Ever wonder what optometry looks like across the world?

Join Bethany and Hasnain Mamdani, an optometrist from the UK and host of the Optics Room Podcast in the first of a two-part special as they dive into a discussion comparing the life of an optometrist in the US and the UK to find out what we may be able to learn from each other.

Discover why becoming an optometrist requires a unique journey on each side of the Atlantic, and how differing patient expectations and healthcare systems play a significant role in shaping the profession. From pricing strategies to clinical practices, we’ll delve into the fascinating international web of optometry and identify ways to improve eyecare no matter where you call home.


September 6, 2023



Read the Transcription

Becca Starks: We have the ear with the students to hear what they’re looking for. They’re very, very few students that we’re working with, with the class of 2023 that will even consider an opportunity that is not private practice.

Dr. Bethany Fishbein: Hey, I am Bethany Fishbein. I am the CEO of The Power Practice and Host of The Power Hour Optometry Podcast. And I just want to first congratulate all of the new optometrists graduating this week from the optometry schools across the country. It’s such an exciting time. It doesn’t feel like that long ago since I and my classmates at New England College of Optometry in 1997 graduated. It goes fast. It’s really an exciting time. So congratulations, first of all, and this show is inspired by and dedicated to you and all of the people that you are hoping will hire you. Once you get your licenses and get out there into the world. So I’ve invited a guest, I have Becca Starks, Becca handles Enterprise Accounts and Operations for KMK Careers. And she’s here to help me sort out some of the things that today’s optometry students are looking for, and help educate some of the optometrists who are looking to hire young optometrists about misconceptions they may have or differing perceptions of this graduating class. So, Becca, thanks for doing this your second podcast ever. That’s awesome.

Becca Starks: Yes, thank you for having me. This is exciting. 

Dr. Bethany Fishbein: Yeah, thank you. It’s an interesting time because we work with mostly established optometric practice owners. So most of the people that I’m speaking to day to day are employers of young optometrists, and they have this vision of what today’s graduates are like, and then I get the opportunity to speak with optometry students and recent grads and they’re not necessarily like that perception at all. So hopefully, you can help us bridge the gap a little bit.

Becca Starks: Yeah, absolutely.

Dr.Bethany Fishbein: So, talk about yourself for a minute here. I want you to just talk about KMK and KMK Careers because when I want to data on students, I knew you were the one to go to. And so I want all of my listeners to understand your involvement with young optometrists today. 

Becca Starks: Yeah, absolutely. So KMK for those that don’t know KMK’s foundation is the KMK board review, which was started 18 years ago by Dr. Kyle Cheatham. And now fast forward 18 years we are inside of all of the 23 optometry schools nationwide. We have a team of optometrist instructors that traveled to all of the schools and we have a relationship with both third and fourth-year optometry students and 98, This is a big number to remember 98% of optometry students utilize KMK to pass their boards. So essentially we have a relationship with almost every single optometry student nationwide from the board’s perspective. And so we now have a new division of KMK specifically on careers which is just a natural extension of supporting those same students and finding their first career.

Dr.Bethany Fishbein: So you’re initially talking to these students when they’re students studying for boards. And then they hopefully pass boards and you know, move on and take more boards and pass those and move on. So what are the services that you’re providing for these students once they’ve graduated as doctors?

Becca Starks: Yeah, so it’s really fun. Personally, I am mostly an employee you’re facing so those that are looking for these candidates. However, we have a team of career advisors and all day long, they’re the luckiest ones in the world. They get to speak to these upcoming grads. So right now they are around the clock talking to those that are about to graduate here and a couple of weeks or maybe have graduated just recently. And uncovering what they’re looking for in a practice is really it’s a one-on-one relationship, so it’s totally free to students. They sign up to get a career advisor. They have calls with that career advisor to uncover what are they looking for what type of practice is it specific specialties, just anything that may be the true motivating factor as to why they want to go to a certain practice. And then essentially we play matchmaker so the career advisors speak to students all day long. I speak to employers all day long, and then we come together and get to build a bridge between the two and hopefully connect great candidates with a great opportunity.

Dr.Bethany Fishbein: Maybe it’ll be the next Netflix show after Indian matchmaking, Jewish matchmaking. It’ll be optometric career matchmaking. And be a celebrity.

Becca Starks: I think some of us would watch that, at least your listeners would probably enjoy that.

Dr.Bethany Fishbein: My husband and I would watch it so 

Becca Starks: same. 

Dr.Bethany Fishbein: So I mean, you’ve got a line of sight into exactly who today’s optometrists or today’s graduating class, today’s brand new optometrists are, can you give some facts and figures of what that class looks like?

Becca Starks: Yeah, so essentially, from a demographic perspective, it’s highly female. The data is showing 70% female and 30% Male.

Dr.Bethany Fishbein: 70?

Becca Starks: 70 Percent.

Dr.Bethany Fishbein: Wow. 

Becca Starks: Yes. And there’s information I believe you are going to be able to put in the show notes. But there is a really robust report. I believe it’s lots and lots of pages. I don’t remember how many but there are highlights within that on pages nine and 10 that give a really good but really quick summary of demographics of this class, within gender within race. There’s even financial information about how many needed to have financial aid, that sort of thing, and some really detailed information even about by school breakdown.

Dr.Bethany Fishbein: Are you able to roll through some of the things in there that kind of stood out to you?

Becca Starks: So the biggest thing that stands out to me is female and how as you it shows kind of year over year how that transition has changed from much more female than male as it was in the past. Same thing with race, I believe I don’t remember how many years ago it was but just not too long ago. It was predominantly white for professionals graduating and now that’s shifted to highly other races, whether it’s Asian or black or other races that are included in that.

Dr.Bethany Fishbein: And what about the financial piece? Because I feel like that’s such a big topic for new doctors. Is this need to pay back student loans? Do you have any stats on the amount of debt that students are graduating with? 

Becca Starks: Yeah, so the report itself shows 85% of students are utilizing some type of support financial aid, loans, and the average for a graduate right now graduating is about $200,000 in debt. So definitely it is.

Dr.Bethany Fishbein: That’s just from optometry school or that’s including undergrad debt?

Becca Starks: That’s actually a good question. We just get the stat of 200,000 and I assumed it was just optometry school. But that’s a good question.

Dr.Bethany Fishbein: So young, female, and any change in like age demographic? Or is it typically right out of college a year or two out of college starting into Optometry?

