When it comes to delivering eye care services, many optoms in regional Australia are stretched to the limit. Yet in the cities, competition for business among optical practitioners is intense. So why don’t more optoms take a tree change and establish themselves out of the city? mivision spoke to a few who have made the change and discovered that the grass really is greener beyond the great divide.
Australia’s metropolitan centres have traditionally been the most attractive option for optometrists as they emerge from university. Not only because many of the graduates have grown up in city areas and progressed from their local high school to their local School of Optometry, but also because of the lure of big city life.
However, as the desire to be in close proximity of city pubs and clubs diminishes, and frustrations with congestion, pollution and the cost of living climb, there is a plethora of options for those who choose to look further afield.
Those options are accompanied by high demand for optometry services in regional and rural Australia where, in some cases, patients must wait for several months to have their eyes checked. In fact, such is the demand that, in general, salaries are higher for optometrists that work in regional areas than they are for city-based optoms. Additionally, in its desire to move people from our cities into regional areas, both federal and state governments are offering cash incentives to those who relocate. They are also considering tax rebates.
The scarcity of ophthalmologists in regional and rural Australia makes the clinical challenge… very interesting
Rural Education Required
Associate Professor Philip Anderton worked as an academic at the University of New South Wales until 2005 when he semi-retired to Manila, a town of 3,000 people, in Northern NSW. Now he practices one day a week at the Manilla Health Service, volunteers on outback eyecare programs and heads the Rural Optometry Group of the Optometrists Association of Australia. He is also the profession’s representative on the National Rural Health Alliance. Mr. Anderton says that while there is definitely a need to encourage health care providers from the city to the bush to work across all spheres of medicine, the Government should be placing more emphasis on educating regional and rural kids to take on the work themselves.
“It’s difficult to attract people from the city to the bush – especially younger generations because they don’t have an appreciation for the lifestyle out here. What we should be doing is helping local kids study closer to home, for example, in regional centres – they’re the ones who understand regional Australia and they’ve got family ties there, so they’re more likely to complete their studies and at some point, move back to work,” he says.
However, rural and regional kids that want to work in optometry and other areas of medicine face a two-fold problem. With huge demand for places at Australian Schools of Optometry, the results required for the Australian Tertiary Admissions Ranking (ATAR) and Undergraduate Medicine and Health Sciences Admissions Test (UMAT) are extremely high. Additionally, the costs incurred for students to move to the city to study for several years, along with university fees, can be prohibitive.
“Most students in rural or regional Australia are unable to compete against students in city areas for places in optometry schools. The city kids are often given coaching to get into selective schools, then coaching for the ATAR and again for the UMAT. Those options just don’t exist in the country,” said Mr. Anderton.
“In reality, extraordinary results in ATAR and UMAT are not what you need to be a great optometrist – what we need is people who can be good practitioners – good students with excellent people skills, who want to work as optometrists.
“So the government needs to provide programs and assistance to help local kids get to university – those school kids who’ve worked hard at school and had part time work with an optometrist – who have demonstrated a genuine interest in optometry as a career,” he added.
Jenna Owen is a young optometrist who was given the opportunity that Mr. Anderton would like to see more regional and rural kids receive. Ms. Owen grew up in Albert, a remote part of Australia with a population of 11. She studied optometry at the University of New South Wales and is now working in Port Macquarie on the NSW north coast.
“Moving away from Mum and dad when I was so young was daunting and pretty difficult. I didn’t know anyone and I had to make new friends, it was scary. But I was lucky enough to get a scholarship at a residential college and so I met a heap of people and I had an amazing time,” said Ms. Owen.
A More Rewarding Role
As one of Australia’s first Indigenous optometrists Ms. Owen says the opportunity to work in regional Australia is more rewarding than working in a
“I work for a group of six different practices across the region owned by two partners. Every week I practice from three of the group’s practices and then, if someone is sick or on holiday, I work for the other three. That means I’m not sitting in one place in the same room, day in and day out. I get to travel short distances between practices, which I really enjoy,” said Ms. Owen.
Quynh Lam established her own optometry practice in Tamworth, having set up a business in Sydney and worked as a locum in regional Australia.
“I partnered with an optometrist in Sydney to establish a business but the work was intense – I was in the practice six days a week and had to leave home by seven every morning to get there. I didn’t get home til 7.30 every night, yet I had little input into the decision making. I quickly decided that that wasn’t the lifestyle I’d studied so hard to achieve.
“Then, when I left the practice to become a locum in regional Australia, I was surprised to find that people had to wait over two months to have their eyes checked. With such high demand for services outside the city, it wasn’t hard to see the opportunity and I knew that I had the experience to establish a practice on my own, so I decided to make the move,” she said.
