A CEO's Insights into Ophthalmology Staffing Resources & Solutions

The staffing shortage in ophthalmology is not new. However, it's become progressively worse in recent years. Today's candidate pool is smaller, and the job market is more competitive than ever. This means our practices must be able to attract high-quality candidates, train them effectively and retain them for the long term.

In this article, you'll learn strategic solutions to remedy your ophthalmology staffing problems (including doctors and other skilled employees, as well as support staff), backed by our experiences dealing with a staffing crisis at a regional eyecare center, and with a particular focus on the following areas:

• The pros and cons of traditional staffing agency solutions, and how to augment these processes for better results
• Strategies for attracting the best candidates for any open position at your vision care practice
• How to use student internships as a pipeline for a highly-trained workforce
• Creative staff retention techniques, including some commonly overlooked methods, to keep your best talent on board
• Optimization of training programs to get new employees up and running fast
• Automation of lengthy, repetitive tasks to prevent errors and reduce stress on staff members.

It's essential to understand the roots of these problems in staffing to apply the appropriate solutions. While the situation seems complicated, there are actually two underlying causes – lack of candidates to recruit and the burden training places on ophthalmology practices and teams.

Understanding the Problems Behind Ophthalmology Staffing Shortages

The staffing shortage problems in ophthalmology are driven by two primary causes: first, a lack of available candidates, and second, the burden that training new staff members places on daily operations.

A shortage of employees disrupts the ratio of support staff to physicians, causing a loss of efficiency in the clinic with far-reaching implications. The optimal ratio of staff to doctors is approximately 3 to 1, but this is difficult to achieve when you're unable to draw from a sufficiently large pool of qualified candidates, or when candidates are looking for jobs in other industries.

Staffing shortages can decrease patient satisfaction and trust in the team, ultimately affecting patient outcomes. Shortages also place more responsibility onto already-overburdened team members, eventually leading to more loss of staff, compounding the problem.

Additionally, requirements like onboarding, entry-level skill development, skill maximization, and growth development needs place additional burdens on the entire team. A lack of proper training increases turnover and perpetuates these problems in a vicious cycle.

Before we cover strategies and solutions to turn the tide, I'll share my practice's personal experience of what these issues have looked like in the vision care industry over the last several years.

Post-COVID Staffing Shortages

Earlier in my career — as a medical administrator and now CEO of EYE-Q, a comprehensive regional eye care provider — ophthalmology and other medical specialties enjoyed long relationships with staff who were loyal to the practice and the providers.

But those relationships were disrupted when the COVID-19 pandemic forced our offices to furlough team members while the offices were closed. After the practice re-opened for business, many team members did not want to come back to work for reasons such as:

• An increase in wages paid by fast food franchises and chain stores like Target or Starbucks
• The availability of lengthy unemployment benefits
• The prevalence of less stressful, higher-paying jobs outside of ophthalmology

The depth of the problem at our practice was significant. COVID left us with 17 open positions in our workforce of 90 employees, resulting in a 19% vacancy rate. Staff were forced to take on much greater workloads, reducing the overall efficiency of the office.

We continued to lose staff due to stress and watched our turnover rate rise to 25%, far above our KPI of 10%. We tried to fill these 17 positions, but could not do so amid the compounding problems of industry-wide staffing shortages. Many other practices across the US faced similar issues, which still continue today.

Training Challenges

With an open position rate of 19% and an increasing turnover rate, training was the first thing to fall by the wayside at our practice.

For example, while training as an ophthalmology assistant — the staff member who rooms the patient, collects intake data, and conducts screening tests for the physician — a new employee should have time to absorb new information from trainers. But in a severely understaffed office, new employees are often pulled from training to help complete daily tasks.

New employees frequently left the practice due to a lack of adequate training and increased stress from this situation. Some candidates lasted only a week, while a few walked out during the day, reporting that the job needed to be easier, more relaxed, and slower-paced. In response to new employees exiting the practice, seasoned staff became increasingly overworked and stressed out training new team members while also trying to fill gaps in staff simultaneously.

Unfortunately, seasoned members left the practice as well during this time. As a leadership team, we realized that we had to rethink our approach to our employees and to hiring staff to stop our practice from spiraling. In our search for solutions, we analyzed the successes and challenges of conventional staffing methods combined with innovative automation to remove the workload burden on our current team members.

