When an ophthalmologist’s practice administrator hires a technician or a receptionist, she knows exactly what to look for. There’s a job description, standard certifications and pay levels that both parties expect. Optical personnel, however, often have different levels of experience and expectations – even when they have the same certification.

Here are some guidelines for matching the right optical

personnel to your dispensary.

Choosing the best candidate

Retinal, corneal

and pediatric all define specialties and related skills within ophthalmology. Opticians also have special skills that develop as a result of their work experience, albeit not as formally defined. Knowing which skills an optician has mastered will help you select the best candidate to meet your particular needs.

To pick the best person for your dispensary, rank the nine items listed on the following pages in order of their importance in your practice. Some of these items call for more scientific knowledge and experience; some call for more artistic judgment and social ability. If you have a strong tech support team, you may want to look for someone who’s stronger in terms of art and people skills. If you have a volume practice, you may want to hire one lead optician who has strong technical skills, and one or two sales opticians who can focus on the remaining areas. (Note: If you hire more than one person, predetermine who will have purchasing power and to what level.)

Once you determine exactly what you need from your optician(s), make those criteria part of the job description and incorporate them into your standard operating procedures.

Optician skills

The skills below are listed from the most general to the most technical.

* Selling skills.

An optician won’t be employed for long – especially by a major chain – if his selling skills are poor. During the interview, ask the applicant what the company sales goals were at his previous job and how much gross sales increased because of his selling efforts. (This is often tied to commissions, so the applicant should know the answer.) Ask what specific products the applicant sold to make those gains. If it sounds as if he or she "oversold" an item, ask under what conditions the applicant wouldn’t sell that item.

Remember: Even though you may not set sales goals in your practice, selling skills are still crucial.

* Cosmetic frame fitting.

Matching frame shapes to face shapes and visualizing color is more art than science. But opticians and stylists should be able to tell you why a frame looks good – not just that it does. If you want your patients to get excited about buying glasses, this should be a key factor when you choose your optical personnel.

* Frame adjustment.

Good frame adjustment can save you many re-dos and unhappy patients. But don’t just assume your applicant can adjust a pair of glasses. This hands-on skill takes training and practice.

During the interview, ask questions that require experience to answer. For example: "What would you do to my frame if I complained that one side of my nose hurt as well as the opposite ear?" A good answer would be something like this:

"If one side of the patient’s nose and the opposite ear hurt, one temple has been pulled out too far. This probably resulted from the patient taking the glasses off with one hand or sleeping on them. To fix the problem, I’d pull the temple back perpendicular to the frame front."

This is the most common optical adjustment, so if the applicant says to bend the temple behind the ear or to adjust the nosepads, he doesn’t understand basic adjusting principles – and your patients will have sore ears and noses!

* Lens verification/neutralization.

Your tech can check this out by asking the applicant to "double-check" a prescription that’s been neutralized.

* Frame repair.

Except for replacing nosepads or lost screws, most opticians shouldn’t spend time "repairing" frames. Ask applicants what kind of repairs they regularly perform.

* Technical problem solving.

Can your applicant solve a problem caused by poor fit? An optician who saves you chair time by correctly diagnosing and resolving technical problems is very valuable indeed. (See the June 1998 issue of Ophthal-mology Management, page 62, for specific examples.)

* Handling customer complaints.

It takes people skills to calm an irate patient who can’t see. Ask your applicant to list three techniques that help him deal with an angry customer. (A good answer might include listening to the complaint without interrupting, or restating the complaint and asking how the patient would like the problem to be resolved.)

* Lab management.

From order to delivery: Can your applicant get the job completed in time? Does he cut and edge, tint or surface lenses in-house? Each process requires optical personnel who can work together to meet patient expectations. Even if you send every order to an outside lab, your applicant should be able to determine minimum blank size and lens availability, and choose the most cost-effective lens for the job.

To check this skill, before the applicant arrives, choose a pair of frames for yourself. Ask your lab representative to measure your PD, measure the frame’s A, B, ED and DBL sizes, and determine the minimum blank size. Then ask your applicant to do the same procedure and compare the results.

* Frame management.

Has your applicant developed a frame model and inventory system? Does he understand how to track and compare sold inventory and stock inventory? Has he negotiated the best frame pricing? Has he selected vendors? Most important, does your applicant know when to say "no" to a frame vendor?

In addition to looking for the skills listed above, keep in mind that the average ophthalmology patient is 70 years old and may bring in optically-related medical issues. Your optician needs to have an awareness of these issues, and how they affect a patient’s vision and quality of life.

