Optometrists today have many unique and different career paths available to them. In this article series, we’ll be engaging with optometrists from various common (and not-so-common) practice modalities to get a firsthand perspective on what optometry is like in their setting.
Today, we’re interviewing two optometrists who have extensive experience practicing in community health centers: Lindsay Braun, OD, and Richard Ho, OD. Dr. Braun is adjunct faculty at the New England College of Optometry and director of eye care services at a multidisciplinary health center in Dorchester, Massachusetts. Dr. Ho is a staff optometrist at a large, multidisciplinary health center in Boston, Massachusetts.
What advice would you offer optometrists considering a career path in community health?
Dr. Braun: To go for it! Working in community health has been exciting and challenging. Every day is different, and you are involved in the diagnosis and treatment of eye conditions that some optometrists only read about.
Dr. Ho: The community health practice modality is a very unique setting for health care providers. Community health centers typically focus on serving populations that have difficulty accessing health care for a myriad of reasons (for example, geographical barriers, socioeconomic inequities, racial disparities, to name a few). You learn to recognize and understand what the barriers to care are, and oftentimes there is a responsibility to minimize those barriers as much as possible for your patients. As a result, optometrists are not only expected to provide eye care for these patients, but also are encouraged to work as advocates for their patients’ overall well-being. It is quite a different mentality when you compare it to private practice or a hospital setting, but I have found that the holistic immersion into the community I serve is extremely rewarding.
What is the most rewarding aspect of practicing in a community health setting?
Dr. Braun: It is very rewarding to be providing eye care to a community that is at risk and traditionally has many barriers to health care. I am proud to be part of my health center as a whole, which provides so many services for its patients. If a patient is having a problem in his/her life beyond the eyes, ie legal, food insecurity, financial, etc there is someone within the health center that I can connect the patient with for assistance.
Dr. Ho: It is rewarding to feel like I am making a difference in a community that desperately needs access to quality healthcare. I know that there are huge gaps and disparities in care between the communities I serve and the rest of the general population, but serving my patients feels like I am doing my part to bridge some of those gaps.
What is the biggest challenge?
Dr. Braun: The no-shows can be challenging. We have tried various strategies over the years to target and lessen no shows, but we have struggled to have an impact on decreasing the no show rate, which can hover around 15-20%.
Dr. Ho: We serve patients where English is not their native language. Occasionally, it can be a little difficult to communicate, but our health center is lucky to have in-house interpreters who speak the languages of the patients in our community.
Is further education recommended/required for optometrists to successfully work in a community health center setting? Would you recommend additional residency training?
Dr. Braun: I would always recommend a residency. This extra year is an invaluable time of so much learning and growth.
Dr. Ho: Although an optometry residency is not required for community health centers, it is strongly recommended. Combining the number of patients with chronic systemic health conditions with issues accessing quality healthcare means that there is a tremendous amount of ocular pathology that goes through the vision clinic. I strongly recommend completing a residency program in order to prepare yourself for the many challenging cases that inevitably go through your clinic.
How is your clinic time allocated during the week? Can you briefly walk us through a “day in the life” of your typical work routine?
Dr. Braun: My typical weeks consist of a mix between direct patient care, precepting students and a resident, and administrative clinic tasks. I like to tell people about the day when I saw a 3 year old for a vision check followed by a 102 year old for a comprehensive exam. The primary languages spoken at the clinic are Vietnamese, Spanish, English, and Portuguese Creole, so most sessions I utilize our in-person or phone interpreters. I see a lot of diabetic retinopathy, glaucoma, amblyopia, conjunctivitis, and dry eye.
Dr. Ho: I do direct patient care everyday, but since we have optometry students rotating through our clinic regularly, I also spend time precepting and training students. Our patient demographic is predominantly LatinX, but we also have a sizeable Moroccan population. We are also available to any resident who lives in the surrounding communities.
We see a lot of ocular disease, including, but not limited to, diabetic retinopathy, glaucoma, pterygia, and cataracts.
Some community health centers offer residency programs. What are some unique skills graduates may have after completing their residency program in community health?
Dr. Braun: Our residents graduate from the program with increased confidence in their ability to manage complex patients. They are accustomed to working with patients of all ages and from all different backgrounds. Non-English eye exams are no longer intimidating for a graduate of a community health residency. They have exposure to a wide range of ocular and systemic disease, from the common to the rare, and I think they are prepared for practicing in any setting.
Dr. Ho: Unfortunately our community health center does not offer a residency. However, doing a community health residency will give you first-hand experience at understanding what it takes to provide excellent care in this fast-paced, complex, and rewarding practice modality.
Optometrists interested in pursuing community health have the option of starting their career path immediately after graduation through one of the unique community health residency programs available. As medical optometry becomes more prevalent within the optometric profession, opportunities to practice in community health settings will continue to expand. According to the AOA, only 1 in 5 health centers currently offers eye care services. Practicing in a multidisciplinary, community health setting can be a rewarding experience for both ODs and patients. In community health settings, eye care providers must look beyond just the patient’s eye exam and help connect their patients with other resources and medical services for an overall comprehensive health care experience.