The ophthalmic staff: a diverse and specialized group

Our third annual subscriber survey data reveal highly-trained professionals capable of meeting ever-increasing demands.

COA and COT. OCS and OSC. COMT and OCT-C.

The third annual Ophthalmic Professional subscriber survey uncovered much about our readership, but one of the most revealing discoveries was the number of certifications and subsequent acronyms. And, as it turns out, this diversity is necessary in many ophthalmic practices due to their complex and ever-increasing workload.

Here, industry experts provide their opinions on the results of our survey and how the data coincide with their experiences in this specialty.

Certifications and diversity

We asked our readers to indicate their effective certifications and allowed for 13 different certifications (plus the option to indicate “other”). Eight certifications received at least 5% of responses (Figure 1), including “other,” which 21% of respondents chose. These additional certifications included CST, LPN, CCRP, and more. Only 17.4% of respondents indicated that they are not certified.

Figure 1. Your effective certifications

The need for certification may be self driven or required by the employer. Ophthalmic professionals may want to advance their skills and show proficiency in various areas of the field, says Jane Shuman, OP’s co-editor-in-chief, whose certifications include COT, COE, OCS, CMSS, and OSC.

Some of the decision, however, may also fall on the practice. “We see practices are either totally encouraging certification at some level or, in some cases, mandating it within a certain period of time,” says Ms. Shuman, president of Eyetechs. “That’s been a sea change over the last couple of years.”

Evergreen Eye Center in Federal Way, WA, supports technicians who choose to get their next level certification, both in terms of giving them the time to pursue it and rewarding them financially, says Zachary Smith, MHSA, chief operating officer at the practice. When technicians complete their COA certification, they automatically receive another dollar per hour because the practice sees the value. “I wouldn’t say there are specific skills that are always better when we have a COA or COT, but it demonstrates commitment and their level of comprehension is generally better,” Mr. Smith says.

Survey methodology

The Ophthalmic Professional Subscriber Survey was conducted earlier this year. Subscribers were sent three separate email invitations to participate in the online survey, beginning on May 24. The survey closed June 12. As an incentive, respondents were entered in a drawing for an iPad Air 2, which was won by Virginia Veteri with Norman Reinach, MD in New Hyde Park, NY. After removing duplicate responses, Ophthalmic Professional received 427 responses. All individual survey responses are confidential.

The seemingly countless number of certifications among ophthalmic professionals shows the diversity in potential job positions, functions, and career paths. For example, COA (Certified Ophthalmic Assistant) is the entry-level core designation for the Joint Commission on Allied Health Personnel in Ophthalmology (JCAHPO). After achieving this certification, a COA who finds that she prefers to work in the OR can get her OSA (Ophthalmic Surgical Assisting) certification. Also, many other certifications do not require a COA (OCS [Ophthalmic Coding Specialist], OSC [Ophthalmic Scribe Certification]), so technicians can move in a number of directions with their careers, says Ms. Shuman.

The multitude of potential certifications is out of necessity due to the various specificities and complexities in ophthalmology. For instance, OSC, OCS, CPC (Certified Procedural Coder), and CPMA (Certified Professional Medical Auditor) are all related to the complexity of billing, coding, and compliance, says Laurie K. Brown, MBA, COMT, COE, while other certifications such as COMT (Certified Ophthalmic Medical Technologist), ROUB (Registered Ophthalmic Ultrasound Biometrist), and OCT-C (Optical Coherence Tomographer-Certified) are related to specialty technology and advanced skills.

“Ophthalmology practice staff positions are becoming more internally specialized due to the complicated workflows, advanced skill levels, and compliance risks associated with tasks,” says Ms. Brown, senior consultant, BSM Consulting.

More on complexity

In recent years, we asked subscribers to indicate their greatest concerns about their career, and by far the most common response was growing complexity (50.3% in last year’s survey). So, we wanted to know: What is the single factor creating the most complexity in your job (Figure 2)? Of the eight potential responses, “increased workloads” (32%) was the most common.

Figure 2. What is the single factor creating the most complexity in your job role?

According to Ms. Shuman, a perfect storm of several factors creates this complexity. “We have many new diagnostics that get added to the workflow and there are far more regulations coupled with more patients and less staff. And, with the need to remain on time, ophthalmic professionals are doing more for many patients.”

When broken down by primary position, “increased workload” was even more common among COTs (Certified Ophthalmic Technicians). C. Jolynn Cook, RN, COE, CASC, says that, in part, is due to COTs being motivated and dedicated individuals who are relied on to carry a heavier workload. “To obtain these certifications, you must be knowledgeable and willing to work hard,” says Ms. Cook, senior consultant, BSM Consulting. “These are the ‘stars’ in the practice that management counts on for training new staff, working with new doctors, helping in the OR, and so forth.”

The next largest factor creating complexity, IT/electronic medical records (16.4%), was also common among COTs (about 26%) as well as COAs (about 29%). “The clinical staff do the charting and have to get an incredible amount of detail correct to minimize coding, documentation, and billing risk and to achieve accurate records of the quality of care delivered,” says Ms. Brown.