‍One solution for these issues is revBot by Revival Health, an innovative automation service that eliminates most repetitive tasks at eye care practices, minimizes mistakes, and helps teams do their best work together.

The Conventional Ophthalmology Staffing Process — and How to
Improve It

The traditional recruitment process includes sourcing candidates, screening, selection assistance, and Human Resource (HR) onboarding assistance. In many cases, practices use recruiters or "head-hunting" firms for assistance — either to achieve better results, save time for management personnel, or both.

We have found these conventional ophthalmology staffing resources useful at times for filling professional positions, but with some caveats. While headhunters and recruiting firms can sometimes deliver good results, the process needs a more personal connection to attract the very best candidates. In other words, a cold introduction through a recruiting agency is less effective than a warm introduction to a candidate through a referral.

On the other hand, using a recruiting firm to hire ophthalmology assistants (OA) or front desk positions is costly, and no more effective than the results we've achieved using Indeed and other online job boards. In fact, when our managers were involved in the recruiting process for OAs and front desk positions, our success rates were the same or better than the recruiting firms.

Warm Introductions and Network Referrals

The most effective method for hiring top-tier physician candidates is to reach them in medical school or residency.

Warm introductions are our secret formula for finding and recruiting the best physicians — and unlike hiring recruiting firms, they're free. You can use this method at your practice to take advantage of existing network connections.

The warm introduction method includes:

• Engaging the current physician team for referrals
• Sourcing candidates through physicians in your professional network who remain connected to their medical school, residency, fellowship, or alumni programs
• Leveraging relationships with medical programs to identify candidates before graduation

Taking advantage of networking opportunities with your own providers is your best resource for marketing your open physician positions.

How to Recruit Other Vision Care Team Members

Similar to recruiting physicians, you can also engage support staff to recruit OAs and front desk associates — which are challenging positions to fill. Ask your teams:

• Who do you know looking for work?
• What colleagues do you have connections with in the ophthalmology market?
• Can you help connect us with your OA or technical training program?
  

To increase the likelihood that team members would engage in recruitment activities, we find it works well to formally recognize and reward the team members for referrals that resulted in a new hire.

Finally, we've also found that local outreach for public awareness helps to further boost the effectiveness of these methods. Examples include volunteering or working together with local charitable organizations.

While participating in these activities, our team members wear a company t-shirt and are encouraged to discuss the practice when appropriate. We get positive press coverage and local awareness, and our employees take pride in helping others out in the local area.

How to Attract the Best Candidates for Open Positions — and Retain Them

In the wake of staffing challenges, our company culture has shifted to emphasize team member satisfaction in a more focused way than in the past. This includes attracting the best candidates with good benefits, competitive wages, and forward-thinking policies, and retaining them by making the job itself attractive and appealing to their sense of purpose.

Here's what that looks like:

How to Attract Physician Candidates

Physician candidates, whether seasoned or fresh out of residency, are drawn to positions with adequate compensation, great benefits, and flexibility. But it's not uncommon for a physician to be recruited for a position and forgo an income until the practice employs them. Instead, to get the best candidates, we take a different approach.

You can achieve superior results with physician recruitment by offering:

• Sign-on bonuses — we don't wait until the physician is physically in the practice to pay them. This incentive increases their connection to the practice and the physician's likelihood to join the practice and stay committed during their tenure. We've paid sign-on bonuses as far ahead as a year in advance to help us recruit the best candidates from residency or who were completing previous contracts.
• Relocation fees — ensuring the physician and family smoothly transition to a new position in a new area. We want our physicians and their families to feel supported by the practice.
• Flexible schedules — adapting clinical schedules to break the traditional Monday through Friday mold is incredibly helpful to attract and retain physicians.

Combined with the networking recruitment approach covered in previous sections, these incentives create a powerful advantage in a competitive job market with a limited labor pool.

