Treat Your Mohs Tech Well - And Prosper

SAN DIEGO - Train them well, pay them well, appreciate them well – and they will provide years of reliable service.

Those are the simple secrets that allow Mohs surgeons to retain their right-hand man or woman: the Mohs technician, Alexander Lutz said at a meeting sponsored by the American Society of Mohs Surgeons.

Paying careful attention to the details that keep a Mohs technician professionally satisfied and secure will pay off in a big way, said Mr. Lutz, the owner of Travel Tech Mohs Services, Carson, Calif. "It’s important to hold on to your technician – because once they get trained, once they get good – they are going to be in high demand. There is always a need for good Mohs techs."

The Mohs surgeon–technician relationship is a unique one in medicine – a symbiotic relationship not seen in other areas. "It’s a rare relationship between and physician and nonphysician, even more so than a surgeon with his surgical nurse or tech," said Mr. Lutz. "The nurse might be helping the surgeon, but you aren’t depending on them to complete the surgery. With a Mohs technician, you are."

No Mohs surgeon, however talented, can perform good Mohs surgery without precise slides as a guide. The technician brings the key element to the table for success in every case. "What happens if you lose your tech to a competitor? Not only are you not doing any Mohs, your competitor is doing more," he said.

Hiring

There are three ways to hire a technician, Mr. Lutz said: Hire and train an in-house full- or part-time person; borrow a technician from a nearby lab or hospital and either pay that person or pay the lab for that person’s time; or use a travelling service to hire a tech for only the days Mohs occurs at the office.

"Probably the most popular way is to hire and train the person in your office," Mr Lutz said. In every state except New York and Rhode Island, the trainee does not have to be a certified histotechnician. "It can be someone you already have on staff – even your office manager."

The "borrowing" technique only works well if the physician is located near a lab or is already affiliated with a hospital. The "mobile tech" option works for physicians who do the surgery occasionally, but this service isn’t available in all states – California and Florida are probably the best-supplied, he said.

The hiring process should be exacting and include several interviews. "One consideration – though it’s not necessary – is whether they already have Mohs experience. Even if you are considering an experienced histotechnician, they might not be familiar with Mohs. They might be more used to bread-loafing a specimen and looking for tumor, rather than the concept of slicing horizontally and getting underneath it."

Interviewing

Key points to consider when interviewing are whether the individual has good manual dexterity, good communication skills, and "a perfectionist personality," he said. "In my experience, good Mohs techs have a couple of things in common. They are all manually dextrous and perfectionists. I always ask if they have a hobby that shows dexterity, like knitting, musical instruments, or even juggling."

It’s hard to overstate the importance of good communication skills, Mr. Lutz stressed. "This is critical. And it’s one reason why I suggest that you do the interviewing yourself. Don’t delegate it to your practice manager. This person will be working with you every day, and it helps unbelievably if you have good communication, if you like the person, if you believe them to be ethical."

Communication is also important because, as a Mohs surgeon, you will be liable for the technician’s errors. "The Clinical Laboratory Improvement Amendments see you as the lab director, so you are inheriting [the technician’s] mistakes, and their liability is your liability.’

If the interviewee is experienced in Mohs, find out what cryostat he or she is most familiar with, or if the person is cross-trained on several." You want someone who is competent on your cryostat or can learn it quickly."

Physical limitations must be taken into account, even though interviewers are not allowed to ask about them on an application. "The way to deal with this is to put it in the job description," Mr. Lutz said. "They need to be able to lift 30 pounds. They need to be able to stand for at least 30 minutes at a time and to do repetitive tasks. If they sign off on all these things, they’re telling you they are able to do them. Then, if it turns out they can’t, this makes it easier to let them go."

Don’t forget the background check, he added. "I’m always amazed at how many people will hire without doing a background check."

Wage and Benefits

To attract and maintain the best person, the physician has to be prepared to offer a competitive wage, an attractive benefits package with health care and retirement, and the promise of continuous training. "An intensive 4-day course is fine, but even the best is not enough to go back and start cutting good slides. Find somewhere to get hold of pig skin – a pig’s foot from a market is fine and will last a whole day – and let the person practice cutting and sectioning 40 hours a week for a couple of weeks. If you let them take one course and expect to start surgery the next week, I can tell you the stress on both of you is going to be unimaginable."