Becca Starks: Yeah, So typically, it is kind of a typical route straight out of undergrad and to optometry school. There is about of the 16-1700 graduates there are about 150 of those that are considered you know, like other avenues whether that would be part-time or returning back in at a later point in time.

Dr.Bethany Fishbein: Okay, so out of 1500 you’re talking about? Very typically, right? 1000 young, female, probably non-white doctors. 

Becca Starks: Yeah. 

Dr.Bethany Fishbein: If you had to say this is what’s typical. This is the majority. 

Becca Starks: Yeah. 

Dr.Bethany Fishbein: With debt?

Becca Starks: Yes. A lot of it. 

Dr.Bethany Fishbein: Okay. So, when you talk to this typical doctor and are getting into the field of matching into a career of their dreams, what are they telling you that they want? 

Becca Starks: Yeah. So it’s been interesting to learn that so the things that I came into this thinking people would want my background was actually at LinkedIn for five years before coming on to help launch this division of KMK and I thought it would be very different. I would think pay would exceed everything else. But, interestingly, location is the top deciding factor for these new graduates in determining which practice they want. Obviously, that is the hardest answer because no one can do anything about the location of their practice. But we can touch on this later. Kind of some ideas and tips for those to try to recruit folks into harder locations but definitely the location. Again, before and above pay even this work-life balance coming into play that is much more of a topic. Then I think it has been in years past. Not necessarily meaning, Hey, I want to come in and I want to never work. But this generation is much more just passionate about having that work-life balance of the work to live not live to work mentality. And so location, work-life balance, obviously pay, and structuring pay in a way that is understood to the candidate as well too. So being very upfront about what that pay is so that they know before even applying and putting that in a way that they understand what they actually can make because sometimes it can be hard with percent of production, knowing what that means.

Dr.Bethany Fishbein: So let’s go into those a little bit more and I want to just go back one to work-life balance because I think that’s probably the biggest misunderstanding between a doc maybe in their 50s and a doc in their 20s. This idea of working to live instead of living to work and it’s respectable and it’s necessary and mental health is important and it’s and life has to work for you. But these older docs, that was not their world. And so when I hear it, it’s complaints. They won’t work weekends, they don’t want to put in 40 hours. They’re asking for a four-day workweek. They’re like it’s coming across as we’re lazy. We’re not dedicated to the practice. We don’t want to be here we’re not going to work as hard as you and it. It creates a disconnect from the start like somebody interviewing, who says I don’t want to work every weekend. All of a sudden has all these judgments thrown on them that they probably don’t deserve. Do you see that with the docs that you’re talking to and you’re matching?

Becca Starks: Oh, absolutely. Yeah, it’s the same thing I hear to have. You know, that’s typically the demographic of employers that I’m talking to all day long to have, you know, they came out and maybe cold started or they came out and bought a practice and they’ve been doing it for 20-30 years and like. What?

Dr.Bethany Fishbein: Right and they remember, or maybe they’re still working 70 hours a week and they’re there, you know, every day in the practice and their day off there when the cleaning themselves because that’s what the owners do. How do you coach of 50-something and 60-something-year-old practice owners into understanding that it’s not laziness and it’s not to they don’t want to work?

Becca Starks: Yeah, so that is it is a big misconception of the students that it is laziness, and specifically, most students are expecting to work at least one to two Saturdays a month. So it’s not that they’re coming in and saying I only want four-day workweeks, and I’ll never work a weekend. They are expecting a true full work week and one or two Saturdays per month. To your question about how to coach an owner in that situation. I think it’s just taking a step back and looking really high level at your practice as a business and I’ve had this conversation with many owners of I don’t know why we are open Saturdays, honestly, we’ve just always done it and so determined are we doing this because it’s just always been done or when determining this because it is a true business need. And so same thing with later hours or that sort of thing. If it is a true business need 100% voicing that to a candidate that’s a friend and that’s that’s great, but there may be situations where again, it’s just we’re doing this because it’s been done forever. And actually, our patients wouldn’t mind if we didn’t have a late night or we had a late night instead of a Saturday or vice versa.

Dr.Bethany Fishbein: Do you think docs have like a little bit of that? It’s like that hazy mentality? Like I went through it I put in my time therefore you you need to.

Becca Starks: I think it could be a little of that. Me not being an optometrist. I have to tread lightly because I have not earned my dues. But in the conversations that I’ve had, I think it is a little bit of that at least.

Dr.Bethany Fishbein: Yeah, I worked weekends for 23 years. I’ve never missed it Saturday. I’ve never called out sick. And now I’m going to change my whole practice because this 24-year-old kid doesn’t want to work, like there’s that so what are the students are the new grads thinking about these practice owners, doctors who are in a different demographic from them because there’s got to be misconceptions going that way also.

Becca Starks: Yeah, I don’t get to hear a ton of the misconceptions from the student side. But I think there’s just both sides can teach each other something right like maybe that student can come in and show this business owner who’s been doing this forever, like, wow, I could totally do this differently. And, wow, I’m kind of relieved that you came in and brought up the idea of work-life balance because I as the business owner, really needed that, and wow, my life is different because of it and vice versa. There’s obviously so much that the practice owner can teach and pour into these new grad optometrists. But as far as misconceptions from them, I haven’t heard any to be honest. 

Dr.Bethany Fishbein: I hear that they look at a private practice. They think they’re not going to be paid as much. So they’re thinking that not necessarily that the owner is cheap, but that it’s not. It’s not as profitable, therefore there’s not as much money in it for them. You didn’t mention the mode of practice. You talked about location, work-life balance, and pay. Are students coming out looking for commercial opportunities? Are they looking for private practice or looking for MD offices? I mean, obviously, students are looking for each of those, but what are you seeing most frequently?

Becca Starks: Yeah, great question. So motor practice is very important and private practice remains. Top of the list for I’d say close to 90% of the new grads.

Dr.Bethany Fishbein: Serious?

Becca Starks: Yeah, because I hear the same thing. I hear a lot from private practice owners that say that almost come to the call with me very nervous, like “Becca, what’s going on? Why might all the new grads want private equity and why do they want retail? And can I really afford to hire them? Because it sounds like they’re throwing all the money in the world with them.” And then it’s interesting because we have that ear with the students to hear what they’re looking for. They’re very, very few students that we’re working with, with the class of 2023 that will even consider an opportunity that is not private practice. So there’s just a handful of folks that have said all maybe look at private equity or retail, but the vast majority say I truly, truly, truly want to private practice and there’s even a really good group that says, “Not only do I only one a private practice, but I already know that someday I want to partner slash buy this practice as well.” 

