A recurring news item this summer was the number of flight cancellations and delays wreaking havoc across the country. For example, between the Memorial Day and Independence Day holidays, at least 21,000 flights were cancelled by US-based airlines.¹ This represents almost 3% of the total US flights and affected millions of passengers.

A key reason cited as the cause of this chaos is a lack of pilots: When the pandemic hit, the major airlines offered early retirement to thousands of pilots. As air travel has rebounded, the airlines have been forced to cut routes and recruit and train replacements.

As with the pilot shortage, the pandemic exacerbated the constant need for qualified technicians. When the pandemic closed practices in March 2020, many offices reduced their patient volume, not requiring as many clinical support personnel. As a result, technicians were laid off or furloughed. Some retired due to concerns about their own health, while others chose not to return to work and remained at home caring for their school-age children or aging parents.

The Bureau of Labor Statistics provides additional perspective on the shortage: There were 57,310 ophthalmic technicians in the United States in 2020 and a projected need of 65,700 by 2030. This is an anticipated growth rate of almost 15%; however, like in 2020, this represents only 94% of capacity.²

As someone who has been in the field for more than 30 years, I will explain the key problems that contribute to the staff shortage in ophthalmology and offer several solutions to overcome the shortage.

PUBLIC AWARENESS

A decade has passed without publicity about allied health positions in ophthalmology and ophthalmic assisting as a career option. Many ophthalmic staff, including myself, have found this career path by chance, but relying on employees to find us by chance is not a viable strategy.

When the recession began in 2008, the medical industry had plenty of media coverage that health care was an industry in need. Consequently, the medical assisting programs saw an increase of enrollees.

According to data from the National Center for Education Statistics, programs in healthcare-related fields skyrocketed starting in 2009, with programs in nursing and health-care administration playing a pivotal role in growth.³ Community college enrollment increased around this time as well. The share of 18- to 24-year-olds attending college in the United States hit an all-time high in October 2008, driven by a surge in enrollments at community colleges, according to a Pew Research Center analysis of newly released data from the U.S. Census Bureau.⁴ Many of these community colleges saw students gravitate toward health-care programs. For example, LaGuardia Community College’s EMT/Paramedic certificate program hit a record high of 185 students enrolled in the 2009 winter semester.⁵

In 2010, ophthalmic assisting was given its own classification by the Department of Labor. Yet, without a formal publicity campaign, the number of allied health personnel will continue to fall below the number. Newer training programs, including Alchemy Vision Project and BSM Consulting’s Certified Eyecare Professional, are great additions to the toolbox, but they don’t address the issue of attracting people to the field.

TRAINING PROGRAMS

While publicity about a career in ophthalmology is a problem, I don’t know what comes first: awareness of the opportunities or additional formal programs.

Grassroots programs can be found at community colleges, giving interested students a foundation of knowledge and local practices inroads to candidates. I find that often, however, these classes are not at capacity and if the lead instructor retires, the program may fold.

Currently, 26 accredited programs in the country offer education and training at the assistant, technician or medical technologist level. Another seven programs are in the process of accreditation.⁶ Still, there are fewer programs today than there were at the end of the 20th century. A recently accredited program in Connecticut closed during COVID as the college has been unable to find a new instructor. Another program at Mercy College in Ohio had gone virtual prior to the pandemic but was unable to attract enough students. It closed after its lone student graduated in May 2022.

Of course, initiatives that raise public awareness of the shortage and/or support accredited training programs should be considered. Also, steps can be taken at the practice level to address the staff shortage.

RECRUITING AND HIRING EFFORTS

While ophthalmic assistant programs help at a macro level, they can be expensive, require a minimum of 12 months to complete and do not satisfy the immediate need of individual practices that are experiencing shortages and need to hire as soon as possible. With a proper approach to hiring for on-the-job training, however, the result may be a long-term employee with competent skills who produces quantifiable, reliable results.

This process begins with finding the “right” people — when you can find them. Instead of actively recruiting experienced assistants, look for people with the type of personality you would want to work with your parents or grandparents. Examples include those from the hospitality industry or other customer service businesses. This approach parallels that of many high-impact organizations that believe one of the biggest challenges they face is to find employees “whose personal values are in sync with the values that make the organization tick,” according to a Harvard Business Review article, “Hire for Attitude, Train for Skill,” by Bill Taylor, cofounder of Fast Company. These organizations “believe that character counts more than credentials,” according to Mr. Taylor.⁷

The expression “birds of a feather stick together” can be applied to the recruitment process as well. Your best employees may have friends who are bright with a good work ethic, so consider asking them to help recruit. To incentivize this, offer a referral bonus to your employees if the recruit is a successful hire.

Once you interview a candidate who fits your culture, have them return to shadow the techs who will be their peers. These techs can share their opinions of the candidate, which may include too much sharing of personal information around patients or their level of interest with the job. As you meet with prospective candidates, inform them that this position can be the start of a career, not just a job, but that they are expected to report for work and be willing to learn; it will take time.

