The field of ophthalmology is facing a significant challenge: a shrinking workforce. A recent study on ophthalmology workforce projections in the United States found that while the number of full-time ophthalmologists will decline by 2,650 between 2020 and 2035, the demand for these doctors will jump to 5,150, representing a supply and demand mismatch of 30 percent.¹ For practices, this shortage means stiffer competition for recruiting the available talent.

It’s also getting more difficult to find reliable support staff for ophthalmology clinics, such as administrators, receptionists and technicians. A recent report by the U.S. Bureau of Labor Statistics showed that over the last 20 years, the labor participation rate has declined steadily.² Staff turnover rates have also increased among health-care workers since the COVID-19 pandemic.³

To navigate these current challenges, practices need innovative recruitment and retention strategies. Below, several practice managers and ophthalmologists share their secrets on locking in good physicians and staff and creating a positive environment that nurtures employee retention.

Hunting Down Doctors

When looking for ophthalmologists or optometrists to join your practice, you have to cast your net far and wide to find the person who will be the best fit.

“You’ve got to look everywhere,” says John Pinto, president and founder of J. Pinto & Associates, an ophthalmic practice management firm based in San Diego. “It’s not just one call to a recruiting company and you’re done; to boost the candidate pool, you have to search on the academy website, send letters out to schools, make calls to your friends in the industry,” and so on, he says.

Numerous websites allow you to post job openings and/or search for potential candidates (sometimes for a fee), two examples being Indeed and ZipRecruiter. There are also several online resources specific to MD and OD hiring, such as The Eye Group, ETS Vision and PracticeLink. Saralee Esau, COA, CPSS, practice manager of Empire Eye and Laser Center in Bakersfield, California, says they exhaust all of these resources when hunting for doctors to hire.

“The Eye Group and ETS Vision are physician recruiters, while PracticeLink is a platform we use to post jobs when looking for providers,” she notes. “We’ve seen success using all of these platforms, as well as Indeed.”

Another way to find doctors to hire is by taking advantage of local optometry schools and residency programs. Consider posting directly on local school websites around graduation time, Mrs. Esau suggests. “There have been times where we’ve attended specialty-specific job fairs; some of the national boards and organizations will have gatherings for new grads, and it’s a great opportunity to network with doctors looking for new positions,” she says.

Colleen Halfpenny, MD, a managing partner at Valley Eye Professionals in Huntington Valley, Pennsylvania, and clinical instructor at the cataract and primary eye care clinic at Wills Eye, says that they’ve found most of their physicians through the network of residents and fellows that she or her colleagues already knew or personally trained. “If you live in an area with a lot of residency programs, it’s a great resource,” she says, “especially when you’re involved in teaching them and can recruit them at an early stage, if they’re interested in staying in the area.”

Finding Support Staff

A solid team of support staff is just as integral as skilled physicians to the health and success of a practice. “Patients come to the practice to see the doctors, but their experience starts from the minute they make a phone call to the clinic,” says Dr. Halfpenny. 

Leverage the available resources to attract eager candidates as you would when recruiting physicians. These include online job posting and recruiting platforms, local staffing agencies (especially those that are health-oriented), crowdsourcing to colleagues and friends or, Mr. Pinto adds, even “turning to your own staff and offering a finder’s fee of $1,000 or so for information leading to a successful hire.”

Ms. Esau says that in her experience, the most useful job posting site for finding support staff is ZipRecuiter, which “uses AI support to target candidates and help you identify people that haven’t applied for your position but have characteristics that match what you’re looking for.” 

Ensuring Candidates Fit

When entertaining any potential candidate, it’s important to remember not to hire too quickly; you first have to ensure the person will work well with your existing team and can offer a level of patient care consistent with what patients expect from your practice. Holding multiple phone calls and bringing candidates into the office for at least one physical interview can help you get a better feel for their personality and demeanor, as well as how they interact with the other staff. 

Mary Siegman, who works with Dr. Halfpenny at Valley Eye Professionals as the practice administrator, points out that for some people, job interviews stir up a great deal of anxiety, potentially obscuring their true personality. In these instances, she suggests pausing the interview and redirecting the conversation to one that’s more casual to give them a chance to let their guard down.

“People often get more comfortable when you let them talk about themselves,” she says. “You can’t ask if they have kids or anything like that, because that could be considered discrimination,” she cautions, “but you can ask if they had a nice weekend, or talk about the weather that day; any topic that isn’t related to the interview.”

Another tip is to ask about a candidate’s long-term goals to differentiate people who are solely focused on a paycheck from those trying to build a career—and, according to Ms. Siegman, there’s a tangible difference between the two in terms of work ethic. “People who want a career are the ones who really work hard and work really well with the doctors,” she says. 

To get a feel for a candidate’s work ethic and experience, Mr. Pinto asks about their first job. “You want someone who has a long work history,” he says. “Take people who run successful businesses, who work hard, enjoy work and have a sense of commitment to their organization. If you ask about their first paying job, they’ll typically say, ‘I was babysitting at 12,’ or, ‘I cut all the neighbors’ lawns when I was 14;’ the people with this drive have typically been working since they were quite young.”

