In 1901 when Minnesota became the first state to recognize and legislate the scope of practice for optometrists, ocular healthcare was quite different than today.  As technology has changed and improved to provide safer, faster, and more efficient healthcare solutions, medical providers have had to learn and adopt this new technology to best serve their patient's needs. That's the basis of continuing education hours to maintain  a medical license after all.  But by 1921 when all states in the US had passed legislation recognizing and defining optometric care, the technology that now exists to treat patients could not have been dreamed of or planned for to be written into those original defining laws.  That is the situation that optometry faces now in 2018 where the legislation written in each state that defines the practice of ocular healthcare is now also limiting how the profession can best serve patients. 

Dr. Joanna Bomkamp Gerhardt training on the YAG Laser at the Southern College of Optometry.  Training for minor surgical and laser procedures is a standard part of optometry school curriculum, but the ability to perform these procedures that were taught in school is legislated state by state.  via

The optometric work force is changing!  Women in Optometry reported last year that 66% of optometry school graduates in 2021 will be female.  Dr. Stephanie Aguilar (above) is one of this new generation of optometrists that will be the first to see the profession switch from male dominated to female dominated.

Dr. Aguilar at her residency graduation

The decision to pursue residency training after completing optometry school can be a difficult one.  Dr. Aguilar knew by her third year in school that it was the right decision for her. "All of the coolest speakers (whether AOA representatives, private practice doctors, etc.) that came to school had done residencies and spoke so highly of the experience. My professors in school also recommended a residency to improve my clinical skills, as well as gain knowledge and experience before going into the workplace. At that time, I was also considering a career in a hospital setting and knew if I wanted to ever do that, a residency was a must."

She has great advice for student ODs that are interested in pursuing a residency of their own. "The best way to prepare for residency applications is to start early. The easiest ways to stand out are to be involved in your school and excel in the areas that your residency is in."  During the interview, be prepared to discuss specifics about your clinical experiences so far, and be personable and conversational throughout the process. "Think of a few clinical scenarios that were significant to you, as this was a common topic of conversation during interviews. As always, be yourself because it’s likely that during your interview you are not only being evaluated on your credentials, but also whether or not your preceptors can stand working with you for a year!"  

Finding the right job out of school or residency is a huge milestone (or hurdle!) in a young optometry career. While Dr. Aguilar had entered her residency considering working in a hospital setting, it was a private practice back in her home town of San Antonio, Texas that became the right fit for her.  Like many great opportunities, networking was the key.  "In my case, who I knew was critical. I found my job through a previous volunteer experience. Every time I came home from optometry school, I would volunteer at the Haven for Hope I Care Clinic that provides eye care for the homeless population in San Antonio. I had a good relationship with the manager at the office. While in Boston, I called her and asked if she knew any doctors hiring in the area. She put me in contact with two doctors, one of them being my place of work now. My advice is to treat everyone with respect because you never know who will help you down the road. Keep your options open, interview with many different offices and always ask for what you deserve in compensation."  With our pay gap as it stands currently in optometry, her words of advice can't be more of a call to action!




Patient care is Dr. Aguilar's true passion, and it hasn't taken long in her young career to see her love for optometry touching lives.  Even after a residency focused on treating and managing ocular disease, it's the simple day to day mission of being an optometrist - helping patients see their best - that has left the biggest impression on her so far.  "The patient encounters that impact me the most are those in which I feel I’ve made an improvement in the patients’ lives. Whether it’s a patient that is successfully fit into multifocal contacts, a child seeing their parents clearly for the first time thanks to new glasses, or a corneal ulcer patient that is healed after two weeks of pain and blurred vision."

The future for young optometrists hold exciting promise, but plenty of challenges as well. "In my opinion the biggest immediate risk to our profession is telemedicine or optometry offices that offer a “comprehensive eye exam”, when in reality it’s someone remotely performing refraction and then reviewing anterior and posterior segment photos."  

"Another risk to our profession is the group mentality that someone else will take care of this problem. In my opinion, all optometrists should support the American Optomteric Association because they work tirelessly to support and improve our profession. Without them, there is no telling where optometry would be and I hope I never to find out. So being a member of the AOA, joining their team or lobbying on optometry’s behalf is advantageous to all of us."



Want to learn more from Dr. Aguilar?  Stay tuned for more articles written by her appearing on the blog, and you can reach out to her for advice or mentorship by email!

If it's not obvious by the fact my "down-time" is spent here, blogging about my profession, I really love being an optometrist.  I would make that decision again even if I time-traveled back to my undergrad days (and please, don't let that recurring nightmare of facing tests and papers all over again ever become reality). But there are plenty of times in this career where I've had experiences I'd rather forget.  Uncomfortable encounters with male and female patients, angry belligerence, threats, casual and blatant sexism.  All in a day's work when your profession is part of the customer service industry known as healthcare.

