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Cover Stories | June 2018

Build Your Dream Team

Strategies for staff development.

If new employees arrived perfectly matched to your practice’s culture, to your needs, and to your expectations, you could hire someone and move on with your busy day. Unfortunately, that’s not how it works, especially in this time of constant change within the specialty of ophthalmology.

It is a challenge to find the time to train new staff members while developing existing staff, but doing so is the only way to cultivate the team you truly desire—one that emphasizes patient satisfaction and maximizes outcomes and reimbursement. We must be proactive in order to stay competitive in our field. In this article, I share some tips on how to integrate new staff members and how to strive to make your staff the best it can be.


An interview is the first step to teasing out whether someone is the right fit for your practice, but there is more to the selection process than sitting at a desk and asking questions. You need to find someone who fits the personality of your practice and who reflects the branding that you try to project through your marketing, office design, and other factors. (Editor’s note: For more on the subject of practice branding, see A Short Course in Branding Your Practice, by Crawford Ifland, pg 66.)

To really get a sense of how a person will work out in his or her target position, prehire shadowing can be invaluable. At Matossian Eye Associates, after we have identified a promising potential employee, we invite the candidate to spend 2 hours in the position we’re trying to fill. This amounts to a hands-on test of whether it will be a good fit for both the candidate and for our practice.

We’ve learned valuable things in this shadowing process. For example, we were considering one candidate for a technician position. After her prehire 2-hour stint, she said, “I didn’t realize I had to be on my feet all day long. This is not for me.” It’s a good thing we found that out before hiring her, as technicians are always moving, guiding patients from room to room for testing and procedures.


Once you have identified and hired the right person, training is essential to make sure your new employee is learning the tasks correctly, adhering to set protocols, and executing the learned steps competently. Emphasis on ongoing training keeps everyone current and aligned with the practice goals.

For new employees, training begins with benchmarking. We evaluate every new employee at 30, 60, and 90 days after hire based on a set of benchmarks specific to his or her position. These written evaluations ensure that the new person has learned and internalized all the relevant tasks in the allotted time frame.

To develop a training program, it is first necessary to identify trainers in every department including billing, marketing, front desk, and ophthalmic assisting. Each trainer is committed to both teaching new employees and tracking their progress. If employees do not meet the established benchmarks, the introductory period is extended one time, from 90 to 180 days. If the employee is still unable to meet the set benchmarks in a statisfactory manner within that time, he or she is terminated.

In addition to the training that takes place in the first 90 days, at Matossian Eye Associates we assign every new employee a mentor for his or her first year. The mentor’s role is to shepherd the trainee and to help the new employee feel connected to the team. Because mentors are asked to do more work, we reward them financially with a bonus every quarter during their yearlong mentorship. Once new team members reach the 1-year mark, they are generally well integrated into the staff.

Training is important not only to make sure that employees execute all assigned tasks correctly, but also to ensure that their contributions help maximize the practice’s revenue. A well-trained, efficient scribe, for example, can help improve patient flow so that more patients can be seen in a day. If just one additional patient is seen per day, on average, an additional $40,000 of revenue can be generated for the practice over the span of a year (Figure 1).

Figure 1. Example of how a good scribe can increase a practice’s revenue.

Training also helps to ensure that employees are asking the right questions for coding and reimbursement purposes. If technicians have not been trained properly (Figure 2), they could be missing clues from patients to proceed with point-of-care tests. Asking a patient, “Do you have dry eyes?” may elicit the answer, “No, my eyes are tearing all the time.” Rephrasing that question to, “Do your eyes feel tired? Does your vision fluctuate throughout the day?” may elicit a positive response, empowering the technician to proceed with dry eye testing. »Tear Osmolarity (TearLab) and/or »Inflammadry (Quidel) biomarker testing must be performed before any drops are instilled into the eye. Not only can this information help the eye care provider diagnose the patient’s problem, but it can also boost revenue.

Figure 2. A training schedule can help to ensure that a technician is familiar with all relevant testing.


In addition to learning their own roles, employees need to be exposed to information within the entire practice for them to feel part the team. Whether someone is working at the front desk, in billing or marketing, or as an administrator, spending time with retina, oculoplastics, glaucoma, cataract, and contact lens specialists helps them become better informed; in turn, they will be able to answer patient questions more accurately and embrace the overall mission of the practice. At Matossian Eye, we also invite staff to observe live surgery—although some employees pass on that option.

As I alluded to earlier, training benefits not only new employees but also those who have been with the practice for years. For established employees, we call this staff development. We dedicate 1 hour each week to staff development and everyone is invited, from the front desk staff to billing, marketing, administrative, and surgical staff.

Coming together to talk about topics ranging from a new medication, to a new procedure, to customer service tips, helps gel the staff into a cohesive team.

Contant emphasis on training also encourages employees to seek certification within their fields (see Support Certification for more information).


Certification can boost employee skills and help them maintain high standards. Helping your employees attain the relevant credentials can be a worthwhile investment. These include not only the familiar ophthalmic technician, technologist, and assistant certificates, but others for the front of house and back office:

• COA: certified ophthalmic assistant

• COT: certified ophthalmic technician

• COMT: certified ophthalmic medical technologist

• CPSS: certified patient service specialist (for front desk staff)

• OCS: ophthalmic coding specialist (for billing staff)


Often, people enter midlevel management without having had adequate exposure to management or leadership training. Putting a person into a management position without the requisite skills can be a recipe for dissatisfaction for both the manager and his or her reports. We help guide our new managers by providing skills training. At Matossian Eye, we have a monthly midlevel management meeting where we discuss leadership topics.

At these meetings, we also review the results of anonymous employee surveys that give us an idea of what our staff members are thinking. If a problem is raised in the survey, we commit to addressing it in the best way we can.


To succeed, you need to sweat the small stuff—and, after all, it’s all small stuff. Make sure your employees are up to snuff and positively represent your brand by taking the time to teach them what you want them to do and how to do it. Identify your trainers, teach leadership, allot adequate time for staff development, and maintain realistic expectations. It’s all an investment in building and maintaining your dream team—and one that can be well worth the effort.

Cynthia Matossian, MD, FACS
  • Owner, Founder, and Chief Medical Officer, Matossian Eye Associates, Pennsylvania and New Jersey
  • Clinical Instructor/Adjunct Faculty Member, Temple University School of Medicine, Philadelphia, and Robert Wood Johnson Medical School, New Brunswick, New Jersey
  • Member, CRST Executive Advisory Board
  • cmatossian@matossianeye.com
  • Financial disclosure: None
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