There are many benefits to practicing in a rural environment, including practicing full-scope optometry, job satisfaction, and the potential for loan repayment, forgiveness, or reimbursement programs. When looking to hire an optometrist in a rural setting, there are several things you’ll need to keep in mind that may be different from a practice in a more urban area.
Whether looking for an associate doctor in your private practice or a doctor to run or staff an optometry department within a community health center, keep these factors in mind when interviewing and considering your next OD hire.
Hiring in a rural setting can be challenging for a variety of reasons. Most new grad optometrists are seeking employment in more urban areas where their friends, family, and job opportunities typically exist. Employers and practice owners looking to recruit to a rural area need to understand this and work to create incentives for prospective ODs to come to their area.
Many rural practice owners have grown to play a key role within the community over many decades. This may ultimately cause them to overvalue their practice and/or undervalue prospective candidates, which further decreases their (already low) odds of actually hiring someone to take over their practice.
Unfortunately, many rural practice owners are forced to wait years before finding the right candidate to come to their area. In some cases, practices are simply shutting their doors or being given away for FREE when the owner is ready to retire. For a variety of reasons, it is not surprising that today’s new grad OD is not opting for rural private practice—geography, salary, student loan debt, online optical sales, decrease in insurance reimbursements, etc.
Where to start?
Employers and practice owners in rural settings should start their search early, even 5 to 10 years before they’re looking to retire or reduce their patient care hours. Practice owners need to place a premium on having an exit strategy and incentivize their practice’s employment opportunity as such. Starting salaries should be well above those in urban settings. Additional benefits, such as health insurance, paid vacation/conference/sick time off, and retirement plans, can also help attract quality talent. While the practice may operate at breakeven (or even at a loss) during the initial stages of hiring another OD, owners should understand that they are “buying” their opportunity to retire—if this is in fact what they’re after.
“When marketing a rural practice, owners should pitch any and all aspects that would potentially attract candidates to their area.”
In most rural settings, optometrists see a broader spectrum of ocular disease cases, as there are generally fewer healthcare providers in the area. Rural settings may also allow ODs to delve into various niches, like low vision, myopia control, or dry eye, with greater ease (less competition).
Job listings can also include any benefits to living in the area outside of work. Proximity to national parks, outdoor recreation/seasonal sports, restaurants, and entertainment are all factors that can make a location more appealing.
Rural offices looking to hire an optometrist can start their search in a variety of places. Networking with nearby optometry schools could be a great place to start. While some optometry offices make for great 4th-year externship and/or residency sites, rural employers don’t necessarily need to become one in order to get their name out there (although it is a great way to do so!). Networking with a particular optometry school(s) alumni affairs department may also create a few leads, as some new grad OD’s may desire a rural practice modality but are unsure of where to look.
Networking with current patients can also be a great way to get the word out. The whole six degrees of separation concept could really work to your advantage, as you never know whose grandchild, niece, or friend is about to graduate optometry school.
Rural offices can also list job opportunities with career placement resources/recruiters like Eyes On Eyecare or create geo-targeted ad campaigns, via Google/Facebook ads, placed within the closest big city to your area. These strategies can be great ways to actively spread awareness for employment opportunities at your office.
Eyes On Eyecare has helped hundreds of busy practices hire qualified doctors and staff through specialized job board and recruiting services, as well as through our industry-leading network of partner sites, including Review of Optometry, Vision Monday, and 20/20 Magazine. Learn more here.
Personality is key
Of course, personality is important in any patient care setting. However, when working in a rural environment as a medical provider (including optometrists) personality is even more important. Rural doctors become a part of their community even more so than in a city. You may run into patients at the grocery store, at school events, or walking the dog. Prospective employers should look for someone who wants to become involved in the area and is interested in each patient beyond their presence in the exam room. Patients will appreciate getting to know their new eye doctor and want someone with whom they feel comfortable.
A rural optometrist is often the first point of contact
When working in a rural healthcare setting as an optometrist, you may be the first healthcare provider your patients have seen in many years. Often, patients may only go to a doctor if they have a problem, so routine physicals are often missed. Sometimes this can generate a lot of fear around going to see any doctor, as they want to avoid finding disease.
For these reasons, a rural optometrist is often the first point of entry into the healthcare system for many patients. Often patients will come to see you when they are noticing changes in their vision, expecting they need glasses. On their exam, you may notice signs of hypertension or diabetes, and that can be the perfect entry point for getting them connected with a primary care provider.
In a rural setting, whether that’s in a community health center or in private practice, you’ll quickly get to know other providers serving the same patients and should have no trouble developing a referral network.
