We ophthalmologists are accustomed to adapting to a changing landscape of clinical advances, regulatory requirements, and financial pressures. The most pressing issues we face today are staffing shortages and the financial sustainability of our practices and ambulatory surgery centers (ASCs).
Across the country, ophthalmic practices are struggling to recruit and retain skilled clinical staff, particularly ophthalmic technicians and surgical counselors. No matter how strong patient demand is or how advanced surgical technologies become, practices that lack the staff to support patient flow come to a grinding halt. The challenge is not limited to small practices; large, high-volume practices are equally affected.
Attracting and retaining talented employees is increasingly difficult because competitive wages in less demanding industries lure them away. Ophthalmic technicians and surgical counselors are expected to perform in fast-paced, high-pressure environments that require specialized skills and training, yet their compensation often does not reflect the level of expertise and dedication they bring to the practice. Many private practices invest heavily in training only to see their staff poached by competing practices offering slightly higher wages. The cycle of hiring, training, and losing skilled employees is not only disruptive but costly.
Larger organizations and private equity–backed practices face an additional hurdle: rigid compensation structures. Whereas smaller, independent practices may have the flexibility to offer salary increases or incentives on the spot, corporate-owned groups often require lengthy approval processes, making it difficult for them to retain valued employees. Unfortunately, these organizations sometimes operate under the flawed assumption that losing an experienced technician is not a major concern because they can simply hire and train a replacement who will accept a lower wage. What they fail to recognize is that an experienced, well-trained technician is far more productive and efficient than a new hire, often making the retention of seasoned staff more cost-effective in the long run.
An emerging challenge is anesthesia coverage for cataract surgery in ASCs. Declining reimbursement rates have made it increasingly difficult to secure anesthesia providers, particularly at independent surgery centers. Without a high-volume, highly efficient surgical schedule, anesthesia groups struggle to justify the financial viability of covering ophthalmic procedures when they can earn significantly more in other specialties with longer, higher-paying cases. The shortage threatens to disrupt surgical efficiency, delay patient care, and ultimately affect ASC profitability. For surgeons and practice administrators, this underscores the importance of strategic planning, optimizing surgical throughput, and maintaining strong relationships with anesthesia providers to ensure continued access to high-quality perioperative care.
To sustain the success and profitability of our practices, we must take a proactive approach to workforce retention and financial management. Staffing shortages and anesthesia access are not passing challenges; they are growing trends that require long-term solutions.
The reality is that we have underpaid and undervalued our clinical staff for too long despite the vital role they play in patient care and practice success. If we do not recognize and address this issue, we will continue to lose talented employees to other industries offering similar pay with less stress. Investing in competitive wages, career development opportunities, and workplace culture is no longer optional—it is essential.
In a rapidly evolving health care environment, we must stay ahead of the curve. By acknowledging challenges and implementing thoughtful, proactive solutions, we can ensure that our practices continue to thrive, our patients receive the highest quality of care, and our teams remain engaged, motivated, and well compensated for the essential work they do.
