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I work in private practice, with another doctor, which is only one of the ways you can do optometry. We also have two locations—each doctor spends some time at each location during the week. I see 20 patients on a busy day. Because I'm also a mom, I work Mondays and Tuesdays all day and I work every Saturday. Wednesday, I have meetings in the mornings and patients in the afternoons. The two doctors never see patients at the same time, because then it gets too busy and we'd need more staff and more rooms. We want to make sure everyone gets personalized attention when they're here.

Firstly, with a new patient we take a history. The history is so critical. I really enjoy this part of my job. I really want to know what's going on with the patient. We want to educate the patients about the technology we know about to help them address their needs and make life easier for them. I start by checking the visual acuity of the patient. Then, I determine the refractive error, or eyeglass or contact lens prescription, of the patient. A lot of my day is spent educating people—I talk to them about taking care of their eyewear, cleaning their contacts, and how to protect their eyes. We choose to have a full scope practice, which means that we are helping people with the way they see and also with many medical eye health problems.

We use optics to determine the prescription for a patient to help provide corrective lenses, if necessary. In addition, we also look into eye health, so we always dilate [use an eye drop to make the pupils larger] the pupils and use a microscope to examine the eyes. I look at the retina in the eye and monitor the patient's internal eye health.

The focus of our practice is not necessarily to sell glasses, as it is for some others. We want to offer quality eyewear, but our focus is providing patient care. Ours is a more medically-driven practice than some others. Since we're a full scope private practice, we also provide some additional services. For example, we can remove foreign bodies from they eyes and also provide pre- and post-operation treatment for people who have had surgery on their eyes.

Sometimes a patient is really unhappy with his eyewear. It's usually not an issue with the medical care—usually the problem is with the price. It's not because of overall cost, it's because their insurance doesn't offer the expected coverage. We see people all that time that have vision insurance, but then maybe they get an infection in their eye, so they come to us with the problem. But this is a medical problem, and their medical insurance may not be applicable for our practice. The patient doesn't know that, however. The way we handle it is by educating the patient about how their insurance works. I try to tell people ahead of time about what they need and how much it will cost.

I help to set the tone in the office. That's especially important in a smaller private practice, because I have business and managerial responsibilities as well as the medical responsibilities. The other optometrist and I are really team leaders because our office functions as a team. I can't do this by myself. That was hard for me to grasp. I had to learn that I have to delegate tasks that can be accomplished by someone else. You cannot possibly do it all yourself, so you have to find knowledgeable and responsible staff to help you accomplish these tasks.

I went to a four-year private college and I earned a BA in biology with a pre-optometry concentration, which was similar to a minor. I took basically all the classes that you would take if you were pre-med—there was one class difference, I think. You take classes pretty heavily during your first three years and during your junior year you take the OAT [Optometry Admissions Test], which is like the MCAT for doctors.

Then I went to four years of optometry school in Chicago. During optometry school, you have to take national Board exams, which you pay for yourself. In your fourth year of school, you have externships, which means that you visit clinics so you can actually see patients, under supervision, and you don't have very many classes. If you pass the Board exams and then graduate from optometry school, you can apply for licensure to practice optometry.

Optometry school is a lot of work, and people have high expectations of you. We literally had tests every Monday. You have to study a lot. You need to be able to memorize information, but you also need to be able to process it as well. Having a biology major is a good idea—if not, biochemistry or physics majors work too.

One of the great things about optometry is that you can take it in so many different directions—commercial optometry like something you might find in Wal-Mart, which earns a pretty high salary, or a private practice like ours are just two examples of the many possibilities. After I got done with school, I chose to do a residency. You have to apply for residency because there aren't very many available. I worked at a VA hospital in Kansas City for a year for a very low salary. My residency was in hospital-based optometry, which meant that I worked a lot more on medical problems for a large eye clinic. I gave perhaps a handful of prescriptions in the year that I was there. In that environment, I saw patients that oftentimes had very advanced eye diseases. That prepared me to work for my current practice—my residency was really valuable.

I graduated at the top of my class, and I had the chance to complete a rare residency and so I had a lot of career opportunities. After my residency, I decided to take some time to figure out what I really wanted to do. At first, I didn't know if I wanted to work in a smaller practice like this, but I eventually decided that I should take the job. I was also fortunate because I had a lot less debt than many students just finishing optometry school. I'd gotten a scholarship for most of my schooling, and my husband was helping me pay my loans, so I had the freedom to decide what I wanted to do.

