The College of Optometrists

Hey all, started a pre reg this summer, don't to be honest see optometry as a long term thing. I got in a discussion on an ophthalmology message board and posted the following after referring to optometry as a 'retail based' profession. Any opinions are welcome.

"There's two distinct aspects to optometry, the side ophthalmologists see is that of a 'primary care' role. Where patients come in usually thinking all is well, we spot something and send them on to you guys. The other side to the job is someone comes in for a routine visit and our aim is to make them buy new glasses. It's the latter that pisses me off and makes me want to get out of it.

You spend 3 years at uni being told all about how important patient care is and all that but the truth of the matter is an optometrist today is judged on how many pairs of glasses they sell, not on patient care. In fact someone sitting in my chair for an eye test isn't a patient, it's a customer.

The profession isn't what it used to be. They may as well scrap the whole healthcare side of it, Most people that turn up for an eye test don't even realise that we're screening for disease as well as glasses. A lot of people don't understand why an eye test takes half an hour.

The wages these days also don't reflect the responsibility of the job. A newly qualified optom is lucky to get £25k, which when you consider it takes 4 years worth of training and you are responsible for around 20 pairs of eyes per day is nothing. We are expected to screen every patient that we see for ANY sign of abnormality, develop management plans etc. All practice managers care about is conversion rates, the profession is a mess. It's not healthcare, it's business. An optometrist today is a salesman. I think there's a problem when I turn up to work in the morning and I'm more bothered if someone buys glasses than if their eyes are healthy."

You are correct there are two sides to optometry - commercial and clinical, and yet you seem surprised that having taken a position with a commercial provider the job seems too commercial!

May I suggest you find a clinical practice and ask to spend a day there on your day(s) off to see the other side.

My ractice is on the South Coast, and I would be happy to accommodate any visitors wishing to see the other side.

John Tickner

Thought I'd make a more sensible reply to my rant last night.

I appreciate the two rather distinct aspects of optometry, and in a way it is this that makes the profession unique. I also acknowledge that at the end of the day it's largely a private industry and we make our money from glasses. The more we sell the more we make, so naturally our performance as an employed optometrist is judged on our ability to sell. I know I had a moan about newly qualified wages but established experienced optoms can command large salaries, which can only really be justified if they sell enough glasses.

It is the overlap between clinical and commerical optometry that I have the problem with. Which one is more important? The universities, the GOC and the college will say the first option, whereas the real world, on the whole, would imply the latter.

An optometrist is defined on this website as "trained professionals who examine eyes, test sight, give advice on visual problems, and prescribe and dispense spectacles or contact lenses. They also recommend other treatments or visual aids where appropriate. Optometrists are trained to recognise eye diseases, referring such cases as necessary, and can also use or supply various eye drugs." Now I don't have a problem with this until you get a patient in who needs slightly longer than the normal '20 minute test' to 'recognise eye disease' in and refer on. To the patient you may well have saved their site, to the practice manager and the other waiting customers you're a slow optometrist.

Conversion rates are another. I may be wrong here but I'm firmly of the opinion that on the whole someone knows whether or not they want to buy glasses before they sit in your chair, after all it's usually their 'reason for visit'. Yes there's a few who don't know that they're not legal to drive anymore with their current specs and are here for a routine but on the whole they're in the minority. When paying £200+ on a pair of glasses a customer will usually put some forethought into it. Offering a bonus scheme to boost conversion rates just doesn't seem right, and I think an optometrist who sells more glasses because of one needs to look at themselves ethically.

So anyway where am I going with all this? Well personally I feel the two areas of optometry should be just that, two separate areas. Whilst the commercial side of the business is taking over maybe it's time we started looking at a more continental feel to the profession, where optometrists screen for glasses and doctors screen for disease. Or maybe we should offer two levels of service, allowing people to come in for a quick check on the prescription if they're not concerned about glaucoma. The reason we don't work as they do in Spain or Germany is because there aren't enough doctors over here. The nice setup we have is that ophthalmologists in this country only see someone who is likely to have an eye disease, picked up by an optometrist. Well if this is the case should we not be subsidised by the NHS for our referrals? If it is so important that we screen for disease in all the patients we see why is a standard eye test largely only available as a private service, and not properly recognised by the health service as an efficient way of concentrating the resources of their doctors?

Right I think I've gone on enough here, to briefly sumamrise what I'm trying rample on about yes I know that the profession has two separate aspects but maybe if this is so we should look at concentrating on one or the other when conducting a 'sight test'. After all, what exactly are we screening for in an asymptomatic -2.00 myope just here because he likes the look of some new armani frames? The profession is not in a 'mess' as a said in the first post, but I do feel we need to work out why we are actually here.

I agree ! I think big business has shaped our profession.

I think we should all move to Scotland, where I hear sight tests will be free to everyone in the future (£28 per sight test, increasing to £35 with permission to claim for supplementary tests). This would enhance our screening function, taking the worry of paying for a sight test away from the patient / customer. Optometry Scotland are obviousley going in the right direction. see FODO web page www.fodo.com