In this series, Review of Optometry takes a close look at the dilemmas, decisions and life changes at each stage of an optometrists careerfrom optometry school to active practice to retirement. In each installment, we talk with optometrists in that career stage, as well as consultants who have relevant expertise and insight.

Caleb Schoonover and his wife, Abby, both fourth-year students at Northeastern State University Oklahoma College of Optometry, hope to eventually own a practice in Oklahoma. First, though, they still have a lot to learn about treating patients. And they need to pass the boards, get their first jobs in optometry and start paying down their student loans.

It really can be overwhelming when you think about the challenges ahead, Mr. Schoonover says.

The Schoonovers have taken a fairly scientific approach to make those challenges more manageable. First, they discussed their priorities and the kinds of communities that appeal to them. They came up with a short list of places to live, mostly in Oklahoma, where both were raised. Next, they started looking at hard data to help them narrow the job search. We looked at U.S. Census data on population and income for the areas were interested in, then cross-referenced that with The Blue Book of Optometrists (Jobson Publishing) to see which areas might have more demand for optometrists, Mr. Schoonover says.

Theyve also started attending meetings of the Oklahoma Association of Optometric Physicians so they can network and get up to speed on local issues. 

The Schoonovers are doing everything right, says Janice Mignogna, executive director of the Irving Bennett Business and Practice Management Center at the Pennsylvania College of Optometry (PCO). Ideally, optometry students should start considering how and where they want to practice from their very first year in school, she says. 

 
Solid Planning

Admittedly, it can be tough to focus on the future when clinical studies and board exams are looming. Even so, Ms. Mignogna says, a solid career plan is extremely important.

The biggest change shes seen: A lack of serious concern by many students for accumulating debt in school. Todays students are accustomed to using credit cards for many things that are not necessary, she says. Tack that on to the increase in school loan debt, which is rising each year, and it becomes a serious issue when choosing a mode of practice.

In fact, student debt is skyrocketing. The American Optometric Student Association (AOSA) estimates that the average debt load from optometry school alone is more than $108,000. For students who have family responsibilities, large credit card bills or undergraduate debt, the pressure to start earning some cold hard cash as soon as possible after graduation can be even more intense.

Students who arent proactive about researching their options can end up wasting time in an unnecessary residency or a job that doesnt move them closer to their ultimate career goals. Ms. Mignognas advice: Get an early start on the two core decisions that must precede any effective job search, namely where to practice and mode of practice.

 

Location, Location, Location

Ideally, a young optometrist wants to start building connections and a patient base in the area where they want to practice over the long term, Ms. Mignogna says. But where is that?

The choice of location involves many practical and intangible or emotional factors. These include cultural values, climate, proximity of family, a significant others preferences and job, local optometry competition, and more.

Rural areas often have a need for more optometrists and can offer a lower cost of living. However, they may not appeal to a young, single optometrist with a hankering for urban life. You really have to think about your short- and long-term personal goals and how they fit in with your practice goals, Ms. Mignogna says.

 

Practice Modality Pros and Cons

The next step is to decide what type of practice setting is appealing in the long run and then map out a strategy to get there. 

Traditionally, most optometrists have been in solo private practice, but in recent years an increasing number have worked for large corporate chains. Today, says Ms. Mignogna, a little more than half of optometry school graduates go this route, starting their careers at Wal-Mart or LensCrafters, for example.

On the plus side, such jobs offer an immediate opening with a good income. They allow new optometrists to start seeing patients independently, obtain practical experience and start sizing up communities they like. However, corporate settings arent necessarily as secure at they might seem, Ms. Mignogna cautions. Moreover, it can be hard to give up the steady income to pursue other goals later. 

Mr. Schoonover hopes to eventually be in private practice, perhaps starting out as an employee and working up to partner or owner. Ultimately, I think private practice will give us the most flexibility to balance our personal and professional lives, he says. 

Although most of his classmates are also interested in private practice, student indebtedness is a major obstacle. It really prevents students from pursuing their preferred practice modality, Mr. Schoonover says. As the current president of AOSA, he is actively working on legislative and other approaches to reduce the debt burden.

There are lots of different private-practice scenarios, including group practice, solo practice, hospital-owned or -affiliated practices, independent practice associations, and more. The overhead costs, long hours, lack of guaranteed income and liability risk deter some optometrists from going this route, but others see private practice in some form as the only way to practice to their full potential. I think youre going to work a lot harder and be a lot more committed to a practice if you have an ownership stake in it, Mr. Schoonover says. 

Many newly minted O.D.s start out as employees in an optometrist- or ophthalmologist-owned practice. Each has its pros and cons. An M.D. practice typically offers a very good salary and benefits, but future partnership opportunities are usually limited. Additionally, it is important to understand whether the practice expects you to just perform refractions and contact lens fittings, or whether there will be opportunities for a broader scope of practice, Ms. Mignogna advises.

Working for an optometry practice may lead more directly to future partnership or a buyout. The owner or partners and the junior optometrist all have a chance to try each other out, and the new optometrist can begin developing a patient base and learning from an established mentor. The tradeoff is often a lower initial salary and benefits than one might find elsewhere. And, even the best-laid plans dont always work out. For every successful transition, there is another senior doctor who just cant bring himself to retire, leaving the younger associate discouraged and uncertain of what to do next. 

