Feature, Report

Tipping point – the changing workforce

In the last decade, the optometry workforce has become more feminised and younger, while in ophthalmology women are demanding greater representation and recognition. RHIANNON BOWMAN meets the women striding forward.

As a graduate, independent New South Wales optometrist Ms Yang Wang never envisaged a career that would allow her to run a successful business with a young family.

But as her career has progressed, she’s come to appreciate the fulfilment she continues to get from her work, while managing perhaps her most important job – motherhood.

“Optometry is an ideal career for raising a family, partly because you can plan work around family. The hours are generally nine to five, no late nights, and it’s relatively stress-free,” Wang, the mother of a two-year-old child, says. “And it’s rewarding, especially when you can establish patient contact for life.”

Today Wang – the owner and principal optometrist at Eyecare Plus Corrimal – can count herself among the majority in an Australian optometry workforce that is increasing in size, becoming more female and younger.

Aged between 30 and 34, she is one of 533 female registered optometrists in Australia, the largest age group, second only to the 25-29 cohort, which has 805 female registered optometrists, according to Optometry Board of Australia (OBA) statistics.

Yang Wang is the owner and principal optometrist at Eyecare Plus Corrima.

Combined, women in these two age groups make up the largest contingent of a profession that is now 56% female and 44% male, according to OBA data from 1 April 2020 to 30 June 2020.

It was a different picture in 2012 when Wang and her then-boyfriend moved to Australia. Then, the profession was 47% female, 50% male, (with the remaining unspecified).

According to Optometry Australia (OA), in general, younger workforces want more flexible employment, often to fulfil caring responsibilities, and opportunities to continually learn and develop.

This is true for Wang, who grew up in New Zealand and graduated from the University of Auckland (therapeutically endorsed) in 2011, with her now-husband, Mr Roland Mak.

The couple moved to Australia in 2012 due to greater job opportunities. She was attracted to working in a rural setting because she wanted exposure to a variety of ocular pathologies and to practise to her full scope.

As a first-time business owner and parent, she says that timing is important when managing family life with running Eyecare Plus Corrimal with her husband.

Supportive staff, who are also female, have helped and the support of a group such as Eyecare Plus has been invaluable, Wang says. And after taking a brief time out of the business on maternity leave, she eased back into her professional role, working one day a week and slowly building up.

Balancing parenthood and operating a successful practice, throughout a pandemic and upcoming practice renovations – in the same year – is no small feat. Attributes she didn’t initially appreciate, such as the flexible hours, help make it a rewarding career choice.

“Getting the balance right means utilising and maximising your time at work, and at home, and prioritising what’s important – don’t fuss over the little things,” she says.

“Optometry, as a career, offers an opportunity for work-life balance, and that’s valuable.”

Leading by example

For ophthalmologist Associate Professor Anne Brooks, the biggest hurdle she has overcome in her career is work-life balance. It’s a challenge she highlighted in an interview with RANZCO to celebrate International Women’s Day in 2018, and one she believes continues to top the list for most ophthalmologists, regardless of gender.

A/Prof Anne Brooks was the female to be awarded the College Medal, RANZCO’s highest honour.

“Life is always a balancing act and ophthalmology is a very involved profession. Beyond the clinical, many of us work in research, run businesses, do administration, teach and serve on committees and advisory boards,” Brooks says.

“Finding time to balance the myriad of ‘home’ roles in addition to these is difficult. The balancing act has traditionally been one done by women more than men, and while this is still probably the case, many men are now trying to achieve balance too. That is a good thing.”

Highly regarded in ophthalmology and teaching, Brooks has received RANZCO’s award for Excellence in Training eight times and in 2019 became the first female to be awarded the College Medal, RANZCO’s highest honour, following 28 male awardees.

“It is a great honour to have been recognised in this way, and something I had never dreamed of. It has increased the respect of my colleagues,” Brooks, who works in private practice and at the Royal Victorian Eye and Ear Hospital, and specialises in glaucoma and cataract, says.

“I am hopeful that it will inspire more nominations from colleagues that recognise the outstanding work being done by so many other women in the College. We don’t work for recognition, but it is nice to receive it.”

The award was presented by RANZCO’s president Associate Professor Heather Mack, the first female president in the college’s 50-year history who ends her two-year tenure this month.

The achievements of both Brooks and Mack in a traditionally male- dominated profession may help to demonstrate how the profession is changing.

However, the figures suggest there is some way to go until ophthalmology reaches parity. Although numbers are trending upwards, Australian Government figures from 2016 show males represented 79.5% of clinicians, and were aged 54 years on average. By contrast, females represented 20.5% of clinicians and were aged 48 years on average, six years younger than their male counterparts.

In 2016, there were 95 male trainees and 51 female. Today, RANZCO boasts 80 female trainees, and 298 female Fellows.

