Dr. Stanley Woo is the Director of the Waterloo School of Optometry and Vision Science. In his role, he is an avid advocate for the advancement and growth of optometry. In this episode, Dr. Woo shares his views on the future of optometry in Canada from the point of view of a person responsible for the education of future optometrists. Dr. Stanley Woo also shares the role of Waterloo School in several disruptions in the industry. We cover all the relevant topics to what is changing in the landscape of Canadian optometry. Tune in to this episode to find out more.
Check out these links:
Seeing Beyond 2020 Campaign: https://uwaterloo.ca/seeing-beyond-2020/
Canadian College of Specialties in Optometry: https://ccso-ccso.ca/en/
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The Future Of Canadian Optometry - Dr. Stanley Woo, Director Of The Waterloo School Of Optometry
I'm honored to have Dr. Stanley Woo on the show. He is the Director of the School of Optometry and Vision Science at the University of Waterloo. That is the only English-speaking optometry school in Canada. They have a large presence in the industry and the profession of optometry here in Canada. I'm honored to have you here, Dr. Woo. Thank you for joining me.
Thank you very much for the opportunity. It is certainly a pleasure to be here. I appreciate all the great work that you are doing to promote awareness and education through your show. It is an honor to be here. Thank you so much.
Dr. Woo, before we jump into it, I love for you to give us a little bit of self-intro. What is your position at the University of Waterloo?
As Director of the School of Optometry Vision Science, we lead the school mission, vision, values, and certainly the multiple missions that we have there, our talented faculty, staff, and students. We have a big presence in delivering patient care. We are also responsible for clinical education and training for the contemporary practice of optometry. Last but not least, being able to do innovative research from self to society to be able to encompass new techniques, technologies, and research that we can translate into practice to improve health outcomes. It covers the gamut, and I'm fortunate to be the spokesperson for all the great people back home.
You are a great spokesperson. I want to quickly throw this in there before we jump into it, but I have heard you speak multiple times. You come to BC for the conference every year to share what is happening and what is new at Waterloo and remind everybody that this is the preeminent institute in Canada, especially on the research side.
It is always fun to hear you talk because you are always entertaining and charismatic on stage. It is part of the reason why I was excited to have you on. I knew you would be a good guest from that side of things. We will dig a little bit more into that stuff toward the end of the show. The research side is interesting to me. That is a side that perhaps we don't think about enough and how important that is to our profession. We will get into that.
To set the stage, one of the reasons I was so excited to have you on is the future of Canadian optometry. I have had multiple conversations now with guests and talk about the future of Canadian optometry. What is the future of the profession? What does the presence of certain entities in the profession mean? What does the education look like? What does the training for students coming out of school look like? What do we expect the future to look like for our profession? Is it bright or dim? Is it positive? Is it negative?
What better person to have this conversation with than the Director of the University here in Canada who is leading the educational programs for the new graduates? I wanted to dig into this conversation with you, Dr. Woo. There are seven previous episodes and this is the eighth in this vein here of the future of Canadian optometry. The first question I've asked every guest is, in your opinion, what is the current state of optometry in Canada?
That’s an excellent question and a challenging one. There is no simple answer. We are at a bit of a crossroads in Canada. Optometry is a profession. We are well-positioned to assume a primary care role to address the growing eye and vision care needs of an aging population. By the same token, we often fall outside of the priorities for health systems. Remuneration has lagged significantly behind the level of education, skill, and training that we are able to bring into play. Those challenges put us in a position where there is a great opportunity, but there are challenges to be better recognized within the system, and how we can help to improve access while also being appropriately remunerated.
I would agree on that crossroads. There are good and bad in there. We have to look at how we are always going to progress. In your opinion, how do you see us improving the remuneration and recognition within the healthcare system?
One of the pivotal areas is to be able to raise awareness and public education of both potential patients and communities, but also with the government to highlight that there is a public health crisis in vision care. It is often taken for granted at the margins. Yet we do recognize it with various organizations. The evidence is there to point out that it is something that needs to be urgently addressed.
Raise awareness, so public education of potential patients and communities, also with the government highlights the public health crisis in vision care.
In 2019, the World Health Organization pushed out its first vision report ever. It highlighted over 2.2 billion people with vision loss, almost half of which could be preventable. We might think that the World Health Organization is only addressing issues that are abroad where there might be less well-developed infrastructure. In point of fact is that a lot of the challenges they’ve identified also face us right here at home.
We recognize that there are a tremendous number of Canadians who are at risk of vision loss. Not everybody recognizes the ability or the need to get comprehensive eye examinations to address it. The economic impact is projected to be about $56 billion by 2015 as far as the annual cost of vision loss, and it is at about $33 billion now.
There is an urgent need to raise awareness to drive the recognition that it is a challenge that could and should be addressed. We need to be thoughtful and strategic in how we organize ourselves and be able to meet this challenge both as individual optometrists in our own communities and also through our provincial associations, colleges, and the national association.
One of the things that makes it somewhat optimistic is that there is a little bit greater awareness. There is a Private Member Bill by MP Judy Sgro for C-284, calling for a national vision care strategy. There is a growing awareness that we often take our sight for granted, but those who have been touched by vision loss and if you live long enough, everybody will have some experience with impaired vision. It is important to recognize that early diagnosis, intervention, and management treatments are critical to maximizing everybody's independence, quality of life, and the like.
One of the questions that come up quite a lot is the scope of practice and whether or not it is important for us to continue pushing to grow or expand that scope of practice. I think I know your answer to this, but where do you sit as far as expanding the scope of practice? How do we go about doing that?
