Tech Support: How to Empower Your Staff

Certification of eye techs assures employers of basic skills and capabilities so that the practice can delegate procedures with greater confidence.

Diagnostic testing in ophthalmology is the engine that powers the practice, and its role is only likely to increase. So too will the demand for qualified personnel to operate these complex and expensive technologies.¹ Ophthalmology is fortunate to have a number of physician extenders who can take the load off providers and provide efficient and effective use of provider time for the benefit of our demanding and growing patient population.

Effective delegation to techs is a popular topic for colleagues and consultants to highlight as an avenue to increased efficiency. Often overlooked in the discussion, however, are the differences among techs based on their backgrounds, and particularly the role of certification in clarifying an individual's capabilities. As a manager, would you pay a premium to bring in a certified tech over a non-certified candidate? What would that certification enable the person to do better or differently than a non-certified counterpart?

The purpose of this article is to explain the differences between certified and non-certified status, explore some commonly held perceptions and discuss advances in ophthalmic diagnostic testing technologies and the use of ancillary personnel as they relate to improving accurate and efficient patient flow. Demand for ophthalmic techs remains high, with more openings in general than individuals to fill them.

Tech-nicalities

A short history review is in order to gain some perspective. About 40 years ago, the idea of having a standardized set of skills for the back-office assistants became important to a few forward-looking MDs. There were wide variances in capabilities, a need to provide a more complete base of knowledge and training, and a desire to delegate some repetitive but important tasks to increase office efficiency. Out of this need grew three organizations. The present organizational names and abbreviations are used here. Because each organization has some potential conflict of interest with the others, they are distinct, with different goals, even though they all may have some relevance to your technical staff. These three organizations are:

• JCAHPO (Joint Commission for Allied Health Personnel in Ophthalmology), is sort of a federation of “partner organizations with similar interests,” and is the examination and certification organization. Your techs, if certified, take the JCAHPO examination and also do continuing education to maintain their status. JCAHPO will verify the certification status of applicants and staff for you at no cost.

• ATPO (Association of Technical Personnel in Ophthalmology) is the professional organization for techs, with both certified and non-certified categories of membership. There are approximately 1,600 ATPO members. ATPO puts a salary and benefits survey together about every two to three years.

• COA-OMP (Commission on Accreditation of Ophthalmic Medical Programs) accredits educational programs of the formal training bodies. Formal tech training programs may seek accreditation from COA-OMP for each level for which they train students.

Each organization has a counterpart in ophthalmology on the physician side, but the perception of utility, while not perfect, is important. Physicians have separate organizations that function as professional societies, examination and certification of knowledge and skills, and residency programmatic accreditation. Each serves a specific need, but there is also a personal need for goal attainment and professional interaction. Ophthalmic techs are generally detail-oriented and goal-focused individuals and may desire the same professional relevance and career-path.

Certification? Certainly!

So, is it worth having certified techs? Certified staff fall into one of the following three categories: COA (certified ophthalmic assistant), COT (certified ophthalmic technician) and COMT (certified ophthalmic medical technologist). Generally speaking, the level of capabilities rises with each new level of certification.

Currently there are about 17,500 certified ancillary ophthalmology personnel in the workforce, with a likely equivalent number who are non-certified, but data have not been collected recently. Allied health personnel is the proper term for what we colloquially know within ophthalmology as “eye techs”—and they encompass both certified and non-certified individuals. COAs make up about 75% of this total, and COTs about 22%. COA numbers are growing, as are COT, but at a slower rate. There are only 650 COMTs—a number that has remained fairly constant over the past 10 years.

The national certification examinations do change over time in response to surveys of employers and techs so that they reflect the actual duties performed. There are additional and separate specialty certifications available in the areas of ultrasound, ophthalmic photography and contact lenses. There is approximately a 50% increase in the amount and level of ophthalmology-related subjects as techs progress to each successive higher level. COT and COMT candidates must also pass a skills test on some basic, pre-determined skills, with reported salaries generally higher for greater experience and certification level.⁵

Any discussion about the risk-reward benefit of certification needs to take in account the practice's financial situation and staffing requirements. Some physicians may say that certification means greater personnel costs, and this is generally found to be true in both papers and a search of web-listed job postings. There is also the misinformed notion that no direct patient care benefits are noted with certified ophthalmic technical staff. There are statistically reliable studies that refute this idea.² Patients' perceptions of the knowledge and skill set of your back-office help should not be taken lightly. Given a choice, most patients would likely prefer those involved in their direct care to have a higher knowledge base—and given this, it's easy to see how this would engender greater confidence in their physician.

