As an optometry graduate from the United States, my thought was to settle down in the States and join a private practice. Moving back to Toronto has been an eye-opener with regards to the differences in the health care systems. Those studying in the States and planning to practice optometry in Canada may have some questions that no one has answered as of yet. Below are a few pointers on the major differences between the systems that I have come to notice over the past year.
Practice Modality – Canada vs. United States
Practice modalities in Canada vary between provinces and cities but are mostly limited to private practice, retail optometry and corporate optometry. Some familiar corporations you may have heard of include LensCrafters, Pearle Vision, Walmart and Costco. Every optometrist dreams of joining a private practice, either as a solo owner or in partnership. In reality, most optometrists in Canada work for corporations.
Practice modalities for optometrists in the States have no limit. Some modes of practice include private practice, health maintenance organizations, retail optometry, od/md practices, public health, academia/research and corporate optometry.
Working in Toronto over the past year, I have noted one thing. Optometrists in the States are committed to in-office treatment whereas optometrists in Canada are very liberal with ophthalmology referrals. A larger networking capacity exists in the States with OD/MD offices becoming a more popular practice modality. In Canada, working with ophthalmologists has been more challenging. On-call ophthalmologists are not always willing to accept emergency cases, especially those on Friday evenings.
Advice to current optometry students: If given the opportunity, reach out to local optometrists and ophthalmologists in your area. Every state or province and every city has a different population demographic. Once exposed to these practice modalities, you will determine which one suits your work style best.
Advice to new graduates: Most new graduates are unable to find a full time position at one location. They usually split their work days with 2 or sometimes 3 different practice locations. Corporate locations are a great way to begin your career; however, never stop looking for other career opportunities to expand your scope of practice.
Declaring a Specialty - Canada vs. United States
Optometrists in Canada are not legally able to declare a specialty. According to The College of Optometrists of Ontario, “There are currently no specialist designations that are approved by the College for use by members, therefore members cannot call themselves a specialist in any area of practice.” Although a specialty cannot be declared, many do so under the rug.
Unlike in Canada, optometrists in the States are able to declare a specialty, whether it be general optometry, paediatrics, low vision, geriatrics or vision therapy. As a graduate from the New England College of Optometry, I had the opportunity and privilege to work alongside some of the best optometrists and ophthalmologists in the above listed specialties. They gave me the confidence to self-manage ocular conditions in-office and to realize when it is appropriate to refer a patient to an ophthalmologist. These experiences enabled me to become a well-rounded clinician.
Advice to current optometry students and new graduates: If you are a graduate from the States and are planning on moving back to Canada, do not apply for a residency. Residency is great idea if you plan to stay in the States, as it will help you move up the ladder in job positions. With a residency, you will gain more knowledge in one particular specialty; however, it will not necessarily help you find a job in Canada.
Billing and Coding – Canada vs. United States
This is a topic that is usually not covered in optometry school; however, it is considered the bread and butter of an optometrist.
Billing and coding in Canada is very simple compared to the States, consisting of 3-digit codes, not specific to a particular condition but a broad variety of ocular conditions.
In the States, the icd-10 coding system is in place, more complex and very specific in comparison to Canadian system. ICD10Data.com has a handy set of reference guides for the US coding system.
Example of coding for myopia:
- In Canada – 367 for myopia (right eye, left eye or bilateral)
- In States – H52.11 for myopia (right eye); H52.12 for myopia (left eye); H52.13 for myopia (bilateral)
Salary – Canada vs. United States
No matter what profession or how honorable, money is on everyone’s mind. Optometry, as a profession, may be the same in the States and in Canada; however, there is a noticeable difference in pay. Optometrists in the States are on salary whereas optometrists in Canada are paid on a per patient basis. This could be difficult at first, especially as a new graduate. Once patients get familiar with your work, the client base will grow.
Canada has been labelled “the land of free healthcare.” In Ontario, all children under the age of 19 and all seniors over the age of 65 are covered for a comprehensive eye exam by the government on an annual basis along with any necessary follow up examinations. This exam remuneration is significantly reduced compared to patients paying out of pocket for similar services.
Most Canadians expect all aspects of health care to be “free” which, unfortunately, is not the case. There are a handful of patients on a weekly basis who complain regarding this matter. On the other hand, Americans know healthcare does not come cheap in the States. Medicare and Medicaid programs are in place; however, the so-called money battle is not an apparent issue with patients in medical offices.
Optometry in Canada is worth exploring
I cannot say the same for every graduate from the States, but I have grown to love practicing in Canada. From listening to colleagues, I had doubts at first about moving back to Toronto. Adjustments needed to be made but after a year, I have finally found my niche as an associate at a private practice in Toronto.
If you find yourself in a similar situation, consider writing both the American and Canadian board exams. It is a hassle to study for both but trust me, the extra studying is worth it. I am extremely happy that I am board certified in both Canada and the States, not sure if I will be moving the States in the future but I feel better knowing that I have options for the future. Everyone needs a backup plan!