The scope of practice is something that every health profession continues to expand and drive. We always want to be able to incorporate new technology and treatments, and accelerate that translation into practice so we can take the best possible care of our patients. The scope of practice isn't something that should be limited or constrained. It should be something that we promote and accelerate to leverage the rapid pace of technology and treatments available.
Waterloo School Of Optometry: Every health profession should continue to expand and drive the scope of practice. We always want to incorporate new technology and treatments and accelerate that translation into practice so we can take the best possible care of our patients.
The other challenge is we recognize that North America has the most well-developed optometry profession and programs in both education and research. We lead the way as far as being able to be primary eye-care providers and address particular medical eye-care needs. It is a challenging problem. We have an aging population and medical eye diseases like age-related macular degeneration, glaucoma, and diabetic retinopathy. These are all things that optometry is well-positioned to be able to incorporate and adapt to.
Some of the scopes of practice are a bit frustrating because technologies like lasers for glaucoma have been around for decades. They have been successfully deployed by optometrists in Oklahoma for over twenty years successfully and safely with improved access to patients to get better care and better outcomes. It is challenging that it has taken so long to do what seems to be self-evidently beneficial to the public, the health system, and the individual patients in remote communities that may not have access to care.
The scope of practice is critical. It is important to recognize that the school has a responsibility to be able to deliver that contemporary education, and to enable all of our graduates to practice at the highest level of scope available. Also, to support those in the profession with continuing professional development to be able to have access to education skills and training so they can deploy that into their communities.
We’re working together closely with the associations for their advocacy efforts with the colleges, with their duty to protect the public, and with the school providing the educational foundation. Having that collaboration among all three entities enables us to put together the evidence. It also enables us to demonstrate, particularly to the government, that it is imperative that optometrists are recognized for their full capabilities to help meet that growing demand, helps relieves stress on the health system, and look after folks in the community where they reside or are closer to home.
That is one of the more common frustrations, myself included. It has been a while since I graduated. Even with newer grads who are studying, whether it is in Canada or in the States, they’re coming back home and realizing that a good chunk of the medical training they have is not valuable or applicable. Our scope of practice is fairly narrow compared to the level of education. What do you think has been the main obstacle over the past couple of decades or however long it has been since we have been trained to a certain level but not able to practice to the same level?
First off is that we want to be able to educate to the highest level. Hopefully, that creates a passion, desire, and sense of initiative where new grads will want to press to say, “Why can't we do what we have been trained to do? Why can't we do the most that we can to support our patients and our community?” With that grassroots effort, the hope is that can help coordinate with provincial associations like the Alberta Association of Optometrists.
They have been effective in being able to build the case. They are a large province. They have a very wide geographic distribution. They have a strong case for improving rural access to medical eye care. They have assembled the evidence, the education, the research, and the impact. It is a question of being able to say, “At what stage does this have to be implemented? What is the hold-up?” The frustration comes down to a balance of awareness of reviewing the evidence, and not being afraid to institute change.
Health systems and lots of systems are resistant to change. Oftentimes, that disruption of the status quo can cause challenges. In this case, it might be a little bit upsetting to some. If we put patients first and recognize what their best interest is to get accessible medical eye-care, optometrists are well positioned.
Waterloo School Of Optometry: Optometrists are well positioned if we put patients first and recognize their best interest is to get accessible medical eye care.
We are in many more communities. There are many more of us than other eye-care providers. The opportunity to look after folks closer to home would be a benefit to those individuals in those communities, not having to travel as great a distance, getting more convenient care, and with the doctor that has already been looking after them. It is a natural extension to be able to promote it. The challenge is to get that first province like Alberta to be able to say, “It is overdue. The time is now to help make this happen.”
Kudos to our colleagues in Alberta for leading the way and paving that path a little bit. We look to them to see the progression they have made in serving their patients in different ways to prescribe and treat diseases that we are not able to in BC. I know other provinces are not yet, but we will hopefully continue moving forward. I was chatting with our mutual friend, Dr. Richard Maharaj, and he gave me a quote from you that I was hoping you might expand on which is, “Education before legislation.” Is that what you are talking about here or is there more to that?
It is a common mantra. I spent over two decades down in the US. I spent most of my academic career down there. I had been involved with the American Optometric Association, our state association in Texas, and this was a common refrain. When I was at the University of Houston, the College of Optometry there, we worked with the Texas Optometric Association.
The notion was if the criticism from folks who are reticent or concerned is there is no sufficient education for optometrists to be able to deliver this care safely and effectively, we then have to address that. We have to provide that foundation and make sure that we educate before legislation or before those changes are enacted to promote the opportunity. It does make good sense to make sure that the educational foundation is sound and that folks are prepared and able to deliver competent care.
Education before legislation resides within the school. We deliver the content first to our students but also to the profession. We have an advanced procedures course that we have incorporated. We have learned from our colleagues down in Oklahoma who have been doing this for over two decades. We have adapted it for the Canadian context.
Our healthcare systems are different. Some of the values are different. It is an opportunity to be able to provide that education. As associations go to their various legislatures, they can reassure those members that we have addressed the safety concerns and efficacy concerns. It is an important change that can help to improve the system.
Provide education so as associations go to their various legislatures, they can reassure those members that we have addressed the safety and efficacy concerns. It's an important change that can help to improve the system.
The other thing to consider is that education before legislation also reflects on educating the public and government officials. We have been fortunate to have MPs and NPPs come to visit the school. Their perception of what optometry is, where we are, where we have been, and where we have been going is a bit limited or narrow. Being able to come and visit the school, see the facilities and imaging technology, and see how we use lasers for YAG capsulotomies and SLT. It all of a sudden makes sense. They go, “You use that bio microscope every day. You put an energy source on there and you are still using the same technique. That isn't as big a reach.”
