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In the fast-changing world of recruitment, hiring and firing in the eyecare sector, a few things hold true: gone are the days when a competitive salary, bonus plan and matching 401K contributions were sufficient to attract and retain employees. These days, ECP practices and clinics have to sweeten the pot with incentives that address both hard and soft skill needs.

In light of the increasing shortage of ophthalmologists and optometrists in the United States, candidates are in high demand and the profession is facing what would be termed a “buyer’s market” in real estate terms. This gap between supply and demand in eyecare is a subset of an unfortunate broader reality of a severe shortage of physicians across the board, including general practitioners and specialists in all therapeutic areas, not only in the United States but in Canada and Europe, as well.

An aging population with a resulting high incidence of comorbidities, including ocular diseases, as well as people working and living longer, have combined to create a perfect storm, resulting in a lack of adequate eyecare resources that affects urban areas but jeopardizes rural and low-income residents and those with mobility issues, in particular.

A recent study, “Ophthalmology Workforce Projections in the United States, 2020 to 2035,” published in Ophthalmology journal, 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. For practices, this shortage means stiffer competition for recruiting the available talent.

It’s also becoming 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. According to the

study “Job Flows into and out of Health Care Before and After the COVID-19 Pandemic,” published in JAMA Health Forum, staff turnover rates have also increased among health care workers since the start of the COVID-19 pandemic.


New Jobs Being Created or Lost
Evan Kaplan, OD, and associate clinical professor (Emeritus), SUNY College of Optometry, in private practice in New York City, underscores that the current health care crisis will fuel the demand for ECPs. “The need for care will be further amplified by the increasing prevalence of chronic health conditions in the United States, such as obesity and hypertension, which are closely linked to eye-related complications. Because of this, I don’t believe any jobs are being lost; instead, the demand for skilled eyecare professionals continues to grow.”



Evan Kaplan, OD



“Several expanding technological developments are revolutionizing the eyecare industry,” stated Brett Kestenbaum, COO of Eyes On Eyecare, a digital publication that provides quality clinical and career education to the next generation of optometrists, headquartered in San Diego, Calif. The growth of artificial intelligence and tele-optometry have literally changed the way physicians do business.

“There is an increasing push throughout both health care and general business for efficiency. We may begin to see administrative tasks either automated or jobs lost within a practice. An example of this is scribe services. There are now tools that can help a practitioner take notes during their examination rather than having a scribe in the examination room,” he said.

“As the need for health care services continues to grow due to a variety of factors, such as the doubling of the population of individuals over the age of 65 by 2030, the need for optometry services, and thus the need for optometrists, opticians and technicians, will continue to expand during that time,” continued Kestenbaum. “We may also start to see the displacement of jobs rather than their loss or creation. This can be very beneficial for the general population, especially for people who live in areas where it is difficult to find care.




Brett Kestenbaum


“This displacement may be seen, for example, with advancements in tele-optometry and the ability for a practitioner to see a patient without having to be in direct contact with a patient. We may find that practitioners tend even further toward living in urban and suburban areas while being able to service rural communities,” Kestenbaum said.

According to Howard Purcell, OD, president of New England College of Optometry in Boston, Mass., new jobs in the optical industry are emerging in technology-driven areas such as tele-optometry, virtual care coordination and AI-enhanced diagnostics. “Positions like digital marketing specialists for practices, telehealth coordinators and data analysts for patient outcomes are on the rise. On the other hand, traditional optical lab technician roles may decline as more automation and digital lens technology streamline those processes,” he explained.

Kestenbaum’s point of view is that the eyecare industry has a stable ecosystem of patient care and products to meet those patients’ needs. “AI opens up a whole new world as it augments the knowledge of potentially less educated individuals. With the ability to answer questions and reason out answers, AI will have a trickle-down effect bringing what typically was more specialized skills to the average person. Examples of this in the eyecare industry could be an increase in the role of the technician.”

Kestenbaum continued, “As technology becomes more capable of general and advanced diagnostics, technicians will be able to be more involved within an examination without having to synthesize as much information, since the synthesis can be done at the level of the technology. This will allow the clinician to either see more patients in the same period of time, expanding care to more individuals—more patients per hour means that in a society where we likely have an undersupply of optometrists, a larger percentage of the population will have access to more immediate care when needed—or will be able to go deeper into an examination with a patient in less time because they have tools that are managing a larger portion of the workload.”

