Category Archives: SCCO

Goooooaaaaaaaaalllll!!!!! (like the soccer announcers say after a scoring goal) and Optometric Residency

Real conversation the other day at SCCO.

“What are you doing after graduation Sarah*?” (not real name) -me

“I’m doing a residency in pediatrics/vision therapy in order to fulfill my goal of introducing this specialty as an associate or even in my own private practice when the opportunity arises.” – Sarah

“YES!!!! GREAT ANSWER!!!” – me

I loved it! Because she mentioned something that I personally love doing in order to figure out where I’m going and why I am going there. She set goals and decided to pursue an optometry residency because it would help her fulfill her goals. 

Another friend of mine Scott (not real name) gave me this answer to the same question.

“I’m going to do a residency in primary care and then figure out what I am going to do later during my residency.”  – Scott. “I’m just applying to the residencies in Los Angeles. The VA staff doc really liked me and so I figured I’d give it a shot.”

When I hear the latter I just shake my head. Scott doesn’t have a plan. Or maybe he does, but he hasn’t adequately linked his decision to do a residency to a more longterm goal. Right now, his focus is myopic. His goal is to get a residency, nothing more. If that doesn’t pan out, he’ll start his job search.

Before you do anything, it should fit in a longterm plan. Otherwise you are just performing random acts in order to achieve success. All success requires clear planning followed by defined actions.

Which is why every optometric practice, or any business for that matter, should have a mission statement. The statement should define the longterm goals of a practice and henceforth drive all decision making. Let me give you some examples:

We create happiness by providing the finest in entertainment for people of all ages, everywhere.” -Disney
To bring inspiration and innovation to every athlete in the world. – Nike
Optometry related ones:
Our mission is excellence in patient care, clinical education, and research in orange county.   – SCCO Eye Care Center
To provide the highest quality of compassionate, timely primary and secondary eye care services to veterans in a hospital-based environment and to educate optometric interns and residents for national practice, as well as other members of the Medical Staff and associated health care trainees. – VA West LA eye clinic
All of the above are GREAT examples of ones for businesses. You should have a clear idea of what your values are that drive your business model. All staff meetings from there are out must address your mission statement in one form or another.

HeartSmart Eyecare – Optometry expanding its role in primary care

In case you did not realize it, optometry is quickly expanding its role in primary care as a healthcare profession. I’ve seen it in action at the IHS hospital and Veteran’s Affairs clinic I’ve worked at and patients are definitely better off because of it. Strange asymmetric optic nerve cupping, CRVO’s, suspected ocular ischemic syndrome have all been reasons for referrals on our part for carotid ultrasounds.

Recently I stumbled across this article in review of optometric business by Dr. Kathleen Andersen. (you’ll have to create an account to read the article but I think it’s very worthwhile to read some of the other great articles on that website). Dr. Andersen has introduced vascular health screenings along with her comprehensive eye examinations and I think it’s fantastic. By evaluating the carotid intima media thickness, optometrists can get a good indication on an individual’s vascular health.

Myself, I’ve recently started working with HeartSmart’s EyeCare division. Basically our goal is to expand optometry’s role as a primary health care provider by offering patients vascular health screenings. Millions of eye exams are conducted each year. In fact many Americans go see their optometrist more often than even their primary care physician!

If you think optometrists should play a bigger role in keeping patients healthy, like us at http://www.facebook.com/HeartSmartEyeCare

CHOC experience with pediatric exams

I have the pleasure of working at the Children’s Hospital of Orange County on Fridays. We do pediatric examinations for underprivileged children in the area. It’s a great overall experience. The kids come in a little shy but we generally have them smiling (except when we put in the dreaded eye drops) at the end of the day.

During my time there I get to work with Dr. Monique Nguyen, a residency trained doctor who owns a private practice in Ladera Ranch. It’s refreshing to talk to her about vision therapy and how she runs her private practice.

Working at CHOC is an awesome reminder of why I joined this profession. You have these children who are struggling in school because of significant myopia but cannot afford glasses. And many children rarely complain, quietly struggling through academics for years just because they have poor vision and can’t see what the teacher is working on in front of the classroom.

So it’s rewarding to break ground and give them their first pair of glasses. One patient (not at CHOC) but who I am following at the Eye Care Center who has a +9.50 DS Rx in both eyes proudly yelled at my last amblyopia continuing evaluation.

“I LOVE MY GLASSES!!”

Awesome.

Refracting like an OD and not a student

Besides blog.drmai.info I am also a featured guest blogger for the AOSA and have also been asked to contribute to optometrystudents.com

In case you did not realize, the AOSA and AOA both have blogs where leaders post their thoughts and experiences. Here is my first blog as an AOSA blogger. I think I am the only non-former AOSA trustee or cabinet member to be invited to blog so I feel very honored!

