This story is from Phil. Here he shares his experience of providing optometry services to people outside of the cities. Phil highlights the need for remote health professionals to keep up to date and in touch with your peer professional networks, but that this is not always easy. Phil also points out that keeping up to date is all the more important for people working in remote areas as most allied health professionals will by necessity be practicing with an extended scope of practice.

Phil’s story:

The typical day of a rural optometrist involves seeing a number of patients with specific problems involving their eyes and vision. Most rural optometrists are quite busy, perhaps seeing 10-15 patients per day (average consultation is 20-40 minutes). At the end of the day the business paperwork needs to be completed, including Medicare, private health insurance, referral letters and response letters to General Practitioners who may have referred patients to you.
The “core” role of optometrists is to provide accurate optical refraction to find the correct optical prescription for clear comfortable binocular vision at both distance and near, and to support a suitable visual aid to treat the problem (spectacles, bifocals, progressive lenses, contact lenses, magnifiers for patients with low vision).

Optometrists also routinely monitor for signs and symptoms of diseases of the eye and visual system, and, if necessary, organize appropriate management. The most common conditions are 1. Diabetes and Diabetic Retinopathy; 2. Glaucoma; 3. Cataract; 4. Age-related Macular Degeneration. If these conditions are discovered, they are assessed and treatment regimens provided. This will often involve co-management with a remote ophthalmologist and collaboration with the patient’s local GP.

The challenges of a rural optometrist are similar to those encountered by other rural and remote health practitioners. The challenges are relative isolation from your peer group, high work load with frequent unplanned “emergency” situations involving out-of-hours additional work. There’s also the consideration of your children’s’ educational opportunities, and decisions regarding possible relocation to boarding school.

Then there’s your own professional development and the distance from mandatory continuing professional development events (APRHA required mandatory education in essential skills). We do have difficulty with succession planning.
Sadly, I had to leave rural practice for family reasons. But I have observed and communicated with a number of colleagues in rural practice over the years that we have developed a number of strategies to help us deal with the challenges we face when going rural. These strategies involve - 1. Becoming involved with Optometry NSW/ACT organizational events - expenses are covered for rural office holders, 2. Annual attendance at final year events to find students interested in a rural career (e.g. see Tim Duffy’s practice in Gunnedah “Vision Splendid”) and 3. Collaboration with Universities and Optometry NSW/ACT to run CPD events in closer regional centres.

I was an academic and I ran courses which extended the scope of practice of optometrists to enable prescription of S4 topical eye drops - antibiotics, anti-inflammatories and anti-glaucoma drops. In my early courses the students were nearly all from rural NSW, because they had by necessity been practicing for years with an extended scope of practice. They knew it all and had excellent relationships with their local GPs and most available ophthalmologist colleagues.

My colleagues who are rural optometrists do excellent challenging work, and deserve both support and recognition.

Overall, I think that Optometry in Australia has a minimal presence in State Health. But Optometrists can provide excellent public health services as consultants in rural health centres and hospitals.