Looking to Australia

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 The UK practitioner who wants to apply to be recognised as an optometrist in Australia must hold a listed qualification - BSc or BSc (Hons) in optometry or ophthalmic optics from one of the schools of optometry in the UK: Aston, Bradford, Cardiff, City, Glasgow Caledonian, APU, Manchester or Ulster.

The applicant must also have passed the PQE or its equivalent within a four-year degree and must have passed an examination, or examinations as specified by the board.

Optometrists who have not graduated in Australia or New Zealand are required to pass an exam before being registered.

This exam is conducted by the Optometry Council of Australia and New Zealand (OCANZ) and is accepted in all jurisdictions. The candidate is required to pass two three-hour exams in clinical science. Hence, the applicant's background knowledge in basic bio-medical, vision, optical and clinical science and the ability to apply the knowledge clinically. The candidate is then eligible to sit one two-hour exam in diagnosis and management.

This exam consists of up to 20 photographs of clinical conditions and test findings accompanied by case histories where appropriate. This tests the candidate's assessment, diagnosis and management knowledge. Having sat this set of exams myself, the time given is very little for the content of the exams, although only 50 per cent is the required pass rate. Subjects covered range from visual perception to practical optometry.

The majority of questions are based around real-life situations, where experience proves more beneficial than book work.

On passing these examinations, the candidate is then eligible to sit the clinical skills assessment. This is a stations exam, comprising of seven stations on specific diagnostic and information-gaining techniques.

Finally, on passing this exam, the candidate is assessed on four patient examinations. This exhausting process takes from four to six weeks in total.

Education
Surprisingly, there are only three institutes in Australia conducting optometric courses - the University of New South Wales, the University of Melbourne and Queensland University of Technology.

Not every state in Australia conducts the optometric course, thereby registration of an optometrist in one state automatically confirms registration in all states. Each course is four to five years, leading to a bachelor degree.

This academic year (ending in December 2005) will produce no optometrist graduates as the course has increased by one year due to the therapeutic legislative changes. The prerequisite of graduation is a demonstrated competence in clinical skills (so no PQEs).

Employment
Approximately 16 per cent of Australians make use of optometric services and over 75 per cent make use of all vision-care services in Australia.

Unlike the UK, most Australian optometrists are self-employed or partners in private practice. Remaining optometrists work as employees of other optometrists. In contrast to many other countries, optometrists are not employed to any great extent by hospital eye services or related institutions.

Domiciliary visits are occasional and not as widespread as those in the UK. Most optometrists are located in practices in or near shopping areas. This is the same for Australian doctors or dentists.

Scope of clinical practice
The Australian optometric profession is well established and highly developed. The scope of practice, the legislative framework and social status of the profession are seen as comparable to that experienced by optometrists in the UK and Canada.

The basic range of clinical skills are just as those in the UK: refraction, binocular vision, ophthalmoscopy, slit-lamp biomicroscopy, tonometry, contact lens patients and the supply and management of spectacles.

Gonioscopy is a clinical test used commonly in areas of Australia. As therapeutic management of patients, such as those suffering from glaucoma, increases across the country, gonioscopy is being employed by more practitioners. Table 1 lists the drugs available to optometrists.

Optometrists Association Australia
The Optometrists Association Australia is the professional association for optometrists. Membership is open to all registered optometrists who practise optometry in any state or territory of Australia.

Membership fees are set by each state division (of which there are six). This is because the services provided to members by each of the state divisions vary. Fees also vary on a membership level which is based on the amount of time spent in practice per week, so part-time optometrists generally pay lower membership fees.

Services provided by the association include representation of members and their interests to the government and other bodies. The OAA provides resources and publications to assist optometrists in practice. The public is also provided with information and other services.
OAA members are required to practise in line with the association's code of ethics (Table 2).

Medicare
The structure of the Australian government is unique in that some matters are governed by federal legislation, whereas others are state-controlled. The Commonwealth of Australia comprises of six states (New South Wales, Queensland, South Australia, Tasmania, Victoria and Western Australia - see map) and two territories (the Australian Capital Territory and the Northern Territory). With this structure, the country is governed by both a Federal Parliament and the independent Parliaments of States and Territories.

It is the state and territorial governments that are responsible for the control of optometric practice and registrations. The Australian national health programme is governed by the federal government - this provides benefits for consultations with optometrists to all Australians.
Medicare is the Federal Government National Health scheme, in effect all Australian optometrists have agreed to participate as providers of optometric care for Medicare.

Optometrists in the UK are bound by contractual terms with the ophthalmic terms of service to be on the ophthalmic list. Similarly, Australian optometrists are required to achieve the Medicare standards of practice.

The Australian version of the ophthalmic list application is called the Common Form of Undertaking (CFU). This is a legal agreement between an individual optometrist and the Federal Minister for Health and Ageing.

The CFU specifies the conditions under which an optometrist needs to operate in order to access Medicare benefits. The contents of the CFU are comparable to the ophthalmic terms of service, such as details on prescriptions, recalls, record-keeping and advertising. Upon signing the CFU, optometrists are given a 'provider' number - the Australian ophthalmic list number.

Continuing professional development
As with CET, CPD is an essential part of optometry to maintain and improve the standard of care provided to patients and to advance the interests of optometrists. If you practise in Australia and want to stay on the GOC list, accumulated CET points can be transferred as long as proof has been provided.