Soaring demand. Rising compensation.

You can’t ask for much more than that in a career path.

Ophthalmic professionals who keep up certifications are in a very enviable situation. For employers, however, there are three big challenges. First, how to keep turnover down. Second, how to attract new hires, especially from the too-small pool of young prospects. And, third, how to afford it all.

To find out more about this flourishing field — its opportunities and challenges — we invited subscribers to share their experiences in this annual survey. And, to put it all in perspective, we asked experts to weigh in on those findings.

Life-long opportunity

Many questions we posed underscored the extent to which ophthalmic professionals commit long-term — through ongoing commitment to their education for example — to their careers.

The most indicative: about 45% have worked in an ophthalmic-related position for more than 25 years (Figure 1). That commitment is reflected in the age of respondents — 27% are between 40 and 50, while nearly six of 10 (58%) are over 50.

Brad McCorkle, founder and CEO of Local Eye Site, explains some of the reasons for this. “Young professionals who try ‘teching’ typically like it. Good hours, good wages, rewarding work. The longevity is pushing overall wages up (along with the shortage of backfill techs and increased demand). Doctors don’t want to lose trained, tenured techs. They are difficult to replace.”

Boling Vision Center and INSIGHT Surgery Center in Elkhart, IN, takes a different approach to longevity and wages. “In my practice, we actually don’t compensate based on longevity/tenure,” says Hayley Boling, MBA, CEO of the Indiana practice. “We reward for education/growth/development as well as increases in duties and/or job responsibilities. The career progression for education/certifications is made clear from the beginning.”

While this approach increases salaries, it also increase skillsets and “overall value to the practice,” says Ms. Boling. “I consider it a win-win.”

The demand

When asked about effective certifications, only 12% of respondents said they have none, whereas 40% reported COA certification and 24% indicated COT (Figure 2).

“Certifications are and always have been important,” says Mr. McCorkle. “They demonstrate not only a mastery of clinical materials and skills, but also a dedication to [creating] a career, not just a job.”

The problem? “I hear from many practices the struggles in recruiting and retaining high-quality technicians,” confirms Bruce Maller, president and CEO of BSM Consulting. “I do not hear the same feedback regarding other positions in the practice.”

The rewards

“In effect, you have a ‘buyers’ market,” adds Mr. Maller, OP’s co-editor-in-chief. “Often, the better-qualified candidates may have multiple offers and, as such, can command a higher compensation package.”

Nearly half of those surveyed (47%) earn between $40,000 to $60,000 in gross compensation annually (Figure 3). Plus, about 40% of practices compensate ophthalmic professionals with bonuses to both attract and retain them.

“You can see an increased demand play out in salaries,” says Mr. McCorkle. “COAs have seen a 20% plus increase in annual salaries since 2015 (ATPO data). That is stunning when you consider what’s happened with wages in the rest of the economy, where average hourly rates are only up about 8% since 2015.”

Managing benefits

Almost all survey respondents (94%) are offered medical insurance by their employer (Figure 4), and nearly 85% of those surveyed rank benefits as “extremely valuable.” As the cost of providing these benefits increases, employers are coping in a variety of ways. Currently, 36% cover between 50% to 74%, and just 15% cover 100%, down from 30% three years ago.

“This is the question that grinds at many of us,” says Ms. Boling. “Increasing premiums are becoming suffocating all over the country. Practices are definitely cutting those insurance plans that have diluted benefits and higher-than-average deductibles. In my practice, we cover a flat amount (80% to 90%) toward premiums.”

Settings + surgery

The vast majority (64%) of respondents work in private practices (Figure 5). Respondents also indicate they work in their practice’s surgery center — one quarter, in fact — with 20% reporting time spent in both the practice’s offices and surgery center (Figure 6). “I see this number increasing in the future,” says Ms. Boling. “In our practice, for example, more of my clinical personnel are striving to get their OSA (ophthalmic surgical assisting) certification and other more advanced degrees (LPN, RN, BSN, etc.). Plus, cross-trained team members are far more valuable to a practice.”

Purchasing power

More than four out of 10 of those surveyed are involved in evaluating and recommending diagnostic equipment and durable supplies and equipment, and just over half report they meet with vendor reps (Figure 7). Also, 37% of respondents are charged with ordering the products. “This is a result of the long-term expertise in the field,” says Lydia Lansberry, practice administrator at Northwest Eye Specialists in Tucson, AZ. “In our practice, the clinic and administrative staff work together to evaluate products, pricing, plans, etc., and then relay the information to our physicians.”

Time eaters

Asked what single factor contributes the most to an increase in their workload (Figure 8), respondents pointed to EMR (30%).

“EMR has definitely been the biggest burden for a practice in the last three to five years,” Ms. Lansberry says. “That’s because it affects so many areas — provider and staff training, MIPS compliance, IT expenses, software upgrades, licensing fees, customized templates, clinic workflow, system maintenance, regular reporting, etc.”

The same goes for compliance, the factor that 22% of respondents indicated was the biggest contributor to their workload.

“Government regulations continue to increase the oversight of medical practices, and this directly impacts the amount of time we spend on compliance. Many aspects require tedious work by the administrative staff. Our compliance manuals tend to sound like a litany of acronyms: OSHA, HIPAA, HITECH, OCR, FMLA, ADA, MIPS, SRA ... and the list goes on. We could spend a decent part of our day on just compliance alone.”

Ms. Boling says that Boling Vision Center and INSIGHT Surgery Center replaced a time-consuming EMR system with a new system “that works beautifully.”

“I asked my leadership team, ‘Why should we continue to limp with a system that isn’t working for us … when we can sprint with a system that was designed for us?’” Ms. Boling says.

Once the practice calculated the cost implications of retiring the old system and the value proposition of bringing on the new system, the decision to change “was a no-brainer,” she says.

Ms. Boling agrees that compliance “will just continue to get more complex and time consuming, even with the current ‘efforts’ to relieve the regulatory burdens on healthcare providers.”

The solution? “I do believe that once we have consistently defined expectations that don’t constantly change, this workload will be significantly relieved,” Ms. Boling says. “We’ll know what to expect and will then be able to plan accordingly as a result

The future

What will all this mean in the years to come?

“As the boomers retire, there will be a major need to welcome younger generations with open arms,” says Ms. Boling. “As practices, we will need to adjust our leadership styles and recruiting methods.

“Practice leadership will have to do some serious checking of their generational biases and employ situational leadership in order to provide a warm and welcoming career opportunity for younger workers.”

Adds Mr. McCorkle: “I see ophthalmic technicians taking on an even bigger role, clinically speaking. The same type of shortages exist with ODs and MDs, so in situations like this, we typically see more clinical responsibilities getting pushed downstream.” OP