I decided I wanted to be an optometrist when I was five, when I first got glasses. I had a very high prescription. I feel fortunate, because I knew optometry was my calling. I feel that I was somehow given this direction at a young age, and I'm really glad for that now. Different things that occurred during optometry school really made me feel like I was in the right field. Because I feel like I am supposed to be doing this, it really makes my job all that much more enjoyable.

At the beginning of the day, I come in and look at my schedule. The staff usually has a print out of my schedule, and sometimes it has notes about why people have made an appointment. In a given day, we have a certain amount of time reserved for comprehensive eye exams [the yearly check-ups]. We have a certain number of spots are reserved for contact lenses. These are for people who need to make sure their contact lenses are functioning properly. In addition, then, we have to prioritize the more urgent care patients who have some type of eye trauma.

I also see children patients, including infants aged 6-12 months, to make sure their eyes are healthy. I spend some time consulting with specialists by sending them digital photos through email, or with other eye care providers in the area. Every so often, I do presentations about eye care and eye health in the community for other health care professionals or for schools. I also do health fairs at the local colleges to answer questions.

I have a lot of variety at work, and it's because we see patients of widely various ages— from infants to the elderly. Because I see all ages and all types of people, I get a lot of variety. Some people work in a Lasik surgery practice, and they see primarily people in their 20s and 30s who are healthy. So they won't see many of the situations we see in our practice.

We have meetings with our office team and we really get their input. There might be things happening at the front desk that we just don't hear about and don't know about, so we like to get feedback about that. Every year, we have a big meeting that we call our "Year in Review," and we discuss the statistics of our practice—what types of problems we encounter, the average age of our patients, and other similar data. We have to make decisions about insurance plans and with whom we enter into a contract. I also spend some time meeting continuing education requirements. In the state of Iowa, we have to have 50 credits in two years in order to maintain licensure. Because we write prescriptions for medications, we need a Controlled Substances Application that has to be renewed every few years.

I think I probably interact the most with my main technician, although I also spend a lot of time with my patients. The technician does the preliminary testing with patients and then tells me what she learned. Because of the way we practice, I spend more time with a patient than a lot of other doctors. Our practice is different because we have a lot more "chair time," or time spent with the patient.

I encounter so many different types of problems at work. I had a patient that was a first time bifocal wearer and he thought he was having trouble adjusting to them, and it was really much worse. He didn't know that he had lung cancer that had already spread to his brain and was affecting his visual field. His condition hadn't been discovered at all before this vision problem.

At the VA hospital during my residency, I had a patient who was seeing things that just weren't there—he told me [a female doctor] that I needed to shave my beard. I saw a woman who had had two hemorrhages, which are broken blood vessels that look like little red spots, on her eye. Because of that, we discovered that her carotid artery was completely blocked. Now she can take medical steps to help with that previously unknown condition.

Optometry is a nice career because it gives you a lot of options. Some people work 50 hours a week, but because you can really decide how much you want to do with optometry, I can work less than that. This allows me to volunteer at my kids' school and also be involved in my community. I'm lucky because I found a way to do both—work and still spend time with my kids. The only negative is that I can't be home with my kids all the time. Also, I enjoy getting to know people, learning about their personalities, and watching their kids grow up. You learn things from people—I feel like I learn something from every single patient and I love that.

At least once a week, I go to our other office in Bellevue, which is a 50-mile trip total. Also, I usually travel to meet continuing education requirements. The fun thing about that is that I can do that anywhere I was in Chicago recently, taking some classes, which is nice because I can see some of my college friends. I travel a few times a year to get those requirements done. Occasionally there's something in the area, but not very often. There are some optometrists that really only do the lecture circuit presenting to other doctors, rather than spending a lot of time with patients.

Since the advent of Lasik surgery, people ask me if I'm out of a job. I'm not worried because not everyone is eligible for Lasik. Everyone has eyes and we're all getting older. After you reach middle age, nearly everyone needs some kind of corrective lenses, especially so they can read. Many of them are still working a lot and they're conscious of just how much their eyes have to do in a day. Because so many of these people that are well-educated do a lot of computer work, they are aware that they need the best eye wear and eye care. However, there are many other doctors that work for big eye care providers whose jobs are much less stable than mine because they don't have a personal relationship with their employers.

Because I'm a part owner, I won't really earn any benefits from the business. My husband is also self-employed, so our retirement fund is really just made up of what we save, personally. I could sell my portion of the practice, eventually, when I decide to retire. At this point, that wouldn't get me a huge sum, but we try to build the practice so it will be worth more in the future. I do plan on retiring someday. I really like what I do, but I've learned that I will be ready for it when the time comes. I guess my retirement ago will be partially based on my health. That's the nice thing about optometry—you can gradually cut back on your hours and still not really be retired.

