Due to COVID restrictions, our staff is working split shifts. When I arrived to work one Monday afternoon, a staff member informed me that a long-term patient called to ask me to see his 101 year-old aunt, who is also a patient. She had been seeing a large black spot in front of her left eye for a few days. 

He was directed by our staff to go to the nearest hospital where there is an ophthalmologist on call. We are in a rural area and do not have an ophthalmology department in our local hospital. He was upset as his aunt lives in a nursing home and they preferred she did not go to the hospital. Also, he did not feel that the patient was well enough to travel to this hospital and wait to be seen for an undetermined amount of time. He clearly stated that he would not take her to the hospital. Her physician was also away for the next three days. I made the decision to see this patient knowing that her primary care physician would not be able to examine, diagnose and treat for this type of symptom.  

She was not feeling well on Tuesday, but she came to her appointment anyway. She said to me that her vision was important to her. “I don’t want to go blind”. Keeping the mask on throughout her examination was difficult for her. Even, walking down the hallway to my exam chair was difficult for her. It made me wonder how she could have dealt with a hospital ER.  

At her previous yearly examination in 2019, this patient’s vision was excellent but was now diagnosed with a large choroidal neovascular membrane caused by wet macular degeneration. I contacted our local ophthalmologist and made arrangements for her to be seen for treatment. I explained the difficult situation with her fragile health, and they assured me that they would do their best to avoid any wait time in their office.

I can’t help but think back to the response that we got from the government during COVID that optometrists were not essential first line healthcare professionals. I honestly do not believe that this extremely vulnerable lady would have been able to access care any other way. Her nephew made it clear to us that the other alternatives were not an option for them. This patient was seen immediately in our office when she arrived and her visit at the ophthalmologist’s will be efficiently managed because they already have a diagnosis and are aware of her general health status. 

Situations like this one happen every week in our practice. This patient, as well as all the others just like her, deserve the best possible care. This involves getting diagnosed and treated effectively. And it also involves looking at the bigger picture and participating in helping our elderly population have a better quality of life.  

We’re seeing a huge decrease in the number of patients we’re seeing because of COVID. We’re spending more time cleaning the office but seeing fewer patients due to social distancing. 

Normally, we could stay afloat if volume is high, even if renumeration is not great. However, when renumeration is not great and volume is significantly down you have to be very deliberate about the patients you’re seeing. We try to see everyone we can and see patients based on need, but now we have to limit the number of OHIP patients. 

It’s been difficult for us to subsidize OHIP-insured patients for many years now and COVID-19 has made it much more difficult for us to continue to subsidize these patients. It will be difficult to see more patients in the future and difficult for us to survive if OHIP doesn’t increase funding so that we’re at least not losing money on these patients when we see them.  

I’ve been doing this for 25 years and I want patients to get the best care possible. This is impossible with the current system and I don’t see it getting better any time soon. We cannot continue to subsidize exams out of pocket and risk losing our practice. If we can’t operate, how will that help Ontarians?  

Without change, Ontarians will need to get used to this new normal.  

Currently, the biggest challenge we’re facing is booking patients in Ontario to receive eye care. With limited time slots and significant demand, we are trying to figure out how to care for patients, especially those who have an acute or urgent concern.  

When patients call in, the problem we face is utilizing our limited appointment slots. I was having to subsidize OHIP care prior to COVID-19. Now we have increased overhead expenses, we are scheduling longer appointments to meet regulations and therefore have less appointment availabilities which means I am further subsidizing OHIP care. OHIP, especially OHIP partial exams don’t sustain the practice, period. I’m stuck in a place where I want to help my patients but don’t have the space – and if I have the space, I don’t know how I can possibly carry the cost. We’re extremely underfunded by OHIP remuneration. I have bills to pay, staff to employ and significant overhead, making it extremely difficult to care for OHIP covered patients.  

