Ophthalmic allied health personnel are highly skilled medical personnel who are qualified by academic and clinical training to perform diagnostic and therapeutic procedures under the direction of an ophthalmologist. There are three levels of extenders. The most basic level of training is for assistants; the intermediate level is for technicians, and the advanced level is for technologists. Allied health personnel are certified by professional associations, but they are not licensed as independent practitioners. Most work in physician’s private practice and contribute to the treatment team by providing important information for the diagnosis and treatment plan that are formulated by the ophthalmologist. Ophthalmic medical personnel do not diagnose or prescribe medications for patients.
These are relatively new "professions," although medical office personnel have been employed and informally trained on the job for many years. In 1969 the Joint Committee unallied Health Personnel in Ophthalmology was formed to recognize ophthalmic support personnel and develop standards for their training. In 1974 the Council on Health Manpower of the American Medical Association accredited training programs for a single level of expertise: ophthalmic assistants. In 1988 this concept was abandoned in favor of the current three-tier certification program.
Typical Duties
The size of the staff and patient load for an ophthalmologist’s practice often determines the responsibilities assigned to support staff. In large practices, assistants typically assume administrative duties, although these responsibilities might be performed by a technician in a smaller office. These tasks might include:
- Obtain patient data
- Maintain medical records
- Type and do medical transcription
- Handle telephone calls, correspondence, reports, manuscripts
- Care for the office
- Maintain and update insurance matters, office accounts, Collections
- Collect patient history and physical data
- Administer treatments ordered by ophthalmologist
- Make anatomical and functional ocular measurements
- Test for ocular function, visual acuity, visual fields, sensory motor functions
- Administer topical ophthalmic medications
- Instruct patients in the use of contact lenses or self-care requirements
- Assist in fitting contact lenses or eyeglasses
- Make repairs or adjustments to glasses
- Maintain ophthalmic and surgical equipment
- Assist in ophthalmic surgery in the office or hospital
- Perform ophthalmic clinical photography
- Perform fluorescent angiography
- Test for ocular motility
- Perform binocular function tests
- Perform microbiological and electrophysiological procedures
- Provide instruction and supervision of personnel
- Conduct patient education sessions
Working Conditions
As in the other eye care professions, ophthalmic medical personnel work in pleasant surroundings. Offices are clean, comfortable, and attractive. Although workers are expected to be productive, there is usually a close relationship between the ophthalmologists and his or her support team.
Since ophthalmic practices are prevalent in almost every type of community, employment close to home is generally good possibility. The higher salaries and more specialized positions are found in metropolitan areas where ophthalmologists are associated with, or employed by, hospitals and medical schools.
The work is not physically demanding, but is somewhat stressful in busy offices. This is a career for "people people," and only the gregarious should apply. Since the majority of the elderly have vision problems, successful careerists appreciate and enjoy working with older people.
Most ophthalmologists now have evening and weekend appointments, in order to accommodate working patients. Depending on the size of the staff, support personnel are expected to share night and weekend duties.
Most ophthalmic personnel work full-time, but ophthalmologists are becoming more flexible about scheduling because of the competition for good workers. About 90 percent of the workforce is women because this is a career thatblends well with family life.
Education and Training
Perhaps one of the best features of this career choice is the flexibility that the Joint Commission on AideHealth Personnel in Ophthalmology allows in attaining the requirements for the various skill levels. There are many accredited training programs in the United States and Canada for ophthalmic medical personnel. The prerequisite for all programs is a high school diploma or its equivalent. Two years of college are preferred for technicians and technologists. There are other routes to certification that include workexperience, a home-study course, and approved continuing education "short courses."
Training programs for assistants are generally twelve weeks in length. Technicians study for one year and technologists for two years. Course work usually includes:Anatomy and physiology—basic and ocular Medicalterminology Medical law and ethnics Psychology Ophthalmic Microbiology, Ophthalmic pharmacology and toxicology Ocularmotility, Diseases of the eye, Diagnostic and treatment procedures, Visual field testing, Contact lenses,Ophthalmic surgery, Proper care and maintenance of ophthalmic equipment and instruments.
These courses plus supervised, clinical, hands-on training are directed at preparing the student for the certification examination as well as the world of work.
Since an ophthalmologist's endorsement is required for certification, almost all applicants have worked in that setting. Some start as receptionists and return to their sponsor’s office. Others go on to run laboratories in hospitals or work on research projects at university medical schools or pharmaceutical companies. Some go on to teach in preparation programs.
Once certification is obtained, the JCAHPO requires that all levels of personnel complete continuing education requirements. In a field that changes as quickly as ophthalmology, continuing education is necessary in order to provide state-of-the-art care for patients.
Salary and Employment Outlook
Salaries for assistants average about $16,000 per year. Technicians can expect to earn in the low twenties, and technologists command a higher salary of about $25,000. Pay scales vary according to the geographic location and practice size and type.
Employment for all levels of ophthalmic medical personnel is expected to be much better than average through the year 2005. A major factor affecting the need for ophthalmic personnel will be the cost effectiveness of using paraprofessionals. As ophthalmologists experience a continued decline in reimbursement for services, they will need to increase their productivity by using more office staff to see more patients. Using paraprofessionals will allow them to provide quality care at a lower cost than sharing income with another physician. The anticipated demand for these workers will far exceed the supply. Competition for certified, experienced workers will compel employers to offer flexible scheduling and excellent benefits packages as recruitment incentives.