Beyond the corporate vs. private practice dichotomy, there are myriad other career options that are less common but may offer great opportunities for career growth and satisfaction. Academic centers, hospitals and nursing homes all employ optometrists, as do Veterans Affairs Medical Centers, the Indian Health Service, and the eye care industry. Increasing numbers of students are pursuing optometric residencies to expand their knowledge and specialize in particular areas of interest.

If Private Practice Is The Ultimate Goal

The cost of launching or buying an independent practice is steep, and many young optometrists despair of ever being able to achieve their goals. Careful planning, however, can make the dream a reality, experts say.

Dont spend everything you make. The reality is that you have to live very lean, says Gary Gerber, O.D., president of the Power Practice, a consulting firm specializing in practice-building strategies for optometrists. The biggest problem he sees is that people get caught up in the money and find themselves unable to escape the golden handcuffs to pursue the career they really want.

Dr. Gerber offers this advice to any student who is determined to eventually enter private practice:

Start early. If you walk into a practice and tell them youre graduating in two years and are interested in this area, that gives the owners some time to think about how to bring a new person into the practice, Dr. Gerber says.  

Do your homework. Learn as much about a practice as possible if you are interested in working there and potentially becoming an owner. The best strategy is to demonstrate how you provide their patients with a service the practice doesnt currently offer, such as low vision therapy or specialty contact lens fitting, Dr. Gerber says.

Consider multiple part-time jobs instead of searching for a single full-time job. This gives practices the opportunity to bring in a young optometrist without committing to a full-time salary or future partnership before they are sure their practice can absorb it. And, it gives the new optometrist a chance to try out multiple practices before making any decisions to stay with one over the other.

The Power of Networking

Once you decide where you are interested in practicing, I think its really important to become involved and to start networking with people there, Mr. Schoonover says. The executive director of the state association is a great resource, he says, because he or she often knows about local needs and positions.

Ms. Mignogna agrees. Local optometry society meetings are the perfect place to introduce yourself and start networking, she says.

She recommends that students or recent grads prepare business cards to help contacts remember them. Cards can be printed quickly and cheaply at any retail print shop. A students card, for example might read: Joan Smith, Pennsylvania College of Optometry, Class of 2008, joan@emailaddress.com.

She also recommends getting to know industry sales representatives during student externships or early career positions. Sales reps are a valuable but little-understood resource for new grads. They are often the first to know about opportunities in their territory, she says.  

Old-fashioned pavement pounding also works. If you find a town you like and there are 15 O.D.s, visit them all, Dr. Gerber says. You could send a letter in advance to each of the doctors, asking to take them to lunch or stop by the office for an informational interview. 

Finally, national professional conferences offer a wealth of opportunities for networking and practice-management education.

 

Get It In Writing

The decisions have been made, the job is found, and everything looks good, right? Not so fast, warn Ms. Mignogna and Dr. Gerber. New grads should ensure that they have an employment contract or lease that clearly and fairly spells out terms and expectations. This should include duties, hours, benefits and insurance, continuing education, a termination clause and non-compete covenants or other restrictions on future or concurrent practice.

Confidentiality and non-compete clauses are common, although sometimes they dont come into play until the employee or associate has been on the job for a month or more. Be sure you know what youre getting into, Ms. Mignogna says. For example, if your non-compete agreement specifies that you cant practice within 10 miles of the employer, and they have multiple offices, that could mean a 10-mile radius around each location, effectively blocking you from practicing in a very large swath of territory. 

Another big mistake she sees is that important aspects of the arrangementsuch as a target date for buying into the practice or expectations of patient volume and the scope of workare often left as verbal agreements and not put into writing. This leaves the new optometrist little recourse if the agreement isnt fulfilled.

In a corporate setting, the optometrist usually must sign a lease. Before signing, Dr. Gerber says, ask whether any terms of the lease will change in the second or third year. If possible, speak to similar leaseholders in other locations. Its also imperative to have an attorney or other expert review any contract or lease.

 

Looking Ahead

Mr. Schoonover says he knows that dotting the is and crossing the ts will be critical in his first job out of school and that it will be important to keep focused on his ultimate goal. From what Ive heard, the first five years in practice are where your future is made or broken, right there in the beginning, he says.

Career Resources

Optometrys Career Center, a joint effort of the American Optometric Association and the American Optometric Student Association, is an online placement service offered free for two years before and one year after graduation at www.optometryscareercenter.org. Most optometry schools have targeted job search sites. School-affiliated online classifieds with nationwide search networks include:      http://ecampus.pco.edu/placement.      http://secointernational1.com/jobsite.      http://spectacle.berkeley.edu/positions_practices/positions.html.      www.ne-optometry.edu/students/career. Other optometry job search sites not affiliated with schools include:      www.optiboard.com.      www.opticareers.com.      www.eyehunter.com.      www.odwire.org. Additional resources include:      Optometry Residency Matching Service at           www.optometryresident.org.      Department of Veterans Affairs Opportunities             at www.va.gov/optometry and www.navao.org.      American Optometric Student Association at         http://www.theaosa.org/.