March 29, 2023
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Dr.Bethany Fishbein: If this person existed, if I could wave a magic wand and have this person show up in my office on Monday, who did every single one of these things who checked every single one of these boxes? What would I be willing to pay them?
Hi! This is Bethany Fishbein, CEO of the Power Practice and host of the Power Hour Optometry Podcast. Before we get into podcast content, I wanted to invite you to an exciting event. Power Practice is partnering with Euclid to bring you an event filled with myopia management and practice management education. If you’re already fitting Ortho K lenses and are looking to elevate your game, come join us and unlock the potential of your practice with clinical financial and practice management strategies for success. the event takes place May first and second at the Euclid headquarters in Reston, Virginia. We hope to see you there for more information, please visit www.powerpractice.com.
Today’s episode is about being able to pay your staff more. A couple of weeks ago I spoke with Evon Mendrin. And we talked about helping your staff learn good financial management. And afterward I started thinking about the things that all of us want to do to help our staff members. And the truth of the matter is we really in many cases wish that we could pay them more but as we know, income is limited. It’s not like we’ve gotten a raise from insurance companies. It’s not like we’ve been able to raise prices tremendously. We need to stay competitive in our markets. So in many cases, the expenses of the practice are outpacing the income of the practice. And at the same time, all of the other expenses in the world are increasing. If you’ve been grocery shopping recently, if you’ve bought a car, if you’ve tried to borrow money, just about everything is more expensive than it was. And so our staff members are feeling that strain, and in some cases coming to us and asking for more money asking for raises in higher amounts than we’ve typically raised before. Or maybe you have somebody in your office who’s a great loyal employee and is kind of hit the max for their position and is asking where can I go from here? Or maybe they’re not asking and they’re just looking for another position because other employers might be willing to pay more for a skill set that somebody has and take a good employee right out of your office. So we get the question periodically, a staff member asked for a raise, what do I do? Or how do I help this staff member? What else can I do? She’s been here for four years doing a good job and is at the top of my pay scale or a staff member spoken to me and has told me that they’re looking for a job because they want a bigger position that I’m able to offer in my office or they’ve just kind of checked out a little bit. They feel that they’ve done all there is to do in a certain position and just kind of start coasting, which isn’t what we’re looking for. So that’s what I’m talking about today.
And when this comes up, I feel that the goal instead of just paying them more or trying to think what’s the minimum amount that I can give them and they’re still going to be willing to stay if I give them 50 cents an hour or is that cut this conversation for a while if I give them $1 An hour does that do it? I think that the ideal outcome is to find a way to help that employee earn the additional money that they’re asking for by benefiting your practice more than the amount that you’re giving them. So we’re happy to give staff more as long as we have the income to justify that salary increase. And if there is something that they can do, that will give us the additional income, then we are more than happy to share the wealth and give them the salary that they’re looking for. So here’s what we’ve done. In my office and with several of our clients and just a different way that you can think about this. So let’s say you have a technician. And your typical range for attack is let’s say $16 to $20 an hour and somebody’s coming in brand new no experience. You’d start them at $16 an hour. Your tech who’s been there for two and a half years and does a real good job is making 20 And that’s what you have as the range for that position. In the meantime, that tech who’s making 20 has worked a year at 20. And you’re cognizant of, well, if I just give him 21 Or 22 Or 23 you start to see this salary creep. What happens if they’re with you? seven years, eight years, 10 years. So you got to think about what else could this person be doing to justify additional income that you’re looking for.
So what I suggest you do is sit down with a piece of paper or whiteboard blank Word document, however, usually brainstorm and start to think about the most incredible thing you could imagine someone in that position being able to do now what your person does now, but if you had the absolute ultimate dream, perfect better than perfect employee in that role, what would they be able to do? So maybe your tech now, I’m saying every day they’re reliable. They work up all the patients they keep your exam rooms clean, they keep you stocked with drops and tissues. And you think well, what else could an ultimate tech be able to do and you think, maybe an ultimate tech would be able to provide some patient education. If you’re recommending a dry treatment. Wouldn’t it be something if you were able to then walk out of the room and had a staff member who was able to explain to a patient, all of the treatment that was recommended. If there’s additional procedures that are recommended, be able to give the patient the information, give pricing, deliver it in a way that closes the deal. So the patients accept the treatment, schedule and pay for it 80% of the time. And then fill in your chart so that all you have to do at the end is sign off on it. You know exactly what happened. That would be amazing.
Wouldn’t it be something if you had a tech who was trained and able to accurately refract not necessarily that they’re writing the final prescription that’s always on you. But if they were able to do a preliminary refraction so that it decreased the time you were spending with each patient by three or four minutes through the course of a day, that’s an hour. And if you had that you could see two additional patients a day which would equal 10% increase for your practice that would be cool. Wouldn’t it be something if you had a tech who could handle most of the prior authorization requests that came in from your pharmacies. Every time you prescribe a drop that they were able to take the information from your chart, get it into a prior off that just allowed you to look and sign off on it instead of figuring out everything yourself? And you just keep brainstorming maybe some of the things on that list that they’ve done already that they’re already doing. And there might be some things on that list that they haven’t done at all. Maybe you have always thought about being able to use your patient portal but you just haven’t pulled the trigger. And wouldn’t it be amazing if the tech could upload everything to the patient portal. Set the process in motion so that the patient gets an email informing them their information is on the portal and they’re able to access it? Maybe they’d be able to send reports back to referring doctors. So if you’re doing letters yourself, maybe they would be able to take on some of the letters maybe there’s things within your office that you are doing clinically that you know I think that somebody could probably be trained to look at the topographies look at the refraction here the patient make the initial contact lens selection, and get the patient into that first set of contacts. Evaluate the trial lenses make a change if something is needed, and get the patient to where they’re comfortable and ready to be finalized. And these are things that I’ve seen different techs are doing in different offices. So this is your chance to dream a little bit.