Another factor tied to quality of care, reporting requirements, received the third most responses with regards to complexity (14.7%). However, this was the top response among office managers/administrators (about 39%). The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) replaced the previous sustainable growth rate system, including physician quality reporting, meaningful use, and the value-based payment modifier. Included in this new system was a new merit-based incentive payment system (MIPS). Based on their composite score under this system, eligible professionals will receive a negative, neutral, or positive payment adjustment to their reimbursements for 2019 and future years. The brunt of this, Ms. Brown says, falls on the managers and administrators. “(The responses) allude to their level of responsibility for the outcome of reporting requirements,” she says. “Any penalties assessed significantly affect the practice’s future profitability.”

All of these complexities speak to the “new norm” in health care, says Ms. Cook, in which technicians, nurses, and managers will need to demonstrate flexibility, adaptability, and a willingness to continually change their processes.


The number of practices offering medical insurance to employees (93.4% in 2017) has remained fairly consistent during the last three years, according to OP subscriber survey results. However, the percentage of medical insurance paid in full by the employer has dropped steadily since 2015 (Figure 3, page 12). Ms. Cook attributes this to increasing premiums due to implementation of the Affordable Care Act. For instance, as a former administrator at Laurel Eye in Brookville, PA, she says the practice’s health insurance increased by more than 20% in one year. “The options are to have the employees pay towards the premium or to get a plan with high deductibles that the practice can afford and then implement some way to help the employee with funding to offset the deductible, such as a health savings account,” she says.

Figure 3. Practice paid 100% of your medical insurance.

The struggle to cover medical insurance can even impact a practice’s ability to retain staff, particularly in a smaller practice. Mr. Smith says his practice recently lost a valuable technician, who left to join a large hospital system because his practice could not match the hospital’s benefits package. “I think we have a good insurance plan, but we can’t compete with the large systems,” he says.

Social media

Ophthalmic professionals and practices continue to experiment with ways to use social media to their benefit. More than half of survey respondents (52.4%) indicated they use Facebook for work-related issues, which dropped from about 72% last year (Figure 4, page 14). Almost one third (32.9%) indicated they use LinkedIn, which also declined from about 50% last year. Alternatively, 25.1% of respondents say they use YouTube for work issues, which more than doubled from last year’s survey (about 10%). Ms. Shuman says that YouTube (and video content in general) have become increasingly important for staff members who want to view a quick demonstration or explanation of a diagnostic procedure, for example.

Figure 4. Which social media sites do you frequent for work-related issues?

Practices are also seeing value in presenting video content to patients. Mr. Smith says his practice is producing videos for patients on what they can expect on the day of their surgery. “Some of these elderly patients may not open an email and watch a video, but many of them have a family member or friend who can get the content to them and sit them down in front of a computer,” he says. Alternatively, when a patient is in the office, Mr. Smith says the practice provides tablet devices to patients so they can watch short playlists of videos with information regarding their upcoming procedure.

At a glance

Other notable findings from this year’s survey include the following:

  • Longevity. As previously mentioned, the number of different career paths in ophthalmology make the specialty an attractive career option. And our subscribers demonstrate this via their longevity — 52.3% have worked in an ophthalmic-related position for more than 20 years and nearly 82% for more than 11 years (Figure 5, page 14). Of those in ophthalmology for more than 20 years, about 48% say they’ve worked in the same practice for more than 20 years. “Ophthalmology is an industry where we tend to promote from within,” Mr. Smith says. “We grow leaders internally. You see a lot of practice administrators who are former techs.”
  • Figure 5. How long have you worked in an ophthalmic-related position?

  • Gross annual income. At the upper end of the pay scale, 17% of respondents report they earn more than $85,000 per year (Figure 6, page 16). About 63% of these respondents were office managers/administrators.
  • Figure 6. What is the range for your gross annual income?

  • Age. Given the longevity of respondents, it’s not surprising to see that about 39% of respondents were 51 to 60 years old (Figure 7, page 16). Only 17.3% of respondents were 40 years old and under. These numbers might indicate a substantial turnover within the industry in 10 to 15 years, Mr. Smith says. “Do people continue to promote from within and work their way up the ranks, or does it start to be a situation in which you have younger physicians going out and ‘headhunting’ and looking for someone who has the skills and not necessarily the experience?”
  • Figure 7. What is your age?

  • Type of practice. Similar to previous years, respondents were primarily employed in a private practice setting (55.3%). (Figure 8, page 16). Multi-specialty clinic (23.2%) was the next highest response. OP
  • Figure 8. What is the type of ophthalmic practice in which you are employed?

Ophthalmic Professional subscribers have even more access to the results of our subscriber survey. Thanks to the support of OP advertisers, our comprehensive survey report is available to download at no cost. Visit our website ( ) to view the data, and please tell us what you think. What are your takeaways, and how can we improve this survey to make it even better next year?