How to refract like an OD and not a student. I realize that many optometry students and optometrists are masters at refraction, but hopefully some of my insights can help!

The Value of an Optometry Degree according to my readers

I decided to make this it’s own post from the comments section. This is a comment from a reader concerning career success (slightly edited).

From Joe M. – An engineer and father of an optometrist

I would like to state that I am not a Doctor of any kind and the father of a Optometry student and a son that is a DC. I have a engineering EE /ME back gound and more importantly business owner and CEO for over 35 years. First let me say that success is not simple to achieve and or maintain. And most believe that a degree entitles you to instant success and or big $$$ , well you are dead wrong. Trust me when i say I’ll take Lucky over Smart any and every day but we have to help your own luck by working longer, harder and smarter. If anyone expects the make 150- 200K plus to start working 40hrs a week on your first job you better have come from a very wealthy family and buy into a business or joining a family business or rethink your plan and get real. The system has provided you access to the tools of your craft , that is optometry, now it is up to you to use them to achieve a successful life.

I will tell you most times that success takes longer and is harder then planed and will not be in the same form as envisioned at the beginning.. . Get a second job to generate your play money or saving for the future. And some day you will not need the second income. BTW did you ever study about the 80 -20 rule? if not google it , if so then you know that 20% of the OD make 80% of the MONEY. What do you want to be… a 20 % guy or a 80% guy? I also will tell you yourself will be the only source of your failure in any thing you do. Keep working at your goal, always stay positive, and GOOD LUCK along the way.

 

Failing NBEO Part I

I received this email yesterday from a distraught 4th year optometry student (I left out the name):

” I came across your blog for optometry residencies. I have matched a program for next year already. They accepted me even though I had not passed Part 1 boards. I re-took them in March and failed again. Can they take my residency spot away? Please let me know if you have any advice.”

You need to pass all parts of NBEO to practice optometry. If her residency programs begins in July, and the soonest she can retake her boards is in August (with scores released a couple of months afterwards), I told her to contact her residency program, to keep her head up, and best wishes.

NBEO Part 1, begin with the end in mind

In all things, begin with the end in mind. This allows you to focus on the big picture when a world of minutiae tends to get people hung up.

That’s also my buzz word (and enemy) of the quarter: Minutiae. There are many ways to study for a big test, but I believe firmly that the worse way is to feel like you must know EVERY thing. I have been telling classmates that if you try learning everything, you miss important concepts or at least fail to reinforce them.

There is a principle called the Pareto principle (aka the 80/20 law) that about 80% of the effects come from 20% of the causes. For instance, Pareto was growing peas and found out that 80% of his peas were being grown from only 20% of his plants.

Which means that 80% of his plants, which he had to care for and watch over just as closely as his 20%, weren’t doing much good in the big picture. The same is true with studying for a boards exam. When I look at a new drug/disease/any concept, I like to do the following:

What are 2-3 things I will take away from this (sort of like, which plant out of these five will give me the greatest return of intellectual investment)? And then I move on. If I can nail those 2-3 IMPORTANT concepts, then knowing anymore than that is just gravy (but unnecessary)

This is not an excuse to be lazy. I will spend the SAME amount of time studying, but just ensuring I hit big ticket items first always.

Kentucky expands optometric scope of practice

http://www.lrc.ky.gov/record/11rs/sb110.htm

Kentucky has followed in Oklahoma’s footsteps to pass a bill allowing optometrists to perform laser surgery. (SLT, LPI etc)

Here is a video of optometrists and ophthalmologists arguing whether or not optometrists should be allowed to train for laser procedures.

http://www.ket.org/cgi-bin/cheetah/w…tdir=&template

The KOA president, Ben Gaddie, has been to SCCO multiple times to discuss practice management. It was great to see him representing the profession.

Optometric Clinical Pearls, first 2 weeks of clinic in my 3rd Year June 2010

This is the first of many optometry clinical encounters where I learned something.

1. Very first patient ever in my life. (I don’t count seeing classmates/friends as first time experiences). 66 year old male contact lens patient who wants multifocals CLs. But he’s doing a modified monovision of sorts where he has a multifocal in one eye and a distance toric lens in the other. I fit him with the CIBA Air Optix Aqua Multifocals in his non-dominant eye and the CIBA Air Optix Toric Lens distance contact lens in his dominant. He LOVES the vision, reads happily and can see distance great and the over-refraction (loose lens in multifocal eye, and the distance I did a sphero- cyl OR through the phoropter) was about plano-ish in both eyes.

 

The clinical pearl is that modified monovision can be an excellent option for patients with a little bit of astigmatism (he had 1.25 D of cyl.) Especially if the patient loves the feel of a particular contact lens multifocal but a toric multifocal option isn’t available.