Communication

Good communication is the foundation of success, he said. "This bears repeating. You want to speak diligently to the tech about what’s happening in surgery, and have that person in the surgical suite with you if possible. If you’re doing anything out of the norm of what they usually see – eyelid with a conjunctival margin, ear wedge with cartilage – you have to let them know, or they can mess up the slides."

Don’t expect a tech to make a silk purse out of a sow’s ear, he said. "They need good sections to make the kind of slides you need for diagnosis. Give them sections with complete margins, with beveled edges and clean cuts and at least 1-2 mm of epidermal rim. Specimens with jagged epidermal edges are difficult to lay flat and tend to pull out of the medium much more than a nice circular or oval cut with a 30- to 45-degree bevel."

Training

Pay a lot of attention to training. "Send them to courses as much as possible so they can hone their skills." Included in training should be courses on cryostat maintenance and adjustment. "Let your techs adjust the cryostat themselves. Don’t be afraid to let the tech learn to do that, to recondition the microtome. That way if there’s a maintenance issue, you won’t be dead in the water. Get them the education they need so if there is a problem, they know what to do to solve it."

Finally, he said, as soon as the new tech is competent, have him or her train another person in the office. This might make some people nervous about job security, but it’s a matter of practicality for everyone. "If that person ever wants to go on vacation, he’ll need someone good to cover for him."

SAN DIEGO - Train them well, pay them well, appreciate them well – and they will provide years of reliable service.

Those are the simple secrets that allow Mohs surgeons to retain their right-hand man or woman: the Mohs technician, Alexander Lutz said at a meeting sponsored by the American Society of Mohs Surgeons.

Paying careful attention to the details that keep a Mohs technician professionally satisfied and secure will pay off in a big way, said Mr. Lutz, the owner of Travel Tech Mohs Services, Carson, Calif. "It’s important to hold on to your technician – because once they get trained, once they get good – they are going to be in high demand. There is always a need for good Mohs techs."

The Mohs surgeon–technician relationship is a unique one in medicine – a symbiotic relationship not seen in other areas. "It’s a rare relationship between and physician and nonphysician, even more so than a surgeon with his surgical nurse or tech," said Mr. Lutz. "The nurse might be helping the surgeon, but you aren’t depending on them to complete the surgery. With a Mohs technician, you are."

No Mohs surgeon, however talented, can perform good Mohs surgery without precise slides as a guide. The technician brings the key element to the table for success in every case. "What happens if you lose your tech to a competitor? Not only are you not doing any Mohs, your competitor is doing more," he said.

Hiring

There are three ways to hire a technician, Mr. Lutz said: Hire and train an in-house full- or part-time person; borrow a technician from a nearby lab or hospital and either pay that person or pay the lab for that person’s time; or use a travelling service to hire a tech for only the days Mohs occurs at the office.

"Probably the most popular way is to hire and train the person in your office," Mr Lutz said. In every state except New York and Rhode Island, the trainee does not have to be a certified histotechnician. "It can be someone you already have on staff – even your office manager."

The "borrowing" technique only works well if the physician is located near a lab or is already affiliated with a hospital. The "mobile tech" option works for physicians who do the surgery occasionally, but this service isn’t available in all states – California and Florida are probably the best-supplied, he said.

The hiring process should be exacting and include several interviews. "One consideration – though it’s not necessary – is whether they already have Mohs experience. Even if you are considering an experienced histotechnician, they might not be familiar with Mohs. They might be more used to bread-loafing a specimen and looking for tumor, rather than the concept of slicing horizontally and getting underneath it."

Interviewing

Key points to consider when interviewing are whether the individual has good manual dexterity, good communication skills, and "a perfectionist personality," he said. "In my experience, good Mohs techs have a couple of things in common. They are all manually dextrous and perfectionists. I always ask if they have a hobby that shows dexterity, like knitting, musical instruments, or even juggling."

It’s hard to overstate the importance of good communication skills, Mr. Lutz stressed. "This is critical. And it’s one reason why I suggest that you do the interviewing yourself. Don’t delegate it to your practice manager. This person will be working with you every day, and it helps unbelievably if you have good communication, if you like the person, if you believe them to be ethical."