Some offices have such trouble identifying trained tech position applicants that they have taken to “growing their own” tech staff. Other practices would consider that option if they only knew what resources were available to assist with the training. Your office may only wish to train to the specific needs of the practice. Doing so has some drawbacks—the entire staff will need additional training when new ophthalmologic services are offered. If training your own staff at a basic level, it makes more sense to provide them with a well-rounded start as well as add your office's specific tasks and equipment to the mix. It's important to make the commitment and stick to it if providing in-house training.

There are many resources to provide basic and well-rounded ophthalmic assistant training. Continuing education courses are offered offsite as well as onsite, and web-based CE is another option. Whichever option is chosen, be sure to follow up on skills and knowledge learned. It shows commitment to the training as well as providing feedback to learners. The AAO has an “Allied Health On-the-Job Training Kit” available for purchase via its Web site.⁶ It contains a Home Study course, a DVD on Fundamentals, a multimedia six-lesson course, a Primer and a Trainer's guide with sequential lesson plans. The AAO also has a “starter kit” available with only the Home Study course and Fundamentals DVD.

Professional Development

OK, we've provided a broad base for training—now what? It's important to put specific time limits on completion of assigned tasks and to follow-up with questions. Don't just “turn them loose” and expect great techs and no errors. When a particularly valuable learning situation presents itself, save the information and context so it can be revisited with your entire technical team. An atmosphere of positive feedback is important to impart to new technical staff who may not be comfortable with the possibility of error. Even experienced staff benefit from review of charts and roundtable discussions presented in a “no fault” atmosphere. Likewise, encourage staff to speak up with equipment issues and improvement suggestions. They are “in the trenches” and have a unique perspective on clinical patient flow.

New equipment naturally needs orientation and, at first, one or two individuals may gain proficiency faster than others. While this helps get the proper results, it's important not to become too dependent on specific techs for specific pieces of equipment—be sure every tech can give adequate results—so cross-training is a key to prevention of clinical flow bottlenecks. Remediate training as needed periodically so that skills stay current.

It's also a good idea to have clearly written job descriptions that reflect accurately the tech's jobs. This includes the ability to maintain proficiency on applicable clinical testing within your office. Having annual reviews for technical staff goes without saying, but because so much of their jobs entail performing diagnostic testing, the need to validate those skills periodically is crucial to achieve accurate results and proper treatment of your patients. Even your most highly skilled techs should have to undergo periodic skills assessments as a part of your practice's employee evaluation system—it shows employees that standards are high, enforced equally and clinical efficiency is expected.

Finally, a word of caution is in order related to physicians and their working relationship to technical staff. Because of the unique position of technical staff within the clinic, they may feel they have the provider's ear. Since it's highly likely that there is a reporting hierarchy in your office, as physicians you are at the top and delegate certain essential functions to others. Be absolutely sure you support your managers and administrators who have accepted those responsibilities from you. If approached about an HR-related issue, have your techs go to the appropriate HR person. Remember that skills can be trained but personalities are difficult to alter.

Your current technical staff and tech applicants may come with highly varied backgrounds and certifications. Providers and managers (especially those new to ophthalmology) should have a passing knowledge of the differences between certification levels and expectations. While ophthalmology techs with certification may demand higher salaries, they also generally provide increased clinical efficiency^2-4 and patient satisfaction. If hiring qualified applicants is problematic for your practice, consider doing in-house training for internal candidates with good interpersonal skills using well-vetted training tools such as those from the AAO. OM

References

1. Eye care employment among fastest-growing U.S. jobs. Press Release, JCAHPO; 2009 Feb 05. http://www.jcahpo.org/pdfs/Fastest_Growing_Jobsweb.pdf.
2. Woodworth KE Jr, et. al. A comparative study of the impact of certified and non-certified ophthalmic medical personnel on practice quality and productivity. Eye Contact Lens 2008 Jan;34(1):28-34. http://www.ncbi.nlm.nih.gov/pubmed/18180680.
3. Astle WF, et. al. Survey on allied health personnel in Canadian ophthalmology: the scalpel for change. Can J Ophthalmol. 2011 Feb;46(1):28-34. http://www.ncbi.nlm.nih.gov/pubmed/21283154.
4. Woodworth KE Jr, et. al. Analysis of tasks performed by certified ophthalmic medical personnel. Ophthalmology. 1995 Dec;102(12):1973-86. http://www.ncbi.nlm.nih.gov/pubmed/9098305.
5. Association of Technical Personnel in Ophthalmology. 2009 National Salary and Benefits Report.
6. American Academy of Ophthalmology. “Allied Health On-the-Job Training Kit”. https://secure.aao.org/EbusPPROD/AcademyStore/ProductDetail/tabid/55/Defaul t.aspx?ProductId=18830.

Paul Larson is an Associate Consultant with Corcoran Consulting Group. He has over 35 years experience within ophthalmology, and has served as both Program Director and faculty member for Ophthalmic Technology training programs. He can be contacted at 800-399-6565, ext 224, or plarson@corcoranccg.com.