Optometrists today have many unique and different career paths available to them. In this article series, we’ll be engaging with optometrists from various common (and not-so-common) practice modalities to get a firsthand perspective on what optometry is like in their setting.
Today, we’re interviewing two optometrists who share their professional experiences of practicing in the VA healthcare system: Janelle Fern, OD and Jesse Merwin, OD. Drs. Fern and Merwin both have extensive experience practicing in various VA settings throughout New England, with their VA careers beginning as student interns and residents.
What advice would you offer optometrists considering a career path with the Veteran Affairs health care system?
Dr. Fern: I would encourage optometrists to seek clinical experiences in ocular disease and/or geriatric optometry, as it would be beneficial in endeavoring a career path as an optometrist at the VA. It may be helpful to contact the staff optometrists at your local VA to find out about their career experiences and inquire about shadowing for a day.
Dr. Merwin: Be prepared for a rewarding experience with constant challenges!
What is the most rewarding aspect of practicing in a VA setting?
Dr. Fern: Certainly, the most rewarding aspect of practicing in a VA setting is serving our veteran patients and appreciating their incredible sacrifices. They deserve the best possible care we can provide.
It is also rewarding to provide a team-approach to comprehensive care. Within the eye clinic, it is a privilege to work with my colleagues who have decades of experience in both private offices and health centers.
Dr. Merwin: The most rewarding aspect of practicing in a VA setting is serving our country’s veteran population. This is true in both an academic and personal sense. As the majority of patients are elderly, managing ocular disease is common practice and provides a constant challenge. In a personal sense, these men and women put their lives on the line for our country – it is incredibly fulfilling to be able to give back to them in some way, even if it’s just an eye exam!
One of the biggest challenges in working in a VA setting is providing care to patients with a delicate psychiatric history. Many veterans have traumatic experiences related to combat exposure while in the military. When seeing them for an eye exam, detailed information regarding their military history is not always readily available. Sometimes eye exams need to be tailored to accommodate these patients, though it is not always initially clear how to do so.
Is further education recommended or required for optometrists to successfully work in a VA setting?
I'm not 100% sure about this but I think a residency may be required for employment as an optometrist at a VA. Specifically, residency training in ocular disease
or geriatric optometry would be most helpful.
Dr. Merwin: It depends. In many rural areas of the country, a residency may not be required to obtain a VA optometrist position – a specified number of years in practice may suffice. However, in more urban settings a residency is generally required. In my personal opinion, I strongly recommend a residency if pursuing a position within the VA. VA patients can be complex, often presenting with a complicated medical history to go along with any number of ocular diseases. Completing a residency prior to beginning independent work at the VA provides abundant exposure to these types of patients with supervision.
Can you briefly walk us through a “day in the life” of your typical work routine?
Dr. Fern: I am only a part-time employee. Eye clinics are run differently depending on the VA. At our local VA eye clinic we have a year-long residency program, and the clinic is also a 4th-year externship site for optometry students. Once a week we have an hour-long morning meeting/discussion, during which either the students, residents, or attending optometrists lecture on a particular topic or article. Our morning clinic session runs until 12:30, and our afternoon session is from 1:00-4:30PM. During each session, we see male and female veterans of all ages, though the typical patient is a white male over 60 years of age.
As such, we commonly encounter glaucoma, AMD, cataracts, dry eye disease, diabetic retinopathy, and other retinal vascular disease. Attending optometrists supervise residents and students in providing patient care, though we may also provide direct care depending on the day. We provide routine exams, imaging and visual field testing, urgent care, and spectacle fitting and repair. We occasionally provide medically-necessary contact lens fits. Once a week a glaucoma specialist and a retina specialist provide care, assisted by the residents.
Dr. Merwin: In our clinic, students and residents work closely with the attending optometrists to provide patient care. The examinations are completed by a student or resident and checked by an attending optometrist, with more guidance and supervision given to the students. Patients are seen throughout the day, and in addition to precepting, a staff optometrist will also be busy with various administrative duties, including charting, communicating with other providers within the facility and reviewing medical records from non-VA eye care providers for collaboration of patient care. Typical patient profile is mostly >50 year old males. Commonly seen ocular conditions include cataracts, diabetic retinopathy, macular degeneration, and glaucoma.
Most VA hospitals offer ocular disease residency programs. What are some unique clinical skills VA residents may have after completing their residency program?
Dr. Fern: Completing a residency program at a VA offers exposure to extensive ocular disease in patients with systemic comorbidities. Consequently, residents can gain experience with the diagnosis and management of acute and chronic conditions, ordering and interpreting imaging and labwork, coordinating referrals with other providers, and adopting a comprehensive approach to and understanding of ocular health care. A VA residency can also offer the unique advantage of providing care in an environment without insurance restrictions, and helps boost confidence by giving residents' the experience of supervising student externs.
Dr. Merwin: As VA patients typically present with a variety of anterior and posterior ocular findings, residents can expect to utilize their slit lamp, gonioscopy, and posterior evaluation skills often. In doing so, they become proficient in recognizing, identifying, and managing a wide array of eye conditions.
Optometrists practicing in VA settings are providing much needed healthcare to military veterans and current service men and women of our country. Optometrists working in a VA setting will typically see a high volume of ocular disease in the adult patient population.
Optometrists interested in pursuing a career path in the VA healthcare system have the option of starting while still a student. Many 4th year externship rotations are available throughout the country, allowing students to gain better insight into whether or not this practice modality is right for them. Newgrads can also opt to pursue one of the many unique VA ocular disease residency programs
available as well.