Dr.Bethany Fishbein: Do you think though that it’s, it’s like self-selecting a little bit because retail opportunities are so easy to come by? That they might not even consider needing to work with a company like yours? They just need to go on Ziprecruiter, Indeed, and type in optometrists job and the geography they want and they have their choice. Are you talking to them before they’re job-seeking?

Becca Starks: Yeah, so we actually start a process with them a year before they graduate. And so we have them fill out a profile with us it looks just like a LinkedIn profile, but it’s specifically for KMK, and go in and select all of the different types of practices that they’re open to. And so, we have both from the data from what they input on their profile and then they all have a one-on-one call with a career advisor as well. And so that’s where those points come from, both in the data they enter and then the conversations they have with a career advisor.

Dr.Bethany Fishbein: And is that when a student should be starting their job search is early in fourth year?

Becca Starks: Yeah, so we were really surprised in the timeline as well that a lot of students start having conversations about the fall before they graduate. So this class of 2023 they were starting interviews, October timeframe, and then a lot of them were during their Christmas break, timeframe holiday break, going on visits to practice owners. And then as soon as the New Year transitioned over there were many that were in contract. So definitely, Fall time is like you can feel good. About yourself being ahead of the game, wintertime is still very safe, you still have a lot of opportunity to be reaching out to candidates, and then as we enter into more of the springtime, a lot of I’d say probably half if not more of those that we’re working with are 100% in contract ready to go.

Dr.Bethany Fishbein: When you start working with them. Is there any issue with students who are starting the search and still haven’t passed their boards or won’t have the credentials to work when they graduate?

Becca Starks: Yeah, Yep. There is information from ASCO also about passage rates. And it goes into detail even of school by school, but it essentially shows year over year the decrease in passage rates, and I think we’re at about 70% passage rate, right now. 73%. And so there’s a huge population of students that don’t pass typically it’s part one where the struggle is and so there are some students that will even graduate and still have not passed boards. And another misconception there is, “Oh, these students are lazy or they’re not understanding the information, and I don’t want those students because they won’t be good doctors”. And completely not true. Those are students that could either be not very good test takers. These are also the population that came into optometry school right in the heart of COVID. There are some that have just had really rough life events around the time that it is to take boards and so but they are all great people that will be great doctors, they simply just need to pass this test. Many of them have had really great GPAs some of them have other degrees that help them with the practice management side and so it’s just a matter of getting past that one test or many of them.


Dr.Bethany Fishbein: And how does, how did they navigate that with the job contract like, will an employer sign something with a student who hasn’t yet passed boards?

Becca Starks: Yes, we are running into that actually part one. Board scores were just released this past week. And it was a lot of that there was a lot of celebration and there was a lot of sadness around those that didn’t pass. And the good news is, I don’t know that I’ve come across a single employer partner that we work with that isn’t at least open to the idea of bringing on someone that’s graduated in kind of a super tech role. It’s kind of how we position it to practice under that optometrist owner until they graduate and we even have some that say, “Hey KMK I know that you, as an organization, do great at coaching them and helping them after they fail boards.” I will even invest in that side of the house to ensure that they can pass boards not only to show that, hey, I believe in you and the hardest time in your life student but also that gains them a really loyal employee that again, is going to be a great doctor has just had trouble taking this one test.

Dr.Bethany Fishbein: Coming in as a super tech though, obviously, they’re coming in at a lower pay scale and they would come in as an optometrist, and they have those student loans. So let’s talk about compensation of obviously it’s going to vary around the country and regionally and how many hours and all of that but what is it that a new OD is looking for as far as the ability to earn money?

Becca Starks: Yeah, good question. So, specifically with this new grad population, the way that I kind of coach, the employer partners that we work with private practice owners is, a lot of times they’ll come into the call and say why pay 16% of production, but with this new grad population, they aren’t able to really wrap their brains around what that is, you could have a $1.5 million, your practice and they still just don’t, they can’t really understand that. And so the recommendation that we give is to at least have some sort of salary and we have information and concrete data on specific areas of the nation. So by all means, if, if we can support you in any way with that, I’m happy to to make sure that you’re competitive, but having some type of salary listed up front is what’s going to entice these new grad population because they can wrap their brains around 140,000. They can’t necessarily wrap their brains around 16% of production. And so totally understand, then obviously the argument private practice owner, I hear you what’s going on in your head is. “Well, I need to motivate them to work hard. Like if I just give them a salary, then what’s the motivation to work hard”, and so there’s been kind of this really nice avenue that we’ve taken with a lot of partners that’s worked well in that advertising a salary a little higher than you probably would have normally, but then decreasing to a really low percent of production, so that there’s some salaries that’s there that’s enticing to a new grad, but a lower percent of production. So for the first year only, so year one higher salary and lower percent of production, and then having that shift for year two and year beyond your two to a lower salary, higher percent of production. And so what that does is again, entices this new grad to apply, and even want to learn more about your practice because there’s a salary, but that little bit of percent of production will get them to realize in their first year of working well. I’m doing the math, and if I would have went on the percent of production, I probably would have made more than my salary. This is making sense this is motivating me to work harder. And then again, you can even have it in the contract that upon year two that shifts to a lower salary that’s guaranteed and a higher percent of production. So as they’ve gotten their feet wet, they’ve learned they’ve been mentored that first year shifting then into percent of production.

Dr.Bethany Fishbein: So you’re coaching your doctors to do a salary plus a percent of production?

Becca Starks: Yeah, that’s pretty typical. 

Dr.Bethany Fishbein: And what about benefits and stuff like that is that important? Yes, it is important. Is that something that a brand new grad is going to give enough importance to that it’s going to help them decide one place versus another? 

