Drs. Sophia Convertini and Michael Sellars met while studying to become optometrists and have together come to Vermont for residency, working closely with Dr. Dean Barcelow, president of the Vermont Optometric Association. Below they share their experience as students and what they have learned on the ground in Vermont — and the ways in which expanding the scope of work for optometry would positively impact up-and–coming providers, patients and eye care at large.
Tell us a little about yourselves and your history:
Dr. Sophia Convertini (SC) — I am an ocular disease resident at the White River Junction VA Hospital and work in a private practice. I started my residency in July, so I’m about halfway through this point. I’m originally from upstate New York. So I made the move to New England.
Dr. Michael Sellars (MS) — We met in optometry school. So we graduated around the same time and we decided to go to this residency program together and White River Junction because we liked Vermont. One of my rotations was up in South Royalton and I really enjoyed it. And I figured another year here would be great. But I also work at the VA and then I also work at a private practice in White River Junction.
What has your training and education looked like to get to this point?
SC — It hasn’t been a walk in the park. We do four years of school — this is on top of college. So basically I did undergrad for four years, I graduated with a degree in biology and Mike did the same, with a Bachelor of Science and then we moved on to our graduate program. It’s four years: the first three are more didactic, and then in the second year, we start going into clinic. And it starts off with a day a week and then you move on to doing more like two or three days a week.
Our fourth year is all just clinical. So you’re at a different site for three months at a time you do four different rotations — you’re working under different doctors and you work at different practice modalities. People do private practices, VA hospitals, medical hospitals, and university hospitals. There is opportunity for basically any modality you want to experience, you get that experience in your fourth year.
Through this you learn how to work and work up patients and do the whole exam and everything so you’re comfortable with any skills, basically, to take your boards.
MS — We go through all that and then in our third year we started prepping for our board exam, which is three parts. The first part is hard science, you know, health system type stuff, and then the second part is more clinically driven, case-based questions — treatment and management of disease, what medications we can use for what, what’s safe and what’s not.
And then part three, we have to fly out to Charlotte, North Carolina, to take an in-person exam. There are four stations and we go through a full eye exam in front of people who determine whether you’re able to practice or not based on how you perform.
Each year, you can’t move on unless you pass your clinical skills examples, so they are really important.
How would the proposed scope expansion impact your work as a new practitioner?
MS — The really nice thing about working at the VA is that as optometrists, we can work within the scope of practice we are educated and trained to do. Also known as “as taught” which is what Vermont is trying to pass.
At the VA hospital, we’re able to do things like live lesion removals, or inject into chalazion and other procedures that we have become proficient in — so Vermont is already doing it within the VA because it’s legal in certain states meaning optometrists in different places are doing some of these procedures already.
It seems awkward that we can work with attending doctors at the VA, but in private practice, if someone has an eye health issue and needs one of these procedures today, we have to refer them elsewhere — often an hour and a half away — to an ophthalmologist who might be very, very busy doing other critical procedures for their patients.
Today, we are having difficulty attracting an ophthalmologist at the VA to do cataract surgery. Right now, there’s an enormous backlog there because ophthalmologists are too busy. So, by expanding the scope of practice for optometry and allowing some of these laser procedures, it will provide Vermonters access to earlier intervention with less travel, and at the same time lessen the burden for ophthalmologists.
SC — Right now we’re referring people out either to Burlington or Boston; there are not a lot of options in between. Even with our veterans, we can’t refer to Dartmouth anymore. Currently, Dartmouth is not taking new patients. So, unless you’re a current patient, you have no access to Dartmouth. Our option at this point for our patients is to refer people to Jamaica Plain in Boston, at least for the veterans.
In private practice, I have not done many referrals, but what is clear is that patients don’t want to travel to Boston. As a doctor, it feels like there’s not a lot we can do for patients. Some of those delays in care would be eliminated if Vermont were to pass an expansion of scope for optometry. I think that would open up a lot of doors and it would bring a lot of relief to a lot of patients, especially in rural areas like where I practice. Vermont has more optometrists and more people willing to provide this care — there’s an element of frustration to some extent, where we’d like to be doing these things to give our patients the best care.
Talk more about the frustration around a scope that stifles your ability to do what you’re trained to do.
SC — In addition to what we’re trained for medically, we are also trained so we know when to send patients to someone else. Even when you take the board exam you have to take a written part that asks, “Do you know how to deal with these complications and things like that?”
The expanded scope would continue to be under a very controlled way of handling these procedures, which I feel like when the media talks about it, there’s misrepresentation. I know last year, I was bummed because in our last month of fourth year, we were about to graduate and become doctors, and there was a bill in Florida seeking to end calling optometrists doctors. We worked for years and then there was a state saying they don’t like it.
Thank you for sharing your experiences and views on scope expansion — congratulations on all your hard work thus far.
To learn more about the proposed scope of practice expansion and what it could mean for you, visit vtoptometrists.org/scope.