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Commitment and career are two of the key themes echoed in the results of the fifth annual Ophthalmic Professional Subscriber Survey.
It’s not unusual to find subscribers who have worked in ophthalmology for more than 30 years, with more than 75% of respondents reporting a tenure of longer than 15 years.
In addition to longevity, this year’s survey captured a portrait of the ophthalmic professional in terms of compensation, practice size, workload (no surprise, it’s increasing), and job/career satisfaction.
To help put those findings into perspective, we asked experts for their input on what the data mean for today and tomorrow.
Tackling more tasks
More than 90% of those surveyed agree that they have more work than a year ago (Figure 1). The crux of the issue: “As the population ages, more patients are in need of eye care, yet there is no increase in the number of ophthalmologists,” explains Jane Shuman, MSM, COT, COE, OCS, CMSS, president and founder of Eyetechs and co-editor-in-chief of OP. As a result, more tasks are assigned to the allied health staff.
“This and the increasing number of regulations imposed by the insurance carriers are contributing to the stress levels,” says Ms. Shuman. “Practices are looking for creative ways to solve these problems. However, adding staff to accomplish non-revenue producing tasks — i.e. insurance preauthorizations for surgery and prior authorizations for prescription drugs — is a last consideration for many offices.”
In fact, 43% of those surveyed say they are now responsible for pharmacy call-backs and/or authorizations for medications (Figure 2).
Sergina Flaherty, COMT, OSC, CTC, (F)ATPO, who owns Ophthalmic Seminars, says one of the solutions to the increased workload is “finding, training, and retaining competent ophthalmic technicians” — 37% of our respondents said a staff shortage contributes most to their increased workload (Figure 3). One solution, she explains, is the Association of Technical Personnel in Ophthalmology’s (ATPO’s) Ambassador Program. “We are recruiting members to become ambassadors for the profession in their local communities. Some of the first initiatives for our ambassador members are to introduce ophthalmic assisting to high school counselors and students in health career classes and also to attend the HOSA – Future Health Professionals meetings around the country.”
Steps like this will hopefully help decrease the workload. As Ms. Flaherty says, “When we bring more people into the field, the problem may disappear as more technicians will be able to spread the workload.”
In addition to attracting more individuals, training and certification of existing staff also become critical in strengthening the profession, says Antonio Cutino, COT, vice president of medical communications at Alimera Sciences. “The ATPO and the educational group JCAHPO (Joint Commission on Allied Health Personnel in Ophthalmology) have done a tremendous amount to enhance and build the profession over the years.”
He adds, “Nonetheless, very few ophthalmic techs are certified. I made the decision to get certified because I thought that it would show my professional abilities and training if I needed or wanted to change doctors. It’s a gold standard, yet schools don’t do enough to promote certification and certified techs.”
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 April 26, 2019. The survey closed on May 24, 2019. As an incentive, respondents were entered in a drawing for one of five $100 American Express gift card, which were won by Andrew Bell, Flushing, NY; Robin Bradford, Grand Rapids, MI; Jan Ledford, Franklin, NC; Lisa Shaw, Brookville, PA; Nancy Hudson, Denton, TX. After removing duplicate responses, Ophthalmic Professional received 268 responses. All individual survey responses are confidential.
A highly recommended career
Interestingly, a nearly identical percentage of respondents who report their workload is increasing also say they’re likely to recommend the profession to others. About 56% are extremely likely, and another 37% report they are “somewhat likely” (Figure 4).
This is the first time OP has posed this question in our annual survey and Ms. Flaherty’s reaction to the positive response: “That’s awesome!”
Mr. Cutino says he recommends the profession “all the time. If someone likes to help people, what a great career. I tell people that even though I’ve been out of the clinic for over 20 years, I still keep up my certification.”
A high rate of satisfaction with the career may help to explain longevity in the profession. More than one third of those surveyed say they have been in ophthalmology for more than 30 years (Figure 5). More than 90% of respondents are over age 40, with nearly six out of 10 over age 50 (Figure 6).
Mr. Cutino explains the dedication. “It’s not just a career. It’s a love affair,” he says. It can also open up a lot of doors. “I started as a tech right out of high school,” he adds. “I’m still in ophthalmology 46 years later.”