The dangers and the things we manufacture in our minds about what that could mean and how it might be a threat division demystifies the whole thing. Education before legislation has two arms. One is for the profession and students. The other is for government officials so that they understand that this is realistic, credible, defensible, and ultimately to the benefit of patients.
Speaking of the education of students, these are two-pronged questions here. One is what types of disruption do you feel you have seen or should we expect to see coming in the profession? Two is regarding the education of students. How would you think Waterloo is addressing potential disruptions in the industry?
One of the things that are both exciting and a little anxiety-laden is technology. The pace of technological development and how that impacts the way we practice is growing by leaps and bounds. If we embrace that and help to shape it in a way that helps us do our jobs more efficiently and effectively, it can show great promise and potential. On the other hand, if we are resistant and we think we can delay or postpone it, it creates anxiety about, “What is our role? How can we adapt?”
One example is tele-optometry. Within telehealth and telemedicine, optometry is developing the technology that is at the cusp of being able to deliver comprehensive remote eye examinations. On the one hand, that could be a good thing. On the other, it might be disruptive and may even be challenging. From a positive standpoint, the notion is that it could be leveraged to help deliver access to care for rural and remote communities, in particular the indigenous communities, first nations, Inuit, and Métis.
It is not a panacea and a cure-all. Folks recognize that we have a big geographic distribution in Canada, and the weather is challenging sometimes. If tele-optometry technology can help us to improve year-round access and assist in the management of chronic eye diseases like glaucoma, that would be a benefit. The flip side is that tele-optometry is not limited to those areas. It also can provide convenient care. Whether it is extended hours or shorter wait times because it is a new modality, not everybody is comfortable with it. For those who do, it offers an alternative.
Being able to reconcile where we want to be, what we want to do, and how we want to incorporate as a profession to benefit our patients is one example of a disruption that we are navigating now. To address that for our students, we need to make an investment in infrastructure. We are fortunate to have a tele-optometry lane that we have deployed so we can start to understand how that works.
Our faculty team and graduate students are looking at that and trying to get a better handle on how it works, what the limitations are, and how we might help support policymaking and guidance to make sure that it is used effectively to maintain the standards of care. The other technology that is quite disruptive is AI. We get to the extremes where we have Skynet and Terminator. That is more sensationalized.
I view AI as something that can be harnessed for clinical decision support. I don't see it as a replacement. There is an important role to play for optometrists in the doctor-patient relationship to be able to cast, educate and guide patients through their journey as they seek healthcare, whether it is eye and vision care or beyond. There is a trusted relationship there and a connection. While there may be some who are happy with everything being remote, there will always be an opportunity for AI to support the work that we do.
Waterloo School Of Optometry: Optometrists have a role to play in the doctor-patient relationship to counsel, educate, and guide patients through their journey as they seek healthcare, whether it's eye vision care or beyond.
The challenge is we have to help shape how that unfolds. We need to be able to look under the hood and make sure that we understand how those algorithms are designed and built. Make sure that it is trustable and explainable, and helps to support the work that we need to do, particularly in a primary care setting.
With ophthalmic imaging, optometrists have OCT, fundus cameras, and technology for ophthalmic imaging. It is important that we recognize and harness that resource to work collectively to help shape how AI is developed. As you can imagine, we are the ones who see folks before they develop eye disease. If you are going to develop predictive models, it is not the end stage of identification. It is the things that are further upstream.
That enables us to create the infrastructure with the school as a potential resource and partner to now aggregate that information all across and address things like de-identification, privacy, and cybersecurity. We can create a public good to help support the next level and next generation of innovation. Those are two examples of some of the disruptions, and the role that we are trying to position the school as a national resource to support students, the profession, and the public.
Those are probably the two types of technology and disruption at the forefront of most people's minds. You mentioned that you felt like tele-optometry was on the cusp. I have spoken to some people who feel it is beyond that. It is here and ready. Would you disagree?
On the cusp, I referenced the middle of the normal distribution. There are early adopters who have already been implementing and doing it and doing a good job. There are still some gray areas from a regulatory standpoint and an efficacy standpoint. That is again a charge to the two schools, both us and Montreal, to develop the research protocols to find the evidence to support the efficacy and the effectiveness, and be able to look at it from both the patient experience and outcome lens and from a provider experience.
One of the things we need to explore is the pain points for folks to adopt technology like tele-optometry. Rather than simply leaving it in the gray area, it would be helpful to better understand when does it work well? When is it limited? How do we address the various patient pathways so that we can make sure that patients are looked after regardless of the technology or tool that we use to implement it?
With the AI thing, the whole Skynet thing is half a joke. I also think about the movie iRobot. I don't know if you remember seeing that one. Eventually, the machines take over. A real fear for many ODs is that machines will take over our jobs, but not necessarily control our world. Maybe one day, but I'm a bit of a conspiracy theorist. There is a fear that AI and virtual technology will bump the OD out of the exam room entirely. Do you think that is a concern?
It is always a concern. As technology gets better, and patience and the public choose their own pathway for how they want to seek and receive care, we have to be able to respond to that. It is incumbent upon us to demonstrate our value to our patients, the public, and the government about why it is important to have an optometrist to still be in the role to interpret that data and override the AI when it is incorrect. Recognize that there is a person behind all of the data that is gathered, and there is still a human component to what is required in being able to deliver the art and practice of optometry.