You can have it be skills, you can have it be personal qualities. Maybe you have a great tech, who’s very efficient but your ultimate tech would be somebody who is friendly and remembers patients by name, and remembers to ask about a personal detail that they shared at their last visit. Maybe there’s something you want them to do from a practice-building standpoint. You want them to ask about family members, and if the patient has family members who need exams to get them on the schedule, maybe there’s an opportunity for leadership where you as a practice owner, interviewing and hiring and onboarding and training new techs, and maybe your ultimate tech would take on some of that responsibility. Maybe they would be the one that gets contacted if another tech calls out or another tech needs to be laid. Maybe they would be able to learn to be a skilled interviewer and evaluate other candidates for the position. Maybe they would do all of the training of new tech to get them to the level that they need to be in your practice. So you just keep going. And this is a free-form, kind of stream-of-consciousness, brainstorming, list of pretty much all of the things that you can think of in terms of how somebody would do the job, and exactly what skills they would have. And you can have metrics for your practice in there as well. Maybe it’s does these things to increase efficiency and allow 20 exams a day instead of 18. So there can be practice metrics in there too. So what you end up with is this kind of rambling list of all the things that your ultimate person for this position, somebody that you can only dream up in your mind so far, is going to be able to do. So then what I do with that is I just want to organize it a little bit. So you start to divide it into categories.
There’s a category for skills. Maybe there’s a category for personality, maybe there’s a category for leadership, maybe there’s a category for metrics, and you start to look at all the individual points that you’ve created, and figure out are there some you can combine. Did you write the same thing twice because you were totally into the brainstorming and how can you categorize these into an outline? That makes sense. So at the end of this, you have an outline, which can become what we call in our office the ultimate job description. This is what the ultimate person in this role would look like. This is what the ultimate person would be able to do. This is how they do it. And this would be the effect on the practice when that happens. So that’s your list. Okay. Then the question to ask yourself is if this person existed if I could wave a magic wand and have this person show up in my office on Monday, who did every single one of these things and checked every single one of these boxes? What would I be willing to pay them? So maybe you have a range in your mind of $16 to $20 an hour for a tech. But if you had a tech who was remembering all of your patients who was a joy to work with who is doing the initial refractions who was doing the initial contact lens selections and initial fits, they were closing your myopia cases or your dry eye treatments had a higher rate and you yourself was closing them and because of everything that they were doing, they were allowing you to see two additional patients per day while having fewer administrative headaches because they were also taking on some of the leadership responsibility for their department. What would you be willing to pay them? I don’t know the answer, but I’m guessing it’s probably more than $20 an hour or probably more than your highest-paid tech is currently making. And you can do this for any position in the office. It doesn’t have to be the ultimate tech. I’m just sharing that as an example you can do ultimate front desk, ultimate optical whatever the roles are. So now you have an idea of what the true maximum for the position as your practice stands now really is and it’s more than what you thought it was. So if a tech in your practice could make let’s say $24 an hour and you’ve got a tech making $20 an hour, you kind of owe it to them, to let them know what the potential is for their position and what they would need to do to be able to achieve it. So if they’ve asked you for a raise it’s easy, you say “Yeah, there is potential to make more in this role and to hit the salary that you’re looking for. Here’s some of what I would need.” If they’re not asking maybe it’s somebody who’s just starting but they’re coming in, you’ve worked with them for a couple of weeks. They seem great. And you want them to know that there’s potential to grow within your practice. Maybe it’s somebody that you just get the feeling you signed deed open on their computer or something that they’re starting to look for other options. So to let them know that this potential exists, does a couple of things. It can give them something to strive for. So they might think that they’re maxed out because you’ve never asked more of them than they’re giving. So to show them, that potential exists for them to have a different larger, more challenging role within your company and have the potential for a higher salary that goes with it can keep somebody engaged in your practice, and let them know there’s room for growth. They don’t have to look elsewhere for a different job. If they want to do something different, be challenged or make more. Sometimes it can recover somebody who’s kind of thinking that they’re on the way out, or it can really be motivating to somebody who’s just coming in even brand new to know what the potential is that they can achieve in your business. So to use this document, this ultimate job description when you have it, the way that we’ve done it is we take it and we share it with the employees as well. And we ask them to rate every single one of the bullet points on a scale from zero to 10. Zero is I’m not doing any of this right now. And 10 is I’m doing it -excellent. So your top salary that you’ve created is kind of based on somebody’s getting nine or 10 on every single bullet point. You’re giving this to them. And you’re just asking, let’s see where you are on each of these. You’re going to rate yourself from zero to 10. I’m going to rate you zero to 10 and then we’re going to talk about it. So some of the things sticking with a tech example, they might already be eights and nines and 10s especially on some of the technical skills, you want them to be able to utilize all the instruments in an efficient manner and you have to define an efficient manner. So you want them to be able to do all of the instruments in your testing room in six minutes or less, depending on how many instruments that you have. Maybe there’s some next-level instrumentation, you want them to be able to do some of the more complex testings for glaucoma for Scleral Lens Fitting or for binocular vision testing, things like that. So every single one of them you say okay autorefractor now they got that there are 10 good taking a photo. There might be taking a regular photo and then there are those special ones where you’re like, Oh, the patient has a lesion superior nasal, can you make sure that we get a picture that it’s way out there? Can they get that? Maybe they’re already there. They’re 10 they’re getting it every time maybe they’re not. So you go through they go through and every single thing on the list. And there’s some that you might say, Maybe you came up with your ultimate tech does the initial refraction, and they’re like, What the heck, you never even asked me to do this. I have no idea like okay, fine, zero.