Certification and licensing

Opticians also may have different levels of certification. Certification by the American Board of Opticianry (ABO) requires proficiency in most of the areas I’ve mentioned. It’s recognized in most states as a benchmark of proficiency for

dispensing opticians.

An optician who fits contact lenses may also be certified by the National Contact Lens Examiners (NCLE). Both of these certifications require continuing education to maintain.

Licensing requirements differ from state to state. Your state may require both ABO and NCLE certification, as well as passing a state test, to obtain a license. Not all states license opticians and most ophthalmologists aren’t required to hire a licensed optician. But if a patient wants to file a complaint about your optician and your optician isn’t licensed, the complaint may be forwarded to the ophthalmology board. This can cause major headaches for you.

It really does make sense to hire the most qualified person you can find.

Staying on track

Once you find the right person, you should do everything you can to keep him or her in your practice. (Opticians are often forced to move from job to job just to get a raise.) Before you hire, decide how you’re going to compensate your optician, including a plan to allow growth and development along with your practice.

It’s important to be able to evaluate your optician’s performance. Track your optical’s performance before the optician arrives. This benchmarks the "before" performance of your optical. (See "Dispensing Frontiers" in the February, March and April 1998 issues of Ophthalmology Management for help.)

After the new optician takes over, continue monitoring your dispensary’s performance and review the results with the optician regularly. When designing his compensation plan, make sure he shares in the additional profits being generated.

Commissions, 401k plans, paid vacations, sick pay and yearly performance reviews are all ways to keep your optician excited about working for you. But the best way to show respect for the person you hire is to offer a fair base salary. If you offer good pay, good benefits and standard M.D. office hours (8 a.m. to 5 p.m.), you should be able to attract the best opticians the industry has to offer.

Going for the gold

As you can see, a dispensing optician has a broad job description with many facets. Despite this, most ophthalmologists hire a single person to handle all of these responsibilities.

A wise choice of candidate is obviously essential. And remember: Your patients will perceive the optician as a direct extension of you, the doctor. Any mistakes, omissions or difficulties will be seen as your responsibility.

There’s no better way to assure the success of your dispensary than with an experienced, talented optical team. Once you’ve got a terrific optician on board, your dispensary can become a key profit center for your practice and a boon to your patients, and save you from having to deal with many minor problems and complaints. Then . . . the sky’s the limit.

Technical Frame Fitting

Although smaller shapes cover a myriad of fitting errors, the basic rules of fitting still apply. Ask the applicant to list five aspects of a good frame fit. Here are some answers an experienced optician might give:

• The top of the frame shouldn’t sit above the brow.
• If the space between the side of the face and the temple is more than the thickness of one index finger, the frame is too large.
• The eye should center in the frame.
• The nosepads should rest flat on the nose, about halfway between the corner of the eye and the bridge bone. The frame should never rock on the nose.
• From a side perspective, the frame should tilt toward the cheek about 20°.
• The frame should never rest on the cheeks. If the frame can’t have 20° pantoscopic tilt without sitting on the cheek, the bridge is too wide or the frame is too deep.
• The temple should break slightly behind the top of the ear at a 45° angle.
• The temple should sit perpendicularly on the face. If it tilts up, the frame will slip. If the temple tilts down, the bridge will press heavy on the nose.
• The frame shouldn’t sit more than 12 mm away from the eye. If it does, any prescription stronger than 6D will need to be adjusted.
• The patient’s eyelashes should never touch the back of the lenses. If they do, don’t increase the base curve – choose smaller bridge sizes!

Helping Your Optician Adjust

Opticians who’ve only worked in a retail environment may have difficulty adapting to a medical environment, primarily

for two reasons:

• The patients are different. Retail environments generate 60% single vision prescriptions and 40% bifocal prescriptions. In contrast, medical environments are oriented toward an older client base; almost all the prescriptions are more technically difficult multifocal prescriptions.

• The focus is different. A retail environment is designed to "create" customer needs in an effort to sell as much product as possible. In contrast, most medical environments are focused on doing the minimum amount possible to solve a problem. Like many doctors, you may find your optician’s focus on "creating sales" foreign.

The most useful path lies somewhere in between. As the doctor, try to remain open to new ideas, but set boundaries so that your optician "knows the rules" about sales and service

.

Leona Meditz has 25 years experience in the optical industry. If you have questions regarding this article, please e-mail her at leonam@cwix.com.