Back in 2011 when I started blogging, there weren’t many optometrists sharing their experiences online. Fast forward to 2017 and it’s been so great seeing how many OD voices are creating content and spreading their interests and expertise with the world.  Jane is one of these pioneering optometrists, sharing witty and refreshingly candid insights into life as a optometrist in Australia on her BrightEyedBlog. Optometry on the other side of the globe shares many of the same challenges we face in the States, and her experiences as a young female doctor resonate loudly. Check out Best Ways to Annoy Your Optometrist if you aren't believing me that our professional annoyances are universal.

Tell us about yourself and how you got started in optometry!

I'm 27 years old and I live in Melbourne, Australia. I graduated from the University of Melbourne in 2012 with a Bachelor of Optometry. My graduate job was out in the middle of nowhere in a small town in rural Victoria. It paid well and I got to see lots of cool ocular pathology but it was a 4 hour drive from Melbourne where my friends and family are, and after 2 years I thought I had better move back before I eventually fell asleep at the wheel one day driving up and down! I now work in metro Melbourne just on the outskirts of the city for a private health insurance company. It's a healthcare center which means I also work alongside other healthcare practitioners such as dentists and remedial massage therapist (which is great because it means I can have a sneaky massage between patients!). Aside from Dr.L: Just for the record, I’m extremely jealous. One about massages and two about “between patients” which is a forgotten luxury most days.

In Victoria, during our final year of high school, year 12, we have to submit university preferences. Which offers we receive will be determined by our final score calculated across all our subjects for that year and the required entry score into each course changes every year depending on the demand of that particular university course. During my year 12, I was tossing up between dentistry and optometry. I knew I wanted to do a health science because I like helping people but I didn't want to deal with the hours of a medical degree; nursing and paramedic was also on the list (as well as a really random choice of forensic science). Ultimately, I was accepted into Melbourne University's Bachelor of Optometry course. In hindsight it was a pretty good option - good pay, ability to have flexible working hours, I can make a positive difference in the lives of my patients, and I don't have to pull out any teeth! 

What inspired you to start BrightEyedBlog?

I can't even remember how I stumbled across Eyedolatry blog but I realized it was actually kind of useful haha! Even though optometry in Australia is slightly different, particularly with medication prescribing and even some contact lenses, I found that that I could learn useful bits and pieces from the articles. The vision for my blog (good pun) is to provide information for patients, optometry students, and also other optometrists, about various aspects of optometry and present it in such a way that's engaging, easy to read, and possibly even entertaining. I intend for it to be a mix of both cold hard clinical and less clinical posts, such as an article on glaucoma but also about bedside manner and communicating with patients. In a way the blog partly serves for me to share things I've learnt along the way during my rather short career so far, things they don't necessarily teach you at university. 

What is optometry as a profession like in Australia?

Optometry school in Victoria has changed in recent years. My degree was a 5 year Bachelor degree that I could enter into immediately after high school. Since then at Melbourne University it has changed to become a post-graduate course known as the Doctor of Optometry (I think similar to the degree in the US), which requires the student to undergo a 3 year Bachelor degree in something like science or biomedical science, and then continue on for another 4 years to become an OD (so lucky I was the second last intake of the 5 year Bachelor course!). The actual content of the courses are the same and the scope of practice between a Bachelor degree and OD degree is also exactly the same though an OD grad may be more inclined to use the title of Doctor while you won't find many BOptom grads using that; legally we are all permitted to use the title Doctor as long as we specify optometry but the practice is not widespread.  Different optometry schools will conduct their curriculum differently. For example, Deakin University in Geelong, Victoria, operates in trimesters, which means they cram everything into 3 years but have almost no holidays. After graduating we can go straight into work as fully qualified optometrists. 

My class was about 50 people, and roughly equal in ratio for guys to girls. It meant that we got to know each other well (for better or for worse) and build a sense of camaraderie. For Australian citizens the Commonwealth government provides fee assistance, which meant that my school fees amounted to approximately $16,000 AUD a year ($12,305 USD a year with the current exchange rate). I know for my international friends their fees were more in the vicinity of $100k annually! 

