Residency Profile: Kaiser Permanente, Seattle, WA*

Residency Profile: Kaiser Permanente, Seattle, WA*

Residency in Primary Care Optometry
Kaiser Permanente - Seattle, WA

*Formerly Group Health Cooperative Residency in Primary Care Optometry 

Established: 2007

Positions: One

Kaiser Permanente
Northgate Medical Center
9720 Fourth Ave., NE
Seattle, WA  98115

Program Faculty

Coordinator: Gelea Ice, OD

Attendings

• Gelea Ice, OD
• Lynna Kim, OD, FAAO
• Lance Matsuda, OD, FAAO
• Brian Reeh, OD, FAAO
• Shweta Agrawal, OD
• Danielle Robertson, OD

Mission Statement

The Kaiser Permanente Washington Residency in Primary Care Optometry seeks to provide optometric graduates with the experience, skills, knowledge, and understanding necessary to work effectively as a primary eye care clinician, and as an entry point into the health care system.

Our resident will receive advanced clinical training and experience in the diagnosis and management of ocular health and visual function, as well as ophthalmic manifestations of systemic disease and medications. The resident will develop an appreciation of the patient as an individual faced with multiple life and health care challenges.

Program Description

Program Goals

1. Enhance the resident’s clinical experience in primary and secondary eye care.
2. Strengthen the resident’s skills, experience, and knowledge base in primary and secondary eye care, including contact lens and low vision services.
3.  Expand the resident’s skills, experience, and knowledge base in ocular disease detection, diagnosis, management; secondary and tertiary eye care; and, ocular manifestations of systemic disorders and medications.
4. Provide the resident with a practical understanding of their role as an integral member of a multidisciplinary health care team and to recognize the importance of an integrated coordinated approach to health care delivery.
5. Develop the resident’s ability to disseminate knowledge to health care professionals, as well as to the lay public.
6. Provide opportunities for didactic education to enhance the resident’s clinical decision making.
7. Develop the resident's appreciation for scholarly activities and lifelong learning.