With so much experience, ophthalmic professionals “also have an opportunity to mentor future replacements,” says Ms. Flaherty. “I’m always encouraging junior technicians to learn more, do more, adding that this career will serve them well.”
Ms. Shuman offers additional perspectives on the career path and longevity: “Ophthalmic assisting is a career that rides under the radar. Although granted its own job classification by the Department of Labor in 2010, the public is unaware of its existence.
“To that point, many of us who have been in the field for 20-30 years found it quite by chance; and many began at the front desk and were pulled into clinic functions either by necessity or interest.”
On the other hand, says Ms. Shuman, “The older age of many can be attributed to second careers, people looking for work once the children were in school or out of the house. Therefore, starting late, they have found a passion for the work.”
Salary: keeping up with the cost of living
Though 46% of respondents received a bonus last year, most raises were cost-of-living increases (Figures 7 and 8). This can be discouraging. “We’ve all seen certain technicians not wanting to better themselves through education just because there is no monetary incentive to do so,” says Martha Tello, BGS, COMT, OSC, a senior ophthalmic educator of ophthalmic technicians at Bascom Palmer Eye Institute in southeast Florida.
One explanation for smaller raises is that “most practices are not seeing any increase in third-party reimbursement and so are reluctant to increase wages by a significant degree,” says Bruce Maller, president and CEO of BSM Consulting and OP co-editor-in-chief.
This type of thinking can be short-sighted, says Mr. Maller: “Since motivated ophthalmic professionals are in high demand and there is a supply/demand imbalance, better opportunities are not too difficult to find in the current job market.”
There’s also another cost, he adds. “Turnover and loss of good people has a significant impact on patient care, while also causing unnecessary costs to the employer.”
That’s unfortunate on a lot of levels, “because being an ophthalmic tech adds financial stability to a career that provides professionalism and the ability to help others,” adds Ms. Tello. (See Figure 9 for more on compensation.)
“Sure, you’re always going to have some people that fly in and out,” explains Mr. Cutino, “but the more the doctor sees seasoned staff as a partner, the more success that doctor [and practice] will have.”
The future: commitment and consolidation
Looking ahead, there are two key, though not-always-compatible, trends — core commitment and corporate consolidation/private equity transactions.
“In addition to 20 large practices recently being acquired,” says Mr. Maller, “our research finds there are at least 100 additional acquisitions representing nearly 1,000 ophthalmologists. I expect this trend to continue over the next several years,” adding that the onus is on employers to determine what happens next.
“We’re in another age of equity purchase,” adds Mr. Cutino. “The first was in the ‘80s, and what failed then was that when equity acquired a practice, many physicians felt compensated for their efforts and stopped caring the same way. We need to look back and see what we did wrong ... and not do it again.”
“Owners will continue to gain competent technicians only if they support education, continuing education, and certification at all levels ... and pay accordingly,” stresses Ms. Flaherty.
They also need to hire smarter, adds Ms. Tello. “Challenges will continue to come to practices that decide to hire employees with no prior ophthalmology background and no desire to get any education.”
“Whether it’s the MD or the ophthalmic professional,” concludes Mr. Maller, “everyone has to remember that it’s still all about a human interaction with someone in need. It’s not something you squeeze or exploit.” OP
Demographics: Size, location and title
Survey results show the highest percentage of respondents work in small (2-5 MD/OD) practices (33%). The fewest? Solo practice (20%), which is mostly the result of consolidation.
Mr. Maller explains it, “This consolidation is driven in part by private equity investment. Over the past few years, over 20 large practices have been acquired, and these new private equity-backed platform practices are aggressively acquiring smaller ones.”
Ms. Tello points to one of the biggest challenges of working in a small practice. “Ophthalmic professionals working for a solo practice are more susceptible to burn out,” she says. “They are the ones responsible for most clinic operations: patient scheduling, clinic flow, diagnostic testing, and, often, billing. Imagine what can happen to a solo practice when the star technician gets sick.”
The highest percentage of respondents are from the South Atlantic (24%), the Mid-Atlantic (16%), and East North Central (14%) United States.
Out of 19 job titles of respondents, 27% are managers or administrators, 16% COA, and 16% COT.