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Sunday / May 19.
HomemifeatureReady or Not?

Ready or Not?

The graduation photos are framed; the antics of the after party are already starting to take on the status of legend, the job offer has been accepted… it is time for a new cohort of optometry graduates to enter the workforce.But do they really feel equipped? Looking back on that transition from student to employee, what is it that young optometrists wished they’d been taught at university?mivision spoke to several young optometrists who graduated in the past few years – and their employers – about transitioning from university to the workplace.

After at least five years of university study1 that includes significant amounts of practical as well as theoretical training, approximately 140 freshly minted optometrists are released into the wild each year. While the final year of study is mostly spent working under supervision in contact with patients – and a demonstrated competence in clinical skills is a prerequisite of graduation – conditions in the sheltered confines of university are much different to those encountered in the ‘real world’.

Overwhelmingly, most of the young optometrists felt the clinical training they had received adequately equipped them to work in an optometry practice – but that’s not to say there weren’t gaps in their university education.

The first few months in the workforce, it seems, come with a steep learning curve, best negotiated with a mentor by your side.

I’ve come to realise that it doesn’t matter whether you achieved first class honours or you barely passed. If you have a good rapport and are able to solve patient’s complaints then that’s all that matters…

Business Skills

Chris Pooley graduated from the University of New South Wales, class of 2011, and fairly quickly secured a position at an independent optometry practice in Sydney’s affluent lower north shore.

Chris said after graduating he realised there were a number of things on his educational ‘wish list’, including further training in business skills.

“I wish I’d learned more about business skills at university – things from marketing yourself, to understanding a profit and loss statement, to managing stock.

“In my first six months of full-time work, with the advice of my mentors, I undertook further study. I completed the (post graduate) Optometric Business Course run by UNSW. This was a great time to do further study as I’m only going to get busier as a practitioner as my career progresses.”

His thoughts on needing more business training are endorsed by Ayah Hadi, who graduated from the University of Auckland in New Zealand last year (2012), and now works in a corporate franchise practice in rural Victoria.

“Business… definitely business,” Ayah says when asked about her educational ‘wish list’.

For Ayah, basic business skills that should be taught at university would include training on “how to run a practice… I wished I’d known more about accounting, number crunching, profit and loss statements and how to keep track of stock”.

“I definitely feel like there should be business related topics taught at uni. At uni, we were encouraged to take up part-time jobs at clinics while studying and I personally found that those who did work and study were at an advantage to those who didn’t work. We were more prepared for dispensing, dealing with clients and got a realistic idea of how a practice works. I’ve come to realise that it doesn’t matter whether you achieved first class honours or you barely passed. If you have a good rapport and are able to solve patient’s complaints then that’s all that matters.”

Wrapped up in the business aspect of optometry, Ayah said, is the ability to sell – both your eye health advice and particular products – to clients.

“They always say that glasses are your ‘bread and butter’ but you don’t realise how important they really are. When speaking with patients, some patients are only thinking about the costs so you kind of have to be a sales person at the same time. That part of optometry is not explained as much at university. You have to be able to explain and sell the benefits (of the options you’re suggesting),” Ayah said.

Time Management

While all the young optometrists we spoke to said they felt well-versed in the clinical side of optometry when they left university, it was the pace of the real world optometry clinic that came as a shock.

Alice McLennan was quick to nominate time management as her major concern, going into her job at Vision @ Mill Park in the outer suburbs of Melbourne, but that was soon overcome.

“In the uni clinic, we were always allocated a couple of hours per patient. Starting work, I was terrified that I wouldn’t be able to get through all my patients in the scheduled appointment times. After only a couple of months, I could squeeze in red eyes and reviews, take phone calls, write letters and see a full book of patients as easily as any experienced optometrist.”

Handling People

While students have plenty of clinical practice in university, and do interact with real patients, those patients are aware that their eye health practitioner is still in training. In the workplace, young optometrists are suddenly confronted by a wide range of patients – some who have no real interest in their eye health; some who are doubtful about the skills set of their young optometrist.