Program Objectives

1. The resident will log approximately 1200 direct patient care encounters with clinical preceptorship. These encounters will consist of regularly scheduled patients, non-scheduled urgent care patients, and after hours “on-call” patient care.
2. The resident will be supervised and trained to develop the ability to form appropriate ocular differential diagnoses, including differentials for ocular disease and systemic disorders with ophthalmic manifestations. 
3. The resident will participate in case discussions with residency faculty and review the resident’s patient encounters, including the development of differentials and management of selected ocular disease cases.
4. The resident will be assigned and quizzed on selected readings relating to ocular differential diagnosis.
5. The resident will complete thorough and accurate records of examination utilizing a variety of electronic medical record (EPIC) templates, perform appropriate coding for medical procedures and diagnoses, all of which will become part of a comprehensive, multidisciplinary electronic medical record (EMR-EPIC) system.
6. The resident will learn appropriate coding for procedures and diagnoses. Data will be automatically captured and collated by the EMR-EPIC system.
7. The resident will obtain additional experience and skills in the discipline of contact lenses through the Eye Care Services contact lens department, evaluating and fitting routine, cosmetic contact lens patients and participating in specialty contact lens care.
8. The resident will obtain additional experience and skills in the discipline of low vision care.
9. Advanced techniques will be practiced, performed, and assessed in the clinical setting. 
10. The resident will acquire “hands-on” experience in the diagnosis, co-management and/or management of ophthalmic disease, trauma, and degenerative processes.
11. The resident will participate in outpatient clinic “first call” for daily urgent care ophthalmic presentations to Eye Care Services.  The resident will participate in “after-hours call” rounding service, accompanied by supervisory staff.
12. The resident will manage or comanage glaucoma patients, including optic nerve head assessment, stereo disc photography, visual field testing interpretation, pachymetry, and gonioscopy.
13. The resident will evaluate and manage patients presenting with ocular infection, inflammation, and trauma, including appropriate ordering of laboratory tests and imaging studies.
14. The resident will acquire "hands-on" experience in the evaluation and management and/or co-management of ophthalmic manifestations of systemic disease and medications.
15. The resident will interact with ophthalmology colleagues, discussing cases, sharing patients, as well as directly observing ophthalmologic secondary and tertiary care.
16. The resident will utilize direct provider-patient communication, and the electronic medical record system to form a global picture of each patient’s overall health status and multiple health care issues by reviewing and adding to the entirety of the electronic medical record (EMR).
17.  The resident will initiate urgent and non-urgent referrals to non-ophthalmic health care providers, communicate appropriate ophthalmic findings, and specific concerns prompting the referral.
18.  The resident will fully utilize clinical and support services available within the multidisciplinary setting.
19.  The resident will observe and interact with non-ophthalmic health care providers from a variety of disciplines, including but not limited to, family practice, internal medicine, pediatrics, dermatology, neurology, rheumatology, and radiology to enhance understanding of the coordinated, multidisciplinary nature of patient care, and to gain exposure to common acute and chronic health problems experienced by patients.
20. The resident will prepare and deliver lecture presentations to audiences comprised of ophthalmic professionals, non-ophthalmic health care providers, and the lay public.
21. The resident will actively participate in optometric rounds-workshops, attend optometric continuing education, journal club, and non-ophthalmic medical education.
22. The resident will be exposed to a variety of ophthalmic literature and educational materials related to diagnosis and management of ocular disease, and assigned selected readings, audiotapes, internet sites, journals, or other educational materials on ophthalmic disease for weekly review and discussion.
23. The resident will be exposed to a variety of medical literature and educational materials related to medical diagnosis, and specifically systemic disorders and medications with ophthalmic manifestations.  The resident will be supplied with numerous journal reprints, electronic media, and other forms of study materials for review. Additional, timely materials will be provided for review and/or researched by the resident when opportunities for further discussion developed as the result of patient encounters.
24. The resident will prepare a publishable quality manuscript, case report, or poster suitable for presentation at the American Academy of Optometry annual meeting or other major conferences.
25. The resident will be encouraged to complete additional case reports to meet requirements for Fellowship in the American Academy of Optometry.

The Residency Experience

• The resident will be examining approximately 1,200 Kaiser Permanente patients. The resident will perform full comprehensive primary care and secondary care exams; problem-focused ocular disease visits; and, non-scheduled urgent care evaluations, many of which are generated by family practice, pediatric, and internal medicine colleagues. The resident will participate in contact lens care, and will observe and participate in the care of low vision patients in clinic and at The Lighthouse for the Blind, a non-profit, comprehensive low-vision clinic in Seattle. 
• The resident will acquire “hands-on” experience in the diagnosis, co-management and/or independent management of ophthalmic disease, including infectious processes, ocular inflammatory disease, ocular trauma, post-surgical eye care, and glaucoma.  The resident will participate in outpatient clinic “first call” for urgent care ophthalmic presentations to Eye Care Services; and, accompany supervisory staff in quarterly after-hours and weekend call.
• Our resident will initiate appropriate urgent and non-urgent referrals for ophthalmologic care, develop management and co-management strategies with optometric and ophthalmologic colleagues, directly observe ophthalmologic secondary and tertiary care with general ophthalmologists, as well as subspecialists in retina, oculoplastics, glaucoma, pediatrics, and others.
• As an integral part of the health care team, the resident will develop an understanding of common acute and chronic health problems, and the coordinated, multidisciplinary nature of patient care.
• Our resident will gain experience in the evaluation and management and/or co-management of ophthalmic manifestations of systemic disease and medications. The resident will examine patients referred for ocular evaluation by non-ophthalmic healthcare providers (e.g. family practice, pediatrics, dermatology, rheumatology, internal medicine, etc.), as well as participate in Kaiser Permanente's ongoing diabetic retinal screening program. Conversely, the resident will consult with, and refer directly to non-ophthalmic healthcare disciplines, as well as order laboratory and radiology studies as indicated for diagnosis and management of ocular and systemic disease.
• Approximately 60-70% of the resident's time will be spent in direct patient care.
• Approximately 10-15% of the resident's time will include: observation and interaction with family practice and internal medicine clinicians; rotations through a variety of medical specialties, some of which may include: dermatology, neurology, radiology, diabetic education, and rheumatology. Other specialty observations can be arranged depending on the resident's inclination and availability of staff.
• Approximately 10-15% of the resident's time will include observation and interaction with the ophthalmology service, including subspecialty ophthalmology care, and observation of surgery (if desired).
• At least 10% of the resident's remaining time will be set aside for scholarly activities, including preparation of a required case report, poster, or original research of publishable quality; required reading assignments; administrative duties; lecture preparation; library research; log maintenance; and, other assorted tasks.