Ms. Lam says the decision is one she’s glad she made. “The lifestyle here is so much better – I don’t leave for work until 8.45 in the morning and I’m at home by 5.30 every night. I only work Saturday mornings every second week. If the practice is quiet I don’t need to be here and I spend every second weekend with my family in Sydney, where we enjoy yum cha on a Saturday morning. That’s ironic because if I was living in Sydney, I wouldn’t be able to do that – I’d be too busy working.”
Additionally, she says that her work in Tamworth is much more enjoyable because her patients are so pleasurable to work with. “I loved Tamworth as soon as I came here. I love working in an environment where people respect my profession – they value quality service and full eye care – this is what I trained to be an optometrist for,” she said.
“I had a patient recently who was apologetic because when I tested her eyes they had not changed – she didn’t need to buy new glasses. When I explained to her that I’m here to provide eye care – not just sell glasses, she was so grateful. I know now that she’ll feel comfortable dropping in for any eye health concerns – she knows that I’m not sitting here just waiting to sell.”
She says her customers are also much more patient. “In Sydney customers come in and they want their eyes checked immediately. If you’re not available, they’ll go next door. Here people expect to wait for two weeks for an appointment so if I can see them immediately, they’re surprised and extremely grateful.”
Townsville optometrist Sue Mayhew agrees. Originally from the United Kingdom, she also practiced in Sydney and locumed in regional centres before heading north.
“I much prefer working in regional Australia,” she said. “Patients in regional areas have much more respect for us as professionals – they respect our opinions and our time.”
“In the city, people often tend to self diagnose then take themselves straight off to the ophthalmologist. Here ophthalmologists are booked up for months in advance, so we get more involved in patient eyecare, and we get to see more interesting pathology and clinical patients.”
Mr. Anderton says the scarcity of ophthalmologists in regional and rural Australia makes the clinical challenge of working as an optometrist very interesting.
“As a regional optometrist, I work very closely with the ophthalmologist in the area and the general practitioner. The ophthalmologist here has a nine-month waiting list and so understandably, only has time to see people with serious conditions.
“Sometimes a GP will invite me to provide a second opinion before referring a patient on to the ophthalmologist. One day the local GP had a patient with a detached retina who was about to be flown to Newcastle hospital for emergency treatment. The GP asked me to check the patient and, having done so, I was able to advise that he didn’t need to be flown to hospital that day. The patient was able to return home, make the necessary arrangements then travel to Newcastle the following week.”
Additionally, he says, some people in low socio economic situations cannot afford to visit an ophthalmologist, so they need to be treated by an optometrist who will bulk bill.
In Port Macquarie, Ms. Owen cares for an ageing population and has just six ophthalmologists for referrals. “Port Macquarie has a high population of older people which means I get to see a lot of really interesting eye diseases. I also have to handle a lot of foreign body removals.
“In the city you’d tend to send these cases off to an ophthalmologist and focus more on the retail side of things.”
The Fear of Change
In addition to the professional challenges and rewards of rural optometry, comes the lifestyle. For many who have not lived outside major metropolitan cities, this can be a massive impediment to change. John Scott, Franchising Director at Specsavers says it’s difficult to convince enough Australian optometrists to make the move. However, he says, those that do, often lament not making the decision earlier. Conversely, when it comes to overseas optometrists, there is often a greater affinity with regional living. Specsavers receives significant interest in regional practice from optometrists in the United Kingdom. “Unless they’ve lived and worked in London, UK optoms come from regional areas and are well suited to our regional business and lifestyle – where there is a small population, a sense of community and where people actually say ‘hello’ to one another when they pass in the street. They know a lot about Australia and they love the concept of our lifestyle, great weather and friendly people, it’s very enticing,” said Mr. Scott.
The company is currently showcasing franchises in Australian regional areas to optometrists in the United Kingdom, and, with the UK experiencing particularly difficult financial times, Mr. Scott says optometrists are tempted. “Right now we have a window of opportunity to attract the brightest and the best to Australia – a kind of reverse brain drain if you like,” he said. “There is no doubt that we need to find a solution to regional optometry services in the face of an ageing population. The perfect world may be to have enough Australian optoms willing and able to take up regional practice. However, in the absence of this, taking in overseas trained optoms, whose first preference is for regional practice, really makes sense.”
Those who commit to regional Australia are pleasantly rewarded.
For a start, says, Ms. Mayhew, life is much easier and more relaxed. “When I moved to Townsville, I wondered why anyone would want to live here when they could live in Sydney. But I’ve realised that having the facilities that Sydney has, like the Sydney Opera House, theatres, clubs and restaurants on tap, doesn’t mean you use them.
“I often take a few days off to fly down to Sydney, catch up with my friends and go out. In doing so, I’m pretty sure that I make more use of the city than I would if I lived there full-time. As much as I enjoy myself, I always love to get back to Townsville because it’s all so easy – it takes 15 minutes to get to work, to the shops on the weekend or to visit a friend instead of the 45 minutes it takes to get anywhere in the city,” she says.
