Manage technician shortages

What can you do to keep staff from leaving?

We should revel in the wonderment of highly skilled, motivated, dedicated technicians. But instead, we lose sleep over them, worry endlessly about their happiness, try to stay out of their way, and give them space to breathe — sometimes giving them too much leeway during their work day. We fight for salaries out of their pay scale, give them tokens of appreciation, and fawn over the suggestions they bring up.

Why are these excellent employees the death of managers/administrators? Because if (or when) they leave, finding a replacement for them can feel as impossible as climbing Mount Everest with a refrigerator on your back.

Training challenges

Good staff are a gift. “Making” a person good — having them learn “the whole package” — is rare, but not impossible.

You can teach people to be good technicians. But teaching excellence is a massive and time-consuming commitment that you usually end up putting more time into than they do. The “excellent” part comes with the intangibles: these people are kind, empathetic, care about their role in the practice, and want to do a good job. And you can’t teach these traits.

Sanding away the sharp edges on a recruit, removing the aberrant personality quirks, or honing their technical skills to a fine edge often wreaks havoc with the other staff, the doctors, and you. Why? Because it all takes time — and while you spend time getting them up and running, the other staff must cover for that lost staff member.

Competitive challenges

Hiring school-trained students, or waiting for them to graduate, can often feel like playing the lottery. Fifty other practices are waiting as well and trying to outbid your office at every chance. Competition is always stiff, and school-trained technicians are getting rarer and rarer.

I’ve had administrators wring their hands for years worrying that staff might leave for a competitor that is expanding into their locale. Or, they worry another group will “outbid” their salaries — either hiring staff away or bidding against them as they try to hire someone.

Competitors have programs to pay their staff to “poach” other groups for good technicians or past friends who still work in another group. When they get a technician to “jump” to their group, the technician receives a nice “bounty” payment for that new recruit, as well as the undying love of their manager/administrator. Even if the referrers aren’t happy with their group, they paint a rosy picture for the new hire to collect the payment.


What can you do to prevent your staff from leaving, or being lured away, by another group?

1. Examine your turnover rate. Employees leave groups for a number of reasons. When they leave, I evaluate:

  • The reasons they give for leaving (husband is retiring and they just bought an RV to travel the county, a desire to do something your group doesn’t do or they are moving across country);
  • The reasons their coworkers or friends say they left;
  • Where they went (is it closer to where they live?);
  • How I really feel about that person leaving.

If your turnover rate is high and you seem to replace staff frequently, evaluate your practice and your management style. Determine what might be causing staff to routinely leave, then make adjustments. For example, if you hire technicians to work 8 a.m. to 5 p.m. but they continually work until 6:30 every night, either adjust their hours or find other options (such as hiring someone to work a late shift). You also might consider performing exit interviews to see whether the practice needs to adjust something to prevent other staff from wanting to leave in the future. Potential hires have told me that people flood out of the group they are in now, and they want out as well. One reason they give is their group doesn’t respect them, or that they are not allowed to grow in their group.

2. Get feedback. Whereas keeping the clinic staffed and running smoothly is a manager killer, boredom is a staff killer. They want to learn new skills, to feel important to their group, and they want to be “part of the group,” not “just an employee.”

Some groups designate staff to only certain skills (A-scan technician or visual field technician) or allocate a staff member to only work with a specific doctor (scribe or assistant). Other staff members may feel slighted and edged out from doing the “fun and important” things, or from ever even being given the chance to perform these tasks. Even if they dislike that given doctor because he is demanding or vocal, they want that coveted position. It makes them feel important to be their technician.

When you conduct staff reviews, ask your technicians what they want. Then, discuss with them whether this is something you are willing to help them with and any other ideas you have. For example, I had a technician who would forget to mark her pressures down, so the doctor always double-checked her work. She also forgot vertex distances and the times when she dilated the patient. Her goal was to do A-scans! Obviously, this was not going to happen, because the doctors had trust issues with her work.

We talked and compromised on another area that would allow her, and the doctors, to build confidence in her diagnostics skills. Then, we made an agreement to talk about A-scans down the road. She had fun learning the Goldmann visual field (knowing not everyone had this skill), and I haven’t heard about A-scans since that meeting.

3. Don’t jump at the next person who applies for an empty position. Working short-staffed is a morale deflator. It leaves no room for coverage if a staff member’s kid has a school luncheon or dentist visit or simply needs a day to regroup. But, try not to jump at hiring the next warm body that walks through the door. This prevents you from hiring the multi-skilled certified technician whose resume is complete but is looking for another job … again.

Do your due diligence. This includes:

  1. Calling the applicant to have an initial discussion regarding the available position. I review parts of the resume with the applicant to make sure that we are speaking the same language. For example: if the applicant lists that she performed refractions, does she really mean that she put the glasses prescription in the phoropter so that the doctor can perform the refraction? Listen to the responses. Then, set up the interview.
  2. Making sure you check their past experience history, including the dates they worked. Be wary of employees who switch to another site every 18 months. Discuss this with the applicant and try to get a feel for why she left so soon after starting.
  3. Asking key interview questions. I love asking, “If I were to call your manager and ask if she would hire you back if she had the chance, what do you think she would say?” I have received some amazing responses.


Trying to predict when someone might leave your practice is a dicey endeavor at best, and usually a losing battle. It will drive you insane because the one you think might leave isn’t the one who actually does.

Be fair with your staff, promote them when warranted, and allow them to be part of the group by offering a chance to grow and feel wanted. Show them you trust them, have a stake in their development and want only the best for them. Make sure to treat all staff equally, whether they are the chief’s technician or just one of the “worker bees.”

And, when staff leaves — and they will leave at the worst possible times — keep your head. Evaluate the reasoning with regard to how your group practices, and make adjustments if needed.

Staffing is the last worry on your plate when all is going well. But, when no one is making any noise over leaving or staying, remember: silence is golden, unless you are a manager. Then, silence is suspicious! OP