This is okay. This is not a performance review. This is to quantify a starting point for where they are now and give an idea for a path of where they could go. So it creates an interesting conversation. Because when your number and their number are close, that’s easy. Refraction, they gave themselves a zero. They’ve never done it before. You also gave them a zero, no problem. You could probably do 1 to 10 if you want if you don’t like giving zeros. So those are easy to agree with. You say “oh yeah, I give you a zero you haven’t done this before. So that’s an opportunity for learning.” There might be somewhere they’re giving themselves nines and 10s. And you’re giving them nines and 10s and those are also easy. Autorefractor, “Yeah, I got that. I’ve worked here for three years. I know how to push the button. On the autorefractor” “Yeah, you do. Okay.” And then the interesting conversation is where there are somewhere your score of them and their score of themselves are very different. So maybe on Lensometry, you have performed accurately in lensometry on single-vision bifocal and progressive lenses. And they give themselves a 10 because they’ve worked there for three years and of course, they know how to do Lensometry. And you’re giving them a six because they get lensometry most of the time but every once in a while they miss a progressive. And if there’s a prism, forget it. Those are the ones the patient mentions prism and you’re always like, can we reread the glasses, there’s a prism in there. So it’s an opportunity to talk about it because then they’re saying 10 And you’re saying six and now from that difference, it leads to a conversation about exactly what needs to improve. Sometimes you get answers you’re not expecting. And the example that I gave you says when there’s a prism then we’re always having to reread the glasses. And they say something like yeah, I didn’t know there was any way to tell it was a prism. And that’s an opportunity for education. Sometimes it goes the other way where you rate them highly and they give themselves a six or a five. And those usually are just we’re clarifications needed on what exactly you meant by that. When those happen. A lot of times they’re thinking something different than what you’re actually asking for. But sometimes, it may just be confidence or they screwed something up the hour before you’re asking them to do this exercise and that’s fresh on their mind and it’s just letting them know that this is okay. So you have this conversation with them. And you’re able to assess where they are. come to an agreement talk about ones that are different from where you would rate them to where they rate themselves. So those will show some opportunities for improvement there.
And then your face with these that you both rated the employee low again, absolutely fine, not a performance review just things that they haven’t been asked to do yet. Where now we’ve got a path forward. So okay, I’ve never done her fraction. I’ve never done the initial contact lens selection. I’ve never talked about treatments. I’ve never dealt with these crazy forms from the pharmacy. Are you saying that I could? Yeah. Right. You could. And if you do all of those things, especially if we get them to the excellent level that you do, almost everything that I’ve asked you to do so far. Now, they’ve got a potential career path and potentially a path to being able to make more money. So you want to come out of that conversation with a plan to say, “Okay, you’re $20 an hour now and I really feel comfortable that if somebody could do all of these things I will be happy to pay them 24 and feel like I’m getting a bargain. So let’s talk about what you can do in the next three months to help set us on that path”. Depending on how many brand new things there are and how much improvement is needed and the things that they’re already doing. It might be a short path, it might be three or six months. Sometimes we’ve done these and it’s two years before they’re going to know how to do everything. Sometimes that ideal ultimate person would be CPO certified CPOA, CPOT, they’d have the highest level of that maybe they would have completed a course on something. Maybe they would have gone to some continuing education. There’s things in there that this can’t just happen overnight and it shouldn’t because this is a big deal for them and for your practice, especially the ones that need sequential things to happen in order to get the practice result that you need, which is ultimately going to generate the money so that you can improve the salary. So if somebody’s going to be doing refractions with the end goal of you being able to increase one or two patients a day, then what are we going to need to do in the next three months to help set this in motion? And it’s a conversation so you guys can decide together you say, “Well, you know, the first thing is, I want you to read this chapter these chapters in a book about refraction. Maybe even before that, I want you to be reliably able to truly understand and explain myopia, hyperopia, astigmatism, and presbyopia because if you don’t understand why someone would ever need a plus two for distance, then you’re not going to be the type of refractionist we would want in this practice.” So it might be I need you to learn that first. It might be I need you to sign up for the next available CPO test I need you to take this course in the Ophthalmic technician curriculum at a community college. I want you to come into the exam room and observe with me 10 or 20 patient refraction so you can start to hear how I’m speaking to the patient as we’re doing this.