There are currently opportunities to do further study in a specialist field of optometry such as pediatrics, low vision, or contact lenses, in the form of a Masters degree or a specialist certificate. Not possessing such a certificate has no impact on an optometrist's scope of practice though and at the moment also doesn't even guarantee an increase in salary. There are also laws surrounding the use of the word "specialist", so even if an optometrist obtains a specialist certificate in something like anterior ocular disease, we can only say we have a "special interest in anterior ocular disease" rather than being able to claim we are a specialist in the field. 

As an optometrist in Australia we are primary healthcare providers, and are able to diagnose and manage certain eye diseases as well as prescribe glasses and contact lenses. All new graduates nowadays are therapeutically endorsed to prescribe topical medications and for those whose course didn't include therapeutics there is an additional certification they can apply for after undergoing extra study. Unfortunately, current training and legislation doesn't permit us to perform any surgical or laser procedures, nor prescribe oral medications - for such situations we refer the patient upward to an ophthalmologist. The word on the street is that one day optometrists will be able to perform procedures such as LASIK or iridotomies, but for the time being these treatments remain in the realm of ophthalmology. When it comes to spectacles and contact lenses though, we're the bees knees! 

What are some of the challenges you've faced in patient care as a young female OD?

The main challenge I've encountered in regards to patient care is patients not believing the advice I give them or questioning whether I know what I'm doing. I'm sure all optometrists across all ages and in both genders have to deal with this at some point, but being short and female and looking like I should still be in high school doesn't work in my favor when it comes to commanding respect from certain patients (usually those from my parents' generation). I've spent time in the room talking to patients about their cataracts and then after the consult they'll go to the reception desk and ask the dispenser (a big tall late-30s Caucasian male) what they should do about their cataracts. I've learnt not to take it personally but sometimes if I feel doubt radiating from the patient as to my competence then I show off my knowledge a little bit more and hit them with some big words then explain to them in full what I actually meant. 

Aside from Dr. L: This is a situation that most young female grads face in the exam room in the States too! Whether you approach it with humor or with extra confidence like Jane, my advice to any young women reading this post is to remember the underlying cause. The patient is anxious and concerned; they aren’t trying to personally offend you, they are just nervous. Have empathy with their situation and you’ll soon find that these patients that show mistrust will be extremely loyal and thankful to you for going the extra mile to give them an excellent eyecare experience. Check out Jane's post about dealing with critical patients aptly titled Quit Yer Whinin'.

Do you have any advice for young female ODs entering the workplace and navigating working with colleagues or staff?

The issues I've faced with colleagues are similar to what I imagine all human beings encounter in a workplace. I've found majority of conflicts arise from discrepancies between communication styles and differing personalities. For example, I've made comments that are intended to be a matter-of-fact statement or a straightforward question but my colleague has interpreted it differently and tried to read between the lines something that I didn't mean to say. The longer I am in the workforce the better I become at altering my communication style for different people and also at understanding what my colleague means when he or she says something peculiar.

At school and university and within our circles of friends we get to choose who we spend time with, and of course we would gravitate towards the people we naturally click with, but in the workplace we're put together with a group of diverse individuals that we may never have chosen to ever speak to of our own volition, and we're expected to work together and be productive! (Ridiculous, I know). I think it's a great opportunity for personal growth to learn how to work together peacefully and get the best out of each other despite differing personalities, opinions, or modus operandii. 

A recent poll in the US found less than 50% of ODs wouldchose to enter the profession if they could travel back in time. What is the feeling around Optometry in Australia?

At the moment things are looking a little bleak in regards to employment options for optometrists. The industry in all the major cities of the east coast (in the states of Victoria, New South Wales, and Queensland) are saturated due to an over-supply of new graduate optometrists from recently opened schools. Meanwhile, areas such as the west coast and rural parts of the state are still under-serviced, and there is still a call for better provision of eye care for indigenous Australians. 

