Article Date: 5/1/2011

Delegation, Efficiency and Paraoptometry

Delegation, Efficiency and Paraoptometry

Here's how to increase patient volume while maintaining high levels of service and care.

Carmen Castellano, O.D., F.A.A.O. St. Louis, Mo.

As we embrace the medical model and adapt to changes related to healthcare reform, it becomes critical for us to work more efficiently, so we can see more patients and not compromise quality of care. One way to accomplish this is to incorporate paraoptometric staff.

Many doctors feel they are not busy enough to delegate. But this may be a matter of self-fulfilling prophecy: The doctor may not be busy enough because he or she hasn't delegated tasks to the staff. How much should you delegate? That depends on your comfort zone and your state's laws. But, any level of delegation is better than none in creating a more efficient practice.

The paraoptometry model

Paraoptometry can provide O.D.s with trained staff that may become an extension of the doctors themselves in delivering a high level of patient care and service. Whether in the area of patient services (front desk and back office), optical services or technical care, the use of trained paraoptometrics helps a practice to work efficiently, allowing the doctor to concentrate on analysis and decision-making rather than data collection.

Yes, it's true, the costs of hiring and keeping trained personnel might be higher than that of inexperienced staff, but I've found that the increased productivity more than makes up for the increased payroll costs. Let's look at the economics:

The average yearly gross revenue produced by a self-employed private-practice O.D. is about $530,000, according to the American Optometric Association's (AOA) Caring for the Eyes of America 2008 report. This report reveals the average O.D. sees approximately 2,300 complete eye exam patients and has 900 other patient encounters per year, while working 38.5 hours per week. This suggests the average O.D. sees about 1.5 patients per hour (or 40 minutes per patient). Conservatively, by utilizing trained paraoptometric staff, the doctor's time spent with each patient could be cut in half, and, assuming this doubles the patient load, the practice now produces $1 million per year. Factoring in cost of goods and staff costs, this increase could add from $200,000 to $300,000 of working capital (and quite possibly profit) to your practice.

The AOA's Paraoptometric Section (PS) provides an opportunity to provide staff with a number of benefits, including recognition, education and access to publications. It's an economical solution. For example, exam preparation materials for certified paraoptometrics cost $125 for both the book ($65) and CD ($60). (Visit for information on all training materials and discounted pricing for AOA and AOA PS members.) Also, the AOA Commission on Paraoptometric Certification (CPC) (see Table 1, below) offers staff certification at various levels of responsibility.

Table 1
For more information on the AOA Paraoptometric Section and the CPC contact:

Ms. Joan V. Abney
Paraoptometric Section Manager
American Optometric Association
243 N. Lindbergh Blvd., Floor One
St. Louis, Mo. 63141-7881
(314) 983-4222 (direct)

Ms. Darlene Lueschke
Commission on Paraoptometric Certification
American Optometric Association
243 N. Lindbergh Blvd.
St. Louis, Mo. 63141-7881
(314) 983-4135 (direct)

Levels of certification

AOA CPC offers three levels of certification:

Certified Paraoptometrics (CPO). These folks demonstrate competency in basic optometric office duties. They are tested for proficiency in the area of basic science, clinical principles and procedures, ophthalmic optics and dispensing and related professional issues.

Certified Paraoptometric Assistants. (CPOA). These folks demonstrate management responsibility within a practice. They must demonstrate proficiency in office operations, ophthalmic optics and dispensing, testing procedures, special procedures, refractive status of the eye and binocularity, as well as basic ocular anatomy and physiology and basic ocular pharmacology. They are also expected to be familiar with all CPO-level matter.

Certified Optometric Technicians (CPOT). These folks assist O.D.s with a range of patient care functions, such as pretesting or contact lens dispensing. They are tested for proficiency in pretesting procedures, clinical procedures, ophthalmic optics and dispensing, refractive status, binocularity, anatomy and physiology of the eye and practice management. Candidates are expected to be familiar with all subject matter from the CPO and CPOA exams.