It is a potential threat. We have seen disruption in all sorts of industries, including manufacturing and the automotive industry. We are not immune and I recognize there is that challenge. I see that as our opportunity to harness that technology and make sure that we use it to be even better than we already are, and to recognize how it can make us more efficient and effective and deliver better care.
I prefer to see the glass half full. We can benefit from it. We shouldn't fear it. If we adapt and we incorporate it into what we do and demonstrate the evidence to support our value and what we can deliver, I'm confident that we can be even more effective. There are lots of folks who need care and who are unaware that they need care. This can help us be able to help address that challenge.
It comes up enough times during these conversations about the future of optometry in Canada. There are certain groups that are more vocal about this particular point. Particularly in Canada, there are not enough optometrists to meet the need of the general public. Do you agree that there is a shortage of optometrists and not enough optometrists in Canada?
My answers are more nuanced because I don't think it is an either-or. The way I would reframe that question is based on where the need is. Let me start first with where I believe there is a shortage. That is with the number of primary eye-care providers addressing the medical eye-care needs of an aging population.
In that regard, there are for sure not enough optometrists and ophthalmologists to be able to meet the needs. Everybody has declared that. We need to make sure that the optometrists that are graduating and the ones that are practicing are recognized, and that there are opportunities for them to be able to meet that need largely in rural and sometimes more remote communities. They need to have folks out there who are able to address those things most of the time to be able to deliver good care, and help improve and relieve the burden on the system. That would be one facet. We need more highly qualified optometrists ready to deliver contemporary eye-care.
On the flip side, if you go to any big urban center or city, there are lots of optometrists there. In that sense, in both locations, there is plenty of supply. If they limit their scope to more traditional refractive needs, whether that is glasses or contacts, arguably, you have a saturation point where there are sufficient options and choices where you wouldn't necessarily need to grow that segment of the industry.
This has been faced in the States as well, as they look at the increasing supply of optometrists and what the needs are. The take-home message would be that in Canada, in particular, medical eye care needs to outstrip the supply of optometrists and ophthalmologists. We need to continue to attract, recruit, and retain optometrists who are prepared to deliver full-scope contemporary optometry.
Your feeling is that it is more of a geographic imbalance. It is a poorly distributed supply of optometrists. We tend to gather into those metropolitan centers, and the rural areas and get less supply. Do you feel like that is primarily the shortage? There are certain areas that don't have enough primary eye-care providers. It is not that there is a global shortage of optometrists.
In Canada, it is a combination. It is easy to point to rural access to geographic distribution as one area of need. We need more practitioners out in those rural communities. Within the cities and major urban centers, there are still waiting times and demands for medical eye-care access. There is an opportunity for folks to carve out a different niche. The other aspect is growth within the services that are provided.
The depth and breadth of optometry continue to expand. You mentioned Dr. Richard Maharaj earlier. Dry eye, myopia control, medical eye-care management, vision therapy, low vision rehabilitation, there are a lot more that we can do now than we could 30 years ago. In that sense, there is a need for more folks, practitioners, and optometrists to be able to deliver that next level of care. There are folks who are happy to spend more time in those more specialized areas to help meet that growing demand.
The notion overall is if I had to say, “Do we have enough optometrists in Canada?” My short answer would be no. With the cautionary tale that we don't necessarily need everybody doing the same thing. What we need to recognize is we need a better distribution. There are more specialized areas in that there is growing demand, whether it is medical eye care or those others that I mentioned. That could be an opportunity for growth and improved access.
We are in a good state for all of Canada. There are only two schools of optometry here, ourselves and in Montreal, which is a French-speaking school. We recognize that we have a lot of Canadians who are interested in optometry school. Unfortunately, we don't have enough seats for all of the qualified Canadians who are talented and capable enough. They have to go down to the States, other areas, or jurisdictions to be able to get that training and return. There is clearly demand as far as the number of students. There is an opportunity for us to help to address that.
It is a perfect segue because the next part of that question and conversation often is that certain people are more vocal about this than others, but there is a need for more schools. Do you agree with that?
We had strategic planning exercise a number of years ago. One of the priorities that did emerge was to recognize that there are insufficient seats for the number of qualified Canadians who are interested in optometry school and practicing in the profession. One of the things we had proposed that was a bit different than perhaps what has been done previously is that rather than trying to start up a new school from scratch, it would be to work with the School of Optometry here at Waterloo. We already have the expertise and accreditation. We partner with another institution with the infrastructure to deliver health professions education. We work collaboratively in a joint program where we would have a satellite campus of the School of Optometry Waterloo at another location, ideally in a rural location.
The mantra is you recruit from the north for the north. You make it more accessible to folks who might not want to come to Waterloo or go to a big city. It makes it more comfortable, familiar, and closer to home, and leveraging technology. Through COVID, we have learned a lot about hybrid education. We are more comfortable with technology. We can achieve the same learning outcomes and use them to our advantage where it is appropriate and intentional.
Instead of somebody trying to create a school from scratch, which has happened, to my knowledge. I grew up in Waterloo. Every decade somebody decides they want to start a school, but the limitations are threefold. One is you have to have local optometry support. Those docs locally are the ones who are oftentimes that is going to the clinical preceptors to help support the clinical education training. They have to recognize that there is both a greater good and a need because it has been proven that in optometry schools, people end up connecting and settling down. They may start to gravitate and create an oversupply in that region.
Optometrists have to recognize, “We have a shortage. We want that. We want to recruit more folks from those communities, and it is okay if they stay.” Local OD support is one aspect. The second aspect is government. The government has to recognize that there is a need and a workforce shortage to meet healthcare priorities like medical eye care and to be willing to make the investment. Tuition and grant have continued to be flat or regress over the years. This is in every province is my understanding.