Becca Starks: Yeah, such a good question. So I’ll give both sides just agree very important. I would say the majority of private practice owners that we’re working with are offering some sort of benefits, whatever that might look like. Some are very comprehensive, some are very “Hey, we will pay 50% of your medical and leave it at that.” But now that we are in this lane of there is competition from private equity and from retail. Those are just a no-brainer. In those avenues. And so to remain competitive from that regard. They will get a full package of 401K’s with matching with benefits with PTO, all of those things, if they’re considering a retailer or a private equity opportunity in comparison to your private practice opportunity. And so, again, I think most I talked to very few that say “Hey, I’m just percent of production and I don’t give any days off you just you if you’re here you make money if you’re not, you don’t but you can take whatever days you want type of thing”. I have a handful of those but for the most part, most private practices are offering the salary with percent of production, at least something towards medical, and then most do have a 401K whether there’s a match or not with that.

Dr.Bethany Fishbein: Are there other intangible benefits, other things that would make a practice more attractive?

Becca Starks: Yeah. So I think the thing that’s so such a great opportunity with all of the listeners that would have that are trying to hire than our private practice owners that have been doing this for years to a new grad specifically is mentorship. And so those that are willing to do that are excited about that. Well, maybe “Hey, I haven’t really even thought about that. But I’m gonna share over the last 20 years, I really have learned a lot that I could pour into this next upcoming generation”. And so being very vocal with that, even in a job description, or whatever it is that you’re creating, to entice candidates to come your way and some people put a really extensive plan behind, “Hey, we have a weekly meeting, and you get lunch hour with me every week and we will cover XYZ and some it’s kind of informal of just “Hey, I’m going to be with you I’m alongside you. You can call me when you want”, whatever that looks like, or even if you haven’t, some team members that are fairly recent grads, being able to vocalize that to have hey, we’ve got folks that I brought on board as new grads and couple years later looking them go and so the mentorship side is again that intangible free opportunity that I think a lot of people don’t even necessarily recognize they have the ability to give.

Dr.Bethany Fishbein: Is it mostly clinical mentorship they’re looking for? is it practice ownership? like when you say mentorship, what are they hoping to learn from you?

Becca Starks: Yeah, definitely medical at the top of that, but there are again, those those candidates that just know that they know that they want to be very involved in the practice management, the business side of the house. And so for those candidates that are interested in it, being willing to say “Hey, here’s I’ll show you all of our programs and all of our software and how I design the day and this is how I designed the business side of the house”, and so in those situations for folks that are interested in that side, I think it’s important to have just kind of an open door policy of “I’ll show you all that. I’ll show you that number. So I’ll let you in on this.”

Dr.Bethany Fishbein: So for practice in a particular geographic area, if you can get your salary and benefits close, but they don’t necessarily have to be higher. They just have to be within range and you can kind of check off all the other boxes. Is there a type of practice like heavy medical versus refractive versus specialty that people are looking for?

Becca Starks: Yeah, so definitely looking at highly medical. And then what I would also say is kind of another somewhat intangible, but if practice owners are open to new specialties that maybe you don’t have in your practice right now. But hey, if there’s somebody who comes in and is passionate about whatever it may be, and they want to bring that into my practice, that’s a really enticing thing for a candidate to really see themselves. They’re in the long haul of “Wow, I’m passionate about myopia management and this practice says, by all means bringing that on.” That’s such a great thing to be able to offer to a candidate and so definitely, medical and specialties are really where the candidates are wrapping their brains around of how do I see myself there.

Dr.Bethany Fishbein: And what if you’re in rural Wisconsin, where there’s just not a huge population of optometrists looking to settle? What’s the best way for a practice like that to set themselves up to find somebody to join because so many of those are great opportunities to become part of a community to ultimately partner buy a practice have a really low cost of living like it’s how do they make themselves attractive or show how attractive they are I guess I should say.

Becca Starks: Yeah, and I think that so often because I get the luxury of talking to these practice owners in some of these more rural areas. And every time I’m just like, Wow, if I could just record this and let all of these candidates see this owner care about the type of patients they get to see a lot of times it’s the smaller communities that because there’s not a nearby ophthalmology or another office like those are the most medically focused practices. 

Dr.Bethany Fishbein: Absolutely. 

Becca Starks: Yeah. And so, so often I feel better. Oh my gosh, if I could just package this up and get a candidate to truly wrap their head around it. So one of the things that we do on the candidate side is our current advisors do as soon as a student comes in and says, “I only want Miami in New York and LA”, we try to mentor as well and show your kind of cost of living and let’s truly take a look at this and let’s look at your lifestyle and look at

Dr.Bethany Fishbein: Miami, LA, how about rural Wisconsin?

Becca Starks: Right? Yep. 

Dr.Bethany Fishbein: And consider Minnesota.

Becca Starks: Exactly. We play that game all day long. Yep. And then to the practice owners, a lot of what I tell them is, they’ll tell me I say they get to brag. So give me your brag book, when they come on as a partner to me, tell me what’s so great about your practice. And then they’re typically ready to end the call and I say, “Okay, based on your area, we also want you to brag on the geographic location just as much as the opportunity and so getting a candidate to truly understand what their life is going to be like, not just when they’re at work with you all day, but once they leave work, and what does this community look like and what can I do there? Is it great for hiking, is it great for the music scene, and the art scene? Is it great to raise a family and maybe I’m not thinking about that right now. But in the next couple of years, I will be.” And so I always say “Somewhere in your job description, however, you want to do it. It’s a post that you’re putting on to kind of an Indeed or an AOA. Having information, just typed information about your geographic area and what makes it so great. And then also, the other added thing you can do is you can always create videos.” Videos are I feel like that’s kind of how we’re all digesting content at this point. And especially this generation of these new grads, and so if you can even do a quick it doesn’t have to be professionally shot but videos of you just speaking informally, almost as if you’re speaking to a candidate who wouldn’t be right in front of you talking about again, envisioning their life there, the more that a practice owner can make a job description or job post about the candidate instead of themselves. The better that that’s going to relay to the candidates have just really getting to understand “Okay, this isn’t what I thought I was thinking Miami, but now I can kind of envision how my life could be in Wisconsin.”

Dr.Bethany Fishbein: That’s a really strong and valid point. Because when I think about a job ad, it’s all about what we need and what we want. We’re looking for an optometrist to work these hours to do this and when I’m interviewing candidates for Associate optometrist, but really for any position I’m always sensitive to an applicant, who all they’re telling me is what this job is going to do for them. Right. So I’m very critical of it as an employer when they’re like, I’m looking to build my clinical confidence in myopia. I’m looking into, you know, whatever. And I think what are you going to do for me? But in the ad, maybe it should be the other way off, Here’s what I’m going to do for you so that they’re interested and intrigued by the post enough to then come in and want to tell me what they are going to do for me so

Becca Starks: Absolutely 

Dr.Bethany Fishbein: Cool. 

