Category Archives: Make yourself better

Optometry students, test-taking, and the self-serving bias

In psychology there is something called the self-serving bias. To quote from Wikipedia:

“A self-serving bias occurs when people attribute their successes to internal or personal factors but attribute their failures to situational factors beyond their control.” (wikipedia)

Not my fault, the DOG ate my homework!

This is prevalent in optometry school and no doubt with many other professional/graduate  schools. When it comes to test-taking, it seems to happen on every other test that there is a question that students miss yet inevitably blame the instructor for writing a poor test question.

Students sometimes start to think they’re always right, and refuse to listen and learn when they’re wrong. At my friend’s work, she laments often about coworkers who EVERYONE knows is at fault for a particular problem, yet that coworker is too prideful to admit they made a mistake and the politics of the matter makes life difficult to get things done.

So what’s the point of this post? It’s really just to say “don’t take yourself so seriously.” At SCCO they try to teach confidence in the clinic, to make a decision and stick to your guns. This is the right approach, but while learning always remain open to accept criticism for your mistakes.

Thinking like a doctor… not only as it pertains to optometrists

One short anecdote I forgot to mention at the RAM.  My friend Denh was talking to Dr. Gordon, a staff doctor over at OCLA about ocular disease. It went something like this:

“Dr. Gordon! How much disease do you see at OCLA?!”

“Oh we see quite a bit, I guarantee you’ll learn a lot if you come here”

“Awesome! The more disease the better. We just learned about Trachoma in class yesterday, about ARLT’s line it was fun!”

:Chuckling: “A little knowledge can be a dangerous thing.”

I thought it was interesting what Dr. Gordon said, but he is right on the money. How many times do I expect to see Trachoma in the United States in my lifetime? Possibly ZERO times ever. It should very rarely be on my list of differentials. Inclusion bodies from Chlamydia, possible, but not Trachoma. So why do we learn it?

Some will fault optometry school, saying what’s the point of teaching all this “junk” information. Or mention that in a private practices someone shadowed, they never do phorometry on every single patient – so they’re mad that opt schools make us waste our time.

My opinion is that the point of optometry school is to learn as much as possible so that if I ever run across it, I can make the appropriate call. Definitely, it would be financial suicide to do 2 hour exams on all our patients when we graduate, but for now it is academic suicide to not practice all the skills we’ve been taught and to do a thorough (this is the emphasis, not speed) exam.

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.

RAM, Remote Area Medical, and SCCO student volunteerism

It’s much more common to hear about myopia at my age and less so with hyperopia. But the prevalence of hyperopia really struck me when I volunteered for Remote Area Medical last week. What is RAM? Basically it is an event where free healthcare is given to those who cannot afford it on their own.

I volunteered in the lab making glasses as well as dispensing them. With no stretch of the imagination, it seemed at least 75% of the glasses I made were for hyperopes. Some had it bad like +4.00 with a +2.00 add. It makes me wonder how long these people, who could not afford to update their glasses, have been functioning especially at close. With that much uncorrected hyperopia at near, I can’t imagine they could have been reading all that well.

Could the inability to read presently, and the accommodative demand manifesting as eye strain in their pre-presbyopic days have been a significant impact on their current financial plight? This is debatable but I would think it could have certainly impacted their performance in school and ability to learn due to a visual problem.

To me it just highlights the need to see an optometrist regularly. Undetected vision problems can certainly impact one’s ability to learn and just function. How many of these underprivileged people that RAM served could have avoided their situation altogether if they had proper eyecare at a young age?

Vision therapy presentation at SCCO – though mostly tips on great optometric practice management

Just attended a quick presentation by a elite level vision therapist in the bay area who sees 40-50 VT patients a week. And I wanted to jot down some of the take home messages quickly. In general, most things are common sense but sometimes you don’t think of the common sense stuff.

Most of his points were generalities:

Why do patients leave a practice to go somewhere else? It’s never the doctor’s fault. Optometry school is a great equalizer where by and large every student that graduates is an exceptionally smart, talented, and skilled doctor. They leave because of the person they come into contact with first, the staff member who answers the phone, they feel is incompetent or doesn’t care.

Take home message: either answer phones yourself or have the next BEST trained staff member answer the phones. Don’t delegate to the newby. You want the patient to get the most accurate information possible so they know the staff and office are competent.

You think debt in optometry school is a big deal? Not really, the biggest mistakes are the ones you make AFTER you graduate. Spending an extra 50k partying during optometry school is peanuts versus signing a wrong lease, opening cold in a town that can’t support you, hiring a bad staff member or associate doctor, or paying too much to buy out a practice.

THM: Don’t sweat it in school. But don’t rush into hasty decision after schools. All optometrists will be successful as long as they just avoid the trainwrecks.

Don’t inundate your patients with massloads of information. Don’t have a slew of pamphlets and give them information overload. Assess them quickly, and tailor your patient education to their condition.

The presenter sees patients like an orthodontists does, spending 5-6 minutes of individualized time per patient. Spending a lot of time is not necessary. If you watch TV with your spouse for 4 hours, is that quality time? Or is having a 30 minute conversation in a car ride more time well spent in the relationship than the 4 hours spent watching TV?

THM:  Specialize in knowing your patient and address their needs specifically, do not inundate them with information.

I believe his practice is setup right next to another multi-doctor practice that does general practice optometry. The situation is ideal because he can get referrals from them for VT and they don’t mind because they know he isn’t going to steal any of their patients.

VT is mostly private pay because no insurance covers for his patient base. The pay is thus limitless because no 3rd party sets the fee, you do.