Typical Daily or Weekly Schedule in Clinic

The usual weekly hours of resident's attendance will be Monday through Friday, 8:00 a.m. – 5:00 p.m., with one hour for lunch time. The resident is required, however, to remain until all patient care activities are concluded, which rarely extends beyond an additional hour.

Four weeks of after-hours call (evenings, weekends, and possible holidays) with supervisory staff will be required as part of the residency experience, with one week during each quarter of the program.  Each after-hours call week commences at 5:00 p.m. on Friday and extends to 5:00 p.m. the following Friday.  During that time, the resident is required to be available by phone and pager, and in-clinic if needed, for urgent consultations and acute ophthalmic care, if called. Choice of call weeks is negotiable.

A typical monthly schedule may resemble the following:

Each clinic day, there is time for the resident to present interesting cases from the day's encounters for review and discussion with supervisory staff.  From these discussions, the resident may be assigned a topic to research and present at a later date, or asked to review a relevant journal article. There is also a discussion scheduled each week covering a selected topic and associated cases will be discussed. Journal articles will be assigned each week for the given topic.

Our resident will receive personalized training in advanced ophthalmic competencies by medical and technical staff. Advanced techniques will include scleral depression, fundus contact and non-contact lens evaluation, fundus photography, automated visual field testing and interpretation, pachymetry, gonioscopy, OCT testing and interpretation, corneal topography, foreign body removal and patching, dilation and irrigation of the lacrimal system.

Rotation Through Other Services

Teaching Responsibilities

The resident will be required to engage in clinical teaching of ophthalmic disease and examination techniques to Family Practice residents, as well as Eye Care support staff.

Lecturing Opportunities

The resident will be asked to prepare and present a different case, journal article, or ophthalmic topic at regional optometric rounds.  Additionally, the resident will prepare and deliver a topical lecture to the Family Practice residents within Kaiser Permanente; to a non-ophthalmic health care audience at the University of Washington; to attendees at the annual Kaiser Permanente Eye Care Services continuing education conference; and, to a lay audience comprised of patients.

Scholarly Activities

• Scholarly training is emphasized through regional case conferences and weekly local clinic meetings; attendance at Eye Care Services continuing education meetings; and required completion of 50 hours of Washington State Board of Optometry approved continuing optometric education. Additionally, the resident is encouraged to attend multidisciplinary Kaiser Permanente clinical presentations, continuing education, and lectures that are given almost weekly during the year.
• The resident will be asked to prepare and present a different case, journal article, or ophthalmic topic at regional optometric rounds. Additionally, the resident will prepare and deliver a topical lecture to the Kaiser Permanente Family Practice residents; to a non-ophthalmic health care audience at the University of Washington; at the annual Kaiser Permanente Eye Care Services continuing education conference; and, to a lay audience.
• A case report or research paper suitable for publication in a peer-reviewed journal is required.  The resident will also be encouraged to submit a poster presentation and attend the annual meeting of the American Academy of Optometry.
• Journal Clubs

Program Duration

The start date is no later than August 1st, and the end date is no later than August 1st of the following year; the program duration is one year.  The start date maybe a few days earlier than August 1st because of institutional onboarding/intake scheduling dates; when this occurs, the end date is one year from the start date.

