Team members from the Eyre Eye Clinic. From left: Tamra Karolewicz, Craig Farmer, Hannah Stanley, Phil Clem, and Elise Pockney-Clem.
When she graduated nine years ago, Tamra Karolewicz planned to practise optometry with Eyre Eye Centre on the Eyre Peninsula in Port Lincoln in South Australia for two, maybe three years before moving interstate. Now she is a co-director, co-managing complex patients with ophthalmologists and looking forward to opportunities for practice expansion in her region.
Moving out of home is a major step for any young person. For Tamra Karolewicz it meant moving from Adelaide to a remote coastal town, seven hours’ drive from her family and friends.
And while making the decision to move was relatively easy (she had completed her first six-week placement with Eyre Eye during her studies) she admits that as the time came closer to move, “it was challenging but also very exciting”.
Now, reflecting on the 2015 lifestyle change she said, “It definitely made me more independent… it enhanced my personal growth. I am very thankful for it. I secured a rental on the waterfront, which brought an amazing sense of serenity and presence to my daily life. I feel like the ocean has made me a better person.”
Ms Karolewicz believes it also made her a better optometrist.
“In regional optometry, no day is the same. “Every single patient is different. So, it’s not just refractions all day, someone might come in with a red eye and then you might have to squeeze in an emergency because another person lost their vision overnight. And there are people who have had long-term low vision who just need someone to talk to and guide them.
“I wouldn’t have the clinical courage that I do now if I was practising in the city. When an emergency comes in, which happens frequently, you can’t just handball it to the ophthalmologist down the road. Sometimes that means helping people after hours or on holidays. But we know the community appreciates it, and it feels like we’re making a real difference.
“I think about the variety in my ‘standard’ optometry day, and I’m extremely grateful for the opportunity I have.”
Elise Pocknee-Clem, a co-founder of Eyre Eye Centre and President of Optometry South Australia (OSA), agreed. She said with limited ophthalmology services, she and her colleagues are “forced to act with ‘clinical courage’ (when) called upon (and supported) to perform tasks that would normally have been considered outside our scope or at the edge of our scope”.
“We constantly ask, ‘If I don’t do this, who will? The GP? A nurse? Or do I send the patient to Adelaide, which takes seven hours by road or requires a plane flight?’
“So, then we ask ourselves, ‘Can I do this, can I try? Do I have the support? Can I get advice?’ We are a group practice, so we usually seek advice within the group first and then seek outside advice when needed.
“As a result, we have greater opportunity to develop inter-professional relationships with other health and allied health professionals, including general practitioners, pharmacists, physiotherapists, occupational therapists, and of course other optometrists. We also have much closer relationships with the visiting ophthalmologists. We rely on them for advice in challenging situations and they can rely on us for follow-up with their patients when they are not here.”
Ms Pocknee-Clem said all of this “makes optometry exciting but professionally fulfilling as well”.
“Because of the level of care we provide, we have the respect of our community and our patients”.
CO-MANAGEMENT
Eyre Eye Centre works closely with two ophthalmologists to co-manage patients.
Dr John Landers is one. A glaucoma specialist, he visits Eyre Peninsula for just two days a month and from 8.30am–2.30pm on one of those days, is in the operating theatre. The rest of the time he is seeing patients in the clinic.
Dr Landers said close working relationships between visiting ophthalmologists and optometrists are crucial for patient management in regional areas.
“I can’t see a month’s worth of patients in one and a half days. It’s just impossible. So, things need to be delegated and the people who have the knowledge – the people who can co-manage patients the best – are the optometrists.”
While optometrists working in the city are able to grow their skills and expand their scope with easy access to on-site educational activities, Dr Landers believes that in regional areas daily exposure to patients with complex ocular conditions and close working relationships with ophthalmologists provides just as much, if not more, opportunity for professional development.
“In the city, optometrists see so many routine things and when they see something unusual, it can take them by surprise… in the country with fewer optometrists, everything comes to them, so they tend to see a lot more complex presentations, they work closely with me, and so they’re getting teaching all the time as opposed to having to wait and attend a lecture every couple of months.”
Dr Landers has a protocol for managing his glaucoma patients that he said empowers optometrists to co-manage patients.
“A lot of it comes down to the protocol I follow every time I see a patient.”
The protocol starts with diagnosis and commencing the patient on an eye drop with a planned progression of treatments that can be prescribed by the optometrist depending on whether the patient does or does not respond appropriately.
The optometrist “might come back to me in four or six months or sometimes even longer and say, ‘Right, we’ve got to a point now where the pressure is not meeting the targets we’ve set, or their visual fields are getting worse in spite of the targets. So, what do we do next?’
“I’ll take that next management decision… but that might only be for about 10% of patients. The majority can do very well (under the ongoing care of the optometrist).”
Dr Landers said the key to successful comanagement is accessibility.
“Optometrists need to know that when they have a patient in front of them and they are unsure, they can contact me, and I’ll immediately give them an answer. They’ve got my email address, they’ve got my phone number, they can text me, or call me.”
On a day-to-day basis, after glaucoma reviews, co-managing optometrists send Dr Landers their patients’ retinal images and visual field tests.