He also talked about the most important thing to success is how you manage your failures. One successful patient might tell 1 or 2 others if you are lucky. But one failure will tell a dozen or more for sure.

THM: Your reputation is priceless. Manage the failed patient cases by quickly refunding their money. Everyone on staff must realize this as well, and the policy should be in writing and displayed proudly for all the patients to see. A patient can’t be mad at you if the therapy didn’t work if you refunded them the entire amount quickly and honestly. A key is to do it quickly and not grudgingly. (example, if your spouse asks you if you like their new haircut, don’t pause and then say you love it. You must say you love it unequivocally and without hesitation).

Take home message for optometric private practice in Southern California

From a presentation two nights ago.

Cheap stuff may be found at dotmed.com

For recall, patients don’t like emails or letters but postcards. Have them write the postcard if you want.

Hire a consultant if you are a inexperienced. The advice given will pay for itself.

Send postcards for Thanksgiving and Valentines day thanking a patient and showing them you care.

Why SCCO optometrists don’t want to do Private Practice

Why don’t future optometrists want to pursue private practice?

Because they realize they’re going to be broke the first few years out of optometry school if they start in private practice. That it’s a big risk, that working 9-5 and then going home sounds sweet after a grueling optometry school curriculum. And then they’re at Costco, or Walmart, or even a big HMO like Kaiser.

Why does this happen?

For the same reason I drove to Subway for lunch today. I’ve got sandwich supplies at home, but I still didn’t make my own sandwich because the thought of cutting up the tomato, getting the lettuce and turkey and mayonnaise to assemble my own sandwich was too great of a barrier to overcome. So instead I spent MORE time and energy driving around to spend more money on a sandwich that isn’t much better than what I could have made with the supplies at home.

I did it because of barriers.

Those that will have the most success in life recognize barriers quickly and ruthlessly tear them down.  Some barriers are obvious like needing a key to open a door, or opening a backpack to get a book. While others are invisible like the fact that not having a pen at my desk is an obstacle when someone calls and I need to jot something down real fast on a scratch piece of paper. Some barriers are helpful like when I want to stop surfing the internet mindlessly instead of studying, I drive to school and study there in the library or lounge.

But the number 1 obstructive barrier for anyone out there is simple. It’s not the local economy, over saturation of optometrists, OMDs, education,  or lack of money. Just look into a mirror.

It’s YOU.

Just as soon as you dream a dream, you start thinking of all the things that could go wrong.

“I can’t make it in Southern California because it’s so saturated.” When you should be saying “what are the things I need to do to overcome this barrier?”

“I can’t afford to go to optometry school.” instead of “how can I afford to go to optometry school?” (wait a minute, I think I read that somewhere in a Kiyosaki book…)

It’s why when I asked my friend about getting into private practice, she doesn’t ask me about where to find one, how to market and sustain it, or how feasible it is in certain locations. She asks “how the heck am I supposed to get a loan to buy one when I have no credit?”

Some people are afraid because they aren’t aggressive enough for private practice, that they have a hard time commanding people. But who says you need to have these traits? In the words of Dr. Paugh in lecture today, “it’s fine to be an introvert!”

How do you know you need to be aggressive to make a sale? Because you see salespeople on TV do it, or at a car dealership?

It’s more important to follow one rule. Really, just one rule.

Do what is best for the patient. If what is best for the patient happens to be more expensive, so be it, but always advocate for this and you will never go wrong when you advocate for what is best for them. If wearing polarized sunglasses while driving in the morning makes it easier to see, I’m recommending it. If wearing AR coating lets more light reach pass the lenses, I’m recommending it.

In the end, if you want to get from A to Z, don’t keep creating all these mental barriers that stop you from doing something even before you’ve started. If you want something, set a goal and go for it. I know I will, so good luck to the both of us.

Best states to practice optometry

I heard an inquiry about what state is best to practice optometry in on the Student Doctor Network. (http://forums.studentdoctor.net/showthread.php?t=630694)

While the responses are varied, in terms of purely salary one place to look is the Bureau of Labor Statistics. http://www.bls.gov/oes/current/oes291041.htm

Advice for new optometry grads (esp. @ SCCO)

I read articles on optometric management regularly and came across 2 good articles by Dr. Neil Gailmard.

http://www.optometric.com/mtotw/tip.asp?tip=412

Here is another one about finding job opportunities.

http://www.optometric.com/mtotw/tip.asp?tip=413

In this economic climate, and if you are an optometry student in California, it is never too early to start the wheels turning.

Optometry students are weird when it comes to the “Real World”

SCCO students are weird in their prioritites. I’ll explain why.

There’s a practice management symposium coming up this Saturday at SCCO.  It features professional consultants who are generally paid thousands of dollars to speak. They are going to talk about real world stuff, not the ivory tower stuff you often hear at the schools. Like how to set up a practice, how to buyout a practice, negotiating contracts etc. All practical stuff, how to interview, how to communicate. Things they don’t teach at school but should like financial literacy.

The 5-hour event is free, plus, there’s free food.

You’d think out of the 300+ students on campus that most of them would show up. I mean, the vast majority of them show up to lectures about inanely esoteric subjects like how rabbits have a higher percentage of arginine in their aqueous humor than humans do. They furiously highlight and make note of such things. Quiz each other during lunch about it and burn the night cramming these facts into memory.

So far about 30 people want to come. Did I mention there’s free food?

It’s crazy. That students  spend 95% or more of their time learning about things that won’t matter when the real determinants of success – dealing with people, communicating effectively, and financial literacy are, in my humble opinion, incredibly more practically useful.