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 experience with practice in the Indian Health Service: Celia Baker, OD and Kristin White, OD. Dr. Baker currently works in Zuni, New Mexico. Early in her career, Dr. White worked with IHS in Gallup, New Mexico before leaving to help open an optometry department within a tribal-affiliated health center in Northern California.
What advice would you offer to optometrists considering a career path with the Indian Health Service?
Dr. Baker: For students or new grad ODs, do an IHS residency. It’s a great way to get your foot in the door and to try the job on for a year before committing to longer, plus the salary is much higher than almost any other residency. Student externships are also a good exposure. For practicing ODs, reach out to the Chiefs of Optometry for IHS locations in the area where you’d like to practice—we’re often looking for help! Be aware that due to the federal hiring process it can take a long time to go from expressing interest to starting work, so reach out early.
Dr. White: Working with Indian Health Services will not only improve your skills as an optometrist, you will also become aware of a different culture and way of life that most of us non-natives lack awareness of. Working with IHS may give you an opportunity to live in an area of the country you otherwise wouldn’t. Many IHS clinics and hospitals are in rural settings, so you’ll likely have opportunities for outdoor adventures. Overall, I would highly recommend working with Indian Health Services!
What is the most rewarding aspect of practicing in an IHS setting?
Dr. Baker: It’s very rewarding to work with an underserved population and know that I am providing much-needed care free of cost and close to home. I don’t have to think about my patients’ insurance coverage or what they can afford when prescribing medications or doing in office procedures. Additionally, as someone who comes from a place with very little Native American presence, I’ve also really enjoyed getting to learn about native cultures from my patients and community. Finally, we can’t forget about money—in addition to earning a competitive salary, many IHS ODs in remote locations receive funds through the IHS loan repayment program to help pay down their loans more quickly.
Dr. White: Feeling like you’re really making an impact. The hospital I worked at was very rural. Patients would travel several hours roundtrip sometimes for their eye exams. Being able to provide them with excellent care especially knowing they would otherwise go without was very gratifying.
What is the biggest challenge?
Dr. Baker: While working for the federal government has its benefits—good insurance and retirement, job security, hospital funding, etc.—there are also bureaucratic hurdles that add extra steps and paperwork to a lot of functions like buying new equipment or hiring new staff. While completing these kinds of tasks can be challenging and slow, it’s rarely impossible if you’re persistent and have support from the hospital administration.
Dr. White: There was definitely a learning curve to get more comfortable managing an extensive and complicated patient load with some of the worst disease I’ve seen in my career so far. Patients often live far away so follow-ups could sometimes be difficult, with patients lacking transportation to their appointments. Additionally, there were some cultural aspects to get accustomed to, for example not making eye contact in many Native cultures is seen as a sign of respect, which took me a while to get used to.
Is further education recommended/required for optometrists to successfully work in IHS? Would you recommend additional residency training, or is a Doctor of Optometry degree alone sufficient?
Dr. Baker: I absolutely recommend residency training. Many IHS locations are hours away from the nearest ophthalmologist, and our patients don’t always have reliable transportation. Because of this, we often consult with our partners in ophthalmology to manage patients in-house whenever possible. An IHS optometrist will feel much more comfortable with a strong background in ocular disease. Additionally, many optometry positions with IHS require either a residency or two years experience.
Dr. White: Do a residency! It may even be required for all IHS settings, but is certainly required at many/most locations. Even if it is not required to apply for the job, you will need it to gain a broader skill set handling a variety of complex ocular diseases and complications. Often referral centers are quite far away and so OD’s with IHS manage a lot more disease than ODs practicing in a larger city would.
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. Baker: Depending on how many technicians an office has, a doctor might see 15-25 patients in a day. I might see a school age child with high astigmatism, a low tension glaucoma patient, a few diabetics with and without retinopathy, maybe a follow up for dry eyes or uveitis, a patient who needs a referral for cataract surgery, and more. Additionally, urgent walk-ins who could have anything going on—red eyes, trauma, posterior segment disease, etc. Throughout the year we also participate in community health screenings and education, and our staff optometrists and resident trade off taking after-hours call for nights and weekends.
Dr. White: All patients seen at an Indian Health Service hospital or clinic are Native American. You will see patients of all ages from babies through elders. The hospital I worked at was a very large and busy hospital. I was full time with patient care. We also had two residents who I would occasionally discuss cases with, but everyone operated very independently seeing a full patient load.
We saw a lot of complications from diabetes on a daily basis—severe NPDR, proliferative retinopathy, and tractional retinal detachment. We also managed advanced glaucoma. Native Americans tend to have a higher incidence of autoimmune diseases and so we also saw many types of uveitis and inflammatory ocular conditions.
Some IHS hospitals offer ocular disease residency programs. Can you list some unique advantages residents may have after completing an IHS residency program?
Dr. Baker: While our patients are not typically racially diverse, they are all ages, so IHS residency trained ODs should feel quite comfortable managing common problems for people from birth to old age, and will have wide experience with a range of acute and chronic disease. These programs are located within community health centers, so residents get experience working as a team with other healthcare providers to care for the whole patient. An IHS residency allows the resident to build cultural competency skills like being able to listen and learn from patients in order to provide the best care possible for someone whose culture they may not be a part of.
Dr. White: Doing a residency with Indian Health Services will certainly advance your skills of identifying and managing complex ocular disease and systemic manifestations of ocular disease. You will manage a lot on your own which will give you the tools and confidence to practice in the most complicated of settings in the future. I would absolutely recommend an IHS residency and/or working with Indian Health Services during your optometric career—not only are you learning a lot but you will be serving an area of great need.
Conclusion
Optometrists interested in practicing within the Indian Health Service have the option of starting their career path immediately after graduation through one of the many unique residency programs available. Seasoned ODs also have the option to transition into an IHS practice setting later in their career. Practicing within the IHS can offer a unique clinical experience, as well as provide opportunities for cultural immersion and endless outdoor recreation.
