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Practice Made Perfect | Jan 2020

Hiring and Managing Practice Staff

These tips and tricks can help mitigate the challenges of office staffing.

In an ophthalmology practice, the average lay staff member will remain on the job for about 4 years. In a field in which it takes about 2 years to gain the significant skills required by the job, this high staff turnover rate can be profoundly disabling.

In addition to the emotional frustrations that staff turnover can create, there is also a high financial cost associated with it. Estimates vary regarding the cost each time a practice loses a staff member, but a good consensus number is that, each time a staff member is lost, the practice loses about 50% of that person’s wages. This loss stems from a confluence of a variety of things, such as the time and effort of recruiting a new hire, the burdens placed on remaining staff in the interim, and training the new hire.

To help ophthalmic practices hire the best employees possible—and hold onto them—in this article we highlight several tips and tricks for hiring new staff and managing current staff.


Be Clear

When you craft a job posting, be extremely clear about what skills you expect a new hire to bring to the position. Be realistic and clear about wage levels. The unemployment rate is low right now, and many states are considering adopting a $15 per hour minimum wage. It is much better for a practice to hire and employ fewer people at a premium wage than to hire excessively at low wages.

Consider Benefits

Be realistic about benefits. Ophthalmology practices are not accustomed to paying employee benefits at the same levels as local hospitals or large clinics, and yet, ophthalmology practices are competing with those institutions for the same staff. Even though it may be painful, an ophthalmology practice must ensure not only that it is paying at market rates or slightly above, but also that it is providing benefits that come close to the benefits that larger employers offer. The days of medical practices getting by without offering medical insurance are past.

Promote Job Openings

Make sure that you secure the largest possible candidate pool by taking ample time to conduct your hiring search. Often, when an office posts a position, the hiring staff are not patient enough when the applications start flowing in. The hiring manager will interview a handful of candidates, pick the best two, and call it a day. Job openings should be promoted widely, and time should be taken to carefully evaluate candidates.

Allow Employee Shadowing

It is essential to invite your finalist candidate to shadow somebody who is now doing the work that the candidate will be doing if hired. Candidates who have never worked in a fast-paced, perfectionist environment should be given the opportunity to experience it firsthand before being hired.

Allow Potential New Hires to Meet Their Potential Coworkers

Before making the job offer, make sure that each and every person who will be working with the new hire has the opportunity to meet with or interview the candidate. If it is a small practice, this can include all of the doctors.

Provide Thorough Orientation

An area of the hiring process that is often overlooked, particularly in smaller practices, is the onboarding process. Employee orientation should be thorough and deeply detailed so that new hires can gain context for the important work that they will be doing as members of the staff and a deep understanding of their job function within the practice. This cannot be accomplished unless those job functions are written down. All standard operating procedures for the practice should be organized, written down, and easily accessible to staff.


Why Measure Performance?

There are a few reasons why it is a good idea to measure staff performance. One is that what can be measured can be improved. It is difficult to keep track of staff performance improvements if there is no method in place of measuring that performance. Second, measuring and tracking individual performance goals can direct employees and managers to work toward objectives that are aligned with the overall practice goals. Third, being busy doesn’t necessarily equal being productive. This goes for individual employees and for the practice as a whole. Measuring performance can identify areas of productivity and weakness within the practice.

How to Ensure Accurate Evaluation

To ensure accurate employee evaluation, the employee performance appraisal process should be standardized. Practice managers and owners can designate their own protocols in accordance with what works best in their specific practice. In general, an annual performance appraisal should be conducted based on the employee’s hire date so that all performance reviews are not lumped together during one universal review period. If any issues arise during the annual performance appraisal, the practice manager can do a check-in 3 or 6 months later, instead of waiting an entire year before the employee’s next scheduled evaluation.

How to Design a Performance Review

An effective performance appraisal includes at least three measurable and specific goals. For example, you don’t want to tell an employee who works in billing that he or she must simply “be a better biller.” If the situation is handled in this manner, room is left for employee and manager to have differing expectations and standards for what that means. Be specific, and say something along the lines of, “Right now, you are posting 100 charges per day. To be a better biller, you need to post 150 charges per day.”

Specificity makes performance goals measurable and ensures that all parties are on the same page regarding what the goal is. As much as is possible, the manager should develop performance goals with the employee. Sometimes the employee may not see what his or her manager sees, but if the employee and manager can work together to develop goals, the employee is more likely to succeed.

When a Corrective Action Plan is Required

If an employee is not performing up to the practice’s standard and your patience is wearing thin, a corrective action plan may be necessary. A 0 to 10 scoring system (see Employee Evaluation Method) for assessing employees can be helpful to identify employees who may need a corrective action plan. Specific tasks, objectives, and goals should be outlined clearly. The corrective action plan should also have a specific deadline—a date by which the employee’s performance must meet practice standards and individual goals or the employee will be terminated.

Employee Evaluation Method

Step No. 1: Ask a manager to choose an employee and rate that employee’s overall performance on a scale of 0 to 10, where 0 is poor and 10 is excellent. This should be an evaluation of every aspect of the employee’s job performance, including his or her job knowledge and skills, timeliness, and interaction with patients and coworkers.

Step No. 2: Let’s say that the manager rates a given employee as a 5 overall. You should then ask the manager, “What is this employee’s potential?” The manager might say that the employee has the potential become a 7. The next question for the manager is, “What, specifically, would this employee have to do to achieve a 7?”

Step No. 3: The manager can then determine how that employee can reach that full potential and inform the employee of the rating, the potential, and what must be done to achieve it.

This method of evaluation is a quick way to provide an employee with the specific feedback necessary to improve his or her job performance, and it provides a baseline for the manager to refer to when reviewing the employee’s performance a few months later. This evaluation technique can also open a manager’s eyes to employees whose performance is not satisfactory and who have no potential to improve their performance.


Most people show up to work or to a job interview with the intention of doing a good job. It behooves managers to be specific about what they are looking for in new employees, the expectations they hold for current employees, and the improvements that must be made in any current employee’s performance in order for the employee to meet the practice’s standard. If an employee or potential employee knows exactly what has to be done to perform better or to get the job, he or she is more likely to do it.

John B. Pinto
  • President, J. Pinto & Associates, San Diego
  • pintoinc@aol.com
  • Financial disclosure: Owner (J. Pinto & Associates)
Corinne Z. Wohl, MHSA, COE
  • President, C. Wohl & Associates, San Diego
  • czwohl@gmail.com
  • Financial disclosure: Owner (C. Wohl & Associates)
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