“The visual field tests come plotted on a graph for each patient. I can sort through them very quickly and identify the ones who need to come back… that dramatically reduces the load on the country ophthalmologist because then you are only needing to see a fraction of the patients, whereas the rest of them are getting followed up in a protocolised way.”
Dr Landers, who teaches ophthalmology registrars at Flinders University, said teaching, mentoring, and co-managing optometrists that practise in regional Australia is highly fulfilling.
“The optometrists who live in regional areas see patients all the time, and they take on the responsibility; they want to be right, they want to do things accurately. So, they tend to be very comprehensive in their assessments… they really care about being right, about sorting things out, and they want feedback.”
PRACTICE DEVELOPMENT
Beyond clinical scope, regional practice offers business building opportunities that are few and far between in the city, as Ms Pocknee-Clem has found.
Eyre Eye Centre now has practices in Port Lincoln, Whyalla, and Ceduna, and is expanding its Whyalla premises.
“Being rural is more affordable so it has provided more choice in our practice location, design, and fit out etc.,” Ms PockneeClem said. “We are in locations that allow us plenty of space and room for expansion and the opportunity to own our premises.”
In Whyalla, Eyre Eye Centre is currently building a brand-new standalone practice designed specifically for the group’s needs and future growth.
“Although there are challenges associated with building when you are in a remote location (such as sourcing trades), there are also opportunities that might not be possible in the city, like working with a large block on a main street location,” she said.
Access to staff, training, and suppliers has presented challenges that are not so common in the city, however Ms Pocknee-Clem said these have been easily overcome.
One of those is attracting experienced staff.
“We have only employed a staff member with previous experience in optics on two occasions. We don’t expect or rely on previous optical experience and so we have evolved to train our staff fully and comprehensively. We make use of training providers like the Open Training and Education Network and Royal Melbourne Institute of Technology, as well as ProVision, do this.
“Less access to supplier reps and technicians means we have to be quite independent when it comes to seeking out product information and when equipment needs repairs and maintenance,” she added.
For their own professional development, Ms Pocknee-Clem and Ms Karolewicz happily fly intra or interstate to attend conferences and take advantage of online learning.
“You do have to plan – you can’t just jump on a flight, you have to book in advance, which can be a little bit inconvenient… but you can make it work. You can block the day off and fly to Adelaide, do the education evening, and fly back the next morning or plan in a nice little getaway. So, you can make the most of any situation really,” explained Ms Karolewicz.
“These days, especially since the pandemic, there are lots of online conferences, which is very convenient for us. Lots of events come to Port Lincoln as well… When I say lots, I mean probably one or two a year; there used to be zero,” she laughed.
Ms Pocknee-Clem added that being rural and remote does mean extra time and expenses to attend events “but that has been something that I think has paid off in terms of professional satisfaction and the professional relationships I’ve had, and the friendships I’ve made”.
As the immediate past president of Optometry Victoria/South Australia (OVSA), she has been committed to ensuring the voice of rural optometry is heard and to learning about the experiences of other rural and city practitioners, whatever that takes”.
“Optometry Australia has been a big part of my career. It’s almost 20 years since I first sat on the OSA board as a director. It has allowed me to be so much more connected with optometrists in South Australia but also across the country. It has also opened the doors for relationships with suppliers and other network and industry groups that I would not otherwise have had,” Ms Pocknee-Clem said.
“My involvement with OA also has helped me to stay at the forefront of our profession and to be involved in the shaping of the profession. It is fulfilling because I am involved at a strategic level, I attend many events and talk to many people across the country.”
BUILDING HER OWN FUTURE
As a young woman and the co-owner of an optometry practice in a regional town of Australia, Ms Karolewicz continues to be grateful for the career and business decisions she has made and sees a future that is full of potential.
“Three years after moving to the Eyre Peninsula I remember thinking that I should be moving on.
“So, I was kind of looking around when someone asked me why I was thinking about leaving.
“When I told them it was time to move on, they told me ‘the grass isn’t always greener’. And I thought, ‘yeah, that’s true’. So, I stayed because I loved it. There wasn’t any reason for me to leave. I just had it in my head that I had to, because I’d said that from the start. So now, almost 10 years later I’m still here, and I’m the co-owner of a successful group of practices.”
She said making friends her own age can be ”quite hard in such a small population” because many people arrive in town to work then leave after a few years. “But I’ve made lifelong friends here; there are definitely gems in the bunch, it’s a very family-orientated lifestyle.
“And I’m looking forward to the rest of my life here. There are obviously lots of things that can change in the future, there’s lots to get excited about.”
RECOMMENDATIONS?
Asked whether she would recommend a regional lifestyle for other optometrists and why, she said aside from the professional rewards, there are plenty of reasons to leave the city.
“If you hate waiting around in traffic, if you hate city driving from work to home and vice versa, then choosing a country lifestyle just removes that stress. It takes me one minute to get to work and, oh my goodness, if there are three cars at the roundabout, I question what is going on.
“On top of that, it’s just easy living. I am a great advocate for being happy and being as stress free as possible. So being able to go outside regularly, to go for walks in the fresh air on the coast is ideal. I need to be near the water. I feel much happier being away from congestion and traffic and pollution. It’s freeing. I just feel healthier.”