Communication is also important because, as a Mohs surgeon, you will be liable for the technician’s errors. "The Clinical Laboratory Improvement Amendments see you as the lab director, so you are inheriting [the technician’s] mistakes, and their liability is your liability.’

If the interviewee is experienced in Mohs, find out what cryostat he or she is most familiar with, or if the person is cross-trained on several." You want someone who is competent on your cryostat or can learn it quickly."

Physical limitations must be taken into account, even though interviewers are not allowed to ask about them on an application. "The way to deal with this is to put it in the job description," Mr. Lutz said. "They need to be able to lift 30 pounds. They need to be able to stand for at least 30 minutes at a time and to do repetitive tasks. If they sign off on all these things, they’re telling you they are able to do them. Then, if it turns out they can’t, this makes it easier to let them go."

Don’t forget the background check, he added. "I’m always amazed at how many people will hire without doing a background check."

Wage and Benefits

To attract and maintain the best person, the physician has to be prepared to offer a competitive wage, an attractive benefits package with health care and retirement, and the promise of continuous training. "An intensive 4-day course is fine, but even the best is not enough to go back and start cutting good slides. Find somewhere to get hold of pig skin – a pig’s foot from a market is fine and will last a whole day – and let the person practice cutting and sectioning 40 hours a week for a couple of weeks. If you let them take one course and expect to start surgery the next week, I can tell you the stress on both of you is going to be unimaginable."

Communication

Good communication is the foundation of success, he said. "This bears repeating. You want to speak diligently to the tech about what’s happening in surgery, and have that person in the surgical suite with you if possible. If you’re doing anything out of the norm of what they usually see – eyelid with a conjunctival margin, ear wedge with cartilage – you have to let them know, or they can mess up the slides."

Don’t expect a tech to make a silk purse out of a sow’s ear, he said. "They need good sections to make the kind of slides you need for diagnosis. Give them sections with complete margins, with beveled edges and clean cuts and at least 1-2 mm of epidermal rim. Specimens with jagged epidermal edges are difficult to lay flat and tend to pull out of the medium much more than a nice circular or oval cut with a 30- to 45-degree bevel."

Training

Pay a lot of attention to training. "Send them to courses as much as possible so they can hone their skills." Included in training should be courses on cryostat maintenance and adjustment. "Let your techs adjust the cryostat themselves. Don’t be afraid to let the tech learn to do that, to recondition the microtome. That way if there’s a maintenance issue, you won’t be dead in the water. Get them the education they need so if there is a problem, they know what to do to solve it."

Finally, he said, as soon as the new tech is competent, have him or her train another person in the office. This might make some people nervous about job security, but it’s a matter of practicality for everyone. "If that person ever wants to go on vacation, he’ll need someone good to cover for him."

SAN DIEGO - Train them well, pay them well, appreciate them well – and they will provide years of reliable service.

Those are the simple secrets that allow Mohs surgeons to retain their right-hand man or woman: the Mohs technician, Alexander Lutz said at a meeting sponsored by the American Society of Mohs Surgeons.

Paying careful attention to the details that keep a Mohs technician professionally satisfied and secure will pay off in a big way, said Mr. Lutz, the owner of Travel Tech Mohs Services, Carson, Calif. "It’s important to hold on to your technician – because once they get trained, once they get good – they are going to be in high demand. There is always a need for good Mohs techs."

The Mohs surgeon–technician relationship is a unique one in medicine – a symbiotic relationship not seen in other areas. "It’s a rare relationship between and physician and nonphysician, even more so than a surgeon with his surgical nurse or tech," said Mr. Lutz. "The nurse might be helping the surgeon, but you aren’t depending on them to complete the surgery. With a Mohs technician, you are."

No Mohs surgeon, however talented, can perform good Mohs surgery without precise slides as a guide. The technician brings the key element to the table for success in every case. "What happens if you lose your tech to a competitor? Not only are you not doing any Mohs, your competitor is doing more," he said.

Hiring

There are three ways to hire a technician, Mr. Lutz said: Hire and train an in-house full- or part-time person; borrow a technician from a nearby lab or hospital and either pay that person or pay the lab for that person’s time; or use a travelling service to hire a tech for only the days Mohs occurs at the office.