Elizabeth Reay said she ran into unexpected communication difficulties, when conveying instructions to patients and having them understood.

“(When I started working), I didn’t have a lot of experience with people who thought differently to me. The people I met at university all had a similar outlook on life to me and a similar way of thinking.

“I just expected people to understand me, but it was amazing how much of a problem communication could be. You have to communicate in different ways to different people. You have to be patient with people.”

It is a sentiment echoed by Patricia Lianos, who graduated in 2011 and now works at an independent practice in regional New South Wales. “Speaking to patients in layman’s terms was… a hurdle; at times I only had the scientific explanation in my head!”

While some students had role-played dealing with aggressive patients, the reality was confronting.

“I guess the biggest shock is when a patient becomes agitated about their eyes or their eyewear and becomes angry with you, even when it’s not your fault,” says Alice McLennan.

“It was pretty confronting the first time I was verbally abused although I performed my job carefully and diligently. I had a patient who had had a stroke and was also suffering a progressively blinding eye condition. He was angry and threatening because his new glasses did not cure his eye condition, even though I had explained that they wouldn’t. Scenarios like this are not something we are taught to deal with at university.”

Youth, too, can be an issue, but not as much as might be expected.

“I have had the odd patient jokingly question ‘Are you sure you’re old enough to be doing this?’, but no, surprisingly it has not been an issue!” said Patricia Lianos.

“I have discovered that a professional manner and a seemingly confident, competent and qualified practitioner is enough to make any patient feel more than comfortable. Although I must admit, it can be touchy as a young female in my 20s explaining to a new presbyope that their eyes have begun the aging process. The phrase ‘It’s all part of growing up’ usually makes the crisis better,” she said.

“I believe the way you dress and carry yourself is very important,” says Ayah Hadi. “The odd patient does question how long I’ve been practising but more than anything I find patients are grateful at the end of the eye test, often saying ‘The most thorough eye test I’ve had in my life’, which I just attribute to speed and practice.”

“Often when I first started practising, I would get one of my colleagues to check a prescription (particularly high scripts in young children),” says Alice McLennan. “This can make parents a little bit doubtful that you know what you’re doing… I found it very rewarding when a senior optometrist, after checking my prescription, would turn to the parent and say: “It’s spot-on; you’re in really good hands with Alice.”

Patient Pathways

“I wish I’d learned more about the referral pathway,” Chris Pooley told mivision. “At university you never send a patient to an external doctor, rather they go through an ocular pathology clinic, which is scheduled by staff optometrists. This means that you do not go through the process in selecting the right doctor, writing a referral letter and explaining to the patient when and how to go about making an appointment. More importantly, it means that you do not learn how to triage certain conditions.”

Chris said he also wished he’d learnt more about the expected recovery after common ophthalmic surgeries, so he can talk to his patients about what to expect.

“Several times a month I will have patients returning after cataract surgery, LASIK, glaucoma surgery, retinal tear and detachment surgery and have them ask what is the likely course for their recovery or is their current ocular appearance and/or vision normal. It would have been great to have a greater background knowledge in this area before starting work.”

Patricia Lianos said she found the Medicare system difficult to grapple with: “I really wish we were taught in more detail about the correct use of Medicare item numbers, and also the use of authority therapeutic prescriptions. It would have been convenient if we were to do this after each patient at uni, to get the hang of it.”

Employers

All of our young optometrists spoke highly of their employers, referring to them as mentors. But mentoring, as Chris Pooley found, was not just limited to learning from other optometrists.

“The owners of my practice (an optometrist and orthoptist) and our part-time optometrist have been excellent mentors. I’ve also found a mentor in our Lab Manager who has been able to give me valuable advice and guidance in lens selection and prescription troubleshooting.