The face I make when I think about this issue - captured perfectly by artist Karen Goins

Recently I was asked to reflect upon some of the difficult situations I've been placed in as a young female optometrist by fellow OD from across the globe in Australia, Jane of BrightEyed Blog. She interviewed both me and my friend Dr. Jaclyn Garlich of 20/20 Glance fame about some uncomfortable scenarios we've been faced with, and how we best recommend other new grads tackle the challenge if they are ever put in the same situation.  

BrightEyed specializes in both direct to patient communication on topics like Glaucoma or glasses wear, but also on sharing advice on navigating real world optometry issues for young new grads like gaining patient's trust in the exam room.

Jane and her sister on graduation day!

• Start your own practice! The best way to have flexibility over your own schedule is to be the boss. As an employed optometrist your schedule is dictated by the doctor or corporation you work for, but when you are working for yourself, you can arrange your hours in the office to best suit your needs.
• Treat your practice like your first child.  Right out of school, Dr. Shen Lee put all of her time, energy, and disposable income back into her practice. The first few years are the hardest and the leanest, but that dedication to the practice in the start lays the foundation for future success.
• Focus on creating patient loyalty by giving patients a reason to come back every year. One of the biggest mistakes Dr. Shen Lee sees practitioners making around the country is letting a patient that isn't complaining or demanding solutions go without getting education for what she can offer.  Even when a patient is successful in a contact lens, she encourages them to try out the newest technology on the market.  Her practice had grown to around 70% daily disposable lens wear because of her dedication to encouraging her patients try out the best lenses on the market, and she's found this technique is a great practice builder.  Her patients come in asking "what's new?" every year because she has focused on building loyalty and value in her exams. 
• How does she balance home and work life? “Instead of telling you what I do, let me tell you what I don’t do.  I don’t do dishes; I don’t do laundry.” She spends her precious time at home being present and active in the lives of her family and loved ones, helping with homework, trekking to fencing lessons and tournaments with her daughters,and  just being a mom and mentor to her children.   Getting help for the day to day chores that can steal away precious time is essential for her to have the time to explore her passions in optometry and as a mom and wife.

Can I rewind myself in time and start over as a member of Gamma Omicron at my alma mater, the Southern College of Optometry? I'm not saying I want to go back to school, or that I haven't enjoyed the last 5 years seeing patients and you know, getting paid to do so. But today's generation of future female ODs isn't messing around.  They've seen the statistics on the 16% gender starting salary gap for new graduates in our profession and while most of their classmates are women (67% of all enrolled optometry students were female in the 2015-2016 calendar school year), they noticed some overt discrepancies.  When asked, Sandy Trybus (SCO '17) says she cofounded Gamma Omicron on campus when she began realizing none of the successful doctors brought back to speak on campus were women.  Where were her female optometric role models and mentors? Women that could help her and her classmates navigate the issues that they would disproportionately face as they graduated and began searching for job opportunities and navigating establishing leadership and authority in their relationships with employers, staff, and patients? Where were the people like her that were success stories and leaders in our profession? She and cofounder Michelle Moscow set out to bring more female voices on campus by giving them a place all their own.

Head over to the Defocus Podcast for the full interview!!

Gamma Omicron was once a club on campus at SCO back in the 70s, when just a small subset of the student body was female.  At that time, female students at SCO felt they needed a place where they could establish their own leadership and autonomy in a historically male dominated profession.  As female enrollment continued to grow, the club eventually fell out of existence as class sizes became more equally split and equality in the classroom and workplace became less of an exception than a rule in the general public. 40 years later, Trybus and Moscow were looking for a place to focus on women leaders in the profession to help mentor themselves and fellow classmates and came upon Gamma Omicron in old yearbooks.  It was a perfect fit to re-establish the club that had lovingly drawn it's greek letters from "Girls Only."

Gamma Omicron members speak with Dr. Brigitte Keener (SCO '11) at their annual speed-learning event

Over the past month I've had the privilege of speaking with Trybus, and new club leaders Julia Hamm and Maddie Coughlin via the latest Defocus Media podcast, and then to the entire Gamma Omicron club as a speaker at their first 2016-17 school year meeting to talk salary and contract negotiations, and navigating difficulties young women often face in staff, employer, and patient interactions. Our discussions have yielded so many great talking points I wanted to share some pearls with you ladies that might not yet have a Gamma Omicron chapter established at your school:

