Article Date: 12/1/2006


Staffing is one of optometry's biggest challenges. A thorough, organized training program is the key to successful hiring.

Staffing issues are one of the top three problems facing doctors today. In my first ten years of consulting and management, employee issues were at number five. Independent O.D.s say staff management is their biggest challenge, according to an ongoing survey conducted by the Management & Business Academy (MBA). Half of owners do not regularly share financial performance data with staff, and 89% do not have written qualifications for each position. A little more than half of practices do not provide annual written performance appraisals, and 33% conduct infrequent staff meetings — quarterly or less often, according to the MBA.

Some common reasons for these staffing problems are:

Changes to the family unit. There's been an increase in the number of people from dual-income and single-parent households. These employees often demand higher salaries and medical benefits.

Transient employees. This is caused by divorce, plant closings, relocation of spouse or significant other and the "tug-of-war" within the local optometric community for experienced workers.

Lack of discipline. Many employees today were raised in households where structure, organization and consequences to negative behavior were non-existent. A well-run optometric practice that pays attention to detail must live by these parameters. Many staffers will be hired, but cannot make it through their probationary period due to boundaries set by the practice.

It's all relative

You may be asking yourself, "What does this have to do with staff training?" The above societal changes create some data that is critical to staff training. The MBA survey shows most practices have an average annual staff turnover of 17%, meaning about one in six employees leaves the practice each year. It is therefor imperative that you develop a usable and friendly training program for the "revolving door" of employees. Many doctors have thrown their hands up in disgust due to what they feel is the necessity for training staff.

Before we get into the proper way to train staff, let me list the numerous training pitfalls I have witnessed, in my consulting, which you must avoid.

Assigning a new employee to a varsity staffer. This is usually a disaster. The seasoned assistant is normally a key staffer whose plate is already overfilled. As doctors and business owners, we have a tendency to over delegate to our stars. This results in low morale, decreased efficiency, productivity and profitability. Subconsciously, the senior staffer gets agitated with the constant re-training and many times, frustrates the new employee. This is a formula for increased office stress and an early departure of new personnel. If this method persists, you could loose the senior staffer as well.

Ventilation system. In my years of working with O.D.s and M.D.s, I have consulted with numerous offices that hire "Mary" and assign her to a department. Mary is planted and expected to learn as she can. Even the most sophisticated "ventilation" systems have no ability to train. I have interviewed and documented hundreds of employees who had little or no scheduled training. This leads to low morale, increased stress in the workplace and sends a message that the doctor doesn't care. The end results are always errors and poor patient handling.

No verification of employee knowledge or skills. Prospective employees almost always exaggerate their skills and ability. They are hired, for example, as opticians and can't even perform lensometry. I have developed tests for prospective employees who have prior experience. Their performance indicates the level of competency or exaggeration.

Organized training

In order to decrease all these negative employee experiences, you must develop an organized training program. The program must:

Be repeatable. The program must be repeatable, without consuming the doctor's time.

Cross-train the entire staff. All employees must take the program to be cross-trained at a cerebral level. In some offices, it is not important that all employees perform dispensing. But it is absolutely mandatory that all staff be trained on materials and methods used, for example, in optical. This is true for all departments. For example, opticians need basic knowledge as to what and why we bill to major medical providers. This type of cerebral cross-training raises morale, creates a common objective and enables all employees to converse with patients in an intelligent manner.

Be Testable. You must test staff on this cross-training as a check-and-balance system to assure assistants are learning and retaining the information. Do not assume they understand the material presented simply because they were present.

Include workshops. Offer workshops after teaching a particular topic. For example, follow a presentation on ocular anatomy with a hands-on demonstration. Use models, pictures, etc. to bring the information to life.

Be fully paid. Pay the staff for the time spent in training.

Conduct the teaching portion through video, audio or written media. You must decide which method works for your practice.


After surveying presently available training materials, I found that ophthalmology has a textbook program. The information is excellent, but the format is not very practical. How many assistants will read multiple textbooks with no supervision and take an exam at completion?

In my consulting, I commonly observe different assistants speaking and performing the same procedure in different ways. Developing the organizational approach is by far the best way to maximize proper patient care and increase efficiency, productivity and profitability. The following tips will help create an organized training program that results in staff using the same vocabulary and techniques.

The solution I developed for my clients was to hire a professional production company. They came to my office in the evenings and set-up their equipment in rooms where I planned to instruct. When I started developing this course to train ophthalmic technicians, I had no clue how many lectures I would make. Understand that this video ophthalmic training course does not review management aspects. It is intended to cross-train all staffers in clinical and optical technical skills.

It is necessary for you (and your associate, if you have one) to perform the workshop in the first round of training. When a new person is hired, have her go through the entire course. You can assign a varsity assistant who scored well on the subject matter to take the new employee through the course. No matter what media you use, make sure that testing is performed, and delegate the workshops. This will relieve you of most of your stress.

A cohesive workforce

The image of your highly trained organization should be of the highest professional caliber. Patients develop an image of your office based on the verbal, auditory and visual cues they are exposed to. It's critical for those independent practices that want to set themselves apart from the crowd to pay attention to detail when properly training staff.

I am often asked when an O.D. should do the training. For round one, when all staff participate, train in the morning. Do not schedule any patients or answer the phone and lock the door. Either come in an hour early, or start one hour later. Attention span at the end of the day is questionable.

Doctors, as I tell you often in my Fix This Practice column, take charge of your practice. Your employees are projections of you. They can exemplify two images of your practice: A confident, controlled, income-producing practice with a high morale; or a practice that cannot handle its employees, makes constant errors and inappropriate comments. Which would you choose?

Dr. Kattouf is the president and founder of two management and consulting companies. For more information, call 1-800-745-EYES, or send e-mail to Dr. Kattouf at

Optometric Management, Issue: December 2006