Despite this, female representation is increasing in ophthalmology, coinciding with RANZCO releasing a 2019-2020 Women in Ophthalmology Strategic Plan in late 2018.

Although only indirectly involved, Brooks says one rationale of the strategic plan was to focus the efforts of the Women in Ophthalmology (WIO) Advisory Group.

“The WIO Advisory Group is about 20 Fellows and trainees who have an interest in taking a more hands-on approach to gender issues. Determining what to do, how to start and how to measure success really drove the need for a plan,” she says.

The strategic plan was a communication tool to articulate to members what the WIO want to achieve and how this can occur, and was seen as a way to democratise decision making in terms of deciding focus areas, Brooks says.

“The plan was put together by asking Women in Ophthalmology Luncheon participants at the 2018 annual RANZCO Scientific Congress to identify all areas of concern and then hone these down. All refined ideas were then circulated via a survey, open to all female Fellows and trainees, and there was a request to rank these. The top three areas became the three pillars of the plan: awareness, recognition and engagement.”

To illustrate the strategic plan in action, Brooks points to the recent accomplishment of a high-achieving colleague.

“Professor Justine Smith, a Matthew Flinders Distinguished Professor at Flinders University, is an internationally recognised expert in the causes, effects and treatment of uveitis. Her work is both clinical and by research,” Brooks says.

“She was recently appointed as the first female editor-in-chief of the RANZCO Journal Clinical and Experimental Ophthalmology and is the first female editor-in-chief of a major ophthalmology journal.”

In her role training the next generation, Brooks says young female ophthalmologists largely aspire to subspecialisation, which usually involves a period of training overseas, but this has currently been affected by COVID-19.

Breaking the glass ceiling 

Dr Alina Zeldovich is an anterior segment ophthalmologist, business owner and director at Eye Associates in Macquarie Street, Sydney. She’s also from a refugee family who arrived in Australia without knowing a word of English.

She has overcome many hurdles to become a high-achieving member of the ophthalmic community, which also involves roles within RANZCO. She believes ophthalmology has traditionally been a difficult career to enter because of a lack of government-funded training positions.

Dr Alina Zeldovich has overcome many hurdles on her journey to becoming an Australian ophthalmologist.

“While there have traditionally been obstacles that affected women in particular, this is certainly changing. I think the glass ceiling is gradually being broken and many changes have occurred since I started my training in 2002, which have helped advance the careers’ of women,” she says.

Research on gender differences amongst Australian and New Zealand ophthalmologists’ experiences of the workplace, published in 2019, showed that female ophthalmologists worked fewer hours, mainly in the private sector, to fulfil their greater family commitments.

Female ophthalmologists reported additional obstacles to career advancement and were more likely to report experiencing discrimination in the workplace.

Now, a shift towards increased flexibility, including part time training, and increased participation in College initiatives, is changing dynamics within the profession.

“A lot of work has gone into remodelling the RANZCO training program, this is also better for women. In particular, there has been focus on making the process more transparent by having clear guidelines on training admission requirements and training completion,” Zeldovich says.

“In most training programs part time training is permitted and this has really made things better for those who have a family. There are now larger practices with multiple associates or directors, which makes covering one another easier and this enables women to work sessions with flexible hours. It is always better to be able to spread on-call around more people.”

For Zeldovich, part time training also has other benefits for women.

“Doing exams during training rather than beforehand now means that no one is waiting for a position having invested time and money into passing the exams without being guaranteed one,” Zeldovich says.

“Women are also encouraged to participate on committees and special interest groups within the College. There is a Women in Ophthalmology network that runs in every state in Australia and New Zealand where women can get together to work through issues and provide support and collegiality.”

Under a Board initiative from 2015, RANZCO has encouraged 35% female representation on committees, which has been achieved in most states, Zeldovich says.

“The processes for obtaining training posts, jobs and College positions has become more transparent, so things have changed for the better.

“Having our first female RANZCO president and more female representation at Congress is real evidence of breaking through the glass ceiling. I believe with the right support, women can have a very satisfying career and achieve just as much in ophthalmology as men,” she says.

As previously mentioned, Zeldovich has had to overcome her own obstacles, including immigrating to a foreign country as the daughter of refugees who migrated from the Soviet Union to Australia in the late 1970s when she was pre-school aged.

Wanting to pursue a career that could have a significant impact on people’s lives – and coming from a family of doctors, including three of her four grandparents and both parents, who had to retrain in Australia – Zeldovich chose ophthalmology, where her career aspirations continue to grow.

Outside of her consultation rooms, Zeldovich is an active member of her profession; she was a co-convenor for RANZCO’s annual Congress in Sydney last year and is currently the vice chair of its NSW branch and a federal council member.

