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Taking Time Out – What's to Lose

Melanie Kell | 26 March 2017
Taking a few years out from the practice to raise a young family, study, travel the world or dip your toes into a different career opportunity may seem to be a rite of passage once you’ve studied for years and gained on the ground clinical experience. However, have you considered the process you’ll need to go through to get back to optometry once you’re ready? It’s not as easy as many think.

Before an optometrist can return to practise after an absence of more than three years, they must submit a proposed professional development plan and a proposed supervised practice plan for approval by Optometry Board Australia (OBA). It’s not an unreasonable expectation – after all the OBA has a duty of care to ensure the competence of practising optometrists and protect the safety of patients. Anecdotal evidence indicates there are several hurdles to overcome before you can submit your application, let alone have it approved and get back to business.

Melbourne optometrist Debbie Burgess had been practising as an optometrist until 2005, in full and part time roles, when she decided to take a few years off to raise her three children, all under five. Little did she know that once she was ready to get back to optometry, it would take her five months to complete the necessary application process, then 900 hours of supervised optometry practice before she could regain full registration.

“I worked two days a week in between having children but when it got to the point that I had three pre-schoolers under five, it became too difficult to practise. I wasn’t getting enough sleep, my husband’s work-life wasn’t flexible and I didn’t have family close by to help.

“I decided to get out of practise. During that time the re-registration process changed. I was quite excited about that – I liked the idea of working under supervision before I started practicing again and I also wanted to do some further study – but when the time came to re-register, I spoke to Optometry Australia and the whole process sounded pretty impossible. I had to find a practice willing take me on and I needed to work with direct supervision in the room. I couldn’t see how, after six years, anyone would want to take me on.

“I backed off the idea and did some swimming coaching for a while before deciding to give it another try three years later.”

In the year preceding her submission to return to practice, Ms. Burgess completed 26 hours assisting optometrists with a primary school screening program, spent 68 hours observing optometrists including their practice of the skills of biomicroscopy, observation of fundus photography, OCT imaging, visual and developmental training and 14 hours examining volunteers (unsupervised) in an optometry clinic. 

When she eventually submitted her application to return to practice, Ms. Burgess was informed an appropriate period of supervised practice would be three months. She received notification that she would need to complete 900 hours of supervision over six months and see 180 patients before she could be fully registered; comprising 30 patients at level one and level two, 60 at level three, 60 at level four.

“With three children by then at school, I had just 24 hours to accept the agreement, which would require returning to work three days a week unpaid, or request an extension.”

Another optometrist, who we’ll call Ms. Lens (she preferred not to be named), faced a similar experience. “I graduated with first class honours and had three years of excellent experience in optometry with several great mentors before starting a family. When I had my baby I went on maternity leave and ended up not returning to work. We moved out of Sydney into regional New South Wales and I chose to stay at home with my daughter until she started school. I knew the Board had introduced recency of practice requirements but I didn’t expect getting my full registration back would be so difficult.”

Ms. Lens submitted her application to return to practice and waited four months to receive notification back from the Optometry Board Australia. “While I waited I spent time shadowing an ophthalmologist and two optometrists in practice, I attended the Southern Regional Congress in Melbourne, Super Sunday in Sydney, and updated my CPR certificate. I felt I had refreshed my knowledge and it was bringing back my confidence.”

After following up with AHPRA several times during the four month wait to hear word of the outcome of her application, Ms. Lens finally received a letter specifying that to regain full registration, she’d have to see a minimum of 10 patients under level one supervision then a minimum of 75 patients at levels two, three and four. Moving on to the next level of supervision would be at her supervisor’s discretion. She did not expect a hurdle of this magnitude and was given one month to respond to the Board's proposal.

With 50 per cent of the optometry workforce made up of women, Optometry Australia’s National Professional Services Manager Luke Arundel said the challenges faced by Ms. Burgess and Ms. Lens are not uncommon. He said although Optometry Australia appreciates the principle behind the OBA’s return to practice requirements, “the process is often difficult, expensive and drawn out for optometrists”.

