Choosing to change from high street to domiciliary.
An increasing number of Optometrists are choosing to work in the domiciliary sector; this may come as no surprise as the population ages and the number of NHS eligible patients rises. However, what makes an Optometrist switch from the relative comfort of a High Street consulting room to a mobile role?
Some of the reasons are obvious, Optometrists report that they would like to spend more time with their patients, typically within a domiciliary environment the appointment is for about an hour. This allows for a very patient-centric examination enabling clinicians to fully understand all visual requirements, and even how a patient can alter their habitual environment to enhance their quality of vision and life. Optometrists enjoy making a difference to their patients, so helping the elderly to retain their independence at home is important. Optometrists welcome and embrace the challenges that these patients can often present. Sometimes this may be a refractive challenge, sometimes a communication challenge and often a clinical challenge. One thing is for certain; working as a domiciliary optician is never dull and incorporates many of the reasons why Optometrists entered the profession in the first place.
The role is attractive to many as it is so flexible – some work five days Monday to Friday and immensely value the weekends off. Some work four days and relish having a long weekend every week, whilst others use one day a week to spend time on an area of interest such as Hospital work, contact lenses etc.
Other reasons for entering the world of domiciliary optics are more subtle and often only appreciated once started. Most High Street Optometrists spend a great deal of time in a small room with no natural light. Many domiciliary Optometrists say they prefer being ‘out and about’, visiting towns and villages that they would otherwise never be aware of. In addition, being out in daylight hours can be a welcome change, particularly in winter, when commuting to and from a practice in the dark can be the norm.
Seeing less patients a day than you would in practice and travelling in between each one makes the flow of the day very different and less repetitive. Optometrists often say they can remember every patient at the end of the day, not just those that are memorable for being complex or unusual.
A significant number of patients seen at home have reduced vision both distance and near and this gives an opportunity to assess and advise on magnifiers and other aids – many Opticians have limited exposure to low vision but find this aspect of the work interesting and rewarding.
Many High Street Optometrists spend the vast amount of their working day in the consulting room and do not become closely involved with dispensing. Those Optometrists who prefer not to be involved with dispensing can work assisted by a colleague who provides this expertise. For those who enjoy dispensing, some Optometrists (Super Optoms) work on their own providing all aspects of the visit.
As the work is carried out in the patient’s home, it is often a more informal process with patients more relaxed than when visiting a practice. Practitioners often comment on how enjoyable this makes the role and notice how grateful patients are for their personalised care.
Although there is not quite the vast array of equipment available for domiciliary as may be found in the consulting room, most instruments have a portable version and with careful selection and use, a high quality eye examination can be carried out. Often, a traditional technique such as retinoscopy is preferred over an auto-refractor as this is not only more portable but more suited to patients who have small pupils and lens opacities. Practitioners comment that they use their core skills more regularly compared with working in practices that offer pre-screening, and patients and Optometrists alike appreciate this.
Manufacturers and distributors have been introducing new items of equipment that are suitable or intended for domiciliary use. Excellent focimeters, tonometers and test charts have been available for a long time but during the last few years, smaller more lightweight visual field screeners have been introduced, portable fundus cameras are available and test charts have become screen based with many more chart options used. Portable slit lamps are gaining popularity however, as it may be difficult to use for slit lamp biomicroscopy with a condensing lens, many practitioners opt to use Pan Optic ophthalmoscope.
When an Optometrist makes the change to domiciliary work they embark on a period with a steep learning curve. Some of the adaptations are optometric and are easily changed – thinking about how to test more elderly patients often with vision a little reduced is useful. Other areas to become familiar with are more practical – to set up a ‘consulting room’ environment several times a day requires good organisational skills and fitting into a new routine – there is no room for mess or disorder!
With an assisted role, the Optometrist has a dispensing colleague to take them to the patient appointments on their daily schedule, sharing the clinic set up and dispensing to the patient while all testing equipment is being packed away ready for the next patient. For a Super Optom role, the Optometrist should enjoy driving, multitasking, and be able to manage the clinical day of patients, in conjunction with supporting colleagues from the Head Office. Super Optoms receive a one-month induction in order to adapt to the role. This can be tailored to each individual and consists of a mixture of ‘on the job’ training, Optom support days and regular Head Office feedback/support. Although the role may ultimately be one of a lone worker, it is important to know and feel you are part of a team that supports you on a daily basis and to be confident that a senior optometric colleague is only a phone call away should you require advice or guidance.
To conclude, the domiciliary roles are very different to a High Street role but offer a flexible, interesting and challenging alternative with weekends off. Many who have years of experience in the sector say they would not wish to go back to the High Street way of working.
If you are looking for an opportunity to have a varied and rewarding career, perhaps The Outside Clinic is for you!