With the new year, however, I figure it’s the perfect time to get back to publishing Hannah’s hot takes on all things optometry. (This phraseology stolen from one of most faithful readers, and up-and-coming OD, JH. Thank you!)
- I leave between 6:30a and 7:45a to travel to my facility for the day. My longest drive days are ~2 hours, and my shortest drive days are 30-40 minutes
- When I arrive, I unpack all of the equipment from my car, take a COVID screening test at the door, and then meet with my facility contact to assess the day’s patient list.
- My contact takes me to my base for the day (usually a beauty salon, but sometimes just an empty bedroom), where I then unpack all my equipment.
- Depending on the current facility lock-down status, I will either prepare my room to be a makeshift exam room, or I’ll load everything onto a cart to take around from room to room.
- Once I’m set up, it’s time to see patients!
- The optimal set up is when residents are brought to my room for their exams (normally about 20 minutes, including refraction and dilation), but bedside exam days mean lots more steps!
- Currently, I typically see ~10 residents per day, all with varying levels of physical and cognitive abilities.
- Exams can be comprehensive, problem-focused checkups, or simple glasses checks to make sure that what was ordered fits the resident’s needs.
- Once I finish with all the scheduled exams (generally between 12p and 2p), I pack my equipment back up, give written orders for any necessary medications to the nursing staff, and head back home!
- At home, I finish charting, review my following day’s patient list, and then enjoy the remainder of the day!
Perks of the job:
- Flexible schedule: There is no defined time that I have to be at a facility. I typically aim to get there ~8:30a, that way I can meet with my contact before morning meetings (~9:00a). Also, it allows me to see most of my patients before lunch (I’ve learned that some of them get very upset when you come between them and food… especially with a Tonopen or dilating drops), and before they fall asleep for an afternoon nap.
- No defined patient count: I largely get to choose how many residents I see a day. Most docs with the company see 10-14/day, with some seeing fewer, and others seeing up to 20.
- Work/life balance: My typical work day, including driving (sometimes 4 hours), working, and charting, is done by 4. And, there is no overhead for me to worry about. So, once my charts are submitted at the end of the day, I’m done.
- Incredible EHR: The Electronic Health Records system that the company uses was designed entirely in house, and by doctors. It is completely intuitive, allowing for fast, easy charting. Additionally, any suggestions or complaints are submitted directly to the designers, who quickly implement necessary changes.
- Oh yeah, and it’s all housed on a system with onboard internet, so wifi connectivity is never a problem.
- Fantastic support team: Despite being on my own at each facility, I have 24/7 access to my “provider support team” via email, phone, fax, or HIPAA secure text, that allows me to troubleshoot any problems while on the job. (Or anywhere else for that matter…)
- Variety: Since starting optometry school, I have always said that I didn’t think I could survive in a bread and butter optometry practice that primarily focuses on prescribing glasses and contacts. (Maybe this is because I find refraction – which is better 1, or 2 – to be one of the most boring procedures employed in our profession. While shadowing docs, I have literally started nodding off during it. Thankfully, I’ve yet to fall asleep while performing the task, but, you get the picture.) With this job, every patient is a new challenge. Between bedside exams, trying to get as much information as possible out of a completely non-verbal patient, learning to understand what my aphasic residents are telling me, and Macgyvering a pair of specs to hold until a new pair can come in, all while effectively diagnosing, managing, and treating ocular disease, there is literally never a dull moment. And I love it.*
Downfalls of the job:
- Referrals are difficult: In this lovely COVID era, getting residents to see the proper external practitioners has been difficult. Many residents are in poor health to begin with, and thus, facilities are hesitant to risk their physical well-being for an external appointment. Unfortunately, this means that I have seen patients who are seeing 20/400 due to mature cataracts that have been unable to be removed for over a year, or patients with retinal bleeding that have been unable to receive treatment for proliferative diabetic retinopathy, therein increasing their risk of significant, permanent vision loss.
- No scribes or techs: Admittedly, during optometry school, and even through residency, I dreamed of being in a practice where I had scribes to take care of all the charting, and techs to do most of the work-up. And here I am with neither. Thankfully, however, this gives me an opportunity to work on my own optimal exam efficiency.
- COVID: Obviously, nursing homes and long-term care facilities have been among the most hard hit by the effects of COVID. Some days, nearly all of the patients on my schedule have had COVID, and many are still feeling the effects. Additionally, there is significant concern of me bringing the virus into the facility, or taking it home to my loved ones at night. As such, I wear enough PPE (personal protective equipment) to literally be sweating in a 60 degree room – which is hard to find in a nursing home. You can only imagine how it is performing retinoscopy (figuring out a glasses prescription) over a heater in an already 80 degree room. However, I’m happy to wear it all if it means that I, my patients, and my friends and family are safer!
- Long drives: As much as I like driving, some days the 6:30 leave time, hours of darkness, and travel through snowy areas is a lot. Prayers for safety, alertness, and good conditions appreciated!
- COVID Vaccine: Being a doctor working with high risk populations, I was among the first to be eligible and subsequently receive the vaccine. I have only received the first dose so far, but have had minimal side effects – some upper arm soreness, three days with a mild headache (though that may also be attributable to sinus pressure with changing weather conditions), and some mild fatigue (I was less ready to get up before 5 than normal for 1-2 days). I’ll keep you posted as to how things progress after I receive the second dose!
- COVID Testing: Additionally, due to the patient population that I work with, I receive a COVID test a minimum of once per week. (PS: The nasal swab is much better when you can perform it yourself, rather than having someone else try to swipe up to your brain!) The biggest downfall with this is delay of results (especially around the holidays), which can become an issue on the first days of the week when my new results have yet to come in. However, thankfully, many facilities have rapid-testing capabilities to allow me to test on-site before beginning patient care for the day!
Annnd I think that about covers it!