Whatever the steps are, you’re leaving with a plan for what can happen in the next three months. And you can have a plan for one individual bullet point on the list or you can have a plan for several. I would caution you against doing too many things at once. Both from an overwhelm perspective and from somebody’s ability to be concentrating fully on more than one goal at the same time. And also from a practice management side to make the salary increases come at regular intervals. So whatever the initial thing or a couple of things are, you kind of leave with a plan and you may put it on them to start to find some of these resources. I want you to find online resources explaining myopia, hyperopia, astigmatism, and presbyopia and read them and come to me with any questions and then I really want to have a conversation and have you be able to answer questions that show me that you really truly understand it. And then you ask them this patient has a pair of glasses that are plus one and 50 minus a quarter axis whatever Are they for distance or near you know the right answer is it depends but the beginning technician will say near because plus this reading right so this is what you’re looking for. And you record the answers, your numbers, their numbers, you record your plan for the next couple of months. We’ve got it and now over the next three months, your job is to check in every once in a while. How’s it going? Any questions? Did you find that resource, not babysitting, but just continuing to be invested in their success because the goal is that they do it. The goal is that they do it because of the impact that’s going to have both on your practice and on their satisfaction within your practice. So you get an idea if they’re doing it, great. If they need help, you’ve asked, you’re able to provide it if they’re not doing it. You can check in and say “oh, are you still interested?” Assuming they are what’s going on? Oh, it’s just been so busy. This one’s out sick, okay, is there anything I can do just making sure things stay on track. So then three months you meet again, and now you’ve got the initial metrics of here’s where we were zero to 10 on all these things. Three months ago. Are we making progress? Yeah, I got the hang of that lensometer thing. So now the prescriptions are coming in with a prism that saves you a bunch of time. And I learned this and this about refraction. I think I’m ready to learn how to do it. Great! So now we’re in progress. And looking at what’s next? What happens in the next three months? maybe in the next three months is we’re going to work together and go through the steps of refracting 10 staff members so that you can see I’m going to observe this many refraction, whatever the thing is. And so as you do that, and as the staff member starts to do some of the things that are adding value to your practice, either by saving you time, getting rid of some of your headaches, making your day easier, or allowing the practice to increase in productivity. You’re looking at where they are on your mental scale of where they were starting to being at nines and 10s. And all these things. So that same mental scale is from the $20 an hour they’re making to the $24 an hour that you’ve determined has potential and maybe there’s a salary increase if they’ve made some significant progress at three months, maybe there’s not and you talk about the next three months what they would do, and if there is something that’s likely to be associated with his salary increase what we would need to do to get there you did a really great job figuring out that prism say what I’d like in the next three months is for you to teach that to all the other techs so that this is predictable what the techs do, etc.
And as you’re going through this, the benefits are tremendous. Obviously, there’s a benefit to an employee having a what next, having something that they’re striving for, even if they’ve worked in your practice for three or four or five years, having something else that they can learn something else they can do. And the promise that once they do learn that, there’s something in it for them. They’re going to be valued more and higher paid as well. So that engagement in the practice and investment in the practice is positive for them for you and for the practice. Sometimes it leads to benefits for other people in the office where they might realize that to be able to hit some of these goals that they’ve set with you and have determined they wanted. They need to be able to delegate to someone else in the practice. They can’t do everything they were doing before if now they’re going to be increasing their own patient time by five or 10 minutes, because they’re doing more with the patient. So it gives them the opportunity to teach or train somebody else. And it gives that person the opportunity to learn something new to elevate their own position. That’s good. And ultimately, it helps with efficiency of your practice. If they’re doing something that lets you see more patients or lets you spend more high-value time with the patient, high-value time being relationship building, understanding what they’re truly coming in for making sure that your prescription that your recommendations are giving them something that’s going to solve the problem they brought to you in the first place. You’re going to benefit infinitely more than if you’re spending the vast majority of your time with a patient gathering data. So we start to see because the technician is taking on some more of the role. Maybe you’re seeing more patients, maybe you’re increasing capture rate, maybe somebody who’s not you is talking to the patient about treatments that you’re uncomfortable discussing the financial side of and they’re just going for it and getting good results and starting to see the benefits in your practice, which in turn let you feel great about giving an increase in salary. Versus just well they asked for and I’m afraid they’re gonna leave if I don’t give them $1 an hour. So I guess I’ll give it because without changing any performance in the practice, you giving that dollar an hour is essentially handing the staff member $1 an hour out of your own pocket, which in some cases may feel fine. But once they start to tell their friends that you did that now the friend wants a raise and then the other one wants a raise and all of a sudden you’re seeing your profit dip you’ve got to have the increased revenue to offset the salary changes. And this is a method to get there. So if you’re interested in learning more, feel free to email info@powerpractice.com If you’re wanting to level up your team so that you can enjoy your days and make more money, go to powerpractice.com and set up a free initial consultation and do consider joining us at the Euclid Program on May 1st and 2nd we’re hoping to see you there. Thank you again for listening!