Ian Bluntish, Chair of OBA, said the OBA’s return to practice requirements are manageable. “It’s an issue for a lot of people because they don’t think about it early enough, and then, because of the issues they have – family or whatever – and it’s not something they’ve been required to do in the past, it suddenly seems bigger than Ben Hur. In fact, it is manageable,” he told mivision.

Mr. Bluntish said the underlying premise of the requirements are set out in national law, which aim to protect the public and apply to all regulated healthcare professions. “Our role is not to look after the optometrist, we have to undertake a risk assessment of the circumstances to ensure the competence of the practitioner and the safety of the patient,” he said.

Mr. Bluntish said the Board does not have a hard and fast rule that determines the number of supervised hours or the scope of the professional plan each optometrist must comply with to regain full registration. This all comes down to the individual’s level of experience prior to taking absence from practice, his or her areas of competency and the time taken out of practice.

“There are a couple of principles involved:

“1. In determining a person’s skill levels, the first thing we rely on is their own reflective component – it’s the responsibility of the practitioner to describe, in their submission to return to practice, the areas in which they believe they are competent and those areas in which they believe they are deficient.

“2. The Board then considers circumstances around the practitioner’s absence of practice – how long the person has been away, and how long they were practicing before they took absence of practice.

“So, for example, a new graduate who didn’t work at all and took ten years off would not have had the opportunity to consolidate their early learning in a clinical setting so the requirements for that person would be greater than those for someone who had practiced for 10 years before taking three years off.”

“A plan for return to practice will include a period of full supervision followed by periods of lessening supervision and this is important because it means there is someone looking at what they do and making an assessment of the practitioner’s skills.”

Handling the Hurdles

That all makes sense and Ms. Burgess, Ms. Lens and Mr. Arundel have no question that ensuring competency and patient safety is paramount. It’s the hurdles along the way they question.

Mr. Arundel said uncertainty surrounding the level of supervision required for an individual optometrist and how long they will need to be supervised for can make it difficult to find or negotiate with a potential supervisor when developing plans prior to submission to OBA.

Having been out of practice for so many years, Ms. Burgess said Optometry Australia suggested her best option for finding a supervising optometrist would be to ask a friend. “I did this but understandably, my friend’s practice owner said the arrangement wasn’t suitable – as a commercial practice it would have taken up too much of their time. I took my CV out on the road and spoke to 50 optometrists. One of them initially thought he could take me on but, prior to completing the paperwork, changed his mind. I approached the Australian College of Optometry, Melbourne University and Deakin University then eventually I found an optometrist who agreed to take me.”

She said the biggest impediment to finding a supervisor was not being able to tell them what to expect. “The Optometry Board won’t tell you how many hours you’ll need to spend in supervised practice or how many patients you’ll need to see, so you have to get a supervising optometrist to commit to the unknown. Understandably, the first thing an optometrist asks is, “how long will I be supervising you for – what is involved?” 

Mr. Bluntish begged to differ. “The board has been surprised at how supportive practitioners are of others and their willingness to provide assistance – certainly for the corporate employers it’s not a problem. We now have Universities in Sydney, Melbourne, Brisbane and Adelaide that all have clinics so there are opportunities there. At the lower levels of supervision, it is possible for optometrists to work remotely which makes things easier.

“At full supervised level, practitioners are only seeing a few patient cases, even so, for rural and remote practitioners this may be a challenge but it’s not an undue burden.”

He said whether or not a practitioner is paid while they are working through the return to practice period is a business decision for practices and something the board has no involvement in. “The arrangements are generally that the practitioner will be seeing patients in a normal clinical setting and those patients will be paying for the services they receive, so the issues relating to provider numbers and payments are an issue for Medicare not the Registration Board. These practitioners all have provider numbers, so in a commercial context there’s no problem with being paid for the work undertaken.”

Mr. Bluntish added, “By the way the return to practice is structured we would anticipate the supervisee works in a normal way and they just require supervision.”

