A wake-up call for ‘comfortable leaders’

The corporate imperative to maximise efficiency and profit is neither surprising nor inherently malicious, it is simply the nature of the beast. Yet understanding this reality doesn't require us to accept its consequences passively.

While the leaked internal communication is deeply troubling, its revelation is merely a symptom of a deeper malaise affecting our profession: the gradual erosion of professional advocacy. That a major ‘healthcare’ provider could so openly discuss wage suppression strategies – not in a confidential financial report, but in a communication to partners – speaks volumes about how far the corporatisation of optometry has advanced and how little resistance it now expects.

The echoes of this wage suppression strategy resonate deeply throughout labour history's halls. For over a century, healthcare workers have grappled with institutional employers' relentless drive to maximise efficiency at the expense of personal professional autonomy and fair compensation. While corporations will inevitably pursue their profit-maximising mandate, history has shown the benefits of collective action. For example, the 1985 Victorian nurses' strike was a watershed moment in Australian healthcare, when thousands of nurses walked out over pay and staff-to-patient ratios, ultimately securing significant improvements in both. While in Aotearoa in 1993, the public health sector strikes marked another crucial turning point, with nurses and junior doctors uniting to protect professional standards and improve working conditions.

The Australian Medical Association and the New Zealand Resident Doctors' Association have become powerful voices precisely because they understand that protecting professional standards requires collective advocacy. Even today, we see this dynamic at work. In 2024, nurses across New Zealand staged their largest-ever strike, demonstrating that collective action remains vital for maintaining professional standards and fair compensation in healthcare. These movements succeed because healthcare professionals have recognised time and again that individual action is insufficient against institutional and corporate pressure.

Optometry’s advocacy issues

While other healthcare professions have built on this legacy, optometry's unique historical trajectory has created additional challenges for professional advocacy. Unlike many healthcare professions that emerged from medical traditions, optometry's roots lie in skilled craftsmanship and commerce. Early optometrists were respected professionals precisely because they mastered the complex art of lens crafting – a lucrative skill that combined technical expertise with retail acumen. This commercial foundation was not a contradiction but a cornerstone of the profession's identity.

Yet over the past decades, optometry has undergone a remarkable transformation. Through sustained advocacy and professional development, the scope of practice has expanded dramatically. Optometrists fought for and won the right to use diagnostics, prescribe therapeutics, manage glaucoma and, in New Zealand, even perform certain laser procedures, demonstrating a conscious choice to embrace a more comprehensive healthcare role.

The success of this transformation is evident in our educational institutions, which now produce graduates steeped in medical knowledge and healthcare ethics. Young optometrists enter the workforce viewing themselves primarily as healthcare professionals, their training focused on clinical excellence and patient outcomes. Yet upon graduation, they encounter a stark reality: a system still fundamentally driven by commercial metrics and sales targets. This creates a profound disconnect. While our education and scope of practice have evolved toward healthcare, our professional practice remains anchored in retail-driven models.

The publication by Optometry Victoria South Australia’s KPIs and optometry document in 2020 perfectly illustrated this shift. Rather than championing a healthcare-first model, the document dedicated considerable space to "conversion rates" and "actual sales price (ASP) of Medicare billings per patient." It did, however, attempt to soften its corporate focus by acknowledging that "financial considerations... should not influence your integrity and regulatory compliance." Yet this very acknowledgment reveals the fundamental tension: why are we, as healthcare professionals, being asked to balance clinical decisions against retail metrics at all? The inclusion of ‘conversion rates’ as a standard KPI suggests our professional bodies have accepted, and now actively promote, the commodification of eyecare.

This approach stands in stark contrast to how other healthcare professions approach patient care. Consider general practitioners who, despite commanding higher salaries in both Australia and New Zealand in comparison to optometrists, operate under a purely clinical model. Their professional bodies focus on medical outcomes rather than sales metrics.

Even more telling is the approach to optometry taken in certain American states, where legislators have explicitly separated the prescribing and dispensing of glasses to avoid the perverse incentives that arise when clinical care becomes entangled with retail targets. Notably, optometrists in these states – such as Massachusetts and Rhode Island – maintain comparable salary levels to their counterparts in states without such separation. This demolishes the argument that retail targets and sales metrics are necessary for professional viability; rather, it suggests that when freed from retail pressures and protected by robust professional legislation, optometrists can focus on clinical excellence while maintaining professional income through appropriate fee structures for their medical services.

A leadership and advocacy imbalance?

More troubling still is the composition of our professional leadership. The boards of both Optometry Australia and the New Zealand Association of Optometrists are predominantly populated by established practice owners – professionals who have built successful businesses under the retail-focused model and who directly benefit from KPI-driven optometry. While their business acumen and experience are valuable, this raises a crucial question: can leadership drawn primarily from practice owners effectively represent the interests of the entire profession, particularly the growing workforce of employed optometrists?

This is not to diminish the achievements of successful practice owners or suggest malice in their leadership, rather it highlights a structural misalignment between leadership and membership. When those setting professional standards and advocacy priorities have fundamentally different economic interests from the majority of practising optometrists, whose interests are truly being served?

The Facebook group ‘Phoropter Free Fridays’ (set up and populated by many disillusioned members of our profession) and other instances of grassroots resistance to corporate metrics aren't just reactions to corporatisation – they're symptoms of this representational disconnect. When our own professional bodies promote retail metrics alongside clinical standards, they reflect the interests of practice ownership rather than the broader profession.

The leaked corporate communication about locum-wage suppression exemplifies this disconnect. That a major corporation could brazenly celebrate the suppression of locum rates without fear of professional consequences speaks volumes. It demonstrates not just corporate overreach, but a profound failure of our professional bodies to protect their members.

The corporatisation of optometry may have been inevitable in our modern healthcare landscape; however, the abdication of genuine professional advocacy by our representative bodies was far from inevitable, though its consequences have left the majority of practising optometrists without an effective voice.

The time has come for transformative change in how our profession organises and advocates. The solution lies not in reforming existing institutions, but in establishing a true optometry union – one that prioritises the interests of working optometrists and understands that professional standards cannot be measured by retail metrics.

Our future depends on our collective willingness to stand together and demand the professional autonomy and respect our education and expertise deserve.

The views expressed by Chalkeyes are theirs alone and not necessarily the views of NZ Optics Ltd. If you wish to comment on Chalkeyes’ views, please email a brief letter to the editor at [email protected] for consideration. Letters can be edited for space, style, grammar and clarity.