Staff at Empire Eye and Laser Center in Bakersfield, California, have a group chat where they share affirmations and congratulate one another, for example, when someone goes above and beyond for a patient. Photo: Empire Eye and Laser Center.

How to Stand Out

To attract and retain the best candidates, you have to offer unique value and opportunities to your employees that they can’t just find at any other practice in your area. While competitive salaries are undoubtedly attractive to prospective physicians and staff, other factors play into one’s decision to work—and continue working—at a particular practice, such as a positive office culture, performance-based incentives, certain benefits and schedule flexibility.

Here are some insights on fostering a work environment that distinguishes your practice and reduces staff turnover:

• Build staff morale. Encouraging good relationships among staff not only boosts job satisfaction and makes it easier to retain quality employees; it can also positively impact the overall efficiency and success of a practice.

“Something that we focus a lot of energy into is maintaining our staff morale, because it does reflect onto patient care,” says Ms. Esau. “Patients feel the difference if staff genuinely get along and if the overall feeling of the environment is positive.” 

Having a group chat with your employees through text or a communication app like Slack or WhatsApp can help encourage interaction between staff beyond the daily few-minute chats by the lunchroom microwave. For Ms. Esau’s practice, their group chat serves as a place to celebrate and connect with one another, as well as exchange compliments and positive feedback on each other’s performance.

“If it’s someone’s birthday, anniversary, baby shower, etc., we make a ‘thing’ out of it; we get on Slack to post memes and congratulate each other,” she says. On the Slack app, you can create various “channels” to communicate only about specific topics; Ms. Esau says they use this feature by dedicating a channel solely for giving kudos and affirmations to each other. “If a patient compliments someone, if we get a good review online about someone or if a doctor or manager observes something exceptional, we share it there. It really helps to build connections and rapport with the team. It also opens the door for people to show their personality and make connections based on common interests.”

Valley Eye Professionals in Huntington Valley, Pennsylvania, treated its staff to an evening at the Philadelphia Phillies game last spring. Photo: Valley Eye Professionals.

Scheduling social events outside of the office for doctors and staff is another great way to deepen personal relationships between colleagues. Some outings that Ms. Siegman and Dr. Halfpenny have arranged for their employees include a baseball game, bowling party and potluck lunches. At Ms. Esau’s practice, staff events happen quarterly: “This can be a game-filled afternoon or offsite activities, like going to a wine safari, having a paint and sip or, our favorite, an afternoon at the movies.”

At Empire Eye and Laser Center, the favorite quarterly staff event is an afternoon at the movies. Photo: Empire Eye and Laser Center.

• Make it fun. Ms. Esau remarks, “The job market is changing; if we can’t be both fun and productive, we’re behind.”

Some ways to switch up the typical nine-to-five hustle, while also helping your employees to feel more valued and connected, include celebrating employee birthdays and holidays in the office, treating staff to lunch or even weaving fun activities into the clinic day such as quizzes or office scavenger hunts.

Dr. Halfpenny and Ms. Siegman say that at their practice, everyone’s birthday gets celebrated. Each month, they get a cake with everyone’s name on it who has a birthday coming up. “We also give employees a birthday card and small gift on their day,” Dr. Halfpenny adds.

Holidays are another opportunity to sprinkle some fun into the daily grind. “For Chinese New Year, we decorated our kitchen with Chinese lanterns and ordered Chinese food for the day; for Cinco de Mayo, we’ll decorate with sombreros and bring in Mexican food for the staff,” Ms. Siegman says.

At Ms. Esau’s practice, her assistant consults the National Day Calendar and selects a few days to celebrate each month. “For instance, on National Ice Cream Day, which we had in July, we brought in stuff to make sundaes,” she notes. They also celebrate national and international events: “During the Olympics, we put little flags up everywhere, and during the Super Bowl, everyone wore their favorite team’s jersey. These things don’t have to be huge, but they help keep it interesting.”

Another thing Ms. Esau’s clinic does to break up the day is pop quizzes—on the office’s SOPs, for example—where staff can win prizes. “We’ll ask everyone, ‘What is our no-show fee if someone doesn’t show up for a cataract consult?’ Then, the first person to answer correctly receives a $5 Amazon gift card or something small like that,” she says.

Celebrating your employees’ personal milestones in the office, such as by decorating for birthdays or throwing small baby showers, can help them feel seen and appreciated. Photo: Empire Eye and Laser Center.

• Reward your employees. It’s important to express your appreciation for your employees both verbally and financially and to recognize and reward them when they go the extra mile.

One non-financial way to let staff know you recognize their hard work is to hand out thank you cards when you witness them doing an exceptional job, Ms. Siegman suggests. “I will also send an email to our team to congratulate the whole staff when we receive positive feedback from a patient,” she adds.