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Dr.Bethany Fishbein: If this person existed, if I could wave a magic wand and have this person show up in my office on Monday, who did every single one of these things who checked every single one of these boxes? What would I be willing to pay them?
Hi! This is Bethany Fishbein, CEO of the Power Practice and host of the Power Hour Optometry Podcast. Before we get into podcast content, I wanted to invite you to an exciting event. Power Practice is partnering with Euclid to bring you an event filled with myopia management and practice management education. If you’re already fitting Ortho K lenses and are looking to elevate your game, come join us and unlock the potential of your practice with clinical financial and practice management strategies for success. the event takes place May first and second at the Euclid headquarters in Reston, Virginia. We hope to see you there for more information, please visit www.powerpractice.com.
Today’s episode is about being able to pay your staff more. A couple of weeks ago I spoke with Evon Mendrin. And we talked about helping your staff learn good financial management. And afterward I started thinking about the things that all of us want to do to help our staff members. And the truth of the matter is we really in many cases wish that we could pay them more but as we know, income is limited. It’s not like we’ve gotten a raise from insurance companies. It’s not like we’ve been able to raise prices tremendously. We need to stay competitive in our markets. So in many cases, the expenses of the practice are outpacing the income of the practice. And at the same time, all of the other expenses in the world are increasing. If you’ve been grocery shopping recently, if you’ve bought a car, if you’ve tried to borrow money, just about everything is more expensive than it was. And so our staff members are feeling that strain, and in some cases coming to us and asking for more money asking for raises in higher amounts than we’ve typically raised before. Or maybe you have somebody in your office who’s a great loyal employee and is kind of hit the max for their position and is asking where can I go from here? Or maybe they’re not asking and they’re just looking for another position because other employers might be willing to pay more for a skill set that somebody has and take a good employee right out of your office. So we get the question periodically, a staff member asked for a raise, what do I do? Or how do I help this staff member? What else can I do? She’s been here for four years doing a good job and is at the top of my pay scale or a staff member spoken to me and has told me that they’re looking for a job because they want a bigger position that I’m able to offer in my office or they’ve just kind of checked out a little bit. They feel that they’ve done all there is to do in a certain position and just kind of start coasting, which isn’t what we’re looking for. So that’s what I’m talking about today.
And when this comes up, I feel that the goal instead of just paying them more or trying to think what’s the minimum amount that I can give them and they’re still going to be willing to stay if I give them 50 cents an hour or is that cut this conversation for a while if I give them $1 An hour does that do it? I think that the ideal outcome is to find a way to help that employee earn the additional money that they’re asking for by benefiting your practice more than the amount that you’re giving them. So we’re happy to give staff more as long as we have the income to justify that salary increase. And if there is something that they can do, that will give us the additional income, then we are more than happy to share the wealth and give them the salary that they’re looking for. So here’s what we’ve done. In my office and with several of our clients and just a different way that you can think about this. So let’s say you have a technician. And your typical range for attack is let’s say $16 to $20 an hour and somebody’s coming in brand new no experience. You’d start them at $16 an hour. Your tech who’s been there for two and a half years and does a real good job is making 20 And that’s what you have as the range for that position. In the meantime, that tech who’s making 20 has worked a year at 20. And you’re cognizant of, well, if I just give him 21 Or 22 Or 23 you start to see this salary creep. What happens if they’re with you? seven years, eight years, 10 years. So you got to think about what else could this person be doing to justify additional income that you’re looking for.
So what I suggest you do is sit down with a piece of paper or whiteboard blank Word document, however, usually brainstorm and start to think about the most incredible thing you could imagine someone in that position being able to do now what your person does now, but if you had the absolute ultimate dream, perfect better than perfect employee in that role, what would they be able to do? So maybe your tech now, I’m saying every day they’re reliable. They work up all the patients they keep your exam rooms clean, they keep you stocked with drops and tissues. And you think well, what else could an ultimate tech be able to do and you think, maybe an ultimate tech would be able to provide some patient education. If you’re recommending a dry treatment. Wouldn’t it be something if you were able to then walk out of the room and had a staff member who was able to explain to a patient, all of the treatment that was recommended. If there’s additional procedures that are recommended, be able to give the patient the information, give pricing, deliver it in a way that closes the deal. So the patients accept the treatment, schedule and pay for it 80% of the time. And then fill in your chart so that all you have to do at the end is sign off on it. You know exactly what happened. That would be amazing.
Wouldn’t it be something if you had a tech who was trained and able to accurately refract not necessarily that they’re writing the final prescription that’s always on you. But if they were able to do a preliminary refraction so that it decreased the time you were spending with each patient by three or four minutes through the course of a day, that’s an hour. And if you had that you could see two additional patients a day which would equal 10% increase for your practice that would be cool. Wouldn’t it be something if you had a tech who could handle most of the prior authorization requests that came in from your pharmacies. Every time you prescribe a drop that they were able to take the information from your chart, get it into a prior off that just allowed you to look and sign off on it instead of figuring out everything yourself? And you just keep brainstorming maybe some of the things on that list that they’ve done already that they’re already doing. And there might be some things on that list that they haven’t done at all. Maybe you have always thought about being able to use your patient portal but you just haven’t pulled the trigger. And wouldn’t it be amazing if the tech could upload everything to the patient portal. Set the process in motion so that the patient gets an email informing them their information is on the portal and they’re able to access it? Maybe they’d be able to send reports back to referring doctors. So if you’re doing letters yourself, maybe they would be able to take on some of the letters maybe there’s things within your office that you are doing clinically that you know I think that somebody could probably be trained to look at the topographies look at the refraction here the patient make the initial contact lens selection, and get the patient into that first set of contacts. Evaluate the trial lenses make a change if something is needed, and get the patient to where they’re comfortable and ready to be finalized. And these are things that I’ve seen different techs are doing in different offices. So this is your chance to dream a little bit.
