For many, optometry school signifies the final obstacle after years of intensive studies in college or university. Often, the associated workload can be so all-consuming that life after graduation seems like a lifetime away.
When I began preparing for board exams in my third year, the hours devoted to poring through textbooks while balancing time in-clinic seemed to put the rest of my life on hold. I was too busy worrying about my scores and applying for residency programs to devote any thought to how my struggles would evolve as a doctor.
Now, as I begin my residency and transition into direct patient care, new challenges continue to present themselves in ways I had never considered.
Here are the top five challenges I feel are facing optometry students and residents today.
Top 5 challenges for optometry students and residents
Between adapting to online schooling, mixed learning environments, and now returning to pre-pandemic operations, optometry students over the past few years have had many hurdles to face even without taking board exams or patient care into consideration.
As a result, flexibility and resilience have been especially crucial to success in recent years. However, optometry students and residents alike continue to face ongoing challenges that are important to recognize and address.
1. Staying on track with advancements and technology beyond the scope of optometry school.
Many optometry schools offer a wide variety of technology and equipment to work with, which provides the students with a comfortable baseline that prepares them for independent practice.
With the advent of newer inventions, such as virtual reality-incorporated slit lamps and binocular indirect ophthalmoscopy (BIO) headsets, auto-phoropters, and scleral surface profilers, schools are making impressive efforts to keep up with the latest technology and provide sufficient exposure for students in-clinic.
However, it is imperative that students and residents ensure that they have a good awareness of other ongoing advancements in the field that they may not have the chance to encounter at school. For instance, teleretinal imaging has gained popularity in recent years due to the need for remote exams, mainly as screening tools but, in some cases, replacing a dilated eye exam.
Artificial intelligence (AI) diagnostic systems have already been receiving FDA clearance for the interpretation of retinal images without the need for a clinician since 2018. Despite such advances, it is important that healthcare professionals remain vigilant in providing regular dilated eye exams as there still exist many limitations with new imaging techniques.
Action step: Stay open-minded and adaptable while also taking the time to evaluate the validity and reliability of new technology.
Conferences are a great way for students and residents to get direct exposure to new technologies and innovations within the eyecare industry, try them out at the exhibit hall, and directly discuss any questions or concerns.
Online resources and social media groups tailored to optometrists can also provide further exposure to unique treatment and management strategies.
2. Choosing to specialize and expand one’s own scope of practice.
From residencies and fellowships to diplomates and additional certifications, there exist more options for new graduates than ever before for continued education and specialization. It is becoming incredibly common for an optometry clinic to advertise a variety of services tailored to specific niche areas of optometry, such as dry eye, vision rehabilitation, and specialty contact lenses.
The traditional primary care exam provides an excellent baseline for optometry students; however, as wait times for ophthalmologists and other specialists continue to grow, refusing to hone in on further skills can mean having to refer patients that could have been seen in-office.
According to the Association of American Medical Colleges, there is an anticipated deficit of between 37,800 to 124,000 doctors by 2034. Within this statistic, by 2025, there is an expected shortage of about 6,000 ophthalmologists, according to the Health Resources and Services Administration.
It is empowering to have the capacity to recognize when adequate care can be directly provided to the patient by the optometrist or co-managed with a specialist.
Understanding the ocular manifestations of systemic diseases
We are steadily beginning to understand the ramifications of various conditions on the visual system. For instance, convergence insufficiency and oculomotor dysfunction are common findings in patients with attention-deficit/hyperactivity disorder (ADHD). Vision issues can be rampant in patients recovering from a concussion, and sometimes may not be adequately addressed or recognized.
Residency is an excellent option for expanding one’s own scope of practice and provides a comprehensive learning environment while also providing unique opportunities for further involvement in academia and research.
However, learning does not stop with residency; even after completing a residency program, fellowships and certifications should be considered if doctors want to establish their knowledge and networks further. For example, residency can fast-track doctors to attaining their Fellowship with the American Academy of Optometry (FAAO) within a year.
Action step: Take the initiative to be aware of all your options as a student; use the opportunity to ask current residents, lecturers, and supervisors about their experiences, what they found helpful in their own career, and programs they might recommend for you. As a resident, consider how you can use your residency as a stepping stone to additional certifications.