“It was a career highlight to be the co-convenor for the last RANZCO Congress. It was the largest Congress to date and had a female chair of the Scientific Committee, as well as the first female College Medal recipient and female RANZCO president,” she says.

“I aspire to be part of the College’s strategic plan and see its future as an advocacy body, an organisation which unites ophthalmic services and offers both members and the community valuable information on eyecare.”

A lecturer with the University of Sydney’s Faculty of Medicine and completing an MBA at UNSW Business School, Zeldovich hopes to gain business knowledge to help run organisations and promote eye health.

In addition to this, she has co-founded a business called Beamers that produces children’s sunglasses. It was established due to concerns that 80% of UV damage occurs before age 18, and is currently working with the World Society of Paediatric Ophthalmology and Strabismus on a consensus statement to be released later this year.

Dr Alina Zeldovich (left) started a children’s eyewear business over concerns about UV light damage.

As her career to date demonstrates, Zeldovich credits ophthalmology for the range of options it presents.

“The most challenging part is the many years of training and exams, however after this there are many career options, from working in the public system to working in private or a combination of both. There is also the flexibility of working full time or part time, in one or several practices, and the ability to participate in research, work as a surgeon or not operate at all, be involved in RANZCO, or teach and mentor peers. There are many paths for women in ophthalmology that are not necessarily available in other surgical specialties.”

Focus on flexibility and equality 

According to a study published in Clinical and Experimental Optometry in August, the number of registered optometrists in Australia has increased by 30.1% during the past decade, a rate that is greater than the population growth of the country (12.1%).

The study also found that new entrants to the optometry profession could be generalised as graduates of an Australian optometry program, female, aged in their early‐to mid 20s and qualified for therapeutic practice.

OA CEO Ms Lyn Brodie says the growing optometry workforce is favouring flexible employment.

Optometry Australia CEO Ms Lyn Brodie says there are examples across the sector of more flexible employment arrangements.

“Over the last decade we have seen increasing feminisation of the optometry workforce, and an increase in the proportion of the workforce that is made up of younger cohorts. ‘Female optometrists’ and ‘young optometrists’ are, of course, not homogenous groups. However, as it is common across many professions, there appears to be a particular demand from women, and increasingly men, for more flexible employment conditions, often in order to enable them to fulfil caring responsibilities,” she says.

OA has been working to create a more open discussion across the sector on what is needed to create more flexible work conditions that work for optometrists and their employers.

“In the recent past we have worked with FlexAgility to provide advice, case studies and an education session addressing rights with regard to flexible work requests and examples of optometrists working outside typical full-time, standard practice hours arrangements. We also continue to support members one-on-one in their negotiations for flexible working arrangements,” Brodie says.

“There are promising examples across the sector of more flexible approaches being taken to employment arrangements. As the profession continues to evolve, we feel it will need to do better in accommodating flexible work, but also that changing technologies and practice hours may support ever-more flexible arrangements.”

In conjunction with the optometry workforce tipping to a female majority, so too is OA’s membership, albeit only marginally, Brodie says. The organisation is responding by providing women-centric advice on its website and through its member support services.

Brodie acknowledges the strong female leadership across the profession in academia, clinical practice, management and leadership roles in larger service providers and within the governance of entities that support optometrists, such as OA.

“We recognise the need to continue to support women to pursue fulfilling careers and leadership roles within optometry. The Women in Optometry section on our website has been created to support women’s career development. We offer support via advice available to all our members on our website, and one-on-one guidance and support via our Member Support team, around progressing a career in optometry, negotiating working arrangements and pursuing leadership in the sector.”

One of the people providing that support is national professional services advisor and optometrist Ms Sophie Koh.

Sophie Koh says almost all queries Optometry Australia receives regarding extended leave or a career break as result of caregiving and/or parental responsibilities, are from female optometrists.

She says the topics that younger female optometrists contact OA for advice about are broad.

“It ranges from career and contract advice to everyday professional, clinical, or legal issues with patients or their workplace. Generally, there are no major gender differences across the broad topics our membership reach out to us for,” Koh says.

“However, as women in Australia still take on the lion’s share of care responsibilities in the family, whether that is looking after ageing parents or children, almost all queries Optometry Australia receives regarding the topic of taking extended leave or a career break as result of caregiving and/or parental responsibilities, are from female optometrists.”

For a new parent, Koh says, the immediate questions are regarding the logistics of maintaining AHPRA registration, keeping up with CPD requirements and clinical hours to stay registered, while on an extended break.

“We also have a number of female members living overseas whilst being the main carer for young children, so upkeeping registration requirements can be complex.”

Koh says members returning to the workforce after several years contact OA for advice on returning to the sector; others have questions regarding working as a locum.

“There are also everyday HR and workplace flexibility questions that may arise due to maternity leave or returning to work. We help both employees and employers needing such advice,” Koh says.