When mivision approached Specsavers to ask whether they have a policy in place for supervising optometrists planning to return to practice, Peter Larsen, Director of Optometry said although there was no policy, “Specsavers would be delighted to undertake a supervisory role” and that he saw no reason why optometrists would not be taken on in this capacity as paid staff.

“We offer clinical placements for young optometrists from Deakin and other optometry schools so we have a very good route and processes in place for preparing optometrists for clinical practice. The big difference here is that you’re talking about a qualified optometrist coming back into practice, so chances are they are just a little rusty on their skills. We would be delighted to talk to people who want to do it – we are always looking to welcome optometrists at all stages of their careers – our store partners need more and more of them as they open additional consulting rooms.”

Untimely Processing

Having found a supervisor and submitted a proposed return to work plan, Ms. Burgess had to forego ongoing work commitments so that she would be ready to start her supervised practice. By the time she notified her supervising optometrist that her submission was approved and a plan in place, he joked that he’d almost forgotten about the arrangement. Ms. Burgess started unpaid supervised practice on 25 January 2017 and two months later had completed over 100 of her required 900 hours.

“My supervising optometrist is a very good optometrist. He does some ortho-k and complex patient cases so my days are a mix of observing and providing consults under supervision. I’m really enjoying being back, though I’ll admit that those first few weeks were terrifying.”

She said the thought of completing 900 hours and seeing 180 patients was daunting. “As a student the requirement was to see about 110 patients so 900 hours seems quite excessive! I’d have thought a less expensive process, for all parties would be for returning optometrists to have to sit clinical and theoretical examinations so their skills could be quickly assessed and then an appropriate return to work program finalised.

“If I’d known it was going to be this difficult to step back into practice, I would have made every effort to keep my registration going by consulting for 150 hours a year.” 

For Ms. Lens, the process of getting back into practice was even less straightforward. Just as she was advised that she would need to see 235 patients, which she estimated may take a few months to complete, she was diagnosed with an illness that would affect her ability to work for six to twelve months. Having sought a six-month extension to make a decision on her return to work plan, she was given just one week. Then Ms. Lens was advised that she would now need to complete and pass an expensive health assessment. Eventually, she withdrew her application and is still considering her options. 

“While I can see the wisdom in requiring me to do supervised clinical consultations, finding a willing supervisor and putting together the required supervision plan that would fit around the needs of my family felt like a huge hurdle – one that seemed even more intense than what was required at university to gain my initial registration when I had far less experience than I do now.

“I’ve spent many years of my life and made such a financial investment in my career, I know that when I’m well again I’ll pursue getting my registration back but I don’t have the strength to go through this process at the moment. It was far more than I anticipated.”

Mr. Bluntish said most practitioners who return to practice after an absence of more than three years will undertake a period of fully supervised practice. It’s up to the practitioner and the Board to determine whether fully supervised experience is necessary – but it probably is for the majority if they’ve been out for a prolonged period.”

Professional Development Plan

A returning practitioner’s professional development plan is also an important component of their overall return to work submission and Mr. Bluntish said rapid changes in technology, disease diagnosis and treatment make this a particularly important component of a practitioner’s submission.

“We look at each practitioner’s plan and if they are attempting to update their knowledge in areas that we know have not changed during their period of absence, yet ignoring areas where things have significantly changed, we recommend the plan is amended.

“Practitioners have many resources to refer to when determining the areas they need to update themselves on – competency standards for graduates developed by the profession, universities programs, the Australian College of Optometry and Optometry Australia can all be drawn on for assistance. So while there are some procedures to go through it’s not onerous,” he said.

Centre for Eye Health provides optometrists with online continued professional development and has recently drawn on existing resources to deliver a Returning to Practice course, with refreshers in diagnostics.

“You can be out of the workforce for 10 years and get straight back to work with regards to refracting, but things move quickly in the areas of technology and differential diagnosis and management of eye diseases so it’s important that you are updated in these areas,” said Michael Yapp, Chief Staff Optometrist at Centre for Eye Health in Sydney.

“We tend to find that in particular, women who have time off to have children often keep up with their CPD points through online material and conferences however still feel like they need some updating in ocular diseases and technology both in terms of theory and practise.