“Technicians must be proficient in using various instruments to gather accurate data,” explained Dr. Kaplan. “The AI capabilities integrated into many of these tools—with more innovations on the way—will aid in screening patients and detecting potential issues before they become clinically significant. Additionally, optical staff must stay informed about the latest lens technologies and add-on options to effectively educate patients, ensuring they receive the best eyewear tailored to their needs.”

“When it comes to our graduates, there are multiple opportunities in private, group, retail and other modalities,” said Fraser C. Horn, OD, president of the Association of Schools and Colleges of Optometry (ASCO) and dean of Pacific University College of Optometry in Forest Grove, Ore. “I’m uncertain if this is due to new positions being created, but it feels like there is a need for providers. Some of the requests I receive are due to retirements or a need due to an increase in patient care at a practice, while others are due to openings that naturally occur.”


New Career Paths Emerging
Dr. Purcell noted that career paths in the optical industry are diversifying with opportunities beyond traditional clinical practice. For optometrists, roles in corporate optometry, telehealth and vision science research are growing. Opticians can now branch into sales management, digital eyewear consultations and online retail platforms. Business-focused roles like practice management consulting, operations analysis and private equity partnerships in optometry are very prominent, he said.



Howard Purcell, OD



“In-office staff typically include a mix of optometric technicians or assistants, optical dispensers, office managers and receptionists. The skill set is evolving, with many roles now requiring proficiency in practice management software, telehealth technologies and advanced pre-testing devices like OCTs. Cross-training is also on the rise, with staff performing both administrative duties and clinical support,” Dr. Purcell said.

Steven T. Reed, OD, president of the American Optometric Association (AOA), contends that paraoptometric certification promotes a skilled, cohesive care team equipped to build a practice for years to come. “We’ve seen practices measure their excellence by the level of commitment and training of their paraoptometrics. Paraoptometric certification is not only an internal validation of commitment to employees and staff expertise but also an external investment in the future of an optometry practice.

“Additionally, with the increasing demand for primary eye health care services delivered by optometry, as well as optometric scope of practice advances nationwide, optometry practices need competent paraoptometric staff who can demonstrate a high level of clinical capabilities and practice management knowledge to truly set themselves apart,” stated Dr. Reed.




Steven T. Reed, OD


Revolution EHR, based in San Diego, Calif., is a firm specifically designed for optometry practices to simplify patient management and business processes by consolidating computer systems and reducing paperwork. The company reports that new career trends, such as academic or public health settings, are changing the face of the optical industry. Additionally, many optometrists are moving toward specialized fields in optometry, such as pediatric or sports vision, to provide tailored eyecare services to patients.

These optometry career trends are impacting hiring practices, with employers hiring those comfortable with technology and paying bigger salaries to compensate for specialized skills.

Shifting pay and benefits expectations, and a new focus on building a professional network and reputation, are also impacting the future of optometric careers.

“The landscape of medical practice has undergone significant changes in recent years,” stated Dr. Kaplan. “Traditional optometric careers in private or retail settings are evolving due to the growing influence of private equity in private practices and the consolidation of local hospitals into larger health care systems.”



Fraser C. Horn, OD


 
He pointed out that as hospital networks expand, many large MD/OD practices now rely on optometrists as primary care providers to fill the gap left by ophthalmology residents, who increasingly pursue specialty training. Contact lens and pharmaceutical companies recognize this shift, targeting optometrists for roles such as medical directors, medical science liaisons and leaders of professional or academic affairs tasked with educating current and future providers on their products.

“There are the typical career paths of associates, employees, partnerships, faculty and industry,” commented Dr. Horn. “Often, I think career paths may not have changed drastically. However, there are ways that practices have changed. Whether that is integrating some of the latest in specialty care, for example, dry eye, aesthetics and myopia control, or delivering care via remote examinations, there are ways that our colleagues can share their passion to make an impact on our community.

“Within optometric education, there are wonderful changes being made through an integration of active learning strategies. This helps us to engage with our students in different ways and, hopefully, help them understand optometry and health care. Faculty are utilizing myriad techniques including, but not limited to, in-class polling systems, gamifying topics, and utilizing virtual reality and AI. The use of technology is truly adjusting how we’re delivering education and it’s a fun time to be in education,” Dr. Horn said.