How to Attract Team Candidates

Just like physicians, support staff candidates are looking for competitive salaries, good benefits, flexibility, and recognition of their contributions to the business. Staff members want meaningful work where they can feel good about what they do each day. With this in mind, consider offering the following incentives:

• Paid health insurance for employees with employer contributions for dependent coverage
• Competitive hourly wages (not only competitive within the vision care job market, but also with other sectors)
• Robust vacation leave and sick time policies
• Providing training opportunities and promoting from within
• Covering costs for employees to receive their certifications for roles like scribe, ophthalmology assistant, or certified optometry technician
• Increases in pay for successful completion of certification
• Community engagement and social responsibility programs

The point here is to create win-win scenarios to attract and retain entry-level staff, and to develop them into more senior roles over time. Frankly, if you don't comprehensively address compensation, benefits, flexibility, and advancement opportunities, entry-level employees will instead be drawn to roles at national retail and fast-food chains.

The Advantages of Offering Student Internships

Another out-of-the-box method we used to create a pipeline of potential candidates was to start our EYE-Q Visionary Student Internship Program. During COVID, we found ourselves with lots of work and very few hands. We talked to our teams and learned about an untapped resource for the workforce: students looking for paid internships.

Our physicians, staff, and neighbors had high school and college-aged family members who could not go to school or work due to COVID. We brought in and trained entry-level interns aged 16 and older who provided us with these basic, but essential, services:

• Cleaning exam rooms and patient areas
• Collecting COVID exposure information
• Taking patient temperatures
• Guiding patients through a physician-developed COVID screening tool
• Assisting in patient flow through the office

At one point during the height of the pandemic, we had 35 internship students helping us in three locations throughout our practice. This not only helped our patients and permanent staff during this difficult time, but also helped form invaluable, long-lasting relationships with interns, many of whom would later become employees, helping to fill vacant positions.

The feedback we received about this program has been exceptional. Not only did the students love the work, but we fostered an interest in careers and vision care, resulting in a pipeline of potential employees for our practice.

As a result, several of our interns changed majors to medicine or ophthalmology and have gone on to become successful physicians. One intern graduated medical school, continued to work with us through residency and fellowship, joined our practice as an ophthalmologist, and now serves on our board of directors. With a paid student internship program, you can achieve similar results and build a pipeline of physicians and other essential staff.

How to Retain Vision Practice Staff

Networking and making positions attractive to prospective support staff members are essential steps for acquiring great candidates, but if you can't retain your employees, you'll still end up with a staffing shortage.

One of the best ways to increase your staff retention is to look at problems employees deal with and discuss ways to ease their burdens. For example, attendance is sometimes an issue for team members due to the sickness of children and a lack of affordable childcare.

Use your powers of observation to make note of issues like this, then discuss them with your practice managers and employees to offer solutions. You'll find plenty of opportunities to build loyalty and support your staff's work performance.

These are simple, yet impactful, options you can consider to help your staff and build long-lasting relationships:

• Partner with a local daycare for an employee discount to improve attendance for staff with kids.
• Stock the break room with healthy snacks and drinks.
• Provide lunches to help offset costs of living.
• Offer small stipends for on-street parking or ride-sharing incentives.
• Host monthly employee and family barbecues or picnics.
• Award longevity bonuses for 5, 10, 15, 20, and 25+ years of service.
• Recognize employees who go above and beyond with rewards, including bonuses, gift cards, gas cards, or movie tickets.
• Offer assistance for staff in skilled positions or who are looking to grow into a new role, including compensation for training, stipends for continuing medical education (CME), and payment of association dues

The ultimate goal for retention is to create a win-win company culture and keep staff members for decades. While these perks must be balanced with the organization's bottom line, in general, you'll discover that resources for helping your employees feel supported are money well spent.

Social Responsibility Programs

We have an employee-led charity committee called EYE-Q Cares that decides the monthly community charity activities for the year.  

The committee has organized blood drives, volunteered at food banks, and helped out at a pet rescue. The committee also implemented "Jeans Friday," where any team member who donates $7.50 from their paycheck to the current cause can wear jeans on the next Friday. The team raised $15,000, and with a generous donation from our board of directors, the total amount presented to the charity was $20,000.

Community participation in social responsibility programs can be beneficial for the staff and physicians, the practice, and the community at large.

How to Improve Ophthalmology Staff Training and Efficiency

Ineffective or outdated training methods and staff overwhelm due to repetitive tasks are major stumbling blocks to employee satisfaction.