Ms. Siegman gives thank-you notes to staff who do an exceptional job to let them know their hard work is being recognized. Photo: Valley Eye Professionals.

Rather than giving employees a standard 3-percent raise each year, consider basing their annual salary increase on the quality of their performance that year; having employees know that they are working towards a bigger paycheck is a great way to encourage and reward a strong work ethic. 

Ms. Esau says their employees are eligible for a merit increase every year “based on a percentage of their current earnings, and what they receive is based on the score from their performance review; it’s weighted,” she explains. “The better they perform, the more they make. It gives employees something to look forward to, a feeling of growth and an opportunity to build. Rather than passively hoping they’ll get a raise each year, employees will know that one is expected, but that the size of that raise depends on the effort they put in.” This approach also removes subjective variables, such as personal bias or favoritism, from the equation when it comes to measuring performance and calculating wage increases.

• Cater to the increasing demand for work-life balance. Especially since the COVID-19 pandemic, more workers are seeking jobs that offer better work-life balance, with policies that promote scheduling flexibility and overall employee well-being. This is something Ms. Esau has observed while interviewing candidates over the last few years.

“It seems peoples’ values are shifting more towards personal growth and development and self-care; things like being able to take time off without guilt and making sure that lunch breaks are actual lunch breaks are more important to people today,” she says. 

Some strategies to help accommodate those individuals who desire a more flexible schedule and better work-life balance include revisiting vacation and sick time allotments, offering a paid or longer lunch, staggering employees’ shifts or allowing employees to have compressed work weeks, where they work longer hours some days in exchange for shorter days or a day off in the same week.

Dr. Halfpenny points out, “Lots of people have children at home or need time off for different reasons, and if they know we’re willing to work with them in those situations, it leads to a more comfortable working environment.”

Valley Eye Professionals organized a hot dog vendor to come provide lunch to its staff just to switch up the daily routine. Photo: Valley Eye Professionals.

• Review your employee benefits package. If you’re having trouble finding or retaining employees, revisit the benefits your practice offers. Mr. Pinto suggests polling your staff to learn which benefits are most important to them. 

One unique benefit employers are offering more frequently is pet insurance. “I got it priced out for our practice, and it’s not that expensive to add,” Ms. Siegman notes. “Not everyone has a pet, but for those that do, this could be a special thing that sells us vs. the practice down the street,” she notes. 

Employee Check-ins

It’s a good idea to perform “temperature checks” with your employees every few months. These one-on-one discussions serve multiple purposes:

• It opens the door for employees to vocalize any concerns promptly, rather than let them fester until the annual performance review. 

• It allows practice owners to affirm staff’s good performance, as well as offer constructive feedback to address any areas of concern that may be hindering performance or efficiency. 

• It’s a great time to discuss potential promotion opportunities to key staff in on what they’re working towards. 

“Set that time aside to meet one-on-one and discuss areas for improvement, as well as identify those areas of success where the employee did the right thing, made the right call and used those critical thinking skills,” says Ms. Esau. These meetings don’t have to be long, she adds; in her experience, biweekly talks lasting 15 to 20 minutes are ample.

Keeping these open lines of communication can help discourage “quiet quitting,” a more recent phenomenon where employees disengage from their roles by doing the minimum required work, often as a response to burnout, lack of recognition, insufficient compensation or a perceived imbalance between effort and reward. 

“If that door is open for communication, you can usually tell by a person’s body language if they are happy or not, because oftentimes they don’t come right out and say it,” Ms. Esau points out. “If you’re perceptive enough, you can identify someone who may be on their way out, and hopefully be able to mitigate that by pinpointing the areas where they’re struggling.”

Hire Slow, Fire Fast

Retaining a toxic or unmotivated employee can cost you by damaging team morale, overall productivity and company culture.

“So many practices will hold onto staff members much longer than they should, whether it’s out of kindness or desperation,” says Mr. Pinto. “The decision of whether an employee is going to make it at your practice should be made rather briskly,” he advises.

At Ms. Esau’s practice, they have zero tolerance for toxicity or negativity. “It can be easy to let behaviors slide, but by doing this, we may not realize that one person may be responsible for the turnover of three or four,” she says. “We have to look at the value of creating that positive environment, and sometimes that means eliminating people who are taking the culture down.” While this can be difficult and feel like more work at first, Ms. Esau assures, “It’s always for the greater good.”

None of the individuals interviewed in this article have a financial interest in any material presented.

^{1. Berkowitz ST, Finn AP, Parikh R, Kuriyan AE, Patel S. Ophthalmology workforce projections in the United States, 2020 to 2035. Ophthalmology 2024;131:2:133-9.}

^{2. U.S. Bureau of Labor Statistics. Civilian Labor Force Participation Rate. www.bls.gov/charts/employment-situation/civilian-labor-force-participation-rate.htm. Accessed September 1, 2024.}

^{3. Shen K, Eddelbuettel CP, Eisenberg MD. Job flows into and out of health care before and after the COVID-19 pandemic. JAMA Health Forum 2024;5:1:e234964.}