Eyecare in Prison – Alternate Career Pathways

I had just walked out of the room after giving a lecture about retinopathy and risks of blindness to a diabetic focus group over on C yard. I immediately thought to myself how I would have never guessed that our amazing profession would lead me to talking about metabolic disease, health and wellness to a large group of diabetic inmates, but I was excited to be there.

As newgrad optometrists seek to find their professional niche, they are fortunately faced with a vast array of options.

Based on geography and personal/professional goals, some might opt to pursue residency, some might aim for opportunities in private practice or commercial settings while others choose multidisciplinary settings like community health centers, Veterans Affairs Hospitals or Indian Health Service hospitals.

Another professional avenue we have, albeit overlooked and less conventional, is to provide eye care in one of our many correctional institutions, state prisons and/or county jails.

Delivering eyecare in prison, while not for everyone, is certainly a great opportunity for new grads to get on their feet professionally and financially.

Newgrads will also avoid the endless headaches and confusion associated with insurance credentialing and billing.

Prior to relocating after graduation, many optometry newgrads may be discouraged to hear that their ideal location to live has a saturated and competitive market for optometrists or that their scope of practice is so limited that they will be reduced to refractionists with an unfulfilling career.

This could not be further from the truth, especially for those willing to pursue opportunities in a correctional setting. In many cases, these facilities have a high demand for optometrists to come and provide eye exams for inmates.

Optometrists in correctional facilities also frequently manage glaucoma, diabetic eye disease, blunt trauma, iritis/autoimmune conditions, order labwork, and co- manage various cases with ophthalmology, including surgical post ops.

Practicing optometry and delivering eyecare in prison systems has revealed a side of healthcare that most are not fully aware of.

Prisons typically receive state and federal funding to support one or several comprehensive health center; type buildings, fully furnished with primary/urgent care, dental, pharmacy, physical therapy, radiology, lab, and lucky for us, optometry!

Facilities that need optometrists will already have a fully furnished exam room, sometimes with pretesting machines like autorefractor/NCT and a visual field machine. In fact, sometimes while my patients; eyes are dilating, they are in the dental chair getting their teeth cleaned or getting blood drawn at the lab. Given the multidisciplinary setup of these facilities, optometrists also have full access to patients‘ medical history through electronic health records.

The redtape that comes with dealing with private insurance plans tends to drive some new optometrists crazy especially those coming from hospital based settings in prior jobs or residency experiences. Today’s vast array of medical and vision plans continues to dictate how we provide eye care for our patients, whether we like it or not. Sometimes our patients are required to return to the office several times because their various insurance plans won’t allow us to meet all of their eye care needs on the same day (ie: glaucoma testing, photos, refractions, diabetic exams).

While this is the lay of the land in many settings we find ourselves in, this is not the case when delivering eyecare in prison.

You’ll be happy to know that if the patient is diabetic and needs a refraction and dilation check, you can do it! They’re also a glaucoma suspect and need a visual field? Let’s do that too while they’re here. You find a retinal tear or iris neovascularization? Refer!

Most correctional facilities have a network of ophthalmologists they can refer to as necessary. In a correctional setting, there is no waiting period while you’re being credentialed with XYZ insurance plan, or getting lost in processing your CAQH application. You’ll still get paid if you don’t do cover\ test on everyone or don’t see a patient every 10 minutes.

Don’t worry, you’ll still be very busy.

Most facilities can be flexible with your schedule, even if it’s only several days per month. The flat fee pay scale in most cases is also higher than private offices are able to offer a newgrad. Many times, patients will be happy to have had their eyes examined and new glasses ordered, but curious and confused why I’m so enthusiastic about being there with them. I often reference this paragraph as my explanation.

Initially, many newgrads may be intimidated at the idea of working with incarcerated men and women, and rightfully so.

The United States‘ prison population today exceeds 2.2 million people. There are various levels of offenders that occupy correctional settings, typically on a scale of 1 to 4, and not all are created equal. Most prisons I’ve worked in house non-violent, lower level offenders, and I have never felt unsafe, manipulated, or vulnerable.

Optometrists typically will work closely with a nurse and correctional officer at all times.

In the state of California, many lower level inmates are able to transfer to one of the state’s many fire camps and train to be volunteer firefighters. Fire camp provides more freedom for inmates and is a highly sought destination. Many inmates are required to have eye exams prior to leaving for fire camp, especially those with diabetes or preexisting eye conditions. Inmates also typically spend their time in the library, at church, playing sports, or taking high school/college coursework in exchange for an earlier release date.

Unfortunately there are far too many negative forces that cause the high recidivism rate throughout our country.

Through our role as primary eye care providers, we are able to eliminate poor vision as a barrier to rehabilitation and recovery for these people. Many newgrad optometrists will be excited to find how fulfilled they are, both personally and professionally, working with this population.

Staffing companies and recruiting agencies are responsible for subcontracting optometry services for each state’s respective correctional department. They can give you a rundown on opportunities and openings at various facilities in your state.

Below is a brief list of resources for coming across opportunities in the corrections field. It is by no means comprehensive.

  • http://www.jailmedicine.com/
  • http://www.institutionaleyecare.com/

New York

  • http://www.doccs.ny.gov/Jobs/Specialty_and_Ancillary_Care_Services.html

Washington

  • http://www.doc.wa.gov/about/jobs/careers-healthcare.htm

California

  • Burke Professional Corporation, staffing/recruiting services for CDCR – jeffreyburkeod@gmail.com

Colorado

  • https://www.chpdelivers.com/
  • Renae Jordan -Director of Clinical and Correctional Services – renae.jordan@state.co.us

Florida

Illinois

  • Wexford Health Sources, Inc
  • http://www.wexfordhealth.com/

About Kevin Cornwell

Kevin Cornwell
Dr. Kevin Cornwell graduated from The New England College of Optometry in 2015. He went on to complete a residency in ocular and systemic disease with Indian Health Services in Zuni, New Mexico. He now works with MACT Health Board, Inc in Northern California, a nonprofit organization that provides healthcare for Native Americans. He is enthusiastic about bringing eye care to populations in need, both domestically and abroad. He has been involved with several humanitarian outreach projects, in various parts of California, New Mexico, Nicaragua and Mexico. He is passionate about managing the ocular manifestations of systemic disease, and monitoring ocular pathology through retinal imaging with spectral domain optical coherence tomography. He’s also an avid health crusader and enjoys educating and encouraging patients to better manage metabolic disease. Dr. Cornwell enjoys hiking in the Sierras and recording music as a guitarist for Cornwell Studios' youtube channel.

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