COMMENTARY

Optometry's Identity Crisis

Christina M. Sorenson, OD

Disclosures

May 14, 2015

When I was a resident and during my first several years of practice, it was not uncommon for me to be asked, "So what do you do for the doctor?" In those years, most doctors were men, and women were support staff. I knew over time that this presumption would change as more and more women entered the healthcare environment with advanced degrees. Indeed, women now make up the leading proportion of graduates of many programs. One thing that has not changed over the years, however, is the general misunderstanding of the optometric profession.

When asked what I do for a living, if I answer, "I am an optometrist," my companion frequently says, "Oh, so you fit glasses." Or worse, I am favored with a glazed look that conveys, "Oh, snoozeville. What am I to say to that?" If I answer the question by saying, "I am an eye doctor," an entire conversation ensues, inclusive of my educational track and day-to-day tasks.

Over the decades following my graduation, optometric education has continued to strengthen, and work opportunities are now much broader.

The use of cutting-edge knowledge and equipment for evaluation and management of our patients has penetrated the profession across its spectrum. Optometrists are managing ocular disease and performing minor surgical procedures, while retaining strengths in our more traditional bailiwick of binocular vision, contact lenses, visual rehabilitation, and refractive evaluation. Yet the profession continues to be cursed by the ancient view of its breadth.

Moreover, we are stymied by state-by-state levels of licensure. I can perform surgery in one state but become persona non grata in a neighboring state. Is this diverse and potholed licensure causing a massive identity crisis? Certainly as a profession we are not doing our patients any service with this confusion.

But it is doubtful that the level of licensure is the sole factor. Our graduates leave their institutions prepared to provide care at the highest level of licensure. Finding employment to support and grow this knowledge base, however, continues to stunt the profession. Students come out of school in massive debt, often taking the first job that can pay the bills.

Fast-forward a few years, and they are refracting patients for 8 hours a day, never having used above 15% of their training. Critical thinking skills can become unplugged. After being away from such skills as disease management and specialty contact lens fitting, to name a few, they may not want to return to a higher level of practice and thus condemn themselves to refraction—"Which is better, one or two?"—for their entire career.

So what is the problem?

Many professions have multiple levels of licensure and diverse skill sets. Nursing is one such profession. It is well known that nursing has a rich and diverse specialty base. Why is it not known that optometry has diversity and specialization? I have thought about this dichotomy often; it is not the education. The education is broad-based and provides great depth. It may have been the experiential component, but that is certainly shrinking with externships being required for degree conferral, and residency training being commonplace. The educational debt upon graduation contributes, but other professions come out of school in debt and still practice to the level of their education.

Optometric culture must change. All too often we underplay the services we provide and the skills we have to offer patients. My thought is: "Own your education, and go forth and provide care as you were taught."

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