Despite having lived all his life in Australia’s biggest cities, Mr. Anderton says country life agrees with him. “I enjoy the country lifestyle, the freedom it gives me. It’s not important for me to have night clubs around – although I do miss going to concerts.”
Mr. Anderton says living in the country allows him to fulfil his passion for flying.
“I’ve been flying all my life and I belong to the Gliding Club. Living up here enables me to use my light plane to get around the country – for pleasure and to participate in fly-in-fly-out optometry programs,” he says.
Having grown up in a tiny Australian community, Ms. Owens enjoys the opportunity to live and work in the relatively large centre of Port Macquarie.
“Rural Australia is a different kettle of fish to regional Australia. Here at Port Macquarie, we’ve got many more services than we had in Albert. We don’t miss out on anything, but we still have that feel of the country.
“Port Macquarie is beautiful – it’s got stunning beaches – and professionally the work is more challenging and more interesting than the work you get as an optometrist in the city. I like everything about working and living here – I couldn’t recommend it highly enough.”
None of the optometrists I interviewed found it difficult to establish networks in their new towns.
“Because I work across six practices there are plenty of people to meet and socialise with”, says Ms. Owen. “And, as there are only three ophthalmologists, I’ve established great relationships with all
Ms. Mayhew and Ms. Lam both met people by joining clubs. Ms Lam: “During my first six months I really missed Sydney – I didn’t know where to go or what to do. But once I joined a few clubs and groups I began to know people and life became completely different. Now I have a partner and plenty of friends to go out with after hours, so life is far less daunting.”
Ms. Mayhew joined a local running club where she found like-minded people who also canoed and cycled. “Now, as well as cycling, running and canoeing, we often meet to go to the movies or restaurants.”
However, she notes, that because many locals have grown up together, they do not feel the need to pull newcomers into their friendship groups. “It’s not like Sydney where many of the residents are used to people arriving from inter-state or overseas and they’re quick to include them in their social groups – when you’re new to a regional area you have to make the effort to get involved.”
Mr. Anderton said the open and friendly nature of people in Manilla made it easy for he and his wife to meet new friends. “You meet people walking down the street and through your professional work. My wife has met people through her work, through organisations such as Red Cross, a singing Group and the Australian Sign Language classes (AUSLAN)
Life Has its Challenges
It’s all very well to sing the praises of a move to the country but in reality, there are also challenges.
Ms. Mayhew says that while big regional centres offer many of the facilities found in major city centres, newcomers quickly become aware of the lack of choice and supply. “There isn’t the competition that exists in a metropolitan area, so prices can be higher and it can take longer to receive services. For example, if you need medical services or you something as simple as having your hair styled and coloured, you need to book a few weeks in advance. In Sydney we’re used to instant service and we get upset if it doesn’t arrive. People in regional areas don’t mind planning and waiting.”
This year Mr. Anderton’s house flooded as a result of the Queensland floods and in recent years, the water pipes have frozen in the midst of winter. At the other extreme, the heat of mid summer can make it near impossible to work.
However for him, the greatest downside is being away from family. “One of the costs is that we miss sharing our children’s lives – and if they have children of their own, that will present another issue for us,” said Mr. Anderton. This, he says, is an important reason why the government should encourage rural and regional people to train and then return to their hometowns to work. “In the end, people are often drawn back to where their families live,” he says.
For now, and the next ten years at least, Ms. Lam says she sees her future in Tamworth, and Mr. Anderton for one is pleased to hear it. “Quynh was a student of mine when I was at UNSW. Like most of the optometry students at UNSW she was hard
-working, bright and enthusiastic as a student. Her move to Tamworth was a big step for her and I think that she has a lot to offer Tamworth in the future. It is very important that health systems support young professionals like Quynh to establish themselves in rural locations.”
|Government to Review Medical Health & Research|
Mark Butler, the Minister for Mental Health and Ageing, has announced a broad independent review of health and medical research in Australia.
The announcement in October was welcomed by the new Chairperson of the National Rural Health Alliance, Lesley Barclay, who said, “The 10 year strategic health and medical research plan for the nation that is to be shaped by this review will be critical for the health of seven million people who live outside the major cities”.
“When the Alliance met with the Minister recently, we were pleased to hear him emphasise that health and medical research must be linked to areas of greatest health need,” she said. “In aggregate, rural populations are older, poorer, have higher rates of health risk factors such as obesity and smoking, and worse health outcomes for conditions such as diabetes, cancer and heart disease.”
“Australia is blessed with a body of rural and remote health researchers, but the resource base for them within rural, regional and remote areas needs to be boosted and assured. There should be affirmative action for rural and remote health service research, to build capacity and networks within rural areas.”