Becca Starks: We even have one it’s a Power Practice member that wrote a personalized it looks just like a letter you would receive from your grandma in the mail and it was so different and so eye-catching and so engaging. It was truly just a personalized letter, Dear Candidate, and then it just spoke really informally like, Hey, I get it. Words are hard, school is hard, but here’s what it would be like living here. Imagine if you could leave work and go out and do this, this, and this and your two hours within this big city so you can go catch a basketball game and be back home at night. And so it was just very, again trying to get that candidate to envision their life not only with that practice but in that geographical location. And so that was an incredible example. 

Dr.Bethany Fishbein: Did it work?

Becca Starks: We’ve gotten some interest. We don’t have anybody signed on yet, but it has enticed interest.

Dr.Bethany Fishbein: And talked about KMK a little bit again, just before we close. So if a practice owner is looking for an associate, they can reach out to you or how do they go about tapping into this database network matching service that you guys have?

Becca Starks: Yeah, absolutely. Yep. I would be the point of contact Becca Starks. And I’m sure you can put my email in the show notes, but it’s just Becca@kmkodcareers.com. And yeah, we typically just do a really informal introductory call and learn about the practice, learn about what they’re looking for. And then go over kind of our offerings. We’ve got two different offerings to choose from, just depending on what the practice owner is looking for. And then yeah, we just go from there. It’s really simple. It’s free to be in agreement with us and having us promote a practice. And so basically, we get that agreement going and then our current adviser starts promoting any of our partners that we’re working with. And then essentially once we have a student that is a great fit, we play the matchmaking game. 

Dr.Bethany Fishbein: I love it. Thank you. I think this is valuable information for new grads to help them understand what they’re going out into and some of the misconceptions they might be facing. But hopefully, we did our part today to try and reduce some of those and really give today’s employers a more real picture of new grads who are looking for jobs. So thank you so much for taking the time to do this and give this service to all of the optometrists out there.

Becca Starks: Absolutely. My pleasure, Bethany. Thank you. So much. 

Dr.Bethany Fishbein: Thank you


Read the Transcription

Hasnain Mamdani: It’s quite a retail background over here as well. So we see a practice as two parts, clinical and retail, and they go hand in hand. And the model is such where they really complement each other. And patients who come in know that already, so they come in expecting to buy glasses.

Bethany Fishbein: Hi, I am Bethany Fishbein, CEO of The Power Practice, host of the Power Hour Optometry Podcast. And I’m here with Hasnain Mamdani to record a part two of a two-part podcast that we just recorded part one over on his podcast, the Optics Room Podcast in the UK. So Hasnain, thank you for doing this. This is interesting and fun.

Hasnain Mamdani: Yeah, Bethany, thank you so much for having me on. Part one was amazing, and I’m sure part two will be just as good. Can’t wait.

Bethany Fishbein: I hope so. You set the bar pretty high, so…

Hasnain Mamdani: Nice. It’s amazing what we can learn from each other, and we don’t do it very often. And I think it’s needed more.

Bethany Fishbein: Yeah, it’s really been an interesting journey for me as I started to learn about optometry in the UK. And being from the US, I think I pretty much fit the stereotype of just assuming that we were the center of the world and not worrying too much about what anybody else is doing out there. So it was a little bit eye-opening for me to even learn how different the optometry education is in the UK. Talk a little bit about how you guys define an optometrist.

Hasnain Mamdani: An optometrist here is very simple. We take history and symptoms. We do a health check. Essentially, we don’t treat any health problems. We refer them on to a more of a screener than the treater itself, depending on the severity of the condition. So if it’s something like a scratch on the eye or a foreign body where we can take it out, we’ll do that. If it’s embedded into the cornea, we’ll probably refer them on unless we’ve been given the right training. So there’s lots of different courses that we can do once we’re fully qualified from university that we can upskill in.

Once we do those courses, we can then treat patients in practice as well. So it’s not part of the university course, but there’s lots of courses after that that can help enable us to do that as well. And then if we work in a high street practice, then refraction is a big part of what we do, as well as recommending what eyewear they need at the end of the day that’s suited to their lifestyle, their needs, their occupation.

So it’s more of a whole rounded approach, but the health aspect of it is coming very soon and very quickly. And it already has in the last couple of years, especially since COVID.

Bethany Fishbein: To become an optometrist in the UK, what is the education?

Hasnain Mamdani: The education, you need an undergraduate degree in optometry. After that, you do a pre-reg placement. So you work in practice for a year under supervision. Once you’ve passed that year, which involves several assessments, it’s actually, it was the hardest year of my career so far, because you’re working full time and you’re learning and you’re studying as well. So it’s very hard. And then after that, you’re fully qualified.

Bethany Fishbein: So in that undergraduate optometry education, is there a clinical side to that where you’re in clinic or in labs learning to do the testing and all that?

Hasnain Mamdani: Yeah, that’s a really big part of it. So it’s a three year degree. In the second year, we start testing on each other. In the third year, we actually see real patients within the university compounds. The university has a clinic. Most universities have this clinic across the UK. There’s eight or nine. And then you get patients from outside coming in and you test them under supervision as well. One thing that’s been added to universities very recently is the inclusion of a master’s degree alongside your undergraduate. So that optometrist will come out with a master’s and not just an undergraduate degree, which is very, very good. But the model is somewhat shifting in the UK. I feel towards a more clinical side now, because people have realized that refraction can only get you so far, especially in the new age of technology.

Bethany Fishbein: In that three year undergraduate degree, are you also learning general education topics or is it fully focused on optometry?

Hasnain Mamdani: So in the first and second year, you have to learn the background to the eyes, essentially. So there’s a lot of biology, a lot of cranial nerves, a lot to do with the physiological aspect of it. And that can be quite tough sometimes. So you might not see it at the beginning. It’s been connected to the eyes, but eventually it all links in together by the time you finish uni. And then on your third year, you’re like, ah, that’s why I learned that in the first three months. By the time you’re like, why are they making us do this?

Bethany Fishbein: And if you go straight through, how old are you when you finish that clinical year after your undergraduate degree and now you can practice on your own?

Hasnain Mamdani: So a typical person would go to university at the age of 18. It’s a three year course. So they graduate at the age of 21. Then it’s a one year pre-registration period in practice. So they’ll be fully qualified by the age of 22.