There is the constant war between corporate optometry chains and small independent practices. The bigwigs such as Specsavers and OPSM are able to provide lower cost care in the form of cheap frames and lenses, and can more easily absorb expenses such as practice warranties and free additional testing not covered by health insurance such as fundus photography. It means many private practices struggle to survive the competition with what is essentially a duopoly in the industry. Despite this, I think many patients are beginning to realize that cheap prices often equate to cheap quality, and on more than one occasion I've had a patient attend to me complaining that their glasses from one of the optometry chain practices weren't made right or they weren't given proper instruction on contact lens use before they were sent away with lenses that they didn't even know how to insert! 

Another battle we're facing as a profession at the moment is with Medicare. Medicare is Australia's public health insurance system which involves the government funding certain health care procedures such as blood tests, x-rays, doctor consultations, and optometry exams. In 2016 the Australian government announced a Medicare rebate freeze, which meant that there would be no further indexation of the Medicare payments to keep up with wage levels and CPI (consumer price index) until 2021. For health care practitioners this impacts on our ability to provide sustainable patient care as we still need to purchase consumables, pay rent and bills, service equipment, pay staff wages, etc, but the rebate for providing our services doesn't match with the increasing cost of everything else. The effect of the Medicare freeze, in some instances, has been passed on to patients in the form of a co-payment for consultations that used to be entirely bulk-billed and covered by Medicare. Fortunately, in 2015 the Medicare cap was removed from the optometry profession, which meant that we were actually permitted to set our own private billing fees rather than being limited to the Medicare schedule of fees. The current Medicare rebate for a comprehensive initial consultation is $56.80 AUD (only $43.68 USD with the current exchange rate). Professional bodies such as Optometry Australia continue to lobby on the industry's behalf for the indexation freeze to be lifted and for fairer and more realistic rebates. 

Head over to Jane’s BrightEyedBlog to learn more about optometry in Australia and her advice for young female ODs navigating their new careers!

Great news! In four years when the class of 2020 graduates from optometry schools around the country, they will be 70% female for the first time in history.  But just as more women enter the profession, they are faced with some pretty challenging hurdles to overcome in healthcare.  How are they going to start their own practices in the face of mounting student loan debt? How are they going to keep patients loyal to in office doctor-patient care when faced with competition from online refractive vendors? How are they going to balance starting a career with staring a family?  Can they really have it all?

We are all lucky that we have successful and talented female doctors that have navigated the ups and downs of this profession before us to help guide us through these challenges.  One of the women that has become a true force in optometry through her passion for growing our profession and encouraging young female voices to be leaders is Dr. Bridgitte Shen Lee of Vision Optique. A Chinese American immigrant and daughter of two medical professionals, Dr. Shen Lee considered both medical and optometry school before leaving college.  She selected the University of Houston College of Optometry, and looks back on that decision with full confidence that her choice to enter optometry was one of the best she’s made in her life.  What makes her mindset on optometry different? She refuses to define her profession by what she can’t do. She’s been labelled a path-paver in optometry for owning the space of ocular aesthetics and anti-aging eyecare, embracing the fact that as an optometrist, and specifically a female optometrist, she is an expert.  “Optometry has to claim these areas as ours.  We are the experts for everything related to the eyes, but we have to claim it.”

In speaking with Dr. Shen Lee on the most recent Defocus Podcast, another really clear statement about her character comes across: she’s constantly brewing up new ideas! A quick tour of her resume will show you this isn’t a recent development.  Out of optometry school, she cold started her private practice Vision Optique in 1999 with business partner Dr. Bradley Owens.  In addition to running her practice, she founded iTravelCE  in 2010 as a way to bridge the differences in ocular healthcare between the more newly minted optometric professions of Asian countries with those of America and Europe.  She is also a distinguished speaker, working as an ambassador or consultant for Johnson and Johnson Vision Care, OCuSOFT, Essilor, Guardion Health, and most recently Shire. How does she find time for it all? “My greatest advice for young female ODs is that you can have it all, just not at the same time.” She splits her time at her practice, developing optometry’s future in dry eye and ocular aesthetics through consulting, speaking, and social media, and as a wife and mother to two daughters.  Here are some of her keys to success in balancing work and family as a female OD: