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 By Neil B. Gailmard, OD, MBA, FAAO, Editor September 22, 2004 - Tip #140 
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A Real World Indoctrination for a New Grad

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I've had excellent success hiring associate optometrists directly out of school, and in doing so I have come up with a tip that has eased the transition from optometry school clinics to private practice. We all know that there is much to learn, but this concept accelerates the learning curve and makes the new grad a good value to hire.

The no-license syndrome

This idea was born from the inconvenient lag time that exists between optometry school graduation day and the official issue of the state license to practice. Depending on the state where you practice, that can easily be 3 months of down time for the new doctor. If you have been interviewing candidates for an associate position in their senior year, you may easily have made a selection by the middle of May. Many new grads are very anxious to begin work right way - at least the best ones are, in my opinion. Sure, they could take the summer off, but it says a lot about ambition and drive if they are eager to get to work. The new grad is not only at the height of professional enthusiasm, but also has a real financial need for a good paycheck.

The idea is to simply have the new doc work as a technician in the practice, on a temporary basis, until his or her license comes through. This may not seem like rocket science, yet the benefits are much greater than you might think and the situation is quite different from the part-time employment many students experience before graduation.

This concept works extremely well in my practice, because I already delegate a great number of tasks to technicians, and I use scribes in the exam room with me. Our clinical techs also perform frame selection and dispensing tasks, so the learning continues for the new grad. But even if you typically delegate fewer procedures, this new technician with an OD after his or her name will be the most skilled one you've ever employed. This experience may even help the senior doctor move toward a higher level of delegation in general.

Work as a tech

Let's take a look at the work the new graduate would perform and how it helps assimilate him or her into the practice.
  • Pre-test instruments. It's very valuable for a doctor to be able to operate all the instruments in a practice, even the pre-test equipment that will usually be performed by a technician. Instruments differ, and the brand or model that was used in school could be very different. The doctor should be able to do the test herself without hesitation if a tech is not available, and should be able to supervise and train staff as needed. Topographers, field units, retinal cameras, nerve fiber analyzers, contact lens radiuscopes, and pachymeters are just a few examples of instruments the new doc must develop skill with. Nothing does that faster than repetition.
  • Problem focused exam procedures. Taking this a step further, letting the new doctor scribe for the senior doctor provides tremendous learning opportunities. As great as optometric education is today, very few students actually spend much time observing experienced optometrists performing actual eye exams. It's mostly the other way around, with clinical faculty ODs observing students. And in this case, the observation is with the optometrist who has built the practice the new doctor is joining! The real world education that occurs is obvious, from the selection of what tests to run for different cases to how to do a refraction quickly.
  • Interpersonal relations. Just as important as observing the testing is how to communicate during case history, chairside consultation and patient education.
  • Timing and flow. Performing the pre-testing, observing the senior doc and conducting frame selections helps the new doctor get a sense of timing that is needed in the world of private practice.
  • Record keeping and abbreviations. Each practice is unique with regard to record keeping conventions, and scribing the whole record and the optical order is the fastest way to learn.
  • Office policies. Technicians are the people in the office that actually apply the myriad of policies that exist and answer patient's questions. The new doctor learns from the ground up.
  • Contact lens practice. What types of lenses does this office fit and what are the standard clinical and administrative procedures? The new doc gets experience with the brands of choice.
  • Dispensing and optical lab processing. What can be promised when? How to troubleshoot a complaint? What options and materials don't go together? How to communicate lens features and benefits, and drawbacks? Optometry schools may be a little light in this area (admittedly, they have a lot to cover); so new ODs must learn it in the real world.
  • Fees and insurance coding. Our techs write up all procedures and fees on the superbill and indicate the diagnosis codes. They also calculate vision plan benefits and complete forms amid an increasingly complicated set of rules. Is it good for doctors to know this also? Absolutely.
An ego problem?

So how does a young doctor - filled with professional pride - react to the concept of being in the trenches with staff members who are paid by the hour? In my opinion, that reaction could actually prove to be a big indicator as to whether or not the new doc gets a job offer. If he views that kind of work as beneath him, especially in this short non-licensed period, then his ego could end up causing lots of other problems in the future.

I'll admit that it could seem a bit awkward at first and it may take some getting used to, but it actually works very well in practice.

Salary level

This can be any amount deemed fair by all, but I've found that paying a salary of 50% of the agreed upon future salary when this graduate becomes licensed, works well. Even at 50%, that pay level is usually generous for technician duties. I would schedule the new doctor-tech for a full 40-hour week, with evenings and Saturdays.

After the license is issued

The new OD makes an immediate shift to become a real doctor as soon as the license arrives. The receptionists begin to schedule actual appointments, but for the first couple of months, I would space those appointments out so the new doc has about twice the time allotment as usual. This lets the doc get acclimated to the new role, and it won't matter much anyway, since she will not be fully booked for a while.

It's helpful during the first couple months to schedule some private one-on-one meetings with the associate, and to pull several of his patient records at random to review and discuss. This should be done diplomatically and with great respect for the associate's own professional judgment - even if a case was handled differently than the senior doc would have. There can be a good exchange and discussion of patient management if both parties approach this with a constructive attitude. After a short period of time, I would stop reviewing cases and let the doctor practice. At that point, both senior and junior can learn from each other.

With all there is to cover, it may seem like a three month period is not long enough, but these new optometrists are quick studies. They get it.

In addition to learning valuable skills, the new doctor will bond with the staff and will be introduced to a sample of the patient base. It's a winning situation on many levels.

Best wishes for continued success,

Read Past Tips Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week

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Send questions and comments to neil@gailmard.com.

Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.

Please Note: The views expressed in Management Tip of the Week do not necessarily reflect those of the sponsor.

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