Bethany Fishbein: It’s so different here. We have a four year undergraduate degree. It can be in anything, but most people it ends up being in biology or chemistry because you have to take all the courses to get into optometry program. And then the optometry program is four years more of just optometry.

Hasnain Mamdani: Oh, wow.

Bethany Fishbein: And about half of optometry students will choose to do a fifth year residency. And so by the time someone is a practicing optometrist, here in the US, 26 is a very young optometrist.

Hasnain Mamdani: At the same time, you guys, by the end of that 26 year old, that 27 year old can then do a lot more than one optometrist here at 22 can do. So to get to your level, we would then need to do ophthalmology and have a degree in medicine. And I think we’d probably end up qualifying late 20s as well, to be honest, if we were doing what you were doing. So I think it’s worth it in the young years to put in the hard work. And then come out of it more well-rounded.

Bethany Fishbein: For all of that, I mean, obviously, we like the scope of our clinical education. We like to be able to treat and do all of those things. But when it comes to practice management, I think that there’s a lot that we can learn from the way that you’re practicing optometry there. So talk about a typical day in the life in clinic of an optometrist in the UK. How are you scheduling your patients? How many people are you seeing? What is it like?

Hasnain Mamdani: So I think first, it’s important to acknowledge that it’s quite a retail background over here as well. So we see a practice as two parts, clinical and retail. And they go hand in hand. And the model is such where they really complement each other. And patients who come in know that already. So they come in expecting to buy glasses. They go into the test room knowing that their health will be checked. Then they know that the optometrist can’t treat them. And they’ll have to refer them if they need to. But they also know that once the test is finished and they step outside the test room, they’ll be shown glasses.

So a typical day in your life of an optometrist, you go to work, you see maybe approximately 15 patients a day. So it’s about a 25-minute clinic slot. Some practices might give you slightly more depending on if you have to do extra tests or if you’re specializing in certain things like dry eyes or myopia management, for example. You see about 15 patients throughout the day. That includes contact lenses, anything else that a customer or the patient may need. And then after that, you actually do recommend them glasses based on their lifestyle, their needs, and what they will really benefit from at the end of the day. And glasses is quite a fashion statement over here.

People really enjoy wearing certain types of brands, certain types of shapes, colors. So it’s a real nice feeling to be able to then give the patient something to go home in that they actually love wearing at the end of the day. And something that will correct the vision at the end of the day because that’s the main reason they’re there.

Bethany Fishbein: Are you seeing there like we are here where there’s so much competition now for that eyeglass business? So I think what you’re describing is how optometry maybe used to be here. And now, whether it’s through their insurance, it’s an eyeglass place in the mall, it’s something online, it’s eyeglass store. Patients aren’t coming in necessarily anymore thinking that they’re going to buy glasses at their optometrist’s office. Do you feel the same thing?

Hasnain Mamdani: Yeah, there has been a real decline in the last few years, especially with the online market growing so fast, so quickly, which is why I think one of the reasons why practices here and high street companies and big franchises have acknowledged the need to offer something different that online doesn’t. And online can’t treat your eyes. They can’t give you recommendations on your myopia or your dry eyes. And that’s really what the UK optometry is moving towards, a more health-centered approach while still offering the retail aspect of it. Because if I go somewhere to get my dry eyes checked and that optometrist is then recommending me to get these types of glasses with a blue light filter in them, I’m going to do it. Because this person has made my life so much more comfortable throughout the day, that why would I then not listen to their recommendation? Because I now trust that institution.

And there is so much competition out there that one of the main things that will set you apart from the practice literally next door is your customer service and your customer loyalty. And let’s be honest, people can get glasses anywhere. They can get a Ray-Ban anywhere they need to go. So they’ll walk into a store, whatever brand they want, they’ll get anywhere they want.

So why should they come to you? They come to you because you treat them. You treat them as a human. You actually understand what they’re going through. And you build that customer-patient-clinician relationship. And that’s key. It’s customer service satisfaction is so largely emphasized here in the UK that the main thing that will set you apart, nothing else.

Bethany Fishbein: Especially before all of this expansion of clinical care, if you’re essentially doing the same thing as all of your competitors, then you really need that to be a differentiator in the practice.

Hasnain Mamdani: Yeah, definitely. So over here, you’ll find that independent practices typically charge a lot more than a high street franchise. So over here, we have high street multiples. They have Specsavers, Vision Express, Boots, and a couple of others. They’re the big game players here in the UK. But then you also have independent opticians. It might be a small shop on the corner of the road, but maybe it’s making double as what a high street one is.

Simply because its prices are higher, but it provides that comfortable approach. The patient walks in and they feel at home. They know someone’s going to look after them. They trust that clinician. And they recommend the family and the friends to them as well. Because let’s be honest, the independent practice doesn’t have the marketing budget as a high street company. So the only thing that they can do is go by word of mouth and reputation. And that then enables them to charge more as well at the end of the day for them to survive.

Bethany Fishbein: And when you say charge more, can you give an idea of what a higher end, more independent clinic might charge compared to a Boots or a Specsavers? Just I really have no idea what the fees are out there.

Hasnain Mamdani: So in terms of an eye test, you might find a high street multiple charging maybe 20, 25 pounds for an eye test. So maybe that’s 30, $35. Whereas an independent can go charge 60 pounds, 100 pounds, 150. An extra 100 pounds just for an OCT. Okay, extra 100 pounds might be pushing it a little bit. But I know a practice that does that. Most of them charge maybe 50 to 60 pounds for an eye test with an OCT.

So nearly triple what a high street practice charges. And then you get to the frames and then you get to your lenses. You might get a complete pair of glasses, premium, top of the range at a high street practice for maybe 300 to 400 pounds. Whereas at an independent, the same thing with better quality lenses because they have better relationships with the suppliers would cost you maybe 900 to 1000 pounds, depending on how premium you’re willing to go. There are people who can spend even more on their glasses here as well. So there’s a big difference in the prices. But then obviously the volume is a lot lower for an independent practice because they can charge more. So they don’t need to see as many people.

Bethany Fishbein: So an independent practice, you had given the example before of seeing a patient every 20, 25 minutes, did you say?