For each level of certification, the CPC offers a recommended self-study program and optional review course. To be certified at any level, candidates must pass a proctored, written exam. CPOT candidates must also pass a practical exam within three years of the written exam. Also, the CPC offers recertification to ensure its certificants remain current in optometric assisting skills and continue to develop professional expertise through CE activities.

There are 10 U.S. formalized paraoptometric assistant and technician programs (see Table 2, below). The CPC programs prepare individuals for a career in the optometric field.

As the entire healthcare field moves more toward electronic health records and high-efficiency care, the U.S. Department of Labor (DOL) ranks medical assistant among the “fastest growing” occupations in the nation. The DOL also emphasizes that “those with formal training or experience, particularly those with certification, will be the preference of healthcare employers hiring.”

Table 2
Paraoptometric Personnel Assistant and Technician Programs

Madison Area Technical College*
(608) 246-6557
(608) 246-6013 (fax)

Spokane Community College*
Vision Care Specialist/Technologist Program
(509) 533-7315
(509) 533-8621 (fax)

Indiana Univ School of Optometry*
Optician Technician Program School of Optometry
(812) 855-1917
(812) 855-7045 (fax)

US Army Eye Specialist Program*
US Army Medical Center and School
(210) 295-4425

Sheppard Air Force Base*
Ophthalmic Apprentice Program

Florida Community College
Optometric Assisting Program Florida Community College-North Campus
(904) 612-6638

McFatter Vocational-Technical Center
Optometric Asst Program
(754) 321-5720

Traviss Career Center
Optometric Assisting Program Health Occupations Education
(863) 499-2700 (863) 413-2067 (fax)

Prince George's Community College
Optometric Assistance Program
(301) 336-6000

Des Moines Area Community College
Optometric/Ophthalmic Technician Program

*Accreditation Council on Optometric Education approved Oct 2010

Firsthand experience

In our practice, we have utilized paraoptometrics for more than 30 years. During this time, we've achieved significant yearly gross revenues, while utilizing no more than three (and most often two) full-time optometrists. Our staff consists of the following:

Patient services assistants (PSA) who manage the phones, front desk as well as back-office insurance billing and related issues. As the first person a patient generally encounters in the practice, these individuals must be well trained in the practice's philosophies and policies and possess the “people skills” necessary to deliver high-quality “customer” service. The PSA is also trained to provide contact lens instruction to all new wearers.

Data collection technicians administer all pretesting (most of which is now automated) and specialized testing (threshold visual fields, scanning laser ophthalmoscopy, etc).

Chair side technicians assist the doctors in the exam room administering the remaining aspects of routine, medical and contact lens care.

Contact lens lab technicians are responsible for contact lens ordering, maintenance of inventory, contact lens inspection, verification and rigid lens modification.

Opticians manage all aspects of optical dispensing including selection, ordering and management.

► The office administrator oversees all other areas of the office, manages payroll, human resources, coordinates employee reviews and book-keeping.

Some of our staff has come from the aforementioned formalized programs, some have been trained on-the-job and many have had CPC certification and involvement in the AOA's Paraoptometric Section.

Whatever your comfort zone, this is an ideal time to move your practice toward higher efficiency through the use of paraoptometric professionals and increased use of delegation. OM


• The AOA Commission on Paraoptometric Certification (CPC) 2009 Year-In-Review. Journal of the American Optometric Association. June 2010 (Vol. 81, Issue 6, Pages 312-323).
• Occupational Outlook Handbook (OOH), 2008-2009 Edition. Available at:
• American Optometric Association, 2008 Edition, Caring for the Eyes of America.
• Levoy, Robert. Hard Lessons About Delegation, Optometric Management, September 2010, page 85.
• Gailmard, Neil. Delegation: The Usual Excuses, Optometric Management “Tip of the Week”, October 20, 2010.
• Gailmard, Neil. Take the First Step to Success: Delegate Now! Optometric Management “Tip of the Week”, October 27, 2010

Dr. Castellano practices at The Koetting Associates. He is an adjunct assistant professor at the University of Missouri-St. Louis School of Optometry, Pacific University College of Optometry and Dept. of Ophthalmology and Visual Science at the Washington University School of Medicine. Contact Dr. Castellano at, or send comments to

Optometric Management, Issue: May 2011