practice in New York, he highlighted a few more features that attracted him to his current practice. “When you’re in an area with a high demand for techs, you sometimes get some recruitment going on,” he says. “They try to really sell themselves to you, which is a good sign. They’re passionate about their practice and want the best people they can get their hands on. This particular one offered me a flexible schedule, coupled with the technology they had available to them. It made for a tempting offer to work on some new technology I never had worked with  before,” he says. “So when they hired me, they immediately let me know my role and started training me on how to use this new technology, which was really exciting for me.

“Sometimes it’s tough leaving a practice, though,” he continues. “You really get to know the people you work with and appreciate the passion they have for what they’re doing. It’s reassuring to work for a doctor who isn’t just going through the motions—someone who genuinely cares for patients and has a passion for his or her work. It can really be contagious.”  REVIEW

None of the contributors to this article have disclosed any financial interests.

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194843/ accessed 10 Oct 2017.