Remote staffing can play a role in ophthalmology practices
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Employers in nearly every industry are struggling to find new hires amid the current labor shortage, and ophthalmology practices are no different.
“It’s a global problem throughout the whole economy,” Jawad Qureshi, MD, of Retina Center of Texas, said. “When COVID set off, there were a number of governmental fail-safes put into place to help people get through the pandemic, which were fantastic and we actually took advantage of as a practice. However, from a business standpoint, we started to become very thin on staff.”
Source: David Eichenbaum, MD
As Qureshi’s practice volume ramped up toward pre-pandemic levels, he had trouble finding appropriate staff. Those initial hiring pressures are beginning to wane, but retaining staff can be difficult. Technicians and office staff may have more opportunities and potentially higher salaries elsewhere, forcing practices to pivot to find new employees or hold on tight to the ones they already have.
“It’s a competitive market with more limited staff out there,” Qureshi said. “We’ve had to put new incentive programs into place to keep our staff, and it’s more difficult to find the appropriate staff. We’re always working to do that, but it’s become more costly over time.”
Audina M. Berrocal, MD, said that COVID stands as a line of demarcation for staffing issues. Staff at her practice at the University of Miami Health System, particularly women, had other obligations during the pandemic, whether it was helping their children with virtual school or assisting elderly parents.
“That was challenging, but we didn’t feel the lack of staff during that time. It has been more of an issue after the pandemic started to ramp down,” she said. “A lot of people have decided that they wanted to rearrange their lives. They want to work from home. They want to work fewer hours. They want to work at their convenience in a way that fits their lives. We’ve seen a real shift.”
That shift includes more employees retiring early, more people working per diem and more workers taking on new roles, such as traveling nurses.
“It’s been quite a challenge,” Berrocal said. “In the clinics, we have fewer technicians, and it’s been hard to hire new ones. It’s been a struggle all over our institution, and we’ve seen it at every layer.”
There has also been a generational shift, particularly when it comes to working from home and finding a better work-life balance, according to Reginald J. Sanders, MD, of The Retina Group of Washington.
“I have three kids, a 35-year-old, a 30-year-old and a 24-year-old,” he said. “I’m not one of those people who bashes millennials because they want to work just the same. They just want to do it in a more efficient manner so they can have a better quality of life. Why wouldn’t I, as a 62-year-old, want the same thing?”
Sanders said the pandemic showed that working from home was not only possible, but it could also have benefits. People are finding they can get paid the same, or possibly even more, without going into an office, giving them the opportunity to pursue other activities or stay home with their families, he said.
“You can do that and still have a productive job,” he said. “That is our challenge in the service industry. That psychology is not going to change. People are going to want to work from home, at least to a degree.”
Dealing with staffing issues
While hiring and staff retention can be challenging, David Eichenbaum, MD, of Retina Vitreous Associates of Florida, said there is a simple solution.
“There’s James Carville’s old saying, ‘It’s the economy, stupid,’” he said. “At the end of the day for staffing, ‘It’s the pay rate, stupid.’ In the current inflationary economic climate, you have to pay your staff more to retain them, and a lot of small business owners are not plugged into that thinking.”
He said practice owners should be aware of macroeconomics, the practice-level opportunity cost of turnover and the home economic needs of their staff.
“We haven’t lost any of our clinical research staff, and that is because we have continued to pay them well,” Eichenbaum said. “That’s always the answer — just pay them. It might take a chunk out of your bottom line, but you have to think about what will happen if you lose an employee, especially one in a key or revenue-producing role.”
When an employee leaves, there is always some cost associated with it, he said.
“Sometimes our group discusses the high cost of HR. It is the single largest line item (aside from drug stock) on the balance sheet. However, the truth is, if you are able to randomize even one more subject for a trial because of consistency in staff, you paid for everyone’s raises for at least a year,” he said.
Jonathan Feistmann, MD, of NYC Retina, said it is also important to consider the role an employee plays in a practice’s culture and with other team members. That can be just as hard to replace.