“As a result, our return to work course has two components – a practical component which can be put towards supervised hours and a theoretical component which can be put towards the professional development plan.

“We did try to have the course approved by the OBA as a return to practice course however the OBA’s requirements vary from one individual to another, which makes it difficult to approve one particular course as an element of the process. It does, however, carry CPD points.”

Mr. Yapp said the Centre also worked with the School of Optometry at UNSW in an effort to help returning optometrists gain exposure to their other clinics such as vision training, myopia, red eye, contact lenses etc. “This forms part of the return to practice programme. While it would not comply with the full supervision requirements of OBA it does provide practitioners with valuable experience and help identify the areas in which they need to undertake further work and study,” he said.

Where – And When – Do You Start?

Deciding when to begin your preparation to re-enter the workforce is a challenge. Securing a supervising optometrist will take time and then you’ll be unsure of how long it will take to get your submission approved and a plan in place. 

Luke Arundel’s advice is to start before you even begin to take your leave. “My number one piece of advice would be to familiarise yourselves with these documents PRIOR to taking a leave of absence from the profession, so that you can understand the requirements that will be imposed prior to re-joining the registered workforce.

“I would also flag the poorly known fact that currently the OBA allows up to a 12-month exemption for completing CPD for optometrists holding general/practicing category of registration for short periods out of the workforce (e.g. for maternal/paternal leave), however this must be requested ahead of time by writing to the OBA. Consequently, not changing registration type for these shorter breaks can save a lot of paperwork later and still give you the flexibility of being able to do the occasional day of work. 

“If required, all state divisions of Optometry Australia have minimal practice membership categories to enable you to have full professional indemnity insurance coverage at a reduced membership fee. For longer periods of absence consider whether you are meeting the return to practice criteria to maintain general registration before dropping or swapping registration type, think ahead and start approaching potential supervisors early if you are planning to return to the workforce.

Mr. Arundel said, “Practitioners juggling family and work/life commitments can access a multitude of fantastic online or independent CPD that will help meet training plan and CPD obligations. Specific courses such as those run by CFEH can be a great jump-start to working with new technology and current practice standards… Start thinking about return to work logistics as early as possible and contact your State CEO or National office if you need assistance or help assessing your options.”

Mr. Bluntish concurred, acknowledging the advantages of working with Optometry Australia or a corporate employer to prepare a submission for return to practice.

“Developing a successful submission for return to practice is a learning curve. The Board has noticed that plans submitted more recently have been excellent, as practitioners have sought out guidelines from corporate employers and the Associations. As a result, practitioners are more aware of the process, they understand it, and they’ve read through the material, undertaken the appropriate reflection and put together a cogent plan.”

As to whether we can anticipate any changes to the return to practice requirements in the future, Mr. Bluntish wouldn’t be drawn.

“The Board reviews standards and guidelines on a regular scheduled basis and looks at opportunities to improve processes. We are in the process of updating our website to make access to information about recency of practice and return to practice more easy to find – we acknowledge that the website structure hasn’t been as easy as it could be – but as with all standards and guidelines they do go out to public consultation and they are reviewed regularly and updated based on feedback.  

Supervision Requirements for Return to Practice

Level 1: The supervisor must be physically present at the workplace, observing at all times when the supervisee is providing clinical care, as per the supervised practice plan.

Level 2: The supervisor must be physically present at the workplace for the majority of time when the supervisee is providing clinical care. If not present, the supervisor must be accessible by phone or other means of telecommunications.

Level 3: The supervisor must ensure that there are mechanisms in place for monitoring whether the supervisee is practising safely. The supervisee is permitted to work independently provided that the supervisor is readily
contactable by phone or other means of telecommunication.

Level 4: The supervisor must be available for case review or consultation if the supervisee requires assistance. This does not necessarily need to be in person.

Full details at optometryboard.gov.au/Policies-Codes-Guidelines/FAQ.aspx 

' The Optometry Board won’t tell you how many hours you’ll need to spend in supervised practice... Understandably, the first thing an optometrist asks is, “how long will I be supervising you for? '