Referrals typically work both ways: A primary care provider, seeing a patient with systemic conditions will refer their patient to you for their ocular health assessment. An optometrist who makes it a point to connect with other physicians to best take care of the whole patient would do very well in a rural setting. Prospective employers should look for candidates who are team players and take a holistic approach.
In a rural setting, patients may be socially and physically isolated, especially if they don’t drive. When they come to see their doctor, they need a listening ear.
They may have many stressors in their lives that can impact their ocular or overall health. Rural optometrists need to listen carefully to what they’re telling them and be familiar with other services in the area to refer patients to such as behavioral health, safe homes for victims of domestic violence, and other community resources like food pantries, transportation, or youth mentoring programs.
“As a rural optometrist, you can be a great resource for your patients and not just for their eyecare needs.”
For these reasons, rural offices looking to hire an optometrist should seek out caring and compassionate candidates.
Practicing full scope is often required
Given the remote location, specialists are not easy to come by. If someone needs a referral, they will likely have to drive at least two hours round trip to see this doctor. Many patients living in rural areas subsist on a fixed income, so adding in extra expenses, like gas for long road trips, may be financially challenging. They may also have the additional fear of being unable to pay for services required, like surgery.
Many people who are used to "country" driving may also dislike "city" driving, even more than those who live in cities. They will also need to coordinate having a ride home, as their eyes will be dilated. Because of this burden on patients, many may not make it to specialists’ appointments, even for something you tell them is urgent.
For these reasons, it is important for optometrists interested in rural practice to be willing to provide full-scope care. Applicants with residency training (particularly in community health, primary care and/or ocular disease) may also be a better fit for rural settings, as we’ll discuss below.
Therefore, as a prospective employer, you need to hire someone who is comfortable practicing to the fullest scope under their license, managing all types of ocular disease, and referring only when they encounter something that truly cannot be handled on their own because it is outside of the scope of practice. In more populated settings, where specialists abound, it’s less of a problem for patients to make their way to an ophthalmologist for a referral. But, in a rural setting, you will realize patients want and need a single optometrist who can take care of all of their eyecare needs.
A residency-trained doctor brings broader experience
For the reasons mentioned above—less access to specialists, poor overall health, and lack of routine medical care—an optometrist in a rural setting will be managing a lot of ocular disease. That being said, you will need someone who is comfortable managing and treating a wide array of ocular disease in both anterior and posterior segment as well as treating patients of all ages, from children with amblyopia to seniors. You will also see a higher percentage of ocular disease in a rural setting than in a typical optometric practice in a city where there are a variety of subspecialists nearby.
To ensure the doctor is maximally capable of caring for patients with a variety of ocular conditions, a residency is recommended. Residency allows a new grad to develop more independence and is typically equated to at least five years’ experience in practice. In reality, a residency-trained optometrist will likely see cases during residency that most doctors never see in an entire career.
During an interview with prospective applicants, you should ask specific questions relating to how a candidate may handle a variety of situations including urgent and complex cases. This will help give you an idea of their thought process and experience in these circumstances.
If you don’t take this into consideration, you may find yourself with a new doc on staff making a lot of referrals that patients may be either unwilling or unable to seek out and fulfill. These patients then get lost to follow-up and are at risk of permanent vision loss.
Communication skills are critical
According to the US Department of Education, 54% of adults in the US ages 16-74 read below a 6th-grade equivalency level. That percentage may be even greater in a rural setting. Many patients in a rural environment may not have internet or cell phone service.
This means they are primarily getting their health information from their doctors and are likely not performing in-depth research on their particular eye condition at home. When these patients are told they have diabetic retinopathy or cataracts, they typically take the diagnosis at face value and seek their doctor’s opinion on the next best course of action.
Optometrists looking to practice in rural areas need to be able to communicate clearly, concisely, and effectively in language that their patients will understand. If reading material is given, it should be in language that is understandable, by simplifying medical terminology and using diagrams when appropriate.
When looking to hire an optometrist to practice in a rural setting, look for someone that you would want to be your own optometrist. Keep in mind that interpersonal skills, clinical knowledge, and comfort in handling complex ocular conditions are extremely important when practicing in this setting. Specialists offering retina or glaucoma services may be hard to come by, adding extra emphasis on the importance of a candidate’s ocular disease knowledge base. Remember, this person will become a part of the community they serve, so look for someone who wants to participate actively in local events as well.
While not for everyone, rural optometry can provide a rewarding and unique experience for both doctors and patients alike. Employers and practice owners should take the time during the hiring process to ensure their candidate is a satisfactory fit for the area and their practice.
At Eyes On Eyecare, our recruiting is done by people with years of experience recruiting eyecare professionals and ODs. We leverage our network of 40,000 optometrists, including active and passive candidates, to find the perfect fit for your practice. Learn more here.