It’s even harder to provide urgent care. Once we see a patient with an urgent need, we need access to ophthalmology care which is extremely difficult, especially in northern Ontario, where they’re also seeing fewer patients and having to redesign their practice. We’re trying to control intake of patients while sustaining a practice which results in patients being triaged and told to go to the hospital. 

We just can’t afford to do emergency eye care right now. 

I care for my patients, I want to take care of their eyes, but I also need to make sure that my business will survive. If my practice is not sustainable, those are jobs lost. How will that help save eye care?  

The impacts of COVID-19 alone will be devastating to my practice. As an older doctor seeing mostly OHIP patients, the new restrictions in the workplace means I can barely pay my share of the overhead. I can’t carry on without dramatically increasing my hours, which I’m not prepared to do. It’s pretty disastrous. 

The way OHIP renumeration is set up was already dire. In my 35 years, I have gone through every negotiation with the Government and been an active voice for reform. I’ve had meetings, written letters and done everything I could possibly do only to find ourselves back to square one. All this work and absolutely nothing has changed.  

Optometrists have never been properly compensated for the work we do. I find myself asking why am I doing this – there’s no way to earn an income of any kind. I, myself, will be left with no choice but to retire. For 35 years, I have always put my patients first. I care for my patients and their health. But it’s no longer a time to play nice. We can’t afford to continuously roll over and just do what’s best for patients – as much as we want to. It’s gone on for so long, it might be putting us out of business.  

This will not help save eye care in Ontario.  

I’m reaching a turning point. The stresses of reduced patient intake, high overhead and inadequate reform for optometrists is such that I can’t enjoy my job anymore. It’s become challenging for me moving forward to justify working. It’s just not feasible.  

When will the government start to listen? 

Access to eye care in Ontario is in trouble. With the current state of the world, so much is unknown. Since re-opening, I’ve had to cut down my practice to 40% capacity. I’m realizing more every day that things are changing, and we simply will not be able to see the same number of patients in the given time frame.  

How am I expected to pay my staff, pay rent, when we’re paying out of pocket to save eye care? I am one of the few in Ontario who has said that I’m done seeing OHIP patients – I cannot personally afford to any longer. I could barely do it before COVID and now there is just no way to do so and hope to run a business.  

What many fail to understand is the financial situation the government has put us in. Even more jarring is how long it’s been since the government has done anything about it. I graduated in 1992 –I have been waiting 30 years for the government to make effective change.  

I am fed up – it’s become too much.  

Unfortunately, patients will soon feel the impact on access to eye care in Ontario if we don’t make changes now. Patients in Ontario will have nowhere to turn to, and some will have to go to emergency in a time where we cannot afford to so. 

We simply cannot continue to see patients under the current OHIP guidelines and expect to make money. The time to save eye care in Ontario is now. We cannot afford to wait any longer.

In our practice, we primarily deal with pediatrics and vision rehabilitation, which means we see many patients with special needs and in an immunocompromised state.  

We expect everything to change once we reopen. With our population of immunocompromised patients, there is no room for error. We need to ensure we have all the proper supplies and that the proper systems and protocols are in place to protect our patients and our staff. The current return-to-work plan will mean a drastically reduced patient load with increased expenses to ensure we are properly equipped. 

We also worry about increased fear in the community. With extended waitlists and delays in seeing patients, we risk missing vital symptoms. The last thing we want is for people to wait until the last minute to see a doctor and for it to be too late. We need early intervention because when we don’t get to patients on time, we risk vision and we risk lives.  

This will change the whole nature of our practice and those qualifying for our services. It is impossible to continue operating the way OHIP fees are set up. With the decreased number of pediatric patients we are able to see, and the impossibly low renumeration, we will be operating at a significant loss for each OHIP patient. This could force us to prioritize our private pay patients just to keep our doors open.   

We care deeply for all of our patients. This is not what we want to implement, but it is what it will come to without immediate action and change.