With tuition and grant insufficient to match the cost of delivering clinical education and training, there has to be a willingness to make that investment. If you can set tuition and grant, and you can get local OD support, the next part is to make sure you have an accredited program that has the quality that the public deserves and needs to meet that demand. This is where the School of Optometry at Waterloo could be a valuable partner because we have that know-how, accreditation, experience, and expertise. By lending that to a partner and working together collaboratively to co-design what the curriculum could look like, both the didactic, the laboratory, and the clinical education training, we could create that infrastructure in that partnership.
There are those three components. You have to have local support from the optometrist and the government, the economics make sense, and a guarantor for the accreditation and quality of the education that is being delivered. We don't need more folks practicing at different levels. What we need are more graduates practicing to the full scope of optometry with a fire in their belly to go and make that happen so that they can do what they are trained to do.
The last piece there is the accreditation and quality of training. It is certainly something that has been part of the discussion over the past years that I have been having these conversations. There have been rumblings in other countries perhaps to try "to meet the need." There needs to be a change in the level of training. The equivalent would be the nurse practitioner next to the MD, some equivalent in the OD space. That way, more people can have that need met. Is that going to be a possibility or maybe not ever? Is that anywhere on the horizon for Canada? How would we avoid that if you think that is a negative move in the wrong direction?
It is an interesting challenge because, on the one hand, we want to promote access. On the other hand, we already have a public that is not always aware of what eye care is and what is important about it. For example, children oftentimes have coverage for a comprehensive eye examination, but kids are resilient. Not every kid gets an eye exam even though they're eligible and it is covered.
It is fantastic that benefit is available, but the fact is that folks don't take their kids in whether it is awareness, education, or other access problems like transportation. It is a complex question. The challenge is if the public is already struggling with the value of getting an eye exam and then understanding the difference between screenings and comprehensive eye examinations, the last thing we need to do is to cannibalize the profession where you have different levels in different tiers.
Some optometrists do one thing that's not primary care, and others do a different level without it being clear to the public. Advanced practice type stuff specialization is different, but the core is primary eye care. We have to have a common fundamental foundation because that is the entry point. That is why it is primary care. Folks need to know that when they go see an optometrist, they are going to get this level of care. Not maybe this, that, or something lower. They need to understand this is the place to get a comprehensive eye examination for early diagnosis, prevention, treatment, and wellness, all the way through the diagnosis, management, and treatment of disease.
There is a struggle there. When you allow these different levels, it makes it more confusing in a situation that is already challenging. I would go the other direction and want to work with the government, public health, and those kinds of agencies to champion and get a comprehensive eye examination. It is essential to be able to see clearly and comfortably, particularly the children who aren't necessarily going to complain. They are going to adapt. If they can't see clearly, they will work around it.
I know many folks who come, and they have seen it for the first time. They go, “I had no idea my kid couldn't see the board or couldn't see this or that.” It is a shame because there is no reason why they couldn't. Sometimes they are affluent and professional, but it is not top of mind. I push back against this notion of watering down or allowing different aspects because if we are committed to being able to do it and willing to make the investment, we can elevate the expectation and that access without compromising the quality of care. That is what Canadians expect and deserve. That is why we all support each other with the health system. That is the commitment that we make as a profession.
Our offices are in fairly busy metropolitan areas. Even I have felt, as an owner of two offices, the difficulty in recruiting ODs. I’m not sure if there is a shortage or if it is one of those COVID-related things where people want to work less. Whatever the case is, there does seem to be a demand for ODs these days. With that, there are certain entities within the industry that are offering incentives to recruit ODs. Some large entities have more power to do that. They will give loans, pay larger salaries, or signing bonuses.
You are the head of this institution that is grooming these graduates and students to come out into the world of the profession. From that perspective, do you feel like these incentives are a good thing? The students are coming out of school like, “I can pay off my debt like this. I'm going to jump into the profession a lot faster?” Do you think it is somehow clouding their judgment a little bit in the way they are practicing? On one end here, you are trying to train them to the highest level, but perhaps they are taking jobs that are not in line with that because they are just going for the money.
Student debt is a concern whether you go to a Canadian school or a US school. It limits options and opportunities. It delays plans, whether buying a house, starting a family, or becoming a pathway for ownership or partnership in practice. First and foremost, we need to recognize the pressure on new graduates, in particular. Understandably, it will help to shape the choices they make.
I appreciate that there is an important vehicle to be able to help offset some of that student debt. There are some virtuous ways to be able to do that. There were programs where you can incentivize folks to practice in areas that are underserved. There are programs like that in the States. You get one-year loan forgiveness for one year of service to an underserved community. That is a win-win. That would be something that would be helpful for the government, in particular, to be able to help incentivize new grads to practice in communities that don't have as regular or effective access. That would be a pause. I don't want to mislabel relief of student debt as a bad thing only.
To your point, does it unduly influence students and new grads in a pathway that may not necessarily be best in the long term? I have a tremendous amount of respect for all optometrists and optometry graduates. They are smart and capable, but they need to be encouraged to ask the right questions, seek out the right resources, and not fall into the trap that many of us do where we think we are smart and we don't need to get help.
Whether that is accountants, lawyers, or the like, coming out with student debt, you are trying to save money. You think, “Maybe I could do this on my own.” My advice there would be if it sounds too good to be true, maybe it is too good to be true. Get professional advice to help you make those determinations. Ask the questions and see what the fine print means. Make sure it matches both your short-term needs and long-term desires for the profession. New grads are in it for the rest of their life and they are professional careers.