3. Advocating for the profession and its future.
The past 2 years alone have been an uphill battle for the profession. While there have been advancements in scope, such as laser procedures for glaucoma and post-cataract care in several states, it is important to acknowledge the challenges optometry continues to face today.
Florida’s proposed bill (SB230), had it not been vetoed by the governor in June 2023, would have banned optometrists from referring to themselves as physicians. This highlighted the fundamental role that optometrists’ associations play in establishing optometry as a crucial component of health care.
In Ontario, Canada, where eye exams for seniors, children, and patients with certain ocular conditions receive government-funded healthcare, advocacy can be a major hurdle.
While the government’s healthcare plan covers the cost of these eye exams, the compensation for optometrists was insufficient to cover operating and staffing costs. In 2021, optometrists in Ontario withheld services from government-funded eye exams in what became a 3-month job action.
As prospective optometrists, students have a role to play in advocacy. It is important to recognize that current advancements in scope are largely due to current and ongoing efforts by optometric associations and optometry schools alike.
Action step: Get involved in state associations and the American Optometric Association (AOA) or Canadian Association of Optometrists (CAO) for Canadians while you are still in school, and become a member when you graduate.
While membership fees may seem daunting as a new graduate, the contribution to the future of optometry overall is understated, and the resources these associations provide can help kickstart your own practice.
4. Battling burnout, imposter syndrome, and other mental health struggles.
Optometry school is a time when many make some of their closest lifelong friends and strongest memories. However, for many, it can also be a time of intensive isolation and stress, which can easily lead to burnout, depression, and anxiety.
For instance, optometry students spend months preparing for the National Board of Examiners in Optometry (NBEO) board exams, which often lead to disconnection from friends and family back home.
The class of 2023 saw some of the lowest NBEO Part 1 pass rates, with 65.3% of first-time test takers passing in March 2022, compared to 74.1% from March 2021. Failing a board exam can be devastating news and only further exacerbate mental health struggles such as imposter syndrome, which is incredibly rampant amongst students and residents.
In the 2023 Optometry Student Report, almost half of students were most worried about passing exams. With the growing price tag of attending optometry school, burnout amongst eyecare professionals, particularly new graduates, is steadily rising.
Increasing student debt translates to working extra hours at multiple locations and missing out on weekends to grab extra shifts, as well as repetitive work environments. In 2022, the average optometry student loan debt exceeded $200,000, with 10% of new grads owing more than $300,000.
Action step: Be an advocate for yourself! Stay connected with old optometry classmates even after graduation, as they can best empathize with the struggles of being a resident or new graduate. In a stressful time, such as board exam preparation, your mental health is equally as important as memorizing that next page.
5. Transitioning from school to the workplace.
As students, we become used to the idea of deadlines and goalposts to motivate us and carry us forward. Especially in a program that requires years of dedication and schooling, the transition from student and/or resident to eventually an independent doctor can be daunting.
We learn how to become good doctors, but we do not necessarily learn the ancillary skills that help to keep a clinic functioning. From insurance coding and billing to the responsibilities of business ownership, there is a sharp and abrupt transition from a school environment to a working one.
The decision to become a practice owner can be daunting, and it is important to have the correct professional advisors to rely on to draw from existing expertise. Even for those looking to become an associate, having an attorney review a contract prior to signing on can save future headaches and losses.
Action step: Just as you would consult an optometrist or ophthalmologist for an eye-related concern, always reach out to other professionals for financial and legal concerns before making any major decisions. Do your research on key questions to ask during an interview, housekeeping duties, and ways you can prepare before your first day.
Redefining optometry
There remains significant room for growth and advancement in optometry. Just as the field has changed substantially in the last 20 years, the next 10 years alone will see new developments, such as the expansion of scope of practice, recognition of various specializations, and legislation for the profession.
In the meantime, current students and residents should remain open-minded and inquisitive. A precedent serves to guide us, but should not cause the profession to stagnate or become resistant to change.
Self-advocacy is key to success both in optometry but also in promoting your own well-being.
