"Rural" Optometry and the Benefits of Practicing in High-Need Communities

“Sir, you need to go to the ER.” It was only Wednesday and my second stat referral of the week. In truth, the majority of my patients are relatively routine. Rather, it’s my location that provides no lack of interesting cases.

An hour outside of the glitz and glam of Hollywood, you’ll find me in patient care located in the moderately sized city of Lancaster, California. Known mostly for Edwards Air Force Base, more than 170,000 residents have limited access to one important service—healthcare.

While some might not consider 170,000 residents a rural community, the desperate need for healthcare professionals is the same. There’s a big misconception in what “rural” optometry encompasses. The USDA quantifies populations under 50,000 residents as rural communities. In contrast, medical deserts are defined as communities more than 60 miles away from acute-care hospitals. However, both classifications fail to address the healthcare environment in many communities facing physician shortages.

“Rural” optometry should therefore be defined to encompass any community with a high demand for eyecare professionals and limited ability to attract them. It’s an issue impacting anywhere from small towns of a couple thousand to large cities with over three hundred thousand residents. This may sound hard to believe, but it’s the reality many areas around the country face.

New grads are especially prepared to take on these roles in high demand areas, but opportunities in less glamorous areas are often merely glanced over after graduation. The idea of working in bustling cities like New York City, Chicago, Houston, or Los Angeles often keeps new optometrists tethered to urban environments. Consequently, these areas continue to be the most saturated markets in the country.

This is where “rural” opportunities come into play! Let me explain by breaking down the pros and cons and illustrating what a career opportunity can look like.

Two words: clinical experience. There is no better place to continue your education and flourish as a doctor than in a high-need community. Cases you only read about while studying for boards suddenly have a way of presenting themselves in clinic. While slightly intimidating at first, these challenging cases further your knowledge and expertise.

Don’t let complex cases intimidate you or have the mindset that rural optometry is only disease-based. A huge advantage to being a rural physician is that most offices give you the freedom to practice in almost any specialty. Interested in specialty contacts? Done. Love doing pediatric exams? Absolutely! Want to start a vision therapy clinic? When can you start?! There’s unlimited opportunity to learn and push yourself in any specialty.

While you can find great mentors in any setting, rural optometry is an especially small community of colleagues. This means everyone understands what you're going through and are more than willing to help answer your questions. Besides the clinical benefits, partnership opportunities can also easily present themselves. If you’re interested in becoming a partner at a private practice, the timeline to acquire partnership can often be accelerated. Depending on your goals, these shorter timelines can allow new optometrists to reach financial and career milestones quicker.

Smaller communities naturally lend themselves to less competition, not only amongst colleagues but also corporate and online competitors. The lack of foot traffic is often unsustainable for large corporate settings, and many times online trends have difficulty gaining traction. This can help build in a mild buffer from the “doom and gloom” many of us have heard about. Community loyalty also goes a long way, with many regions being strong supporters of staying local.

If you want access to almost any piece of ophthalmic equipment, you’re in the right place. With limited providers, it’s not uncommon to have the latest and greatest equipment at your disposal. It might sound counterintuitive, but high-need communities demand the latest technology. Many times, optometrists might be one of the few doctors patients have access to. This means you’re able to diagnose and treat a variety of conditions with the assistance of a variety of digital tools.

Your efforts do not go unnoticed by the community you serve. These communities are extremely grateful for the care they receive because of the challenges of finding a doctor who will advocate for their health. If done right, practices stand to gain life-long patients. Sounds like a stretch?

I experienced community loyalty within my first few weeks of practice. A keratoconic patient, who had been lost to follow up, requested to be fitted with new corneal RGPs. Unfortunately, her insurance could not be billed for the fitting—not to mention, the patient lived three hours away. Even after advising her that it was in her best interest to find an optometrist closer to home, she refused due to the simple fact that her keratoconus had originally been diagnosed and managed at my location.

Stories like this one are not uncommon.

Compensation is as simple as the principle of supply and demand. A low supply of doctors and high demands for optometric services gives a lot of room for negotiation. Not to mention the many other competitive benefits that are rarely offered in saturated markets. If you’re looking to pay back student debt or save for other big-ticket items, it’s worth knowing your options.

Commuting or moving is potentially the single greatest barrier to high-need communities recruiting physicians, and rightfully so. Everyone has their limit on commute times and communities where they are willing to live. However, it’s important to keep in mind that working in such a community does not necessarily dictate your living or commuting situation forever.

As with any new position, there’s a learning curve involved. Rural communities tend to have a little bit of a steeper learning curve. This is not necessarily true of every high-need community, but as a rule of thumb, expect a few curveball cases throughout the month. Cases can range from bilateral rebound iritises, pseudotumor cerebri, retinitis pigmentosa, traumatic hyphemas, and neovascular glaucoma patients.

Don’t let this deter you! As mentioned above, mentorship goes a long way.

Prepare to grind. Optometrists often treat advanced cases which lends itself to a lot of phone consults with ophthalmology and side research. You are your patients’ advocate and it’s up to you to ensure the standard of care is always delivered. It can be a lot of work but it’s absolutely worth it!

Now here comes the good part: there is an abundance of career opportunities in “rural” optometry that are underrated. Serving these areas does not necessarily mean “moving to the middle of nowhere” or even giving up your day job. Keep in mind, it’s all a matter of perspective and clinical interest.

High-need communities may be much closer than you realize. I live in Hollywood, California, which is only twenty minutes of Griffith Observatory, the Hollywood sign and downtown Los Angeles. My commute to work is an easy no-traffic drive about an hour away. To put this in perspective, the average commute time in LA traffic is, also, an hour. You can still live in major metropolitan areas while serving in communities that need eyecare professionals.

Traveling optometry can also provide a very lucrative experience. I’ve heard of a variety of opportunities both full time and on an as-needed basis. Weekend fill-in work can offer extremely competitive pay in addition to travel and food compensation. Other opportunities offer housing accommodations and a condensed work week in more remote locations like Palm Springs, California. Pushing it even further, extremely remote regions, such as Alaska, fly doctors in to help severely underserved populations.

There’s more: highly sought after positions at large medical organizations still need optometrists. Due to the location, physician vacancies within these organizations can create pockets of opportunity. Openings that are highly desirable and competitive in urban settings become more accessible and available. While this potentially means moving to the area, there is an upside. Most of these communities have been carefully vetted before organizations make substantial investments. This means locations have been evaluated for future population growth, and may eventually offer amenities similar to major metropolitan areas.

Rural optometry can have its challenges but gives back so much more in return. I urge you to take the time to look at and build connections within these communities. You might be surprised at what you find.