How has optometry become such a dire career choice in the UK? Why would almost no optometrist be able to recommend it with a clear conscience to a bright-eyed sixth-former with the right A levels?
Money might be an obvious answer. After graduation and tough professional exams, the starting salary for optometry is poor with no prospect of rising to a level comparable with similar professions. Older optometrists will have experienced a drop in real income of about 30-40 per cent over the last 15 years.
Yet money is only part of the problem. Many – perhaps most – employed optometrists are being bullied at work by often non-professional managers. The optometrist’s worth is today judged on the basis of two criteria: tests per day and conversion rates. Often no secret is made of this and, even at a job interview, it is clear that the answer to these two questions is all that matters.
Pressure to perform
Once in practice, the pressure to ‘perform’ can be intense. If a bonus to see more patients or prescribe more fails, more subtle techniques can be used. ‘Unless you can improve, we may have to move you to a quieter practice.’ ‘The receptionists know that, if they lose their bonus, it’s down to you.’ In another practice every ‘no glasses’ or ‘no change’ requires a form to be completed explaining the ‘failure’.
Yet, optometrists are getting mixed messages from their employer. The professional services departments would all claim to require the ‘highest professional standards’ and would be ‘shocked’ if any of their optometrists cut corners or prescribed unnecessarily. Many advise strict adherence to College of Optometrists guidelines in full knowledge that this could not possibly be achieved in the time their company has allowed for an eye examination.
It hardly needs stating that the optometrist is receiving mutually exclusive demands. It is no coincidence that anecdotal evidence would suggest that optometrists suffer from increasingly high levels of stress.
So, why has this happened? Why has our profession been brought to its knees? The future was obvious from the moment in July 1983 that French and Loran published their research paper into manpower requirements and the findings were ignored by the optical establishment. The paper which appeared in the journal Ophthalmic Optician concluded that the number of optometrists being trained in the UK was ‘about right’ and any increase would be ‘ill advised’.
This cautionary advice did not hinder an explosion in the number of places being offered by existing optometry departments and a rapid increase in the number of institutions offering optometry.
Does it surprise anyone that some locum optometrists were told recently to reduce their examination times to 15 minutes or not come back again? This has been made possible by an oversupply of optometrists.
So who do we blame? The multiples are an obvious target since much of the impetus to increase optometric numbers has come from them. However, the multiples are out to make money for their shareholders and the squashing of the optometric profession has been the result of a highly successful campaign. It is a mistake to think the happiness of optometrists (or indeed the true welfare of any patients that do not sue them) has ever been, or ever will be a consideration.
Oversupply of graduates
So are the AOP or the College of Optometrists the real villains? It is certainly true that they have been far too silent on the plight of the employed optometrist and seem to have ignored the obvious problems resulting from an oversupply. Cynics would argue that both the College and AOP have been quiet on the issue because they have enjoyed spending the revenues that the extra membership fees have brought in. Indeed, it does seem extraordinary that with yet another university wanting to offer optometry and the profession up in arms, the College is apparently only now looking to gather evidence of a possible problem.
Another grievance that many have with the College and AOP is the constant demand for higher professional standards and better record keeping. To achieve these standards would probably require an hour per patient (most optometrists would be thrilled to be able to work to this standard). No major multiple would allow 60-minute appointments but the optometrist failing to follow the guidelines can be sanctioned by the GOC or lose in the civil courts. The guidelines, far from helping practising optometrists, are used by others as a stick to beat them.
Everything is cyclical. In the end, salaries will drop so low and the stress of the job will become so great that the information will trickle down to the careers advisers. Applications will start to dry up and the calibre of those applying will become poor. Perhaps the universities will start closing optometry departments or reducing numbers and the situation may return to some sort of balance.
Until then, the best advice one could give optometry graduates is to take your degree and to seek a career in almost any employment outside optometry.