If it sounds too good to be true, it is too good to be true. But get professional advice to help you make those determinations to ask the questions, see what the fine print means, and ultimately ensure that it matches both your short-term needs and your long-term desires for the profession.
The challenge is you don't want to sacrifice, no matter how painful, that short term is to not make your future opportunities quite as promising. It is tough. It is a big sacrifice that we are asking folks to make. We all make it when we graduate. We have to make those trade-offs. I don't think we begrudge anybody for those choices.
At the end of the day, it is about making an informed choice, an objective and not necessarily emotional one, and being able to make an informed one based on all the evidence and the answers to all the questions that are most critical to have addressed. The most important thing is, how do you want to practice? What does that look like? Is that going to be sustainable for you in the future?
One of the key takeaways from that is making sure you ask the right questions at every step of the way, whether it is of other optometrists or from other professionals who will be involved financially or whatever interaction it might be. That is always important. I always feel like a lot of our colleagues, new grads, or whoever it might be could be a little myopic with seeing what is right in front of you and not seeing what the long-term impact is on your own career or the profession as a whole.
If the majority of our colleagues choose a certain path, it is going to lead to the public and the government seeing, “A lot of optometrists seem to practice like this. Maybe we don't need to expand the scope. Maybe we need to keep it to just this.” If more of us are looking at how we are going to grow the profession and the scope of practice by doing those more specialized types of things, then the public, the government, and everybody else will see, “It looks like optometrists do a lot of different things. Maybe we do need to give them what they are looking for.”
That is a much broader view that I'm hoping that more of us will have so our profession does continue to thrive. I assume you agree with that to some degree, but trying to do that in the most politically correct way without calling out too many people and without demeaning or making anyone feel bad. It is important we try to see things from a larger perspective.
Being able to see the big picture and our role in it is important. It is not necessarily the default. I get that you got pressures that you have to address. The other groups that I would give a shout-out to help with that broader perspective for new grads, in particular, are their provincial associations. They understand what the different challenges are, what the current state is, and what the tools and resources are to make that transition from student into practice. They are ready, willing, and able to help support new grads in being able to be successful. They are an important resource.
The other would be college. The college can help provide guidance on what the right responsibilities and duties are in each jurisdiction for each optometrist. Being aware of what you can and can't do, no matter what other folks are telling you. It is important to know what your rights are, but also your responsibilities because you don't want to inadvertently abdicate some of that. At the end of the day, you still have to be able to answer for the professional standards to which we all subscribe. I would encourage folks to be able to look to those two organizations in each province because they do help provide that context or that big picture, and to be able to see where things land.
The last point there is to emphasize we want folks graduating where they are hungry to do everything they are trained to do. We want them to go, “I am frustrated. I don't understand why I can't do an SLT to help my patient with glaucoma. It makes sense. I'm confident, capable, and ready to do it,” and be able to be that agent for change. We want new grads to be the ones who are going out there saying, “How come this can't get done? What can I do to help? How do I make sure that I can educate before legislation and make sure that my patients, who deserve the best possible care from me, can get it?”
I want to talk about the Seeing Beyond 2020 campaign, but do you have any other thoughts on the future of Canadian optometry? Where do you think we are going, and how can we do our part to make sure the profession thrives in the future?
It is wonderful to be able to look forward. I love the tagline at the top, The Future of Canadian Optometry. I'm optimistic. There are lots of things to dig to be able to do with that entry. One of the things we haven't talked about in-depth, but is worth expanding on, is the depth and breadth of optometry.
There is an increasingly critical mass in specializations. While we are not able to designate that for various reasons and different jurisdictions, largely because of marketing and advertising, there is a growing awareness that you can limit your practice to specific areas and do it well. You spend additional time and training. You see more complex patients in that space. It is beneficial for both our colleagues who may be doing primary care, and not low vision rehabilitation as a specialty. To do that takes time, energy, and expertise. That can be cultivated and developed. The patient benefited by not being limited to what we think is the limit of what we are able to do, but rather working collaboratively together.
Waterloo School Of Optometry: There's a growing awareness that you can limit your practice to specific areas, and do it very well, that you spend additional time and training that you see more and more complex patients in that space.
There is a group called the Canadian College of Specialties in Optometry, spearheaded by Alberta. They are working closely with Forac, which is the national association of the regulatory bodies of all the provincial colleges, to be able to recognize that there is some benefit to the public to know who might be in those different areas who might have had the additional training, education, and credentialing. Recognizing that it is not all about school and education. There is a great deal of clinical wisdom and experience that is brought there as well.
The CCSO is working on trying to create that framework and a pathway for the Canadian context, being able to help support both the regulators and the profession in having a reasonable, attainable, credible, and defensible path, and being able to recognize specialties and they are doing some good work. In full disclosure, I'm one of the directors there. I'm interested in being able to engage with the profession to help address any pain points or concerns, and help promote that credentialing as a benefit to the public and the profession. We start to understand who might be able to do those kinds of things in a way that would maintain the standard and quality that we expect.
The last episode I did on this topic, the Future of Canadian Optometry, was with Dr. Maharaj. He mentioned that. Being one of those ODs, he has spent time specializing. One of the pain points he was talking about was the fact that you can't call yourself a specialist in any particular area even though you have done all the training and specialized beyond what the majority of the profession is.
This is a great initiative to hopefully eventually provide that ability for us to say, “Yes, I'm specialized in this area.” I encourage specialization. It is important. Before I say the next thing, if you can't find the website, Google it, Canadian College of Specialties in Optometry. It will show up right away. Google filled that in for me. I started typing Canadian College of Specialties, and it came up. It is coming up. The website is CCSO-CCSO.ca. That will take you to the homepage there.