Hasnain Mamdani: That’s a high street one, like a multiple, a franchise. Yep, you might still have a 25 minute time slot, but you might have 45 minute time slot because the practice owner has given you the freedom to use that time to number one, create that relationship with your patient. And number two, to do any extra tests that you might need to do as well.

Bethany Fishbein: So hearing that and comparing, in my mind to a US mindset, a US price structure, I think one of the things that I was really surprised by was how profitable the practices in the UK can be because it may be doing the same type of thing, but that focus on complete care and the connection between the retail and the clinical side really makes for a very strong business. Out of those 14 or 15 patients in a day, how many of those will go on to buy glasses in the same place where they had the test?

Hasnain Mamdani: You’re looking at approximately 60 to 65%.

Bethany Fishbein: Okay.

Hasnain Mamdani: On a good day, maybe 75%. On a bad day, 50, 55. So an average of about 65% is what most people aim for.

Bethany Fishbein: Yeah. And here, those numbers vary all over the place. That would be a really strong private practice if you’re doing all of the other stuff, the medical and everything. There are practices that are so focused on the things that you are looking to get into, the dry eye, the glaucoma, the myopia, that they’ve fully de-emphasized the optical piece of their business and are seeing capture rates of 20, 25, 30% and missing out on the associated profitability, but picking up a revenue stream from the area of specialty.

Hasnain Mamdani: Yeah. I think over here, if that was a conversion rate of 25%, that store will be closed by next week. But obviously, it doesn’t offer the clinical side of it, which can bring in an extra income as well.

Bethany Fishbein: That piece feels so different. So is insurance a thing, vision insurance?

Hasnain Mamdani: People sometimes take out private insurance or they have insurance through work, who will then pay for their eye test and pay for glasses. Also, if you work for a company where you’re needed to use a computer, the company will pay towards the cost of your glasses as well. But the large majority wouldn’t have insurance for glasses. There’s a handful who do.

Bethany Fishbein: So most of the patients who are just coming in, they’re paying for the exam, they’re paying for that pair of glasses, and they’re making the choice based on products and service.

Hasnain Mamdani: Yeah, exactly. So obviously, there’s a few patients who the NHS fund, such as over 60s get a free eye test. If you receive any government benefits, you get funding towards the cost of your glasses and a free eye test as well. So the government and the NHS does fund a lot of people for their glasses. That’s a big thing.

Bethany Fishbein: That’s an interesting piece to me because for some of the testing that you’re talking about, enthusiastically getting into, like the glaucoma testing and things like that, many of those patients could get that completely covered at no cost to them through the NHS. Is that true?

Hasnain Mamdani: So I don’t think if a practice was offering those extra treatments, the NHS wouldn’t pay for that at the moment. No. The NHS would pay for a basic eye test, not including any other services. So even if it’s an OCT, the NHS would not pay for the OCT.

Bethany Fishbein: But in a patient who has glaucoma…

Hasnain Mamdani: So if that patient has glaucoma, they would have to be treated at the hospital to be seen under the NHS.

Bethany Fishbein: Okay, so the NHS will cover just a regular sight test, a regular eye exam for a 60-plus-year-old patient in your clinic or in whatever clinic they go to.

Hasnain Mamdani: Correct. That’s it.

Bethany Fishbein: So when you were talking before about some providers who are charging extra if they need to do an OCT or they need to do a picture, if there’s a clinical reason to be doing those, if that patient were to go to a hospital through the NHS, would they then not have to pay for that service?

Hasnain Mamdani: Yeah. So either they can pay, for example, £10 for an OCT on the day, or if they refuse to do that, we can refer them to the hospital, which may have a six-month waiting time, and then they can get it done for free on the NHS. But it’s about how quickly they want to be seen and treated at the end of the day as well.

Bethany Fishbein: Right. They’re making that decision for themselves.

Hasnain Mamdani: So they still have access to that care, to those extra services, but it would have to be at a slightly longer wait time. But the NHS at the moment does not provide funding for myopia management or dry eyes. So that will be totally private.

Bethany Fishbein: So as you start to think about getting into these, is it, I guess, are your colleagues mostly thinking about it as an income source to replace revenue from people buying glasses somewhere else? Is it a clinical enthusiasm to learn more?

Hasnain Mamdani: I think it’s definitely a clinical enthusiasm, but it’s also acknowledging the need to offer those services that we haven’t been able to in the past. So for example, sterilised lenses for myopia management from Essilor, we’ve now only had them available at Vision Express in the last few weeks it’s been released, whereas around the world, it might be quite common to use them. And it’s really exciting because when you have a parent come in and you have to tell them that, look, that your child’s gone from a minus one to minus two, every single parent would always ask the same question. What can we do to stop it? What can we do to slow it down? And we’ve always had to say, look, at the moment, we don’t have the lenses available or the treatment available. But now all of a sudden, we have something that can help that parent, help that child to prevent further eye conditions down the line. Although, yes, it is an extra income stream, I think it’s more of a need in the community to offer those services and acknowledging that these kinds of things are a real problem and we should be providing a more holistic care for patients across the UK.

Bethany Fishbein: Those lenses are not yet available here. We are trying to coordinate with, I know some docs who are coordinating with colleagues in Canada to try to get these lenses for their patients, but there’s a lengthy approval process for any sort of medical device here that they haven’t quite made it through yet, but hopefully soon.

Hasnain Mamdani: Yeah, because Essilor Loxotica also owns Vision Express. We’ve been able to get them quite nicely, which is good.

Bethany Fishbein: So just to go back for a minute, I’m thinking about all the differences in the kind of the back end of a clinic that isn’t really billing insurance most of the time. Has one provider seen patients every 45 minutes? In a private practice, how many staff members would usually be working with an optometrist?

Hasnain Mamdani: You might find one to two people.

Bethany Fishbein: Okay, so the optometrist and then…

Hasnain Mamdani: One receptionist and one optical assistant or dispensing optician helping the patient choose out their glasses and the lenses. They’re usually very small teams, whereas in a high street store, in a multiple store, you might find 30 to 40 people working in the same practice, depending how big it is.

Bethany Fishbein: And how many optometrists would be seeing patients at the same time in a clinic like that?

Hasnain Mamdani: So if it’s a large store, you might have six clinics running at the same time. A smaller store might have one or two clinics. So it depends on the size of the store. Anywhere between one and six. Sometimes I’ve seen eight.

Bethany Fishbein: Eight optometrists.