Stipend
The annual stipend will be $47,000 and is distributed in equal payments at the middle of the month and the last working day of the month. The resident's compensation is not contingent upon the resident’s productivity. In addition to the annual stipend, the resident is awarded $1,600 annually for approved continuing education costs, travel, books and journals, and professional society dues. There is no state income tax for residents domiciled in Washington State. Though our resident is not allowed to work outside of the organization delivering eye care in a paid professional capacity, there are opportunities for “extra work for extra pay” available within the organization.

Benefits
Comprehensive Kaiser Permanente medical and dental coverage is offered, with premiums deducted each pay period. Term life insurance is offered up to $250,000. Sick leave accrues at one day/month to a maximum of 12 days. And, the resident may participate in the 401(k) retirement plan.

Professional liability is covered by Kaiser Permanente.

The following (paid time off) holidays are observed:

• New Year’s Day
• Martin Luther King, Jr. Day
• President’s Day
• Memorial Day
• Independence Day
• Labor Day
• Thanksgiving Day
• Christmas Day

Residents will accrue a total of 15 days of annual leave, along with 5 additional days of professional educational leave that must be approved by the Medical Director and result in at least 5 hours per day of professional education applicable to optometric re-licensure. The resident is encouraged to use their educational leave time to attend the annual meeting of the American Academy of Optometry or other professional continuing educational conferences.

The resident is defined as an employee of the Washington Permanente Medical Group, and as such, she/he will be afforded library privileges and research assistance, a variety of staff discounts, and other assorted benefits available to employees.

As part of the residency contract with the Southern California College of Optometry at Marshall B. Ketchum University, the resident will also be afforded additional benefits as indicated in the SCCO/MBKU Residency Manual and/or Administrative Guide. These may include free attendance at SCCO/MBKU-sponsored continuing education programs on a space available basis, use of SCCO/MBKU Multi-Media Services for approved residency presentations, research design assistance, library services, and discounts from the SCCO/MBKU Campus Store.

Eligibility Criteria and Application Process

• Attainment of the OD degree from a school or college of optometry accredited by the Accreditation Council on Optometric Education (ACOE) of the American Optometric Association.
• Successful completion of the National Board of Examiners in Optometry (NBEO).
• Applicants must satisfy all requirements to allow for Washington State optometric licensure. This includes successful completion of NBEO Part III and passing the Washington State Board of Optometry Law Exam.
• Applicants must submit three letters of reference from faculty members responsible for their clinical education.
• A personal interview is required.
• Applicants chosen for the program will need to submit formal application materials for employment by Washington Permanente Medical Group.
• Applicants should notify the Residency Program Coordinator of their interest in our program.
• Applicants will also need to apply directly to the Optometry Residency Match (ORMatch) National Matching Services, Inc. (ormatch@natmatch.com).
• Applicant chosen for the program is required to be up to date on all vaccinations as required by Washington Permanente Medical Group. 

On or before February 1st of the residency year, applicants should have on file with the Optometry Residency Program Coordinator:

• A current curriculum vitae (CV).
• A one-page letter of intent, discussing the reasons for pursuing residency training, in general, and this program, in particular; expectations from the residency experience; any interested areas of specialization; and, future professional goals.
• Official transcripts of work completed in professional school.
• NBEO transcripts of completed sections.
• Letters of recommendation from three faculty members closely acquainted with the applicant's clinical proficiency.

All prospective applicants are welcome to visit the clinic on an informal basis. Candidates with completed applications may be invited by the Residency Admissions Committee for a formal interview.  All formal interviews will be held by invitation only in January and February.

All residency applicants will be evaluated without regard to sex, race, color, creed, age, national origin, or non-disqualifying physical disabilities.