This is another example of education before legislation. There are two provincial colleges that are able to make the change and say, “Yes, we can recognize specialists.” The majority would require a legislative change. That is more complex. It would take a lot more effort to be able to make those changes. In the meantime, we can provide the foundation, the education, and the evidence to help support it. When the window of opportunity opens to make those legislative changes, we can be able to help promote that.
There is generally an understanding that it is permissible to say, that you have had additional training in a specific area. We may not say it is a specialty, but residency trained in low vision rehabilitation. In this sense, hopefully, the CCSO can provide a pathway saying recognition through CCSO for a particular specialty area. As that continues to grow in momentum and the evidence, and the support from the public and the profession continue to build, legislative change can happen after the education and awareness.
To go back again to this idea of specializing or having additional training and offering specialty services, when I'm talking to the previous guests in this series talking, how do we offer ourselves from disruption and changes in the industry or how do we make sure that we are the ones that are succeeding or thriving through the changes that are happening? One of the most common things was to offer specialty services.
It was to make sure that you have had additional training. You are not doing the standard stuff. We all understand the standard refraction in the sale of eyewear, if it hasn't already, started to fade as part of our allure for what is drawing people in for their comprehensive eye exam. You start to get these offers and other specialty services like myopia management, dry eye vision therapy, and all these things.
If you can offer those things and let the public know that you offer those things, you are going to be able to continue to succeed from a business perspective to a clinical perspective. It is important for us collectively to think about how we are going to continue to offer those services. CCSO is a valuable resource for us as it grows over the years. Thanks for helping to put that together.
I couldn't have said it better. I'm getting goosebumps as you are describing it because that is why optometry has a bright future. We can continue to do more stuff and be able to help patients in new and innovative ways. That technology and research will continue to be translated into practice. This is why there will always be a role for optometry.
We are primary eye care providers, but as we start to differentiate ourselves for patients professionally and in the marketplace, there is a lot of value that we bring. Coming back to Canada, it has been fun to see those cultural differences. We are modest and self-effacing individually as a profession and as a culture. Having been down in the States for quite a while, I relish the opportunity to champion how wonderful the work is that we are able to do. We need to trumpet that more from the get-go.
We are not good at trumpeting, that is for sure. I love going to conferences. When I got to chat with my friends and colleagues down in the States, it was amazing to see how comfortable many of them are at talking with pride about what they do. They are comfortable with telling people that they are good at it, whereas we are self-effacing and we don't like to brag. We need to start doing that a little more. Let's talk about Waterloo a little bit. Let's talk about the Seeing Beyond 2020 campaign. This is a big campaign for the Waterloo Eye Institute. I love for you to tell us a little bit about what it is. What can we do as ODs and as a community to support them?
The Seeing Beyond 2020 campaign is a once-in-a-generation project. We have a $35 million target. We have already raised $26 million. Thanks to optometry, the industry, and folks. The outpouring of support has been incredible. What we are trying to achieve is to modernize the way we are able to be a national resource. There are three different components to that. One is clinical education and training, another is research, and the last part is patient care.
Waterloo School Of Optometry: The Seeing Beyond 2020 campaign is a once-in-a-generation project. What we're trying to achieve is to modernize and be able to be a national resource.
From a clinical education and training standpoint, it is a modernization of our facilities to better reflect the way that optometrists practice. Being able to now break things out to reflect so that there is pretesting, and less emphasis on the data gathering aspect and more about having the progression into being able to incorporate clinical decision-making. Being able to match that patient experience so that they go through that experience, and not like it used to be back in the day when you took a patient back. They spend the entire time in the room or however long that may be.
There is a notion that there are more streamlined pathways that can still result in good outcomes but not necessarily compromise that experience. It is important for our students to be able to experience that. They will have an integrated way of being able to explore that, and certainly an increased emphasis on ophthalmic imaging, how that works at the core of all the different services, primary care, and specialty services, and being able to emphasize and build up those specialty services that provide a unique resource.
Along with that are things like tele-optometry. Making sure that technology is available to them so that they can be prepared to jump into practice and help lead the way. From a research standpoint, there is going to be a second floor as part of our 16,000-square-foot extension that is going to be a center of excellence. On the one side, it will have biomedical research. On the other, it will have imaging research. We are covering the gamut from cell to society, the basic fundamental science of discovery, translational work, and clinical work. We can cover the whole gamut of not vision science but neuroscience and the like.
Make sure that technology is available to them so that students can prepare to jump into practice and help lead the way from a research standpoint.
Those are ambitious plans where our faculty have rallied together to identify where we have strengths, how we can double down and increase that capacity, and build out. Along with that is the ability to partner with the rest of the University of Waterloo. We have excellent faculties in Engineering, Math, Health, and others.
We can help to shape what that AI might look like to help build those bridges and resources that can help support AI and machine learning research to build out the ability to look at big data to help inform not just the individual patient care but population health, and support informed public policy and decision making.
Last but not least, being able to have state-of-the-art patient care so that our students are able to integrate and embrace that. Translating that research into practice more quickly and efficiently. Supporting the development of future clinical practice guidelines, helping to support the rational framework for incorporation of new technologies like tele-optometry, and then supporting that increased depth and breadth, particularly in specialty care.
The Waterloo Eye Institute is going to be a 16,000-square-foot addition to the existing building. It is going to be a complete re-modernization of our clinical facilities where all of that patient care will take place on the first floor. We will also have a tele-optometry hub or mission control to be able to recognize that we want to be able to integrate with that as we look towards the future.
