Residency in Optometry – No Need For One

Mar 1, 2017
5 min read

If you are like me, you’ve been told since you were a first-year that completing a residency in optometry is the next logical step in your career path after graduation.

And if you are even more like me, you questioned why this was the case. Some of the best answers I received involved opportunities for advanced training in a specialty area, mentorship from knowledgeable and experienced attending doctors and an overall boost in self-confidence.

All of the explanations were true to those who volunteered them. I wanted to know if they would be true for me. So began a four-month process of evaluating different residency programs and my motivations for pursuing them.

The main questions I asked myself

What kind of residency in optometry do you want to do?

This question works as the first litmus test for motivation.

If you can’t answer this question easily, it might indicate that you are not completely sold on any one area of practice. That isn’t a bad thing. It just might make for a long year if you’re not enthusiastic about what you are doing.

The second aspect you are evaluating with this question is patient access.

Neuro-rehab patients are much more difficult to come by than pediatrics, primary care or general ocular disease.

If the opportunity to work with the populations you want is limited to large specialty institutions, a residency is a great choice. The number of congenital visually-impaired children coming into a standard practice is limited; but, the number of patients with severe ocular surface disease is abundant. So use this as a rule of thumb. The scarcer the target population, the better a residency may be to concentrate these patient encounters.

Why do you want to do a residency in optometry?

On one level this question is a bit like, “What is glaucoma?”

Okay, maybe not that complex but it can be complicated.

If that’s not the case, evaluate where you will be in five years. Are you in private practice, commercial, other? Will your experience during residency put you in a better position to get there?

There may not be a single program that aligns with all your future goals and completing a residency in optometry for the sake of doing one may prolong the achievement of those goals. If you’re not sure where you will be, make it a question of opportunity.

Does a residency improve possible opportunity or restrict it?

Surprisingly, improve is not always the answer. I’ve talked to Peds/VT residents that felt their training actually hurt their chance of getting a job in a primary care setting.

Once you’ve answered the longer-term question, get specific in the short term. What are three things you hope to learn or skills you hope to gain during your residency time? It might be improving a certain skill, developing a deeper understanding of a particular disease or gaining experience teaching others through clinical instruction or research.

The following question is more difficult. Can these goals be achieved on the job? If you’re honest and creative, I think you’ll find the answer is almost always yes.

Real world residency

The key is to identify the aspects of the residency experience that you are drawn to and manufacture similar opportunities.

For example, becoming an associate at a group practice that has a doctor who is a skilled lens fitter is a huge advantage if your goal is to fit specialty lenses. You acquire an instant mentor and knowledge resource. If this isn’t an option, consider finding a doctor in your area that does the things you want to do and contact them. Most of the time, the experts are more than willing to meet and share what they know.

You may feel at this point in your career that you’re above shadowing; but, some of the most useful clinical tips and tricks I’ve learned came from a recent morning observing in the clinic with a great doc. More importantly, I now have some contacts to “consult” with on difficult cases in the future.

The sheer volume of free information available is astounding. Textbooks aren’t going to make you great, but they will give you all the raw materials necessary to make yourself great.

Many of the best practitioners and innovators didn’t have a large amount of formal training. They consumed all available material, synthesized in such a way that made sense to them and finally implemented it into practice. It takes robust courage and dedication, but the experience may be more valuable than what one would receive in a mediocre residency program.

At the end of day

With a few exceptions, I don’t believe there is anything special about most residency training programs.

I admit there are patients, technology and other resources available at some programs that cannot be duplicated but I believe this is the exception, not the rule. Most of the knowledge, skill, and confidence you gain during a residency is available to you without doing one. It might just take a little more planning and work. The advantage of a residency is the packaging of experience, mentorship, and lifelong learning skills into a neat little 12-month program. That’s really the only difference.

You can develop a specialty all on your own. Read the books, listen to CE lectures, and talk to the experts. Then, develop a plan that works both practically and financially into how you practice. It may take more than a year, but it will be worth it.

About Steven Turpin, OD

Newest member of Cascadia Eye, an OD/MD group practice in Washington. Currently building a specialty lens practice from the ground up. Myopia control and contact lens design are my guilty pleasures.

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