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Practice Managers | Jan/Feb '16

On the Rise: Ophthalmic Administrator Stress

Survey results indicate a need for action.

This past year, I set out to conduct a survey to gauge the stress level of the modern ophthalmic administrator. Dubbed the 2015 Ophthalmic Administrator Stress Level Barometer, this survey focused on job satisfaction and four areas of stress typically experienced by ophthalmic administrators in their daily work. A total of 266 ophthalmology practice management professionals participated. Their responses reveal a need to find ways and solutions that help us increase organization, create a more productive workplace, and increase job satisfaction. 

On a scale of 0 to 100, with 0 indicating no satisfaction and 100 indicating completely satisfied, respondents reported a job satisfaction level of 63.40 for 2015. As a basis for comparison, a recent study by the Partnership for Public Service and Deloitte found that US private sector employees have an overall job satisfaction rate of 76.7%.1 The substantial gap between ophthalmic practice managers and national averages offers an attention-grabbing wake-up call.

The stress level results also are based on a 0 to 100 scale, with 0 indicating no stress and 100 indicating significant stress. The 2015 to 2016 numbers do not paint a pretty picture.


The health care career field is known for its high degree of stress. The Occupational Safety & Health Administration reports that injuries, illness, busy schedules, paperwork, and demanding patients all contribute to making health care one of the most stressful career fields.2 In addition, managing an ophthalmic practice presents other stresses uniquely related to the specialty.

The 2015 Ophthalmic Administrator Stress Survey identified four major areas that significantly contribute to practice management stress, as detailed below.

No. 1: Government compliance challenges. Staying current with government compliance regulations (ICD-10, meaningful use, PQRS, etc.) for ophthalmology practices is just the beginning of an ophthalmic administrator’s unique list of challenges. Legal compliance and paperwork is often the exclusive purview of managers, and it claims a considerable amount of time. The American Health Information Management Association identifies three primary areas of concern for compliance3: (1) privacy and security, (2) clinical coding, and (3) quality data reporting. In addition, the American Recovery and Reinvestment Act and the Affordable Care Act (ACA) brought significant changes to health care IT, increasing responsibility for administrators to update and (re)organize ways to meet government requirements. Compliance violations result in penalties of up to $50,000 per incident. Consequently, administrators are under significant pressure to remain current with a slew of rapidly changing regulations. This can lead to great anxiety.

No. 2: Human resource issues. The ACA presents challenges to ophthalmic administrators in human resources and personnel management as well. One major challenge is the need to (re)evaluate and potentially adjust compensation to lower clinic costs.4 Managers must maintain quality care with reduced budgets, which frequently forces them to reduce expenses across the board. This is especially stressful because staffing level and compensation issues must be considered. Higher patient volume due to the ACA creates the need for more staff, yet budgetary restrictions often prohibit additional hiring. As a result, administrators struggle to balance high-quality patient care with the limitations resulting from marginal staffing.

No. 3: Physician integration issues. The emergent post-ACA health care field is undergoing complex reorganization. The traditional physician-led clinic model is giving way to the practice overseen by business professionals. Increasingly, physicians are becoming employees in ophthalmic clinics. These new and shifting organizational structures often lead to conflict between doctors and administrators, causing ongoing stress for both parties.

No. 4: Practice operations stresses. Increased patient volume is the basis for a number of daily stresses in ophthalmic clinic operations. Staff members may be able to address the smaller operational problems (eg, minor patient complaints or missed appointments), but, ultimately, the administrator is responsible for solving problems of ever-greater complexity. Also, the increasing pace at health care clinics leads to operational issues that consume significant manager time and effort.


Although stress is ever-present and high job satisfaction levels are hard to maintain, all hope is not lost. Below are several ways to battle back.

Objectify and prioritize stress areas. Mitigating stress begins with an objective assessment of stress factors. Ophthalmic administrators face general issues common to all medical practice administrators as well as those specific to the specialty and practice. Taking the time to identify and list these factors in order of priority, from most to least stressful, is a great way to start the solutions process.

Assess leadership and personnel. It is vital that administrators build teams that are effective and efficient. Administrators should objectively identify the most proficient personnel as well as those employees who contribute to a stressful environment.

Develop a strategic plan. The plan should include options for minimizing stress in order of priority. It should identify strategies for building more efficient teams at every level of the practice.

Take action. This is a crucial step to reducing stress and establishing high standards for customer service. Actions should be direct, organized, and intentional.

Review to assess and improve your progress. Administrators should adopt a schedule for the objective review of action taken to reduce workplace stress. Thorough review and assessment enables a practice to advance toward increased organization, a more productive workplace, and greater job satisfaction for everyone.


The 2015 Ophthalmic Administrator Stress Level Barometer survey confirms a workplace reality: The stresses faced by ophthalmic practice managers continue to rise to critical levels. Acknowledging this fact is the first and most important step in finding solutions. As the ophthalmic workplace continues to undergo seismic shifts, practice managers must be proactive and results-driven. The fortunate few who give this due attention will endure far less stress than those who deal reactively to stressful changes.

1. Groden C. Government workers are notably unhappy. Fortune. December 8, 2015.
https://fortune.com/2015/12/08/government-workers-satisfaction/. Accessed January 20, 2016.

2. Healthcare Wide Hazards: Stress. Occupational Safety & Health Administration.
https://www.osha.gov/SLTC/etools/hospital/hazards/stress/stress.html. Accessed January 20, 2016.

3. Emery S, McDavid J, Robb D. Compliance in practice: mitigating risk in clinical and physician practices. J AHIMA. 2010;81(3):28-31.

4. Smith D, Ricci C. Healthcare trends 2015. B.E. Smith. https://www.besmith.com/thought-leadership/white-papers/healthcare-trends-2015. Accessed January 20, 2015.