2. Very first primary care patient ever in my life . 83-year old Spanish speaking only patient comes in with one eye barely open. Chief complaint from his son (translator) is that his left eye is always nearly closed. 20/30 in his open (OD) eye, and light perception only (OS) in the eye that he barely keeps open.

Turns out he has a full-blown retinal detachment secondary to diabetic retinopathy that my partner Chad and I spot which our staff doctor confirms and congratulates us on. So what about the eyelids closing? The patient was able to lift that eye when he desired.

The retinal disparity caused by the retinal detachment between each eye made him voluntarily (and then just out of habit) close his non-seeing eye. This was not a case of ptosis.

3. Second contact lens patient ever. Female keratoconus in her 20s who has lost one gas permeable lens and needs a new one. Chad and I are at it again. Getting a crazy cover test of 20 exotropia in entrance testing. our staff doctor comments when we first meet with him with this clinical pearl:

“Don’t do a binocular test on an essentially monocular patient” (at this point she had just one CL on, and she can see hand motion only in the eye without the RGP.

Other clinical pearls was the patient was getting inferior dimple veiling on the cornea. To fix this we steepened the lens.

We steepened it to allow for better centration so that the lens would not slide down and we also reduced the optic zone diameter to decrease chances of air bubbles.

That’s it for now!

Why do a residency in optometry? Let’s look into the pros and cons.

Most optometrists who have ever done a residency in optometry told me they were glad they did it. Many people who didn’t do one say they are glad they didn’t forfeit the extra year of earnings and that they felt adequately prepared to handle things with the training they received during optometry school.

So what should a third/fourth year optometry student to do? What are the pros and cons of doing a residency in optometry?

Let’s take a look at the pros and cons:

Pros of an optometry residency:

1. You do get paid, probably to the tune of $30-35,000. Not a lot, but that’s 2 times my current spending budget in optometry school so it’s an upgrade!

2. You get REALLY good at something that might have taken many years to get good at. How many keratoconus, prosthetic eye candidates, low vision, or strabismus would you see in private practice? In a residency you’d see multiple EVERYDAY. In saturated optometry markets, carving a specialty niche can be very beneficial. Word of mouth referrals for niche specialists spreads fast which will help your bottom line.

3. Don’t have a job lined up? Don’t know where you want to set up your practice? Remember, in optometry you can succeed as long as you avoid the train-wreck. Ducking away for 1 year gives you more time to shop around for practices, interview, and network with other optometrists to find that perfect opportunity – and not being unemployed. Who knows, maybe the residency itself will help you find a job or partner who requires your unique expertise. Regardless, it’ll give you more time to more carefully examine your post-grad options without leaping for an opportunity out of desperation. Like John Wooden, the famous UCLA basketball coach said, “be quick, but don’t hurry.”

4. Less need to refer because you are better trained. This keeps life more interesting when you can manage the more interesting cases.

5. If you plan on doing academia, teaching, or working in a hospital setting, then a residency needs to seriously be considered. Not only seriously considered, it might even be required.

6. You can apply and still withdraw if you change your mind (but only up to a certain point, afterward it is extremely bad form to not honor your commitment). So it doesn’t hurt to just apply up to a point. You never know what doors could have opened if you never gave it a shot.

7. Psychologically, it’s nice to know you’ve got something going on after you graduate rather than just twiddling your thumbs and nervously looking for fill-in work or a corporate gig after graduation.

8. You can still find fill-in work maybe a couple days a month if you choose to pad your income. I know of an SCCO resident who did just that.

9. Learning is fun. One of the major draws I had to going back to school after I graduated with my BS from UCLA was that I loved learning. In a work environment, you do learn some things here and there, but it’s not your JOB to simply learn. One of the fun things about a residency is that it is still mentored education. You’ve got more responsibilities and privileges, but it is still a learning experience.

10. Board certification passed last year at the AOA meeting. If your intention is to become board certified, I believe you get to leapfrog some of the time-requirements if you complete a residency. This could potentially be a great added benefit to doing a residency if board certification is mandated or looking very favorably on by insurance.

11. It is only one year, honestly.

Cons of an optometry residency:

1. You forfeit a year of real salary. Which can be significant if you’re tired of living life on strict financial restraint.

2. Applying for a residency is like applying to school again. You have to hunt for letters of rec and interview. Could be difficult if you never fostered meaningful relationships with your current faculty.

3. You might not end up geographically where you want to be. If you have a spouse or significant other, is it worth being apart for another year?

4. Not all residencies are created equal, you may end up just being at a “5th year” of optometry school.

5. You may feel already confident with your skill set and any future obstacles can be self-taught.

6. Once you start, you can’t jump ship in the middle of the year. Say you find a can’t miss opportunity, well you might have to wait until you are done with your residency and by then it might be too late. The practice you wanted was sold, the job opening was filled etc.