Hasnain Mamdani: Yeah, so it’s a big operation, but it runs like clockwork. And because it’s a model that’s been ingrained into us, everyone knows the roles. And the optometrist knows they have to see this person by this time. After they’ve seen this person, this person will then be helping them out to choose their glasses and their eyewear. And it’s a very, very smooth operation. So it really helps with a constant flow of patients because our volume is so high. In certain practices, I think the UK runs mostly on volume. That’s the main driver for its success. And whereas I guess if a practice can then make up that income from offering the clinical services, then it can reduce the volume a little bit to focus a bit more on that side as well.

Bethany Fishbein: What are some of the challenges that you think optometrists in the UK are facing right now? Obviously, you’re looking at the opportunities in front of you. What are some of the things that you feel like you’re up against?

Hasnain Mamdani: We’re up against ourselves. What I mean is that if we don’t upskill and learn new things within optometry, we’ll very, very soon fall behind because technology is amazing and we should be embracing it. But as well as embracing it, we should then be upskilling into something else. So if we see technology coming to do a lot of the refraction part of what we do, we should now be upskilling into myopia management or dry eyes. And if there’s a reluctance to do that, then we’ll fall behind. And I think that’s one thing that we can learn from you guys a lot is that you’ve really made a big emphasis on that. So our biggest obstacle is just ourselves.

Yes, there’s a lot of competition around, but as an optometrist, once you’re working in a practice, you’re working there. So that shouldn’t really affect you. That’s more the practice owner’s problem to deal with that competition. You get patients booked into your diary and you see them as simple as that. Patients are a little bit more demanding. They do expect a bit more now than they used to in the past. And they are very, very health conscious and they will happily pay more to know that their eyes are healthy and the healthiest they can be, especially since COVID. Before that, people might be reluctant to pay a 10 pound OCT. But now it’s like, yeah, here, take my money. I just want to make sure my eyes are okay.

Bethany Fishbein: People are relying on their eyesight very differently since COVID. And I know there’s a lot of worry here too about the effect that all of the screen time and indoor time are having on the eyes. So that’s a legit concern. Is it just kind of internally, optometrists not adapting to change or is there pressure from ophthalmology? Like here, whenever optometrists want to be able to do a new skill, just as an example, there are 11 states where optometrists are able to do laser and small surgical procedures, like removing lumps and bumps from the eyelids, things like that. Whenever optometrists are fighting to be able to do this, there’s a big push against it from our colleagues in ophthalmology. They’re concerned if we expand our scope, that’s less for them to do. Is there that same fight in the UK?

Hasnain Mamdani: No, it’s the opposite. Ophthalmologists would love for us to take patients off their hands. They are so run down at the hospital, so overwhelmed with waiting lists or simple things like glaucoma. They would love nothing more than for the optometrist to see them in that high street. And in some areas, there are shared care schemes where if a patient gets referred, they don’t go to the hospital, they get sent to an accredited optometrist who has completed a course and gained an extra qualification, who will then see that patient. The NHS will then pay that optometrist to see that patient. So for example, the optometrist that I practice might get, say, £50 to see that patient, but it costs the NHS about £160, if I’m not mistaken, to see the same patient. So it’s very expensive for the NHS. It’s very time consuming when they already have very long waiting lists. They would much rather pay someone else to see them and not lose out. 

So no, they would love nothing more for us to do that. And there are multiple schemes of ophthalmologists who run events regularly for optometrists so we can care for the patient a little bit more easier. And the communication lines are often very open as well, especially in London. It’s quite easy to get hold of an ophthalmologist to call the hospital and say, look, I’ve got this patient here. They’ve got a red eye, no photophobia, VA’s at this. Is it worth sending them over today, tomorrow? So it’s quite nice. A lot of areas have those. It’s not like that in every area because communication still needs to improve in certain places, I feel, but at least in London, it’s pretty good.

Bethany Fishbein: And if you’re comfortable sharing, but I’m just curious after hearing because you’re throwing around financials that are so different than what we would typically see or expect here, what’s a good optometrist salary in the UK?

Hasnain Mamdani: It varies a lot on your location and your experience. So you might, London is very saturated with optometrists. So salaries might be slightly lower in London. So for example, in London, you might get 50 to 60,000 pounds on a really good one. Whereas if you go outside of London and travel maybe an hour outside where the demand is a little bit more, but the supply of optometrists is not as much, you might get a little bit more. So it also varies on your experience as well. How long you’ve been qualified, what extra accreditation you’ve done as well. And then if you’re in management or you do certain other senior roles or you supervise a pre-registration optometrist, then you get extras on top. But it varies a lot based on your location. If you’re willing to work by the coast where there’s no one within a five mile square radius, you’ll get paid a lot more.

Bethany Fishbein: It’s so interesting. There’s so much that I think that we can learn from each other. Now, between your podcast and mine, we’ve spent about an hour talking, and I feel like it just can lead to so many more questions and so much more conversations. But this has been interesting to learn from you, to learn with you, and I hope this is really just the beginning of further conversations from here. It’s neat to hear.

Hasnain Mamdani: Definitely. It’s been really enjoyable. Thank you so much. And I really feel that optometrists that practice on us in the UK will learn a lot from what you’ve said in part one, and hopefully this in part two as well. And I hope that we can do more collaborations together, because if we share our skills, everyone’s just going to improve massively. And I feel that you guys are more interested now in the eyewear side of it as well, and we’re more interested in the clinical side of it. So something that you’re very good at, something we’ve been good at. So yeah, it’d be great to share guidance and tips to each other.

Bethany Fishbein: Yeah, it’s such an interesting time as you’re looking to get into this, and we’ve been into this and are looking to make sure that we’re not ignoring the part that you guys are so good at and that we’re kind of re-emphasizing the need to take care of the patients optical needs just as strongly as we take care of all of their eye health needs and everything else. So yeah, it’s an interesting learning experience. Thank you so much for taking double time to do this, and I’m looking forward to hearing both of our episodes, yours on the optics room here, on the power hour, and looking forward to collaborating in the future. If someone wants to find your podcast, give the details where they can look to hear more from your side of the pond.

Hasnain Mamdani: I’ll send you a link to it, and if you type in The Optics Room at YouTube, then you’ll get to my channel too. Thank you very much.

Bethany Fishbein: Thank you so much. And for more information on the power practice, you can find out more about us, www.powerpractice.com. Thank you so much for listening.

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