Salaries really vary based on how much and where the optometrist works. At my first job working at the VA hospital during my residency, I earned $21,000 for the year. Doctors working in fairly big OD, MD set up where you have medical doctors and optometrists working in the same setting may earn about $70,000 a year. ODs who are self-employed may earn anywhere from $100,000-$130,000. The most I've heard a private practice OD make is $300,000 a year, because the patients mostly paid privately, or without using insurance.

The baby boomer generation is maturing, and as they grow older, most need progressive bifocal eyeglasses. So the percentage of glasses that you sell that are progressive will be so much higher than the single vision glasses, like the ones kids wear.

We already do a lot on the computer, but there will be more technology coming. Medical records are going to become computerized. People will be filing their insurance forms electronically. So, people will need to be really comfortable with computers. That's really hard for a lot of older doctors.

I definitely enjoy interacting with the people I like meeting with people and talking with people. That's why I didn't want to be a surgeon, because they don't have the time to really talk to people. I also like solving problems. People come in and they tell me what's wrong, and I help them fix it. That's why I think it's so important to get all that information from a patient in their history, because it can really help you fix a problem.

It's challenging to find the right staff. You have to have someone who will represent you well. You want people that will represent the doctors and the office when they answer the phone. You have to give them enough autonomy so that if a problem arises, they can handle it and fix the problem and not have to get help from one of the doctors. But at the same time, they have to see the big picture and not let anyone manipulate them. It's hard to find those people, and in addition to that, it's hard to pay them what they're worth.

Changes in technology have affected us in a huge way. The best bifocal lenses are now designed by computer programs. We type in all the information for that. Sometimes a contact lens we're using requires a computer program as well. Digital imaging allows us to take very detailed pictures of eyes. Also, new equipment is always being developed and since we're a medical facility, we try to stay abreast of that new technology. Information technologies have affected us too. When a saline solution, for example, has been recalled, we can more easily notify our patients. We have a website which allows people to order contacts or schedule appointments. We can communicate more with our patients over the web. We have our history form online so patients can download it and fill it out ahead of time so it saves them time when they get here. We want to provide comprehensive care while still trying to save them time.

The economy does affect our profession. The cost of materials is certainly on the rise, especially the quality ones. Glass lenses in eyeglasses will not scratch and they hold up really well, but most places don't make them anymore because it's so expensive. This is just one example of quality goods being too expensive for providers and buyers. Also, people will avoid care if they cannot afford it. The rising costs of healthcare will decrease our business.

Try to do a residency if you can. Once you're done with school, you have to be prepared to be patient because new doctors will require time to build up a practice or gain experience with patients. Learning about business and marketing before you develop your private practice will be very valuable. They don't teach you about those business aspects in optometry school. They also don't teach you about coding for insurance companies, for which you spend a lot of time filing out paperwork. Learn about insurance and business in addition to learning about the clinical procedures if you can.

The best advice I've heard is that you should always do what's best for the patient. Many times I'm presented with a situation that will cost me money, but it will help the patient. You've always got to do what's right for the patient. Sometimes things just go wrong, and you still have to do the right thing. For example, the lab will make a mistake and make a pair of glasses incorrectly, so the patient will have to wait and then a truck will drive over the box while the new glasses are being delivered and then by the time the correct glasses actually arrive, the patient's prescription has changed. This is just a hypothetical situation, but it would cost me and my office a lot of money to make sure that patient still gets his or her eye wear, but that's exactly what we'd do.

You have to be able to think on your feet. If you're not going to do solely research, you have to really like people, because you will be forced to deal with all types of people. You have to be smart enough to grasp the information that you need to know to help people, and you have to be able to apply it as well. If you're a good communicator, patients are going to leave having had a better experience. You also have to be able to multi-task and work with other people who are also multi-tasking.

I think that anybody who is going into a service industry should work in the food industry, as a waiter or waitress or something similar. You will then find out how you're going to be treated by all types of people, even though you are doing your best. You should work in that capacity because you find out what life is like when you don't have holidays and you work on weekends. When I was in high school, I worked at a country club. It was hard work because members expected me to know what they wanted and how they wanted it done. Working in a setting like that, I learned how to cater to someone's specific needs or wants. If you work at a high-end restaurant, for example, it helps you learn about doing a lot of things at once.

You really have to be able to do a lot of things at one time—you have to see patients, fill out insurance paperwork, pay your staff, and meet continuing education requirements, among other things. You've got to delegate tasks and find people to help you. You have to find honest people because then you can train them. You can't train people to be honest; they have to have that from the beginning. It is also key to get experience, but also have confidence in your intellect and your education.