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’ve worked in the California Department of Corrections and Rehabilitation, Jeffrey Burke, OD and Kevin Cornwell, OD. Drs. Burke and Cornwell sit down with us to discuss what optometrists can expect when considering practice in a correctional setting like a state prison or county jail.
What advice would you offer to optometrists considering a career path in a correctional setting?
Dr. Burke: Give it a shot! Upon graduating myself, a mentor recommended that I try out as many different modes of practice as possible early on in my career to determine what works best for me and that has turned out to be absolutely sage advice. I had always envisioned being in private practice myself, and though that works well for some folks, I didn’t enjoy it at all. Rather, I have found alternative forms of practice (military, corrections, community health, volunteering with the Lions Club) to be way more rewarding and fulfilling.
Practicing optometry in a correctional setting is definitely an unconventional career path for ODs. It can be a large chunk of a career for some, or just a brief chapter for others. For new grads getting on their feet professionally and financially, correctional settings can offer above-average pay, flexible hours and a unique opportunity to practice optometry in a way you never expected. Most states pay optometrists as 1099 independent contractors
, so be sure to negotiate wages accordingly to cover the increase in tax liability.
What is the biggest challenge of working in a correctional environment like a state prison or county jail?
The bureaucracy of government work can be frustrating for many people, and though I feel like I’ve developed a patience for it, the red tape can get to me sometimes as well. However, there will be some headaches wherever you’re at, and I’d prefer dealing with bureaucrats as opposed to insurance companies. With enough effort, you can find your way around the red tape, which is true for any government position (military, VA, corrections, IHS
Dr. Burke at work. Photo contributed by author.
Dr. Cornwell: Logistics! Sometimes correctional facilities can be out in the middle of nowhere and take a while to get to. The good news is that some states pay an additional travel/lodging stipend. When I was working in facilities several hours away, I would pick 2-3 days in a row that I could work and just stay in a nearby hotel to avoid commuting.
When being paid as an independent contractor, you’ll also be responsible for paying your own malpractice insurance
, medical insurance and retirement savings. This may not be the case if you’re also employed elsewhere and have some/all of these expenses covered.
What is the most rewarding aspect of working with this patient population? Are there any specific advantages to practicing in this modality over other settings?
Dr. Burke: You are helping people who truly need the assistance. In private practice, I didn’t feel like I was doing anything special; if you’re not there, the patient will go five minutes down the road to another clinic for the same experience. However, these folks don’t get a lot of people willing to help them out and they are beyond appreciative for the help you are able to provide. That is what keeps me coming back day after day, year after year: the patients are more grateful in this setting than I’ve ever seen in private practice. The same goes for community health work, as well.
Dr. Cornwell: The most rewarding aspect of being in this setting is the opportunity to work with an underserved population, who for the most part are extremely appreciative and grateful for our services. Practicing full scope optometry without the concern for dealing with insurance companies is also a plus! Optometrists will find one of the biggest advantages of working in a correctional setting to be the absence of insurance credentialing/billing.
Coming to work and exclusively doing what I learned in school made for a significantly less stressful routine compared to other practice modalities. Also, most correctional settings are somewhat flexible with scheduling, so ODs looking for part-time work can tailor their schedules with other professional obligations elsewhere.
Are optometrists in a corrections environment able to practice full-scope optometry or is scope of practice fairly limited?
Dr. Burke: I do not feel limited whatsoever. The state recently made a big equipment expenditure, allowing most clinics to be outfitted with OCTs, visual field machines, etc. Additionally, all ODs in this setting have the ability to refer to an outside ophthalmologist, so the patient gets the proper care they need.
Dr. Cornwell: Optometrists are able to practice to the fullest scope of their state’s license. Most facilities will have one or several health center type buildings complete with primary care, dental, pharmacy, and even a lab. So if patients need any topical/oral medications or blood work drawn, these services are all under one roof. I saw a lot of anterior/posterior uveitis cases during my time with CDCR and it was nice to have primary care, pharmacy, and lab services right down the hall.
How is your clinic time allocated? Can you briefly walk us through a “day in the life” of your typical work routine? Typical patient demographics, common ocular diseases, etc.
Dr. Burke: It’s honestly not that much different than the day to day in a regular office: your patients just happen to be incarcerated and there is more security around. That’s it. Other than that, you’re just an optometrist in a medical clinic doing what you would be doing on the outside.
When I worked with CDCR I had a very diverse clinical experience. For the most part, I performed routine eye exams, diabetic retinal evaluations and glaucoma follow ups on a daily basis. I also co-managed cataract, glaucoma
and pterygium surgeries with ophthalmology. Some facilities will have additional diagnostic equipment such as a perimeter, pachymeter, autorefractor or non-contact tonometer, which makes life a bit easier for patient care.
I also got used to trial framing a lot of prescriptions because many patients had some of the craziest Rx’s I’d ever seen (eg. OD: PLANO, OS: -9.00sph). Most hadn’t worn glasses in a long time (or ever). Patients who were unable to wear glasses did qualify for medically necessary contacts.
Some facilities will have diabetic focus groups to help patients with diabetes manage their health given their circumstances. I had the unique opportunity to speak at a few of these meetings, explaining how uncontrolled diabetes can lead to vision loss and blindness.
Walk-in patients would also present on occasion. I found cases of ocular trauma and uveitis to be more common in this setting.
Is further education recommended/required for optometrists to successfully work in a correctional setting? Would you recommend additional residency training, or is a Doctor of Optometry degree alone sufficient?
Dr. Burke: Your OD degree will suit you just fine for this line of work. It’s never a bad thing to further your education, of course, but this is routine optometry, and all grads will be prepared for the work.
Dr. Cornwell: A Doctor of Optometry degree alone is sufficient to practice in a correctional setting. Due to the high volume of ocular pathology seen, optometrists who’ve completed an ocular disease residency may be more comfortable and prepared.
Optometrists interested in corrections can network with peers and colleagues who’ve had prior experience, or email any questions to the interviewees below. Most states will have a department of corrections website that includes job listings. A career path in corrections can offer both new and seasoned ODs a fulfilling and rewarding experience, one that they may not have initially envisioned themselves having.
Have any questions about pursuing this career path? Feel free to get in touch with the authors:
Dr. Burke: email@example.com
Dr. Cornwell: firstname.lastname@example.org