“I would advise new graduates to not be afraid to ask their mentor or dispensers or anyone else in the practice for help and guidance. While I expected to gain greatly from the knowledge of the other two optometrists in my practice, I did not expect to learn so much from our orthoptist/practice manager and our dispensers,” he concedes.

It seems, though, the learning experience goes both ways. Arie Walker, from Vision@Mill Park, said he has learnt “heaps” from his newly graduated employee, Alice McLennan, including a lot about “ocular therapeutic theory, through co-managing difficult cases together”.

Perhaps, more importantly, he says he’s learnt that “there are still young, vibrant, enthusiastic graduates who are determined to learn and practice good optometry”.

And, surely, that’s got to be the most important thing our young optometrists can take with them as they transition from university to the workplace.

Q&A

mivision: What has been the greatest challenge about transitioning from university to the workforce?

Alice McLennan: “I wasn’t prepared to get sick so many times in my first year of practising! I think I caught every cold brought in by a patient.”

Chris Pooley: “…once you leave university and begin working as an optometrist you have no reputation and no credibility. This means that it is often hard to get patients to see you over the other well-established optometrists in the practice.

Elizabeth Reay: “When you first start working, it is so tiring – mentally tiring. You do get used to it eventually, but it’s quite a difficult thing to start with.”

Ayah Hadi: “I found that I had zero energy after work the first couple of months working full time. I also was shocked by the power I was given. At uni I had a supervisor who watched and questioned every step. Once you’re at the work place, you are your own supervisor.”

Q&A

mivision: The most valuable thing I’ve learned is….?

Chris Pooley: “The most valuable thing that I’ve learned is that if you look after the patient, professional satisfaction and financial benefits will follow.”

Patricia Lianos: “Empathise with every patient and treat them like they are your own grandmother. Really listen to what they are saying, even if it seems trivial at first. We are not only optometrists, we are counsellors too. You can’t get more job satisfaction than when a patient leaves happier than when they came in.”

Ayah Hadi: “Even if you’ve done the most amazing refraction, you need to account for adaptation, current specs and patient needs.”

Alice McLennan: “Self-confidence. If I’m not certain of my decisions and the advice I’m giving, my patients won’t trust and respect me.”

What the mentors say…

In speaking with the employers of our young optometrists, it became apparent that the respect and high regard works both ways.

Malinda Halley, Malinda Halley Optometry, Dapto, NSW: “It’s been great to have Patricia, with a brain bursting full of current knowledge, and me with over 15 years’ experience to help shape that knowledge into a great clinician; but it works both ways – I am better for having someone else to work with.”

She advises new graduates that “everything is easier with a guide – having another optometrist to work with for the first three to six months makes things smoother and the learning process faster… seek out a practice that excites you. Work is a large amount of your life, and professional boredom is just not worth it.” (Malinda hired Patricia Lianos in December 2011).

Arie Walker, Vision@Mill Park, Vic: “It is very rewarding to mentor a new graduate, but the real challenge is appropriate time management; it can be difficult. As optometrists we see such a broad variety of presentations, from refractive care to retinal detachments. Time allocation is
tough, especially when you add a mentoring role into the equation.”

His advice to new graduates would be to “choose your first employer carefully… Your first employer can be an important mentor and I often reflect on the great example my first employer set me some 23 years ago. Unfortunately optometry has been partially devoured by foreign-owned corporations that are not optometrists, so it’s become a bit of a jungle out there. Talk to recent grads about their experiences and listen to the ones who are delighted with optometry.”

Are there benefits to employing new graduates? “That’s a no-brainer: I love the enthusiasm and wealth of up-to-date theory my new graduate has offered. It’s also rewarding to try to set a good example on how optometry can best serve the people.” (Arie hired Alice McLennan in September 2010).


References

1. A doctoral degree of four years (following completion of a suitable three year undergraduate degree) is available at the University of Melbourne. Deakin University offers a 3.5 year optometry degree, but the first intake of students will not graduate until 2015.