A year like no other.

That’s certainly one way to describe what ophthalmic professionals, practices, and patients have been through. The findings of OP’s 2021 reader research point to challenges and resetting at the practice level, almost exactly one year after the pandemic took hold.

“We are all more resilient than we might otherwise have thought and, despite the challenges, we have been able to get things done,” says Judy Williams, co-editor-in-chief of Ophthalmic Professional and president of BSM Consulting, based in Phoenix, AZ.

To delve even deeper, OP spoke with several ophthalmic and health professionals who discuss personal and professional developments in this time, struggles with workplace stress, the practical application of the data found in the survey, and the resiliency of ophthalmology practices.

Personal and professional developments

“The human condition is fragile yet resilient,” offers Lynn Girdlestone, COA, OSA, OSC, a training consultant and certified ophthalmic assistant at a practice in northwest Washington State. “So many of us have lost something to this pandemic — loved ones, our jobs, our perceived freedoms, our health, our sense of security — and some have lost their lives.”

Healthcare professionals had the tough job of working through these challenges and may have employed different tactics for getting through it, such as personal development and maintaining a routine.

“I am always on a journey to learn,” says Myra Cherchio, COMT, COE, director of clinical operations at St. Luke’s Eye, with seven Florida locations. “My personal work (reading, meditation, journaling, and my workouts) has been to take care of myself so I can take care of my team.”

Ashlie Barefoot Malone, MBA, JD, COE, practice administrator at Carolina Cataract & Laser Center in Ladson, SC, offered that she leaned heavily on her routine, and trying to maintain some level of normalcy through self-care and exercise. Professionally, the impact of the onset of the pandemic can be seen in very tangible ways, such as new processes put in place.

Ms. Cherchio says: “We have employed technology in new ways that have improved our communication that we might not have leveraged if the pandemic hasn’t necessitated it. Teams and Zoom have afforded a lot more face time than we had before.”

Increasing communication, specifically via transparency, is also a development noted by Carol Olvera, clinical manager at Colorado Retina with five Denver metro locations and one satellite office. Ms. Olvera says: “We were already trying new things, so that made it easier to say to staff, ‘What do you think we could do to make this easier?’ or ‘How can we pivot to doing something differently?’”

Similarly, Ms. Girdlestone says she’s witnessed new technology and empathy.

“We’ve seen passion and compassion,” she says. “We have come together and, if we do that, we can survive. We are resilient. It’s the best lesson I could have learned.”

Stress levels

There’s no question about it: Stress levels are up. (Figure 1.)

Asked if they had experienced an increase in workplace stress as a result of the pandemic, 53% of survey participants strongly agreed, and 34% agreed. All told, nearly nine out of 10 answered “yes.”

The reasons for the respondents’ stress may have changed over the course of the pandemic, but its impact has continued to be felt.

“At first,” explains Ms. Olvera, “a lot of it came from just the rapidly changing policies, and I think it was felt by both staff and management.”

Increased stress was also the result of extended hours, adds Ms. Olvera. “In order to be able to get the patients in we needed to see, our clinic hours were extended. That meant staff was working with the first patient at 7 a.m. and the last at 5 p.m. Even though it was probably the same number of patients, that’s a really long day.”

Another reason for the stress? Close proximity in a socially distant world.

“Working in ophthalmology, we spend a lot of our day within 6-18 inches of a patient’s face,” explains Ms. Girdlestone. “We have to reassure patients when we ourselves may be scared.”

Ms. Malone agrees that the pandemic has worn everyone down. “I feel like people’s threshold for stress is lower,” she says. “It’s all really different.”

How practices are dealing with this, it seems, as with everything pandemic-related, is an ongoing process.

“There is some great research bubbling up about the mental effect of the pandemic as well and the need for employees to feel appreciated, so we are trying different ideas to make sure they know how important they are to us,” says Ms. Malone. “I think one of the great things coming out of this is the retraining all of us to say ‘thank you.’ It is very easy to get caught up in a crazy day and forget the simple manners that humans inherently want.”

Now that COVID numbers in the United States are down and the country is re-opening, will stressors drop, too? Ms. Williams isn’t so sure: “While we will be able to move on with our lives and businesses, I believe we will continue to feel the impact of this stressful period in different, and maybe surprising, ways for a long time.”

Workload vs. workforce

A contributing factor to increased stress levels, are staff challenges.

“For our leadership team, the fallout of resulting staffing challenges as they try to support their teams has been greater than I’ve ever seen,” says Ms. Cherchio. “With demands increasing all the time, finding ways to manage the workload is critical.”

Ms. Cherchio outlined a few of the ways her practice is undertaking this, including:

• Working on a system to mine EHR and practice management software databases for key analytics that will help identify where additional resources are needed.
• Streamlining the hiring process to act quickly when talent is spotted.
• Listening to and incorporating employees’ feedback.

Regarding staff feedback, Ms. Cherchio says her practice just conducted a survey on how employees would like to be appreciated. “Our team is our most valuable resource. When we take care of them, we empower them to take care of our patients!”