Meeting the Needs of Today’s Recruits
Workforce requirements have changed over the years, with the current cadre of graduating and newly-practicing ECPs seeking a new and different set of hard- and soft-skill-related criteria for employment. Personal aspirations are now just as important as professional ones, and workplace culture and a sense of community are paramount.

For Gen Zers and Millennials, a company with tangible community involvement and a sense of giving back is essential, not only for the hiring organization but for its employees as well. Work-life balance is a phrase that dominates any discussion in the hiring process as candidates view themselves as their own corporation.

In some cases, loyalty to oneself may take precedence over long-term loyalty to a company, with a mindset of being self-employed in the sense of managing and driving their own career, even while working under the aegis of an ECP practice. In this context, the ability to set their own schedules, with limited or no overtime, is key. Work is no longer “everything” but rather, just one component of an otherwise busy life.

Expected earning potential, patient demographics and patient volume are major considerations in choosing where to work. Young ECPs seek professional training as well as learning and development opportunities to further their career. In addition, financial considerations are enormous in terms of receiving adequate remuneration to pay off student debt.


The Challenge of Staff Turnover




According to Dr. Horn, within optometric education the turnover of faculty varies based on the program. “I think most, if not all, programs were impacted with turnover of our clinical and administrative staff during and after the COVID-19 pandemic. We have had challenges with recruitment and retention of various positions,” he noted.

Kestenbaum contends that turnover rates for the eyecare industry are relatively low at the physician level, and relatively normal for administrative positions. Optometrists and opticians have a tendency to stay in their positions for longer periods of time than front office staff. There are a few reasons for this. First, optometrists and opticians are typically well-compensated and have fewer financial incentives to look for positions elsewhere. On top of that, the industry is relatively small, and there are only so many opportunities within a given geographic area, and the practice owners may all know each other.

Kestenbaum said, “For administrative positions, these individuals aren’t limited to working in the eyecare industry. They can be administrators in almost any field, so switching jobs can be a much more available option. Right now, in 2024, we’re seeing considerably lower turnover rates than we have in the past. That’s because employment is cyclical, and we’re coming off one of the highest employment rates in recent history, where we saw phenomena such as ‘silent quitting’ and job mobility hitting all-time highs.

“Now, we’re in a cycle where there are fewer open jobs and unemployment rates are climbing. This is due in part to the federal reserve raising interest rates, which tends to slow down economic activity, and the federal government decreasing the amount of stimulus within the economy. At a point in the future, we will see this shift again, but in the present we’re in a period where we’ll likely see lower turnover rates and a slowdown in the rate of wage increases within any given position,” Kestenbaum said.


Role of the Optometrist Recruiter
Kestenbaum views the recruiter as a consultant, helping practices understand the current hiring climate, the needs and wants of job-seeking optometrists, and the process of moving from a prospective candidate to a new hire and a new team member. “Recruiters are constantly talking to both practices and optometrists, so they’re able to see the industry from both sides with a 360-degree view. This knowledge is very helpful in making successful employment happen,” he said.





“Recruiters also assist with negotiations to ensure that offers are appropriate and accepted. It’s typically in a practice’s best interest to hire interested candidates since there is an undersupply and immediate need to fill a vacancy. Ensuring that the process ends in a hire rather than a rejected offer is a critical component. The goal is always to create a win-win for the practice and the job seeker, where all parties feel good about the outcome,” Kestenbaum commented.

“The role of the optometry recruiter for our optometry students is to be an ambassador for their employer,” stated Dr. Horn. “Within optometry education programs, we expect recruiters to be honest with our students about the offerings of working for the business. In addition, we hope that they’ll provide our graduates with opportunities to have mentorship from those in business or in the community. This truly helps our students transition into the optometry community.”

Dr. Purcell pointed out that recruiters assess not only clinical qualifications but also the cultural fit within a practice. They’re tasked with identifying trends in the profession and ensuring the practices they work with stay competitive by hiring optometrists who have the technical skills and some business acumen to thrive in today’s market.

“The problems I’ve encountered often arise from prospective employees misrepresenting their qualifications or the job description not accurately reflecting the actual role. A skilled recruiter can help mitigate these issues by ensuring that only qualified candidates are considered and that applicants fully understand the responsibilities and expectations of the position they are applying for,” added Dr. Kaplan.