As an alternative to hiring new staff, don’t hesitate to ask your current non-clinical staff if they would like to transfer to the clinic. You will have identified the qualities in your employees that make them suitable for direct patient care. These include a good work ethic, great customer service skills and attention to detail.

Also, maintain open interviews so you have someone to contact when an opening arises. If the budget allows, hire even when you are fully staffed. This prevents you from being held hostage by an employee with poor attendance or a bad attitude. Maintain a careers page on your website with the positions that have continuous need, and indicate that you will train for a successful career path. Lastly, carry your business cards with you at all times in case you meet someone who you think would be a great potential employee.

IN-HOUSE TRAINING

Establishing a structured training program for your new hires not only helps the new hire get up to speed quicker, but it can also help attract and retain employees. According to a recent study by Gallup and Amazon, 71% of workers who have participated in training programs agree or strongly agree that the program enhanced their satisfaction with work. About half of participants (48%) reported they would switch to a new job if offered skills training opportunities, and 61% say training opportunities are an important reason to stay at their job.⁸

Successful training programs start with determining the best times for training. Many practices make the mistake of trying to train new technicians during clinic hours while the schedule is filled to pre-pandemic numbers. This results in frustrated trainees who are instructed what to do but not why. By not receiving the tools necessary to do the job, their frustration grows. Instead of feeling as though they are valued, they feel dissatisfied and leave the job, adding to the turnover. Also, the current staff become stressed because they are already doing the work of their absent co-workers and are expected to work with the newest hires, often without recognition of a job well done. The doctors are equally frustrated by longer wait times and unreliable data.

Schedule training when the clinic is closed. Inform the new hires that this may be after hours or a mandatory Saturday session and that they will need to plan accordingly. There is no need to pay overtime to anyone but the trainer if you create a schedule that has variable work hours during their orientation period.

Other strategies for proper onboarding of new technicians include:

• Teaching anatomy and the disease process. This allows new hires to properly put the puzzle pieces together when learning their new job so they can provide the doctors with accurate information. Equally important is that they understand what abnormal results may indicate and when to get help from a more senior tech.
• Providing the tools to learn more about what they observe. The most impactful method is to encourage the techs to shadow the patient with unconventional symptoms with the doctor. At a minimum, the workup tech and examiner should review the assessment and plan.
• Encouraging pursuit of certification in time.
• Checking in with them regularly so any budding issues can be addressed early.
• Providing a checklist of what is to be accomplished and the order in which it is to be done, based on appointment type or the reason for the visit. When new techs are unsure of what is required, they tend to incorrectly do a full workup. After all, no pilot takes off without performing the safety measures on the airline’s checklist together with the co-pilot.

CONCLUSION

One final thought to consider: In his podcast, The Truth of the Great Resignation, Simon Sinek said he believes that the Great Resignation is a leveling of the workforce. People who were laid off during COVID found that the unknown of not working was manageable and less stressful than working for a company that did not value its employees. And the employers that have an accountable culture, that empower and value its workers will have a more loyal staff that feel appreciated. OM

REFERENCES

1. Newsweek. Hundreds of Flights Canceled as Airlines Spark 4th of July Travel Chaos. https://www.newsweek.com/hundreds-flights-canceled-airlines-spark-4th-july-travel-chaos-1720579 . Accessed August 1, 2022.
2. US Bureau of Labor Statistics. Occupational Outlook Handbook. https://www.bls.gov/ooh/about/data-for-occupations-not-covered-in-detail.htm#Healthcare%20practitioners%20and%20technical%20occupations . Accessed August 1, 2022.
3. Ruffalo Noel Levitz. What Might the Great Recession Tell Us About the Future. https://www.ruffalonl.com/blog/enrollment/what-might-the-great-recession-tell-us-about-the-future/ . Accessed August 1, 2022.
4. Pew Research Center. College Enrollment Hits All-Time High, Fueled by Community College Surge. https://www.pewresearch.org/social-trends/2009/10/29/college-enrollment-hits-all-time-high-fueled-by-community-college-surge/ . Accessed August 1, 2022.
5. Queens Chronicle. Recession-proof employment. https://www.qchron.com/editions/western/recession-proof-employment/article_84a38736-dc69-5aa1-8b79-b04db793826b.html . Accessed August 1, 2022.
6. International Council of Accreditation. http://icaccreditation.org/find_a_program/find_a_program.html . Accessed August 1, 2022.
7. Harvard Business Review. Hire for Attitude, Train for Skill. https://hbr.org/2011/02/hire-for-attitude-train-for-sk . Accessed August 1, 2022.
8. Amazon. The American Upskilling Study shows workers want skills training. https://www.aboutamazon.com/news/workplace/the-american-upskilling-study-shows-workers-want-skills-training . Accessed August 1, 2022.

Jane Shuman, president of Eyetechs, is a nationally recognized authority on clinical flow, scheduling and technician training. Prior to founding Eyetechs, she worked for over 15 years as an ophthalmic technician and clinical manager. Also, she is the co-editor-in-chief of Ophthalmic Professional.