You can have it be skills, you can have it be personal qualities. Maybe you have a great tech, who’s very efficient but your ultimate tech would be somebody who is friendly and remembers patients by name, and remembers to ask about a personal detail that they shared at their last visit. Maybe there’s something you want them to do from a practice-building standpoint. You want them to ask about family members, and if the patient has family members who need exams to get them on the schedule, maybe there’s an opportunity for leadership where you as a practice owner, interviewing and hiring and onboarding and training new techs, and maybe your ultimate tech would take on some of that responsibility. Maybe they would be the one that gets contacted if another tech calls out or another tech needs to be laid. Maybe they would be able to learn to be a skilled interviewer and evaluate other candidates for the position. Maybe they would do all of the training of new tech to get them to the level that they need to be in your practice. So you just keep going. And this is a free-form, kind of stream-of-consciousness, brainstorming, list of pretty much all of the things that you can think of in terms of how somebody would do the job, and exactly what skills they would have. And you can have metrics for your practice in there as well. Maybe it’s does these things to increase efficiency and allow 20 exams a day instead of 18. So there can be practice metrics in there too. So what you end up with is this kind of rambling list of all the things that your ultimate person for this position, somebody that you can only dream up in your mind so far, is going to be able to do. So then what I do with that is I just want to organize it a little bit. So you start to divide it into categories.
There’s a category for skills. Maybe there’s a category for personality, maybe there’s a category for leadership, maybe there’s a category for metrics, and you start to look at all the individual points that you’ve created, and figure out are there some you can combine. Did you write the same thing twice because you were totally into the brainstorming and how can you categorize these into an outline? That makes sense. So at the end of this, you have an outline, which can become what we call in our office the ultimate job description. This is what the ultimate person in this role would look like. This is what the ultimate person would be able to do. This is how they do it. And this would be the effect on the practice when that happens. So that’s your list. Okay. Then the question to ask yourself is if this person existed if I could wave a magic wand and have this person show up in my office on Monday, who did every single one of these things and checked every single one of these boxes? What would I be willing to pay them? So maybe you have a range in your mind of $16 to $20 an hour for a tech. But if you had a tech who was remembering all of your patients who was a joy to work with who is doing the initial refractions who was doing the initial contact lens selections and initial fits, they were closing your myopia cases or your dry eye treatments had a higher rate and you yourself was closing them and because of everything that they were doing, they were allowing you to see two additional patients per day while having fewer administrative headaches because they were also taking on some of the leadership responsibility for their department. What would you be willing to pay them? I don’t know the answer, but I’m guessing it’s probably more than $20 an hour or probably more than your highest-paid tech is currently making. And you can do this for any position in the office. It doesn’t have to be the ultimate tech. I’m just sharing that as an example you can do ultimate front desk, ultimate optical whatever the roles are. So now you have an idea of what the true maximum for the position as your practice stands now really is and it’s more than what you thought it was. So if a tech in your practice could make let’s say $24 an hour and you’ve got a tech making $20 an hour, you kind of owe it to them, to let them know what the potential is for their position and what they would need to do to be able to achieve it. So if they’ve asked you for a raise it’s easy, you say “Yeah, there is potential to make more in this role and to hit the salary that you’re looking for. Here’s some of what I would need.” If they’re not asking maybe it’s somebody who’s just starting but they’re coming in, you’ve worked with them for a couple of weeks. They seem great. And you want them to know that there’s potential to grow within your practice. Maybe it’s somebody that you just get the feeling you signed deed open on their computer or something that they’re starting to look for other options. So to let them know that this potential exists, does a couple of things. It can give them something to strive for. So they might think that they’re maxed out because you’ve never asked more of them than they’re giving. So to show them, that potential exists for them to have a different larger, more challenging role within your company and have the potential for a higher salary that goes with it can keep somebody engaged in your practice, and let them know there’s room for growth. They don’t have to look elsewhere for a different job. If they want to do something different, be challenged or make more. Sometimes it can recover somebody who’s kind of thinking that they’re on the way out, or it can really be motivating to somebody who’s just coming in even brand new to know what the potential is that they can achieve in your business. So to use this document, this ultimate job description when you have it, the way that we’ve done it is we take it and we share it with the employees as well. And we ask them to rate every single one of the bullet points on a scale from zero to 10. Zero is I’m not doing any of this right now. And 10 is I’m doing it -excellent. So your top salary that you’ve created is kind of based on somebody’s getting nine or 10 on every single bullet point. You’re giving this to them. And you’re just asking, let’s see where you are on each of these. You’re going to rate yourself from zero to 10. I’m going to rate you zero to 10 and then we’re going to talk about it. So some of the things sticking with a tech example, they might already be eights and nines and 10s especially on some of the technical skills, you want them to be able to utilize all the instruments in an efficient manner and you have to define an efficient manner. So you want them to be able to do all of the instruments in your testing room in six minutes or less, depending on how many instruments that you have. Maybe there’s some next-level instrumentation, you want them to be able to do some of the more complex testings for glaucoma for Scleral Lens Fitting or for binocular vision testing, things like that. So every single one of them you say okay autorefractor now they got that there are 10 good taking a photo. There might be taking a regular photo and then there are those special ones where you’re like, Oh, the patient has a lesion superior nasal, can you make sure that we get a picture that it’s way out there? Can they get that? Maybe they’re already there. They’re 10 they’re getting it every time maybe they’re not. So you go through they go through and every single thing on the list. And there’s some that you might say, Maybe you came up with your ultimate tech does the initial refraction, and they’re like, What the heck, you never even asked me to do this. I have no idea like okay, fine, zero.
