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It’s that time of year again. And no, I am not referring to the holidays. It’s that time when all 4th-year students are realizing that the end is in sight and that important decisions are just around the corner. Many lean toward residencies, others toward private practice. Regardless of your stance, you are doing yourself a disservice if you do not at least consider the many benefits of advanced residency training. Guest author, Dr. Jillian Janes, provides her perspective—as a current resident—on her training and future career.
—Section Editor Jillian Meadows, MD
As a new graduate and optometric resident, I get the same two questions almost daily. The first is, “Are you old enough to be a doctor?” The second is, “I didn’t know optometrists did residencies; does this mean you will do surgery now?” I laugh off the first one every time and assure the questioner that I am older than they think. For the second question, I educate the asker about what exactly a residency-trained optometrist is.
Patients are not the only ones who do not know that optometrists can complete residency programs and what it entails. A vast majority of health care providers are also unaware of this. What complicates the issue further is that residency for optometrists is optional, so not all optometrists choose to pursue one. In fact, most do not. The option is becoming increasingly popular, however, and some clinics and institutions now require their optometrists to be residency trained.
So, what exactly does a residency provide for an optometrist, and why is it beneficial to pursue one? What do your patients and your referral network of health care providers need to know? This article aims to answer both of these questions.
WHAT, MORE STUDY?
The decision to pursue an optometric residency is not an easy one. After 4 long years of optometry school, usually preceded by 4 long years of undergraduate study, most new optometrists just want to get to work. There is the appeal of a full-time salary and, in most cases, a work week with regular hours that does not require nights or weekends. When you are financially and mentally exhausted from years of study and long hours, this can seem like the right road to take, and for many of us, it is.
There is another road however, one that leads to further specialized training through completion of a 1-year optometric residency.
As defined by the Accreditation Council on Optometric Education, “An optometric residency is a postdoctoral educational program centered on clinical training that results in the resident’s attainment of advanced competencies in eye, vision, and health care. Specific to the area of training, the residency expands and builds on the entry-level competencies attained through completion of the doctor of optometry degree program.” In other words, a residency provides advancement of clinical knowledge and skills already mastered and the opportunity to expand on these abilities to be able to practice at the fullest scope possible.
During a residency program, you are mentored and taught by experts in the field, and you receive an accelerated practical learning experience from them. You are immersed in a certain area of optometry for 12 months, and along the way, you are exposed to a wide variety of patient care scenarios that you may not commonly come across in general practice. This builds confidence and experience for times in the future when you may come across these situations again.
Most residency programs have a high volume of patients, and the resident is required to see a certain number before completion. This exposes you to a multitude of patient problems and allows you to become well-equipped to handle them over time.
There are also didactic portions associated with residency programs that require you to constantly keep up to date on the latest research in your particular field and develop skills such as professional writing, public speaking, and interprofessional communication. Residencies are offered in 11 fields:
• Cornea and Contact Lenses
• Primary Eye Care
• Ocular Disease
• Refractive and Ocular Surgery
• Pediatric Optometry
• Vision Therapy and Rehabilitation
• Family Practice Optometry
• Geriatric Optometry
• Low Vision Rehabilitation
• Community Health Optometry
• Brain Injury Vision Rehabilitation
Programs that have large patient volumes may be able to combine two of these categories, such as, for example, pediatrics with vision therapy and rehabilitation, or ocular disease with refractive and ocular surgery.
Also, some programs may be classified under one title but have an emphasis in an additional area, such as, for example, primary care with an emphasis on ocular disease. The US Department of Veterans Affairs hospital residency sites are good examples of this. These hospitals routinely provide primary care optometry services for their patients, but, because of the patient population, they inevitably encounter significant numbers of patients with ocular manifestations of systemic diseases. This residency better equips participants to deal with these types of situations.
Although residencies provide ample opportunity to advance your optometric knowledge and skills, completion of these programs does not come without sacrifices. First, you will not be earning anything close to that full-time salary you have been dreaming of, and with student loan payments looming, this can be a serious concern. The good news is that loans can usually be deferred during the year you are completing residency.
Second, most of your evenings will be spent looking up everything you missed that day so that you can report your research back to your attending the next morning. You may also be on call over the weekends, learning how to troubleshoot patient problems over the phone and how to differentiate a true emergency from something that warrants only reassurance.
PUSHING TO BE THE BEST
I am about a quarter of the way through my residency in ocular disease and ocular and refractive surgery, and I already feel like I have a year’s worth of experience under my belt. The opportunity to be surrounded by experts in both optometry and ophthalmology and to learn from them every day is invaluable. This experience has been instrumental to my growth as a physician, with the ability to consult with colleagues and be coached through difficult cases.
These experts are passing their knowledge and experience on to me, and this has really helped to expand my clinical decision-making skills. What I did not know yesterday, I now know today, and what I do not know today, I will learn tomorrow. Residency has caused me to become even more proactive than I was before when it comes to keeping up with the ever-expanding field of optometry.
The providers you work with during your residency will push you to be your best. They will fully give you the freedom and responsibility commensurate with the degree that you have earned, but they offer that extra support you need to begin to apply all that you know. Although this year may extend my financial and mental exhaustion a little bit longer, I do not regret my decision in the least, and I truly believe I will be the best optometrist that I can be, once it is completed.
SPREAD THE WORD
Once your residency is over, the most important thing you can do is introduce yourself to the health care provider network in your community and educate them on your training. Educate them on what you can provide for their patients should they ever need it. Many patients could benefit from residency-trained optometric care, and if local physicians know the level of your skills and experience, this provides the opportunity for their patients to gain access to the best care you can offer.
It is also important to let your local ophthalmologists know what your residency training entailed, so that you can have a great working and collaborative relationship with them as our fields continue to become more and more complementary to one another.
I believe that all optometrists are qualified to provide the best possible ocular health care to their patients. I also believe that a residency provides an opportunity to gain unique proficiency in a specific field of optometry and add to our already stellar qualifications. In order to put this extra training to its best use, we must be proactive in educating not only the health care community but also our patients regarding exactly what we can provide for them. n
Jillian Janes, OD
• Resident, Virginia Eye Consultants, Norfolk