Editor’s Note: This article first appeared in Administrative Eyecare‘s Sept/Oct 2019 Edition.

It has never been easy to fill technician positions but now it seems to be almost impossible for several reasons:

  • Historically low unemployment rates
  • An increased demand for eyecare services
  • A career path that flies under the radar

Additionally, clinics are so busy that a common complaint is that there is no time to train like there used to be. So, what is a practice to do?


It is important for the leadership team to realize that our employees are our best resource; with the surgeon’s caring attitude and surgical prowess, they can make or break your reputation. Therefore, the first step is to justify the need for the position as you would a new piece of capital equipment.


The second step is to find the “right person” who fits with your culture and has a personality that exudes both compassion and professionalism. Finding this person can take some time and plenty of patience. But it is worth the effort, knowing the overall costs of hiring and training can be reduced by waiting until that person is found.

Hire from a position of strength by maintaining open interviews. Create a non-traditional ad off a career path that includes training that is on your practice website, as well as some online resources with which you have had success.


Have those in whom you are interested return for a session to shadow others in the position for which they have applied. Most job seekers are on their best behavior during the interview process but may let their guard down when interacting with their potential peers and not supervisors.

Each team member shadowed will have different observations of the candidate; these may include conversations with staff, patients, or doctors; work-related questions the candidate asked; a willingness to seat a patient or show someone the way out; or simply that the candidate appeared disinterested.


Just prior to off a position, provide the candidate with concrete expectations so they understand what they must do to be successful. In addition to attendance and appearance, these may include:

  • Reading at home from the textbook provided by the practice
  • Regular quizzes to ensure understanding of the material
  • Periodic skills assessments
  • Regular feedback

The new hire may feel “picked upon,” but feedback should be taken as constructive criticism in order to provide your patients with quality and consistent care.


There are many career pathways in the ophthalmic clinic. Trainees can begin as scribes, diagnostic techs, or work-up technicians with the intention that they will eventually be cross-trained. No matter what their regular position will be, it is important that they all receive knowledge applicable to all departments first. Therefore, the practice must have a plan in place and be prepared to expect the unexpected.

If your new hire is going to begin as a scribe, have them first scribe for a tech to get accustomed to using the EMR and associating what each test is. From there, many practices have the scribe begin with an optometrist before moving up to the ophthalmologists. If, however, the doctor is new to your clinic and patient volume is light, consider starting there so they can learn together. If this is the practice’s first scribe, the doctor must be willing to train him or herself as well, so a partnership can develop.

And if this person is going to be a diagnostic tech, it is critical that they understand the pathology and the importance of attaining reliable results. Investing the time into training is likely to result in a long- term employee.


Depending on the size of the practice, you will need to designate certain technicians as the trainer(s). If you have multiple locations, each with its own trainer, technicians must perform skills identically so that doctors are assured everyone is performing consistently. Keep in mind that the best tech in not necessarily the best trainer.


Once you have hired the new staff they must get acclimated to your workflow and the discipline of ophthalmology.

Have them shadow patients through the office, learn the electronic record (or, if you’re using paper charts, the necessary forms) prior to teaching them the foundation and skills they need. They must learn ocular terminology, anatomy, physiology, and the disease process so they can relate what they learn to their observations. They can be helpful with patient flow by seating patients and showing them out before working on skills.

Start with basic skills. These include visual acuity, confrontational visual fields, and EOMs. Teach them how to take past medical, social, and family histories as well as the Review of Systems.

Do not introduce the Chief Complaint/History of Present Illness (CC/HPI) just yet.

Once these meet your standards, partner up so the trainer and new tech are in rooms opposite or next to one another. The senior tech should do the CC/HPI, applanation, and refraction while the trainee is doing the other exam elements. These should take about the same amount of time and the information can be reviewed at the end of the sessions. Gradually add in more advanced skills.


Most people come to work expecting to be productive. When that is not the case, or they do not understand the rationale behind the skills, they will not feel fulfilled. If you have trained them in multiple areas, they can fill in at some level when more experienced staff are out of the office.

Training staff is never easy; no one sees the hard work that goes into training someone from the ground up. What is seen, however, is a person who has become passionate about their patients and about preserving the best vision possible.

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