Macuhealth

Optometrists shortage to be tackled by new degree - BBC News

In most parts of the UK there are too many Optometrists and salaries are falling every year - I know several who now earn half what they earned twenty years ago!

30000 pounds per year is not unusual, and they are expected to see more and more appointments - often 20 or 25 per day. This is probably why many are now leaving to retrain in another job.

The giant optical companies have deliberately forced down salaries. Refraction will probably be deregulated soon leading to some Optometrists working for even lower wages as refractionists, while some upskill and take on more medical responsibilities.

If an 18 year old has the grades he or she can earn much more in other professions, perhaps this article reflects forward planning for this eventuality.
 
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Christopher Gould said:
In most parts of the UK there are too many Optometrists and salaries are falling every year - I know several who now earn half what they earned twenty years ago! 30000 pounds per year is not unusual, and they are expected to see more and more appointments - often 20 or 25 per day. This is probably why many are now leaving to retrain in another job. The giant optical companies have deliberately forced down salaries. Refraction will probably be deregulated soon leading to some Optometrists working for even lower wages as refractionists, while some upskill and take on more medical responsibilities. If an 18 year old has the grades he or she can earn much more in other professions, perhaps this article reflects forward planning for this eventuality.
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I think Dr Gould has a good handle of what is in store for ODs in the USA
 
Kent Jensen said:
I think Dr Gould has a good handle of what is in store for ODs in the USA
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Europe seems highly entrenched and controlled by big optical. I have seen it in Britain and in Italy. BO dominates the landscape. We have seen the same dominance by BO spread across the U.S. to very near monopolistic control.
 
Christopher Gould said:
In most parts of the UK there are too many Optometrists and salaries are falling every year - I know several who now earn half what they earned twenty years ago! 30000 pounds per year is not unusual, and they are expected to see more and more appointments - often 20 or 25 per day. This is probably why many are now leaving to retrain in another job. The giant optical companies have deliberately forced down salaries. Refraction will probably be deregulated soon leading to some Optometrists working for even lower wages as refractionists, while some upskill and take on more medical responsibilities. If an 18 year old has the grades he or she can earn much more in other professions, perhaps this article reflects forward planning for this eventuality.
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Could you expand upon why wages for ODs are so low in England? Are most ODs employed directly by opticals? Are reimbursements too low? Too many ODs and not enough patients?
 
Mike Ware OD said:
Could you expand upon why wages for ODs are so low in England? Are most ODs employed directly by opticals? Are reimbursements too low? Too many ODs and not enough patients?
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If I recall it also isn't the same amount of training is it? Scope is quite a bit less perhaps? (Which is interesting because I read in some areas they have nurses doing the intravitreal injections.) I think their physicians average quite a bit less as well with the NHS.
 
Scott Caughell said:
If I recall it also isn't the same amount of training is it? Scope is quite a bit less perhaps? (Which is interesting because I read in some areas they have nurses doing the intravitreal injections.) I think their physicians average quite a bit less as well with the NHS.
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Optometry in England is a three-year post-secondary (no undergrad required) bachelors degree with one year clinical practice called pre-registration. I'm uncertain just how supervised that year is, I think it is not very supervised.

I believe that the degree is four years in Scotland.

Scope of practice also varies, generally prescribing of drugs requires additional post-graduate training, although I believe that the Scottish graduates already have this. I could be wrong about a lot of this!
 
Partly correct, partly not. The pre-registration year is supervised - you’re working in practice with a designated supervisor and have to pass tests as you go along (a bit different now from when I did it when you just had a multi part examination at the end). Scope of practice is the highest in Europe - and not very different from many parts of the US.

You are correct that there is an “independent prescribing” qualification which allows you to prescribe medications for more complex eye conditions but any qualified optometrists has access to a restricted formulary.

The only things you can’t prescribe with that qualification are controlled drugs (narcotics basically) and non-parenterals- ie anything that isn’t a tablet, eye drop, gel, cream... and that includes injections. All intravitreal injections are done in hospital here as far as I know - some are administered by nurses and optometrists but they are all technically prescribed by a medical doctor.

The IP qualification is much more prevalent in Scotland as there has been funding for a few years now - and the University in Glasgow, which is currently the only provider of an optometry degree in Scotland, is looking to include the classroom based elements of that course into the degree program - basically you do the course part time over a year or so then you have to do a placement for practical experience and then pass a written exam. If that idea is fully realised then those new graduates would be able to go straight to placement as they’ve already done the theory.

All training in the UK is different - if you want to be a medical doctor you can start at 18 and it’s a 5 year degree - we just don’t have the same system as the US (which always felt like a racket to me?) of having to do an ordinary degree first then specific training.

The salary info people have posted is pretty accurate. £60k would be a pretty good employee position. I have heard of newly qualified optometrists being offered nearly half of what I got in year 1 - and that was nearly 20 years ago (and not after inflation - but literally the same amount which obviously goes a lot less far).

I don’t know all of the reasons for this but some will be the expansion of large corporate practices and some is the fact that many examinations are funded by the NHS - in England the fee is very poor and has risen way behind inflation for 30 years. That hasn’t been helped by significant cross-subsidy in that many practices provide an eye examination at little or no cost and that obviously devalues it - I have a long facetious list of patients who balk at paying a small fee for something when they are eg a hairdresser and charge crazy amounts for things like a dye job which is accepted.

Scotland, Wales and Northern Ireland have much more advanced structures (due to healthcare being devolved to the constituent parts of the UK) which pay better and allow things like monitoring or treatment of conditions in the community - where in England this is patchy due to local commissioning and in some areas this leads to everything just being referred to hospital as patients don’t want to pay privately. These systems are cost effective for the government, good for the patient (especially in rural areas where they may be hours from a hospital) and make the job much more interesting.

It is true that there are shortages in certain areas - generally far from university departments. There have been a number of new courses started in the last few years but I don’t think it’s been long enough to known if that has helped. Anecdotally over the years people have stayed fairly near where they qualified - and if we’re back to salary it probably isn’t enough to make it easy or worth it to move significant distances.
 
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