At this point in the pandemic, those interviewed indicated their practice’s patient volumes have rebounded, many to pre-pandemic levels.

“As of right now, we’re back up to 100%,” says Ms. Olvera.

Ms. Cherchio adds, “We powered back up quickly thanks in no small part to the team’s outstanding job of managing the logistics of tracking and reactivating patients.”

As a result, workloads have not diminished. In fact, as reflected in Figure 2, 77% of respondents say their work has increased. The overriding reason, as shown in Figure 3, is staff shortages.

“Our challenge has been meeting demand despite staffing challenges,” says Ms. Cherchio.

That being said, COVID also has changed the workforce, and that’s something employers need to take to heart.

“The workforce has shifted,” explains Ms. Malone. “In fact, we are seeing a different kind of workforce coming out of COVID, which is going to start altering how we run our companies.”

Figures 4 to 6 show increases in the responses that indicate shorter tenure within the industry, at a practice, and in a given position, demonstrating, perhaps some of this shift.

When compared to 2021, this year’s survey questions related to tenure — at a given practice, and in a given position — saw slight increases in the responses that indicate shorter longevity. These responses are consistent with the comments of some of those interviewed for this article.

Numbers may not add to 100% due to rounding.

Specifically, Ms. Malone says, existing employees are burnt out and in need of rest, while new employees are asking for reduced hours and four-day work weeks.

“My hunch is that the idea of ‘retaining talent’ will look different in our future to be more of a short-term workforce with high turnover. We may not like it, but we will need to embrace it if we are going to thrive long-term,” she says. “Today’s workforce wants to live. They want to try new things, live in new areas, and have more quality time outside of the office. If we can get ahead of this and recognize this is our future, then we can look at skills training programs that allow us to find better balance between what the practice needs and what our workforce wants.”

Ms. Cherchio says she is finding the same at St. Luke’s.

“We are noticing that our workforce is placing more value on work-life balance than ever before,” she says. “We are focused on providing schedules that meet their needs as much as our service-oriented industry will allow.”

Salary trends

Despite this increase in workload and staff demand, the 2021 survey shows little change in terms of year-over-year salary increases (most in the 1-5% range, per Figures 7 and 8). That’s impressive considering what has happened over the course of that year. Figure 9 shows the range for gross salary income as reported by respondents.

It’s a balancing act, adds Ms. Cherchio. “The pandemic has required the entire ophthalmic community to continually check and recheck our pay against the market. We want to be a generous employer and attract the best talent.”

This evaluation is exactly what Ms. Williams and BSM Consulting advise their clients to do in order to attract and retain talent. “Be mindful of local competing employers (not just in health care) who may be attracting the same candidates with higher compensation,” she says. “Consider updating pay scales and/or enhanced benefits (including remote working options for appropriate roles) to encourage retention.”

One-on-one conversations do point to several potential challenges when it comes to compensation: It’s basic math, says Ms. Girdlestone. For those practices with fewer patients coming in, “income will inevitably not come in,” she says. “Depending on the size of your company, it is very possible salary increases may be non-existent in the current climate. It’s a difficult time for executives and boots on the ground alike,” she adds, underscoring the pressure many employers are under.

Another contributing factor is reduced reimbursements, says OP co-editor Jane T. Shuman, MSM, COT, COE, OCS, CMSS, OSC, president of Eyetechs. “This difference can be made up by adding and promoting self-pay services,” Ms. Shuman offers.

Touchpoints and tactics

As the journey through the pandemic continues and the resulting procedures and needs change, making staff a part of the process — and being transparent with them — is savvy management. “It’s easy to lose that vote of confidence if you’re not,” says Ms. Olvera.

“One thing we started during COVID that we are continuing whenever possible is we actually have a staff member at home,” explains Ms. Olvera. “They call new patients a day or two before their visit and do all the medical history and medications (where patients can go to the medicine cabinet if they’re not sure about something) and even discuss a chief visual complaint. We’ve had really good feedback both from employees and patients about it.”

Ms. Cherchio agrees, citing some of her staff’s successes. “We are learning how to look at processes with new eyes. For example, we’ve reinvented our desk processes several times to keep up with evolving requirements. Our team has been unusually creative, first designing a curbside check-in process and then taking it apart and restructuring our clinic flow patterns as our state has opened up.”

St. Luke’s Cataract and Eye Institute is learning to maximize Microsoft Teams. “We have multiple teams set up so work groups of leaders can efficiently connect,” Ms. Cherchio says. “We are using it to share documentation and manage projects. It’s made a big impact on how we communicate.”

Now and next

How do some of these new realities — from staff stress to the bottom line — look going forward? Most of the interviewees feel stress will continue to play an undeniable and not-to-be-ignored role in everyone’s professional as well as personal life.

“While we continue to do our best to acknowledge these, encourage our team to talk about them, and seek help and support, I anticipate that we will need to accommodate the ripple effect of many of these stressors for some considerable time,” Ms. Williams says.

Rebound, yes, but repeat, no. “We’re going to have to start learning how to get back to business differently and get creative in how we’re managing our companies,” explains Ms. Malone. OP