This is okay. This is not a performance review. This is to quantify a starting point for where they are now and give an idea for a path of where they could go. So it creates an interesting conversation. Because when your number and their number are close, that’s easy. Refraction, they gave themselves a zero. They’ve never done it before. You also gave them a zero, no problem. You could probably do 1 to 10 if you want if you don’t like giving zeros. So those are easy to agree with. You say “oh yeah, I give you a zero you haven’t done this before. So that’s an opportunity for learning.” There might be somewhere they’re giving themselves nines and 10s. And you’re giving them nines and 10s and those are also easy. Autorefractor, “Yeah, I got that. I’ve worked here for three years. I know how to push the button. On the autorefractor” “Yeah, you do. Okay.” And then the interesting conversation is where there are somewhere your score of them and their score of themselves are very different. So maybe on Lensometry, you have performed accurately in lensometry on single-vision bifocal and progressive lenses. And they give themselves a 10 because they’ve worked there for three years and of course, they know how to do Lensometry. And you’re giving them a six because they get lensometry most of the time but every once in a while they miss a progressive. And if there’s a prism, forget it. Those are the ones the patient mentions prism and you’re always like, can we reread the glasses, there’s a prism in there. So it’s an opportunity to talk about it because then they’re saying 10 And you’re saying six and now from that difference, it leads to a conversation about exactly what needs to improve. Sometimes you get answers you’re not expecting. And the example that I gave you says when there’s a prism then we’re always having to reread the glasses. And they say something like yeah, I didn’t know there was any way to tell it was a prism. And that’s an opportunity for education. Sometimes it goes the other way where you rate them highly and they give themselves a six or a five. And those usually are just we’re clarifications needed on what exactly you meant by that. When those happen. A lot of times they’re thinking something different than what you’re actually asking for. But sometimes, it may just be confidence or they screwed something up the hour before you’re asking them to do this exercise and that’s fresh on their mind and it’s just letting them know that this is okay. So you have this conversation with them. And you’re able to assess where they are. come to an agreement talk about ones that are different from where you would rate them to where they rate themselves. So those will show some opportunities for improvement there.
And then your face with these that you both rated the employee low again, absolutely fine, not a performance review just things that they haven’t been asked to do yet. Where now we’ve got a path forward. So okay, I’ve never done her fraction. I’ve never done the initial contact lens selection. I’ve never talked about treatments. I’ve never dealt with these crazy forms from the pharmacy. Are you saying that I could? Yeah. Right. You could. And if you do all of those things, especially if we get them to the excellent level that you do, almost everything that I’ve asked you to do so far. Now, they’ve got a potential career path and potentially a path to being able to make more money. So you want to come out of that conversation with a plan to say, “Okay, you’re $20 an hour now and I really feel comfortable that if somebody could do all of these things I will be happy to pay them 24 and feel like I’m getting a bargain. So let’s talk about what you can do in the next three months to help set us on that path”. Depending on how many brand new things there are and how much improvement is needed and the things that they’re already doing. It might be a short path, it might be three or six months. Sometimes we’ve done these and it’s two years before they’re going to know how to do everything. Sometimes that ideal ultimate person would be CPO certified CPOA, CPOT, they’d have the highest level of that maybe they would have completed a course on something. Maybe they would have gone to some continuing education. There’s things in there that this can’t just happen overnight and it shouldn’t because this is a big deal for them and for your practice, especially the ones that need sequential things to happen in order to get the practice result that you need, which is ultimately going to generate the money so that you can improve the salary. So if somebody’s going to be doing refractions with the end goal of you being able to increase one or two patients a day, then what are we going to need to do in the next three months to help set this in motion? And it’s a conversation so you guys can decide together you say, “Well, you know, the first thing is, I want you to read this chapter these chapters in a book about refraction. Maybe even before that, I want you to be reliably able to truly understand and explain myopia, hyperopia, astigmatism, and presbyopia because if you don’t understand why someone would ever need a plus two for distance, then you’re not going to be the type of refractionist we would want in this practice.” So it might be I need you to learn that first. It might be I need you to sign up for the next available CPO test I need you to take this course in the Ophthalmic technician curriculum at a community college. I want you to come into the exam room and observe with me 10 or 20 patient refraction so you can start to hear how I’m speaking to the patient as we’re doing this.