Beyond simply addressing staffing shortages, providing best-in-class training and management practices are essential considerations to help your staff do their best, as well as keep them fulfilled and engaged at your practice.

Training Optimization and Modernization

Having a training process that can be effectively implemented in a busy office  is vital from both the hiring and retention perspectives. But creating a training system that works well can be incredibly challenging. Disruptions to training include:

• Lack of staff to train new team members
• Open positions constantly pull new employees out of training to fill in on the floor
• Limited resources to develop, implement, maintain, and improve evidenced-based training programs
• The high volume of tasks required to complete all job duties

You can support your staff best by offering them  standardized, automated, self-directed training that can be completed during the onboarding period of a new employee. The most successful programs will:

• Be evidence-based and applicable to ophthalmology
• Allow access to training materials at any time
• Offer self-directed courses and assessments
• Minimize the need to disrupt staff in the clinic
• Include step-by-step guides for at-the-elbow training in ophthalmology-relevant clinical and front-office operation skills

Luckily, you don’t need to reinvent the wheel.  There are existing electronic training resources that you can consider implementing in your ophthalmology practice, including the following:

• Alchemy — a complete learning management system with an open API for integration.
• BSM Consulting — offering online courses in ophthalmology assisting, certified eye care professional, and certified patient service specialist (front desk associate).
• Trainual — an operating system allowing you to build your own training program and implement it using their learning management system processes.
• The Learning Library or Academy of your Electronic Health Record (EHR) system — an often-overlooked resource is the learning management system offered by your EHR. With this resource, you can capitalize on best practice workflow and documentation trainings that are relevant to daily tasks at your practice..

You could also consider developing your own training program, though this is critical to consider who is writing and delivering the training. While a team member may be a great at-the-elbow teacher, he or she may not have the acumen to write or deliver a curriculum. Be sure to weigh the pros and cons of in-house training programs against proven resources like those covered above.

Task Automation

The word "automation" is weighty and comes with a myriad of reactions from staff. Even raising the topic with your team may prompt worry about job losses. But automation doesn’t mean that human beings are no longer needed. In fact, the opposite is true: an automated program, like a bot, can only do so much, and lacks the insights a person would have when interacting with others.

The benefits of automation include:

• Removing repetitive tasks taking up staff time
• Providing consistency in workflow and execution of complex tasks, such as prior authorization, where accuracy is key for reimbursement
• Allowing ophthalmology staff to do what they do best — interact with and help care for your patients

One proven automation solution is revBot by Revival Health. Ophthalmology assistants and front desk associates would rather spend time with patients than areas like:

• Billing functions
• Patient benefits review
• Accounting & financial reconciliation
• Claim adjudication tracking and response
• Referral and prior authorization functions

Help your staff understand the benefits of automation and they’ll quickly realize a bot will not be replacing them in the clinic. They may even be excited to hand off the repetitive, mundane processes they dislike.

Not only do staff appreciate the benefits of automation, but your patients will, too. Any function that makes the wait time to see the doctor shorter and increases the speed and accuracy of a visit increases patient satisfaction. Consider utilizing the patient engagement functions of your EHR, such as a patient portal that can:

• Automate and allow for remote check-in
• Collect medical intake data before the appointment
• Allow for self-scheduling
• Improve rates of collection with online payment options

Your patients would rather spend time speaking with staff than watching them bury their heads in the computer to document data or complete financial tasks.

Final Thoughts

To ensure your ophthalmology practice is poised to survive and thrive amidst the staffing shortages and training challenges of today's landscape, your leadership team must focus on strategic solutions aimed at staff recruitment, retention, and repetitive task automation.

Traditional recruitment methods are not as effective in our post-pandemic job market. To be more attractive to candidates:

• Engage your doctors to network and provide warm introductions to potential physician candidates
• Utilize your staff to recruit candidates from their networks and in the community, with rewards for successful referrals
• Implement student internship programs for all types of open positions in your practice

Also consider deploying innovative solutions in staff retention and training by:

• Talking to your teams and implementing processes that help to address their needs
• Optimizing training with online, evidenced-based curriculum solutions contextual to your business model
• Automating repetitive, mundane functions

Next-generation automation solutions offered by revBot by Revival Health can increase productivity and staff, patient, and physician satisfaction by freeing up your team members to do what they do best.

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