“You want to look for people who are motivated just because it’s part of their nature,” he said. “But finding those people remains the biggest challenge, and it has been since before the pandemic.”
When a practice finds those people who fit perfectly, the practice needs to hold on to them, Feistmann said. Fortunately, the option of allowing employees to continue to work from home has given practices a chance to retain those who otherwise might have started to looking for a job if they had been forced to return to the office.
“We had one key staff member who was able to work remotely when they could not come in, and they have continued to do an amazing job,” Feistmann said. “In the past, we wouldn’t have even considered it, but it has allowed that staff member to flourish and actually advance their career instead of having to resign.”
When motivated people work from home, they do not turn into unmotivated people, Feistmann said. In fact, they tend to work harder.
“They want to prove that they can work from home just to make up for the fact that they are not physically here,” he said.
Berrocal said her institution has been trying to attract and retain staff by making salaries more competitive. That also means offering diverse kinds of roles to fit how people want to work.
“We have hired more people who don’t necessarily want to work full-time jobs,” she said. “We have to adapt to this new way of business. For example, the nurses who do injections for us, we used to have one for each doctor. Now, they rotate throughout the clinic. We have more nurses who work different hours, as well as operating room nurses who travel across the country to work temporary positions. I don’t think I ever saw a traveling nurse before the pandemic.”
Finding people to fill technician roles has been particularly difficult.
“We’ve had to become more competitive in the prices and adapting our working hours,” Berrocal said. “We were so used to having staff here from 9 to 5, but we are constantly being challenged to do things differently than what was routine. It’s hard to break those molds, but the pandemic pushed us. Everything is changing.”
Even before the pandemic, Qureshi made retention a top priority for his practice. There was a competitive pay structure, and employees were rewarded for longevity.
“We’ve had a plan in place for years where we have a bonus trip at 5 and 10 years, and that’s for everyone at any position in the practice,” he said. “The 10-year bonus is enough to fund a Hawaii trip for two people. We also have an additional bonus structure that we instituted through our COVID experience that includes bonuses quarterly and increased pay for all levels of the company. That has helped us retain staff.”
Pay is a major driver for staff retention and at the top of mind for physicians who run practices. Eichenbaum said in addition to paying people more, an owner must ensure that people are happy with daily duties in their jobs.
“You have to let your employees know that you appreciate them,” he said. “Regardless of whether they are an employee or equity partner in the business, you have to have an open door, and you have to have an effective manager. A lot of turnover comes when management is unstable. When management is accessible and supportive, you have good rapport with the team in the practice, and you create a positive culture. In a collaborative culture, you’ll be more likely to retain your employees.”
A virtual office
One thing that will not change is that many patient-facing roles must remain in the office. Eichenbaum said positions such as clinic coordinators and technical staff are in the office in person every day.
“It hasn’t so much affected the patient environment,” he said.
In fact, implementing a hybrid workplace, in which some staff are in office and others are at home, has freed up space and actually made the experience better for patients.
“We became busier toward the end of the pandemic and needed more space,” Eichenbaum said. “We have some of our billing staff and our clinical trial contracts and budgets manager working from home, and that has freed up square footage, which everyone needs. In turn, that has allowed us to have more patient-facing employees.”
Feistmann said the pandemic shed light on the possibilities for a virtual or hybrid office.
“Being in New York City, space is very tight,” he said. “We used to think that if we tried to open up extra space by taking our phones off the front desk, we would just have to move them to another building or another office. There isn’t any extra space to just have people answering phones. With all the technology and experience we gained in the last 2 years, we can have those people work our phones in their homes, and we don’t even think twice about it.”
Giving staff a chance to work from home helped retain one of Feistmann’s employees who otherwise would have had to quit. It might not be the right choice for all practices, but he said he has seen the value of allowing at-home work.
“It’s one of those things that is here to stay,” he said. “For the right employee and for the right reason, it’s an extra tool that we have to keep a great employee.”
Eichenbaum said that practices cannot tell employees to work from home and leave them to fend for themselves. Support must be offered.
