Updated: Dec 1, 2020
As I go about my work day as an eye doctor, sometimes my high school and college age patients ask me if Optometry can be a good career choice.
Of course, I'll usually tell people it can be a good career.
And I also tell them that the practice setting and the population you serve can impact how satisfying it might be.
I've practiced in a number of settings: an extremely busy surgical center, Walmart Optical, Lenscrafters, Costco Optical, and in 2011 I opened a small Optometry office in the small city Bellingham, Washington.
I opened it up "cold", as they say - with no history of any patients, built from nothing.
Kind of scary - looking back on it.
With all the challenges I've faced, I now understand why hardly any of the younger optometrists are opening up practices anymore. The younger generation of Optometrists are also saddled with heavy debt and probably don't want to take another huge financial risk either.
Financial risk and day to day challenges aside, none of those practice settings listed above have been more gratifying (or challenging) than private practice.
And I think the real gratification comes not only from being your own boss, but creating the environment you want, and seeing such a variety of patients and eye/vision cases.
What Is It Like To Be A "Private Practice" Optometrist?
If you are in private practice, you might actually be the owner of your business so you will have to learn business skills that you likely weren't taught in school.
Skills like bookkeeping, insurance authorization and billing, marketing, and basic IT skills are probably going to be required, unless you just want to spend the money to hire others. I think all theses skills are highly valuable to learn at least in the beginning so you will know what is going on if you do hire and delegate others to take over.
I won't get into all of this in detail because all of this information could fill a thick textbook, but I do want to explore what the patient care aspect can look like in a typical day.
So here it goes: A Somewhat Typical Day In The Life Of An Optometrist:
Once in a while, I, as an Optometrist will have a schedule full of the stuff that the general public thinks we are limited to.
Somewhat "basic", simple comprehensive exams, evaluating soft contact lenses, prescribing glasses and evaluating eye health. Sometimes everything goes really smoothly and no one has very difficult problems to solve.
This of course is very routine, and after you do an eye exam on about a hundred patients, you will have the pattern ingrained and a lot of the tests you run, you will not even have to think about. You just do it automatically.
These routine cases can be mundane, but sometimes meeting new people, hearing their stories, or just catching up with a patient who's been coming to your for years makes it rewarding. One of my mentors early on told me that Optometry is a "chit chat" profession and he was right. I usually schedule about 30 minutes with a patient and a lot of that time is spent running tests and documenting but a good chunk of it might involve just chatting!
Another day could be wildly different than handling the routine cases and could look like the following:
10:00 am: OrthoKeratology 1 week follow up with the patient who wants good vision without contacts and glasses. The patient might enter doing well, but may have trouble. You might see there is an abrasion on the cornea, in which case you'd have to stop the OrthoK lenses and prescribe and antibiotic for a few days to prevent eye infections:
10:30 am: Vision Therapy Evaluation: Maybe this would be a patient who scheduled in because they had learning difficulties, so you go over a detailed history which will include medical systems, development history (like when the patient learned skills like walking, talking, reading etc.) and academic history. You'll then test eye health, check for a prescription, evaluate the binocular, accommodative, and ocular motor systems for eye tracking or eye teaming difficulties, and often test for visual spatial skills deficits. If the patient has vision problems which impact their learning or give them symptoms like headaches, double vision or fatigue with visual task, you might prescribe vision therapy and/or lenses.
12:00 pm: Adult patient with Diabetes: This patient sees fine but has high blood sugar and is not taking care of it. You dilate the pupils and you see evidence of Diabetic Retinopathy which might include hemorrhaging in the back of the eyes. Depending on how severe it is, you talk to the patient about the Diabetes and how it could affect their eyesight, you write a report to his/her physician on what you found and you may or may not refer to a retinal specialist for further treatment.
12:30 pm: Adult patient: comes in to your office because he's having trouble seeing to read. You update his prescription but not that he has high intraocular pressure, thinning of the optic nerve disc and diagnose Glaucoma. There are other tests to include in the Glaucoma work up but as a definitive diagnosis is made, you prescribe daily eye drops to lower the pressure and schedule him/her to return to your office in a couple of months to re-examine some of the findings.
1:30 pm vision therapy progress evaluation: This patient might be a strabismic amblyope (a person with a crossed eye or and eye that turns out and has reduced vision). They have been working with a vision therapist at your office under your supervision for several weeks and now they come back to retest. You find that their vision has improved and that their ability to control the eyes and align them has improved and prescribe further treatment.
2:00 pm: An 67 year old patient enters and she has lost half of her vision on one side through each eye (hemianopsia) due to a recent stroke. You fit her with peli prisms which allow her to see objects in her blind field similar to the concept of a rear view mirror.
3:00 pm. A family of three comes in for their exams: A mom, a son and a daughter. Their cases are all fairly straightforward. You take a sigh of relief because most of your patients have had more complex problems and these are simple! The mom is 45 and has trouble seeing when she reads (presbyopia), the boy needs glasses to for reading and the girl needs vision correction to see clearly far away. You tell them everything is okay, but emphasize the importance of things like strong lenses like Trivex and the benefits of anti reflective coatings for their glasses lenses.
4:15 pm: A patient with an eye emergency enters: He was on a construction sight and took got a piece of metal in his eye 2 days ago. You evaluate the front part of his eye using a slit lamp biomicroscope and not a metallic foreign body which you remove.
If there's a ring of rust surrounding the metal, then you remove the rust ring with an alger brush. You prescribe antibiotic eye drops, reassure the patient and have him return in a few days to follow up.
Believe it or not, there can be many days in private practice optometry that can be this varied. Many times, you'll see more patients, and if you have a newer practice or it's a slow day, you may see less people. I remember when I first opened my clinic, there were plenty of days where no one would come in. Ouch!
You can of course "specialize" and choose to only see a few types of patients in your optometry clinic. I used to see only vision therapy and vision rehabilitation patients, but I expanded and now see general eye care patients as well.
Although, many doctors do not add vision therapy or brain injury vision rehab, so their eye care will be more tilted to taking care of medical eye problems.
Perhaps in another day, I'll go over what it's like on the business side of things in eye care.