The transition from new grad OD to seasoned optometrist can feel different for each of us. As new grads hit the 5 year anniversary of graduation and starting clinical practice, it can soon feel as though they’re no longer the new kids on the block. While some ODs may feel perpetually challenged in their careers, others can feel their days are on autopilot and less stimulating.
In this article, I want to reflect on some of the lessons I've learned since graduating optometry school and starting clinical practice in 2015.
Optometry is not oversaturated
The oversaturation of the optometric profession and excessive supply of ODs has been a hot topic of debate. With new schools continually opening, the number of qualified candidates applying to our profession is shrinking. As urban job markets also become more competitive and disrupted by technology, optometry may not appear to be the glamorous profession it once was.
Depending on a variety of factors (eg. state, city, practice modality), the highly nuanced issue of oversaturation may not be as bad as it sounds. Geography and practice modality or specialty are likely the best predictors on whether a job market is truly “saturated.” For instance, there will always be a need for medical optometry in rural communities. Despite the number of optometry schools opening, industry conflicts of interest, challenges with insurance companies, or how many app-based refraction services pop up, this fact is unlikely to change. Whether it's a private practice, IHS hospital, VA, or FQHC, our country’s rural communities will always need medical eye care providers.
Approximately 20% of the nearly 1400 federally qualified health centers (FQHC) in our country offer optometry services. From my personal experience helping open optometry departments within several community health centers, most FQHC administrative staff are thrilled to start the conversation of expanding their services to include comprehensive eye care.
This is a HUGE potential career opportunity for new grad and seasoned ODs alike.
Communication is key
It’s easy to fall into the habit of minimizing or even eliminating a proper explanation of certain tests or procedures we perform. “Ok, look down, and now look straight” and boom, a gonioscopy lens is on the patient’s eye. Why are we doing gonioscopy? What are we checking for? While easier said than done, remember to stop periodically throughout your exam to communicate what you’re doing and why. Patients love this.
Depending on your practice modality and location, it is not uncommon for some patients to drive 1-2 hours round trip for their follow-ups with you. Whether it's a follow-up for glaucoma, dry eye, or macular degeneration, be sure to remind patients why you’re having them back and what specific tests you’re doing to ensure their ocular health remains stable and satisfactory. This also makes the patient feel their time is valued when they have a thorough understanding of what they're being asked to do.
At the end of routine exams, most of your patients will appreciate a thorough explanation of what eye conditions they have or don’t have. If necessary, be sure to explain the pathophysiology of any underlying ocular disease and what additional testing/treatment/follow-up will be necessary in the future.
With increasingly busy schedules, it can also be easy for eye care practitioners to fall into the habit of excessive speaking while not letting patients fully voice their concerns. Putting our listening ears on during encounters with patients can sometimes be challenging, especially when numerous other people are waiting on us. Patients come to see us and may often complain that their previous doctor(s) wouldn’t let them fully voice their concerns about their eyes, and it had resulted in a frustrating experience. Don’t repeat this cycle for the patient!
Listening isn’t just valuable in the context of addressing our patients’ worries regarding their vision. Many of our patients are in the midst of other life stressors: depression, anxiety, addiction, violence or abuse, deteriorating physical health. This is especially true during the Covid19 pandemic. While we are not trained to address patients’ mental health needs per se, we must remember that sometimes patients just want to be heard—even for just 60 extra seconds.
Patients are not always looking for definitive solutions to their problems, but often simply need to feel they’ve been heard and understood. In addition to helping you fully address the purpose of their visit, listening can also help establish a positive rapport as patients will remember how you made them feel.
The exam can be your own
During optometry school and into final year externships, optometry students tend to adopt the exam flow patterns taught by preceptors. This is vital to our growth as future eye doctors and should be adhered to. Typically, there is no choice.
When we get out into practice, we have the privilege and freedom to modify our exam flow to our best clinical judgment. We can deviate from the rigid structure of examining patients as a student. If our myopic patient loves removing their glasses at near, and never plans on a bifocal, maybe it's ok to omit the ADD power from their Rx. If your plano diabetic patient is there for their annual retinal exam, and they’re happy with their OTC readers, maybe it's ok to dilate them BEFORE refraction (in the interest of time). Instead of juggling three patients at once, maybe it's easier to see just one or two at a time, keeping your thoughts straight while the third patient waits an extra 10 minutes. They’ll likely be thankful to see you in a less distracted state.
It is important to have our exam flow down; however, it's also crucial that we’re able to occasionally deviate from it in order to optimize patient care and clinic flow.
Commit to lifelong learning
It seems as though the optometric profession is changing at warp speed these days. With constant new advancements in diagnostic technologies and treatment modalities, today’s eyecare providers have more clinical tools than ever at their disposal. It is also crucial that we stay up to date on the ever-changing landscape of our profession (not to mention the challenges of a global pandemic). Our profession and current scope of practice may look very different in just a few years.
With that in mind, find ways to routinely stay abreast on the latest updates in eyecare, whether it’s participating in your favorite CE conference, listening to the latest podcasts in eyecare, or even starting a journal club with your colleagues.
Drs. Melton and Thomas also do an amazing job of providing current updates within our profession, clinical pearls, and the latest scientific research in their annual “Clinical Perspectives” guide or their website eyeupdate.
Resident lifestyle (for > 1 year!)
As students, we’re often told to “live like a resident” for a year or two after we graduate. Surprisingly, living like a resident longer term isn’t too far-fetched of an idea, despite mainstream dogma about how doctors should live, think, or behave. As the cost of education and living expenses continue to rise, many new grad ODs may find the resident lifestyle isn’t so bad after all.
While we may not have a choice in our living standards in the short term, we certainly do down the road. As we pay down our student loan debt and settle into our careers, it can be easy to compromise on our saving and investing and increase our spending on things we might not need.
According to Medscape’s 2020 Physician Wealth and Debt Report, only 43% of doctors (17,000 surveyed) live below their means. Based on their 2019 report, one-quarter of physicians 70 years of age or older still do not have a net worth of at least $1 million. This number is surprising given the relatively high lifetime earning potential of most doctors, including OD’s, when compared to other industries and professions.
Housing and transportation are two areas that could potentially make or break the finances. While a new car would always be nice, maybe the early 2000’s vehicle you had in college would still suffice today. The topic of renting vs. owning a home is another highly disputed topic today. While many of our colleagues may be buying houses, maybe renting for another few years isn’t the worst thing.
As new grads transition into seasoned optometrists, the journey will likely feel different for each of us. As we hit the 5 year anniversary of graduation, it can soon feel as though we’re no longer the newly minted “eager beaver” optometrists we once were.
Regardless of how long we’ve been practicing it's important that we remember why we chose this amazing profession to begin with. Periodically reminding ourselves of the reasons for choosing optometry helps us maintain our enthusiasm and motivation to care for the patients we see everyday.