It has been exciting. We are going to the final design. We anticipate being able to go to construction and tender it soon. We are hoping that folks are as excited about our ability to anticipate where the future will go. They see us as a national resource. I didn't go to Waterloo myself. I can relate to those who may not have attended Waterloo. If you are practicing in Canada, there are two schools of optometry. If we are talking about education before legislation and research for the Canadian context, I hope that everybody looks to Waterloo as being that support for your associations, colleges, and your practice.
That is ambitious. That is a word that comes to mind. I like the phrase cell to society. That is cool. That encapsulates everything in between. I didn't go to Waterloo. I went to the New England College of Optometry. NECO asked me for money all the time understandably. I'm sure every school does of their alum. I like to donate to the school and the undergraduate school that I went to. I want to help support the students coming through. I didn't ask bluntly, “Why should I help Waterloo?”
There is so much in there, and I'm asking facetiously here “Why should I?” You mentioned that Waterloo is working with our associations and with the Canadian Association. We're going to see potentially many of the graduates working in our offices, or our colleagues are going to be from Waterloo. It is only to our entire benefit overall for the profession and for the future of Canadian optometry.
This institute sounds pretty amazing. Research is not something I think of often, but it is extremely important, not just in the biomedical sciences but in the technological side and AI. It is amazing what you are doing there. What can we do then to support? The other question is when this is all done, who can come and see it? I love to see what I donate and contribute towards. What does that look like?
Thank you very much for your support. I do not begrudge those. You always want to support your alma mater, and I appreciate that. NECO is a great school. I know Howard Purcell, their president, very well. You do that because that is where you cut your teeth. That is the school where you came from. That is important to do. You framed it well.
The notion is that you always want to support your school. In Canada, with just the two schools, it is important to be able to support us because we support the profession. That can help to support you individually and grow. Those dollars invested will have a tangible benefit because we have the ambition to be able to support and be that national resource. It is not just a tagline or rhetoric that we are prepared to make the investment in time, talent, energy, and resources, and be able to direct that back to support the public and the profession.
You always want to support your school. But in Canada, it's essential to support us at Waterloo School because we support the profession and help support you individually and grow.
In that regard, we are going to have lots of events to be able to help celebrate. We do anticipate having a groundbreaking ceremony, whether ceremonial or actual. It will depend on the timing of working with the architects and the construction folks. We welcome everybody and anybody to come and attend our programs, visit the school, and see what we envision certainly during construction.
It is an exciting time because it has been something that has been in the making for a few decades, and the ability to come together. I'm the spokesperson for it, but it is a collection of folks who have been dedicated, passionate, and persevered to be able to make it happen. We are closer than we have ever been. It is exciting to know that we will be getting a shovel in the ground. Anybody is welcome to visit. We are happy to talk with folks about what the plans are. We are excited about the potential to be able to support the profession and continue all the good works you all do in your communities.
I might want to come by that groundbreaking ceremony. When it is ready, whatever the timeline is, the ribbon cutting ceremony, or whatever happens at that time, I will be there for that too. It is very exciting. Thank you again, Dr. Woo. I appreciate all the insight and for adding your perspective to this important conversation about the future of Canadian optometry. Are there any final words on that note you would like to share before we wrap up?
You are doing important work. This medium is not natural to me. When we visit in meetings and things, I'm comfortable doing those kinds of things, but I appreciate how professional, how polished, and how well you do this. It is important to help to get that message out there. Thank you for what you are doing. Thank you for the thoughtful questions and the challenges to the leaders in the profession in all the different segments. It is important that we get that word out there that we all want to work together and make ourselves available to your audience, the profession, and folks that they know. I can't thank you enough for the opportunity. You were flattering earlier, but I'm equally humbled and honored to be a guest.
It was very kind. Thank you very much for your time. I know you are a busy person. To have you on here has been an honor for me. Thank you, everybody, wherever you are. Make sure you check out the Seeing Beyond 2020 campaign and the Waterloo Eye Institute. See all the great work that is going on there and what they are ambitiously trying to build. All the support we can provide is going to be valuable. It is going to come back and pay off for the rest of us here in Canada in the future. Thanks again for tuning in. I will be back again soon with another episode. Stay tuned. Take care, guys.
Important Links
Dr. Richard Maharaj – Past Episode
About Dr. Stanley Woo
Dr. Woo is passionate about helping people see. As an optometrist, he works tirelessly to promote eye and vision care for people of all ages across the continuum of care from wellness through chronic disease management to vision rehabilitation. Whether helping a child to see clearly for the first time, or a senior with legal blindness recapture the joy of sight with assistive technology, his sense of wonder never ceases. Education and scholarship have been avenues of inspiration.
Stan has mentored students and residents as they sought to fulfill their potential in health care. He strives to better understand how rehabilitation and technology may help the visually impaired optimize their remaining vision to maximize quality of life and independence, and even has a couple of US patents.
Stan enjoys pushing the boundaries of what’s possible and exploring how we can enhance vision and health. Dr. Woo has had the good fortune to be part of strong teams and is devoted to giving back through service. As President of the Texas Optometric Association, he learned invaluable lessons in collaboration with government and regulatory agencies. His Rice MBA team in medical and health care management presented a model for urgent care clinics to fill the network gap in the Texas Children’s Hospital system.
As the Dean of the Southern California College of Optometry, he applied a health systems perspective to help support the transformation of Marshall B. Ketchum University into an interprofessional health sciences institution. After many years in the US, including optometry school at the University of California at Berkeley, Stan is delighted to return home.
Serving as the Director of the School of Optometry & Vision Science since 2017, he and the team are rolling up their sleeves and poised to do great things in eye, vision, and health care at the University of Waterloo.