Whatever the steps are, you’re leaving with a plan for what can happen in the next three months. And you can have a plan for one individual bullet point on the list or you can have a plan for several. I would caution you against doing too many things at once. Both from an overwhelm perspective and from somebody’s ability to be concentrating fully on more than one goal at the same time. And also from a practice management side to make the salary increases come at regular intervals. So whatever the initial thing or a couple of things are, you kind of leave with a plan and you may put it on them to start to find some of these resources. I want you to find online resources explaining myopia, hyperopia, astigmatism, and presbyopia and read them and come to me with any questions and then I really want to have a conversation and have you be able to answer questions that show me that you really truly understand it. And then you ask them this patient has a pair of glasses that are plus one and 50 minus a quarter axis whatever Are they for distance or near you know the right answer is it depends but the beginning technician will say near because plus this reading right so this is what you’re looking for. And you record the answers, your numbers, their numbers, you record your plan for the next couple of months. We’ve got it and now over the next three months, your job is to check in every once in a while. How’s it going? Any questions? Did you find that resource, not babysitting, but just continuing to be invested in their success because the goal is that they do it. The goal is that they do it because of the impact that’s going to have both on your practice and on their satisfaction within your practice. So you get an idea if they’re doing it, great. If they need help, you’ve asked, you’re able to provide it if they’re not doing it. You can check in and say “oh, are you still interested?” Assuming they are what’s going on? Oh, it’s just been so busy. This one’s out sick, okay, is there anything I can do just making sure things stay on track. So then three months you meet again, and now you’ve got the initial metrics of here’s where we were zero to 10 on all these things. Three months ago. Are we making progress? Yeah, I got the hang of that lensometer thing. So now the prescriptions are coming in with a prism that saves you a bunch of time. And I learned this and this about refraction. I think I’m ready to learn how to do it. Great! So now we’re in progress. And looking at what’s next? What happens in the next three months? maybe in the next three months is we’re going to work together and go through the steps of refracting 10 staff members so that you can see I’m going to observe this many refraction, whatever the thing is. And so as you do that, and as the staff member starts to do some of the things that are adding value to your practice, either by saving you time, getting rid of some of your headaches, making your day easier, or allowing the practice to increase in productivity. You’re looking at where they are on your mental scale of where they were starting to being at nines and 10s. And all these things. So that same mental scale is from the $20 an hour they’re making to the $24 an hour that you’ve determined has potential and maybe there’s a salary increase if they’ve made some significant progress at three months, maybe there’s not and you talk about the next three months what they would do, and if there is something that’s likely to be associated with his salary increase what we would need to do to get there you did a really great job figuring out that prism say what I’d like in the next three months is for you to teach that to all the other techs so that this is predictable what the techs do, etc.
And as you’re going through this, the benefits are tremendous. Obviously, there’s a benefit to an employee having a what next, having something that they’re striving for, even if they’ve worked in your practice for three or four or five years, having something else that they can learn something else they can do. And the promise that once they do learn that, there’s something in it for them. They’re going to be valued more and higher paid as well. So that engagement in the practice and investment in the practice is positive for them for you and for the practice. Sometimes it leads to benefits for other people in the office where they might realize that to be able to hit some of these goals that they’ve set with you and have determined they wanted. They need to be able to delegate to someone else in the practice. They can’t do everything they were doing before if now they’re going to be increasing their own patient time by five or 10 minutes, because they’re doing more with the patient. So it gives them the opportunity to teach or train somebody else. And it gives that person the opportunity to learn something new to elevate their own position. That’s good. And ultimately, it helps with efficiency of your practice. If they’re doing something that lets you see more patients or lets you spend more high-value time with the patient, high-value time being relationship building, understanding what they’re truly coming in for making sure that your prescription that your recommendations are giving them something that’s going to solve the problem they brought to you in the first place. You’re going to benefit infinitely more than if you’re spending the vast majority of your time with a patient gathering data. So we start to see because the technician is taking on some more of the role. Maybe you’re seeing more patients, maybe you’re increasing capture rate, maybe somebody who’s not you is talking to the patient about treatments that you’re uncomfortable discussing the financial side of and they’re just going for it and getting good results and starting to see the benefits in your practice, which in turn let you feel great about giving an increase in salary. Versus just well they asked for and I’m afraid they’re gonna leave if I don’t give them $1 an hour. So I guess I’ll give it because without changing any performance in the practice, you giving that dollar an hour is essentially handing the staff member $1 an hour out of your own pocket, which in some cases may feel fine. But once they start to tell their friends that you did that now the friend wants a raise and then the other one wants a raise and all of a sudden you’re seeing your profit dip you’ve got to have the increased revenue to offset the salary changes. And this is a method to get there. So if you’re interested in learning more, feel free to email info@powerpractice.com If you’re wanting to level up your team so that you can enjoy your days and make more money, go to powerpractice.com and set up a free initial consultation and do consider joining us at the Euclid Program on May 1st and 2nd we’re hoping to see you there. Thank you again for listening!