46.1 Hiring Personnel

When adding allergy to the practice, there may be no need to hire new personnel. The allergist should be able to perform all the tasks required and may enjoy the opportunity to utilize their skills. However, as the allergy service becomes busier, additional staff must be recruited to the allergy team to save allergist’s time and energy. This should be a person(s) who is qualified to perform the job being asked and has been adequately trained by the allergist, who ultimately is responsible for that person’s performance. The physician may train an existing medical assistant or nurse to perform some of the duties, such as skin testing, immunotherapy injections, patient counseling, and inventory. Other duties, such as immunotherapy vial preparation, could be done by a non-care provider who has a background in laboratory work or a pharmacy technician.

In time, most of the duties of a busy allergy service will be in the hands of one or more allergy care providers who will likely be new employees. There may be multiple part-time employees, one full-time employee, or any other combination, but continuity of care from testing and counseling to vial preparation and immunotherapy is an important factor to consider. The allergy staff functions in many ways as a care provider who will likely see the allergy patients much more frequently than the allergist. Patients confide in this person in a way that they would not with the physician. This is why communication between the allergist and allergy care staff is critically important. While the physician will always be directing the allergy care, the allergy care provider should be able to work more independently as experience is gained.

There is no official training program or certification for allergy care providers, but a registered nurse (RN) or licensed practical nurse (LPN) tends to function best in this capacity. It may be possible to find someone who has worked as an allergy care provider before, but they will likely have to undergo some retraining by the allergist because each allergist may have slightly different preferences and methods. Nurses with no prior allergy experience will naturally have to undergo more extensive training. This is why it is so important for the allergist to receive sufficient training, not only to perform all the tasks required, but also to be able to teach the allergy care provider. New graduates from nursing programs may be recruited, but allergy testing and treatment is not part of their standard curriculum, and all this training must be received from the allergist for whom they are working. In addition to advertising in local newspapers and medical journals, courses and meetings are excellent places to network with other allergists and find allergy care providers who may be interested in relocating.

The allergy care provider will be heavily relied upon by the allergist. This person must be easy to work with and have good communication skills. They should be neat, free of strong odors, organized, detail-oriented, and good at multitasking. Good math skills are a plus when it comes to vial formulation and making dilutions of concentrated allergy extracts. When interviewing for the position, the allergist should make sure that the individual is able to perform “hands on” procedures, such as skin testing and venipuncture, but also enjoys interacting with patients. The allergy care provider must understand that they will be following patients over an extended period of time and may frequently be listening to problems that have little to do with allergies. The allergy care provider must also understand that there is a great deal of “on the job” training required. Finally, it is important that the allergy care provider is dependable, because frequent, unplanned absences can be detrimental to both patient care and physician well-being.

While much of the allergy care provider’s training will be done by the allergist directly, there are other options as well. Selected chapters in textbooks, such as this one, should be assigned for reading in advance to facilitate the training sessions. It is best to start slowly and build upon fundamental principles. Make a schedule for training sessions with reasonable deadlines for completion. Too much information given at once will only create confusion and frustration for all parties involved. Outside educational opportunities are also available. Many nurses attend continuing medical education (CME) courses with their allergist and other courses are available online or through nursing societies. It is best to create a list of responsibilities for the allergy care provider, which may be checked off once the training is complete. This list may include:

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  Skin prick testing (SPT).

  
  
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  Intradermal testing (ID).

  
  
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  Modified quantitative testing (MQT).

  
  
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  Venipuncture.

  
  
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  Giving a subcutaneous injection.

  
  
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  Anaphylaxis protocol.

  
  
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  Performing five-fold dilutions of concentrated allergy extracts.

  
  
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  Vial formulation and preparation, SCIT as well as SLIT.

  
  
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  Patient counseling, avoidance strategies, and autoinjectable epinephrine demonstration.

  
  
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  Performing pulmonary function testing.

  
  
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  Lecturing at courses/enrolling research patients (academic practices).

  
  
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  Ordering supplies/billing/scheduling/documentation.

As the allergy department begins to expand, there may be other additions to the staff that become necessary. This might include additional front office staff to assist with check-in and making sure that allergy patients move efficiently through the office. The back office staff may also grow to help manage the increased number of claims that are being processed and to make sure payments are being properly collected. Additional middle staff, such as medical assistants, may also be required to take vital signs and assist the allergy care provider with phone calls and inventory. Conversely, the practice may choose to invest in additional technology, such as key fobs so that patients may scan or swipe to check in, text messaging appointment reminders, and electronic payment programs. While the additional employees or technology may not be a part of the initial budget, they must be factored into future budget calculations for the allergy service.

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