• When applying for a job, how can you negotiate if you haven't really had any experience?  My recommendation is to think outside the box; you may not be an expert in patient care by the numbers, but I bet you're an expert in something your hiring doctor is not.  Look at their practice: are they offering specialty contact lenses, vision therapy or sports vision, infant and pediatric care, or dry eye specialties?  These are all buzzword specialties in optometry that older doctors may not be personally interested in training on, but would love to bring into their practice through you.  Look at their social media: is their website a mess? Facebook underutilized? Are they even online at all? Taking over social media marketing is a great way to bring instant value, and your hiring doctor will not question your generational expertise in this area. For more negotiating tips head here.
• But hold your horses, because bringing value to a practice is great, but you need to make sure you and the hiring doctor are on the same page about your future.  When we first spoke on the podcast, I was surprised to hear that putting a date on when to begin buying in to a practice at the initial contract signing wasn't a top priority for students.  It's true that you want to try out the practice first before you commit, but many friends and good doctors before and after me have fallen into this trap.  If you don't set a date to begin buy-in negotiations, then the day will somehow never magically come.  Five years later you're still waiting to have that conversation and the doctor you work for still thinks you might not be ready to take on the leadership and commitment of being a full partner because you're about to start a family or you're still growing into the position.  That's 5 years of blood, sweat, and tears you've put into that practice that you will eventually have to buy back from yourself, because every day you've worked there you've grown the business patient encounter by patient encounter.  I highly recommend setting a 1 year from hire date to get the practice evaluated by an outside party and to begin buy-in discussions.  Doctors love their practices and those in the baby boomer generation have universally seemed reluctant to walk away or retire, so they often put off handing over the reigns to their practice even after bringing you on board with the mindset to do just that.  Help keep the ball moving in that direction by getting firm plans set in stone for buy-in discussions right from the start.
• "You look like you just graduated high school" or "when's the doctor coming in?" are questions these ladies will likely be asked as new docs (and 5 years later, yes I'm still getting them).  The best medicine is laughter in these situations - I always laugh a little and say something to the effect of "Oh thank you so much! My wrinkle cream must be working!" with a genuine smile like I truly appreciate the compliment.  Yes, I know patients who criticize our appearance as too youthful aren't complimenting my wrinkle-free skin, but they are telling me with those comments that they feel anxious or concerned that my level of care might not be up to par. Th best way to alleviate fear is to help get the patient smiling or laughing with you on the other side.  If I smile and laugh, they will smile and laugh, and it's hard to feel anxious when you're smiling so much!

64.6% of all new graduates were female in 2014 which means now more than ever we need to make strides to close the gender pay gap in our profession.  photo is my 2011 graduating class from the Southern College of Optometry

• Experience:  Did you complete a residency? How long have you been working? Often times job postings are listed with new grads in mind so a doc bringing years of experience would be able to leverage that for a better initial offer.  If you are a new grad, there is still a chance you can advocate for yourself as bringing more experience that an average candidate despite your lack of prior work history or higher training.  Did you extern at a highly competitive or challenging environment?  Completing externships at VA hospitals or clinics offering specialization in pediatrics or brain trauma treatment can give you experiences that even older doctors can't match.  How many patients did you see during your externships?  Keep a log of the number of total patients you saw (I know it is tedious, but just keep a spreadsheet going that you update daily during your rotations).   You may surprise yourself (and your employer) by how many patients you have already cared for, despite your lack of traditional work experience as a new grad.
• Specialties: Does your employer have interest in bulding specialty contact lens services, pediatrics, vision therapy, or low vision? Even if you haven't actually had experience in these areas, just telling your employer that you are interested in developing that area of specialty to expand the scope of their practice can set you apart.  Of course, make sure you follow up by talking about what training you will do (educational events, online lectures, pursuing certification, etc) to make sure you can deliver on this promise for providing specialized care.
• Skills Outside of Patient Care: Think about work you did in optometry school or before that could be valuable to your employer in their office.  Did you perform research or publish journal articles? Did you work in an optical lab cutting lenses? You might not be logging optical hours grinding lenses for your new practice, but even if your employer doesn't have an in-house lab, your optical skill set gives your employer confidence that you will be a great resource working with the opticians in your workplace.  You can even offer to train new staff in their optical duties. 
• Languages: Being bilingual is a huge asset.  You can build up your employer's patient demographic in whatever language you speak.  
• Social Media: Maybe your employer doesn’t have a passable website, or isn't using social media to its fullest (or at all). You could employ your skill set towards creating a valuable digital footprint for the company.   These social media skills are increasingly recognized by employers because an ad for their office in the Yellow Pages just isn't going to cut it anymore. You'll be worth your weight in gold to many private practice ODs if you can come in and take over that side of the practice.
• Technology: Are you applying for a position where they have not yet changed over to electronic medical records?  The window is quickly closing on how long doctors have left to change over before penalties arise, and they need skilled, EMR ready doctors like yourself to get the system in place. As a new or recent grad. you have also just worked with the latest and greatest new technology in eyecare at your school. You were running all of your own OCTs and fundus autofluorescence cameras.  Not only are you now valuable to the doctors you work for because you can show them how to use new technology to its full capacity, but you can also help train their staff on the proper ways to run this equipment for quality scans.  

Want to add value to your employer's business?  Specialty contact lenses have a huge demand, and can quickly grow the practice you work at with referrals from other area doctors that don't provide such services. image via

1. They want to add monetary value to their practice by seeing more patients
2. They are looking to find a retirement  plan, and need to bring someone on to phase themselves out. 
3. They want both options 1 and 2 because retirement is at least five years away.