Today’s optometric profession offers more practice modalities than ever before. A variety of factors will ultimately determine what professional avenue a particular clinician will take, however, geography may be the most significant. Depending on whether a practice location is urban vs. rural can have a big impact on patient demographics, scope-of-practice, insurance plans, access to subspecialists, and more.
In this article we’ll discuss some of the advantages (and disadvantages) to practicing optometry in a major urban area. We’ll review some important factors to consider when choosing a practice setting that aligns with your professional and personal priorities. We’ll also look at opportunities to help underserved populations in urban settings through community health centers and other outreach endeavors as well as ways to carve out your niche within the optometric profession.
Benefits of urban optometry
Many students and new grad ODs often seek to return to their hometowns at some point early in their careers. More often than not, these tend to be urban and suburban areas. Most optometry schools are also located in urban settings, areas where many new grads are likely to begin practicing early in their career.
Urban settings can provide unique career opportunities for optometrists. These include multiple modes of practice to choose from, access to networking/CE events, ease of access to subspecialists, and connections to local optometric societies.
Ease-of-access to general eyecare in urban settings can provide the opportunity for optometrists to specialize in one specific area in the field. Building practices solely on one optometric niche (e.g., specialty contacts, dry eye, myopia control, vision therapy) can be much easier in urban settings, where ALL of patients’ eyecare needs don’t fall on just one provider.
Of course, many seek to practice in an urban environment because they want to live in an urban setting with access to cultural events, restaurants, and cultural and ethnic diversity. Typical practice modalities in urban settings include commercial/retail settings, private practice, OD/MD group practice, hospital-based clinics, and community health centers. Urban settings seem to have it all when it comes to diversity of practice settings, patient demographics, and life outside of work.
“For optometrists who remain uncertain of their preferred practice modality or for those who prefer variety, urban settings offer opportunities to try multiple practice modalities at once.”
While urban optometry has its advantages, it also has some drawbacks to consider.
Disadvantages of urban optometry
Many times, career opportunities in urban settings tend to come with a higher cost-of-living, longer work commutes (traffic), and possibly a more competitive job market. Of course deciding where you want to live has a lot more intangibles to consider such as geographic distance from friends and family and how you like to spend your time outside of work. So an advantage to living in one type of setting for one person may be a disadvantage to someone else.
Scope-of-practice is also something to consider when choosing a career path in an urban practice modality. In general, patients have access to a plethora of subspecialists in most urban and many suburban settings.
Depending on practice setting, it may be the glaucoma specialist managing the glaucoma suspect or the cataract/refractive surgeon doing the routine diabetic exam while the optometrist primarily sees routine patients with vision plans. While this isn't always the case or necessarily a bad thing per se, optometrists’ today are equipped to manage a significantly larger spectrum of patients than just healthy presbyopes.
The fewer specialists there are practicing in your immediate vicinity, the more disease you will manage in house. Where I practice in rural Northern California, many patients come from over an hour away just to have their comprehensive eye exam. Specialists are even farther away and many do not take insurance out of their county.
Due to lack of ophthalmology presence in many rural settings, we’ll typically manage most cases in house unless something falls outside of our scope. In an urban setting, it is easier to refer patients and, as a result, we may be more inclined to do so. Knowing that some patients cannot make the 4-hour round trip to see a specialist for a second opinion motivates us more to manage all that we can in-house.
Filling gaps in patient care
Despite myriad eyecare providers in most urban and suburban settings, gaps in patient care may still exist—particularly for patients who have Medicaid and/or who are uninsured. While many volunteer opportunities likely exist to help meet these patients’ needs (e.g., VSP Mobile Eyes), other practice settings such as community health centers are ideally positioned to care for the most vulnerable patient populations and can provide optometrists paid positions to care for these patients.
“Practicing optometry in a community health center can lead to a fulfilling and rewarding career.”
Regardless of rural vs. urban geography, every health center can benefit from offering eyecare services. Given that only approximately 25% of health centers offer eyecare services on site, this is a big area where you can make a difference by spreading eyecare to those most in need across the country.
In some cases, new grads will opt to pursue a residency training program in community health. Opening an optometry department within an existing health center is something to consider as it’s more than likely that a health center near you may not already incorporate this service.
To learn more about the importance of optometry within community health centers as a means to fill the gaps of care for many underserved patients, check out this webinar. For a more comprehensive step-by-step guide to opening an eye clinic within a community health center, listen here.
Finding your niche as an optometrist
There’s a lot to consider when deciding how to practice optometry. In addition to considering geographical location, there are multiple other factors to consider. Many of us may not know what our niche is until we’ve tried a few different settings whether that be during school, externships, residency, or beyond.
Optometry students and new grad OD’s should be thinking about the type of populations they want to serve. Where is that need strongest? Did one course or rotation in particular always stand out to you—whether that’s specialty contact lenses, pediatrics, vision training, low vision, or ocular disease? During final-year externships, optometry students are able to seize the opportunity to explore a variety of geographical locations and practice modalities to help them further refine their career goals.
Doing a residency is, of course, one of the best ways to separate yourself from your colleagues and develop your expertise in a particular area of optometry.
“Keep in mind that your optometric niche will likely evolve over the course of your career, so it’s ok if you don’t know what that will be right out of school.”
It is also common for former residents of programs in rural settings (e.g., Indian Health Services) to stay on board after their training and continue their career in rural optometry. In fact, studies have shown that the strongest predictor of a later decision to practice in a rural setting is doing clinical training in such a location during school.
Urban optometry can be an exciting place to start or continue a rewarding career path in eyecare. Practicing in both urban and rural settings have different benefits to offer the clinician, both in and outside of work. Knowing your own personality, career goals, and priorities will help you determine whether an urban setting is a good fit for you.