“Part of making them successful is making sure they are all set up at home and feel supported by the brick-and-mortar practice,” he said. “With one key employee, we funded some of the equipment to give her the home office that she needs. She has a good Zoom setup, a flawless laptop and strong internet coverage. You have to set them up for success. You can’t just say, ‘Good luck with your Boost Mobile phone.’ If you’re going to work from home and be productive, we’re going to make sure you have an environment in which you can do that. That doesn’t mean you need to build an addition on your employees’ houses. It just means that you set them up with the tools that they need and be sure that you have clear expectations for availability and for any times that they need to be in person at the brick-and-mortar location.”
Remote work also expanded to some unexpected positions. Sanders said one of the most successful transitions to remote work has been with his scribe. Instead of having them sit in the exam room with him, he wears an earbud and dictates notes while they put that shorthand into the electronic health record from home.
“It works fantastically,” he said. “It hasn’t been much of a change for me, but I think patients like it. When I explain it to them, they are curious. In the back of their minds, I think it shows them their doctor is keeping up with technology.”
Remote work will never be a universal option in medicine, Sanders said, but along with automation to systems such as checking in and checking out, it will be a part of the industry moving forward, particularly as a means for staff retention for employees who have grown accustomed to working from home throughout the pandemic. Its implication as a hiring benefit could be more limited.
“Is it something we can dangle out in front of people for hiring purposes? I don’t think we’re there yet, and I’m not sure if we’re going to get there,” Feistmann said. “We’re a doctor’s office, and we treat patients. Offering remote work before you have a relationship with that person and before they’ve established themselves is going to be tricky. A lot of our training is done at the office, with them watching us and us watching them. I know other industries are able to offer that to new employees, and it could be possible in the future. We’re just not there yet.”
Attracting new hires is not a straightforward process and should not be taken lightly. Feistmann said that the most important thing to look for in a new hire is the right fit.
“Whenever we hire out of desperation and don’t have patience to find the right fit, it usually doesn’t end well,” he said. “Here is a situation that has worked well for us. If we find someone good, we scoop them up, and over time, it works itself out. If they are that good, they create value with their presence. It’s about being patient and hiring for quality.”
In a changing world and business environment, Qureshi said it can come down to rethinking stringent beliefs and guidelines.
“Think outside the box, and figure out ways that people can help you without sticking to the way you’ve always done it before,” he said. “If someone can come in and bring something valuable, you have to be open to it even if they do it in a different way.”
Berrocal said situations continue to change, and people who run practices, particularly those in private practice, need to keep up.
“These managers need to be more flexible,” she said. “They need to think of the future and be more adaptable.”
For better or worse, Sanders said that ophthalmology practices could be reshaped in a larger sense.
“It takes size and scale to develop a program where people can work from home,” he said. “I work in a large network, so we’re motivated and have the resources to make these pilot programs to test out new remote work opportunities. If I were a solo practitioner or a smaller practice, I don’t know if I would have those resources. Over time, consolidation of medical practices and networks will help with that.”
- Reference:
- Sanders R, et al. Disruptive transformative technology and trends in the retinal sphere. Presented at: American Society of Retina Specialists annual meeting; July 13-16, 2022; New York.
- For more information:
- Audina M. Berrocal, MD, can be reached at Bascom Palmer Eye Institute, University of Miami, 900 NW 17th St., Suite 26, Miami, FL 33136; email: aberrocal@med.miami.edu.
- David Eichenbaum, MD, can be reached at Retina Vitreous Associates of Florida, 4344 Central Ave., St. Petersburg, FL 33711; email: deichenb@yahoo.com.
- Jonathan Feistmann, MD, can be reached at NYC Retina, 20 E. 9th St., New York, NY 10003; email: jonathan@nycretina.com.
- Jawad Qureshi, MD, can be reached at Retina Center of Texas, 12222 North Central Expressway, Suite 250 Dallas, TX 75243; email: jawad.qureshi@me.com.
- Reginald J. Sanders, MD, can be reached at The Retina Group of Washington, 5454 Wisconsin Ave., Suite 650, Chevy Chase, MD 20815; email: regsanders@icloud.com.
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