"Probably the most popular way is to hire and train the person in your office," Mr Lutz said. In every state except New York and Rhode Island, the trainee does not have to be a certified histotechnician. "It can be someone you already have on staff – even your office manager."

The "borrowing" technique only works well if the physician is located near a lab or is already affiliated with a hospital. The "mobile tech" option works for physicians who do the surgery occasionally, but this service isn’t available in all states – California and Florida are probably the best-supplied, he said.

The hiring process should be exacting and include several interviews. "One consideration – though it’s not necessary – is whether they already have Mohs experience. Even if you are considering an experienced histotechnician, they might not be familiar with Mohs. They might be more used to bread-loafing a specimen and looking for tumor, rather than the concept of slicing horizontally and getting underneath it."

Interviewing

Key points to consider when interviewing are whether the individual has good manual dexterity, good communication skills, and "a perfectionist personality," he said. "In my experience, good Mohs techs have a couple of things in common. They are all manually dextrous and perfectionists. I always ask if they have a hobby that shows dexterity, like knitting, musical instruments, or even juggling."

It’s hard to overstate the importance of good communication skills, Mr. Lutz stressed. "This is critical. And it’s one reason why I suggest that you do the interviewing yourself. Don’t delegate it to your practice manager. This person will be working with you every day, and it helps unbelievably if you have good communication, if you like the person, if you believe them to be ethical."

Communication is also important because, as a Mohs surgeon, you will be liable for the technician’s errors. "The Clinical Laboratory Improvement Amendments see you as the lab director, so you are inheriting [the technician’s] mistakes, and their liability is your liability.’

If the interviewee is experienced in Mohs, find out what cryostat he or she is most familiar with, or if the person is cross-trained on several." You want someone who is competent on your cryostat or can learn it quickly."

Physical limitations must be taken into account, even though interviewers are not allowed to ask about them on an application. "The way to deal with this is to put it in the job description," Mr. Lutz said. "They need to be able to lift 30 pounds. They need to be able to stand for at least 30 minutes at a time and to do repetitive tasks. If they sign off on all these things, they’re telling you they are able to do them. Then, if it turns out they can’t, this makes it easier to let them go."

Don’t forget the background check, he added. "I’m always amazed at how many people will hire without doing a background check."

Wage and Benefits

To attract and maintain the best person, the physician has to be prepared to offer a competitive wage, an attractive benefits package with health care and retirement, and the promise of continuous training. "An intensive 4-day course is fine, but even the best is not enough to go back and start cutting good slides. Find somewhere to get hold of pig skin – a pig’s foot from a market is fine and will last a whole day – and let the person practice cutting and sectioning 40 hours a week for a couple of weeks. If you let them take one course and expect to start surgery the next week, I can tell you the stress on both of you is going to be unimaginable."

Communication

Good communication is the foundation of success, he said. "This bears repeating. You want to speak diligently to the tech about what’s happening in surgery, and have that person in the surgical suite with you if possible. If you’re doing anything out of the norm of what they usually see – eyelid with a conjunctival margin, ear wedge with cartilage – you have to let them know, or they can mess up the slides."

Don’t expect a tech to make a silk purse out of a sow’s ear, he said. "They need good sections to make the kind of slides you need for diagnosis. Give them sections with complete margins, with beveled edges and clean cuts and at least 1-2 mm of epidermal rim. Specimens with jagged epidermal edges are difficult to lay flat and tend to pull out of the medium much more than a nice circular or oval cut with a 30- to 45-degree bevel."

Training

Pay a lot of attention to training. "Send them to courses as much as possible so they can hone their skills." Included in training should be courses on cryostat maintenance and adjustment. "Let your techs adjust the cryostat themselves. Don’t be afraid to let the tech learn to do that, to recondition the microtome. That way if there’s a maintenance issue, you won’t be dead in the water. Get them the education they need so if there is a problem, they know what to do to solve it."

Finally, he said, as soon as the new tech is competent, have him or her train another person in the office. This might make some people nervous about job security, but it’s a matter of practicality for everyone. "If that person ever wants to go on vacation, he’ll need someone good to cover for him."