Selection Process
Once all the application materials for candidates have been received and the interviews have been conducted, the team at Kaiser Permanente Eye Care – Seattle begins their selection process. The following elements are taken into consideration:

• Statement of Interest (10%) 
• Curriculum Vitae (10%) 
• Letters of Recommendation (10-20%) 
• GPA, Grade Point Average (10-20%)
• NBEO, National Board Scores (10-20%) 
• Interview (40%)

Each of the elements above are weighted as indicated, with the interview weighted most heavily, followed by a combination of GPA, NBEO scores, and Letters of Recommendation at 40%, and the Statement of Interest and Curriculum Vitae each receiving 10% weighting.  Competitive candidates will have at least a 3.0 GPA. Principal faculty members and the current resident independently assess and rank each applicant. The residency coordinator collects and compiles the final rankings, and a group meeting is held to finalize the program’s ranking for submission to the ORMatch.

Program Accreditation
The Accreditation Council on Optometric Education (ACOE - www.theacoe.org - 243 N. Lindbergh Blvd. - St. Louis, MO - 63141) granted the status of “accredited” for the program in 2015. The next currently scheduled site visit will take place in June/ 2024.

The Residency Faculty
The Residency faculty includes five optometric physicians with more than a century of practice experience. Three ODs are Fellows of the American Academy of Optometry and four of the ODs are residency or fellowship trained. Each OD will be involved in residency training and supervision.

• Gelea Ice, OD: Residency Program Coordinator; staff optometrist, Kaiser Permanente, 2010-present (formerly Group Health Cooperative); Kaiser Permanente Washington Residency in Primary Care Optometry Seattle, 2010 (formerly Group Health Cooperative); Doctor of Optometry, Nova Southeastern University, 2009; Bachelor of Science, Biological Sciences, University of Northern Colorado, 2003. Professional interests: ocular disease and primary care. Personal interests: reading, hiking, yoga and pilates.
• Lynna Kim, OD, FAAO: Residency Program Adjunct Faculty; staff optometrist, Kaiser Permanente, 2008-present (formerly Group Health Cooperative); Fellow of the American Academy of Optometry, 2010; Kaiser Permanente Washington Residency in Primary Care Optometry Seattle, 2008 (formerly Group Health Cooperative); Doctor of Optometry, Southern California College of Optometry, 2007; Bachelor of Science, Psychobiology, University of California Los Angeles, 2002. Professional interest: ocular disease. Personal interests: travel, music, hiking and the culinary arts   
• Lance Matsuda, OD, FAAO: Residency Program Adjunct Faculty; North Region Optometry Chief, Kaiser Permanente of Washington; staff optometrist, Kaiser Permanente, 1991-present (formerly Group Health Cooperative); Fellow of the American Academy of Optometry, 1996; VA American Lake Residency in Hospital-Based Optometry, 1991; Doctor of Optometry, University of California Berkeley School of Optometry, 1990; Bachelor of Science, Biology, University of Washington, 1986. Professional interests: geriatrics and contact lenses. Personal interests: fishing and hiking
• Brian Reeh, OD, FAAO: Residency Program Adjunct Faculty; staff optometrist, Kaiser Permanente, 1997-present (formerly Group Health Cooperative); Fellow of the American Academy of Optometry, 2000; Doctor of Optometry, University of California Berkeley School of Optometry, 1996; Bachelor of Science, Biology, University of California Irvine, 1992. Professional interest: contact lenses. Personal interests: reading and travel
• Shweta Agrawal, OD: Residency Program Adjunct Faculty; staff optometrist, Kaiser Permanente, 2018-present; VA Sepulveda Ambulatory Care Center Residency in Primary Eye Care and Ocular Disease, 2018; Doctor of Optometry, Southern California College of Optometry, 2017; Bachelor of Science, Human Biology, University of California San Diego, 2013. Professional interest: ocular disease. Personal interests: hiking, swimming, trying new foods and reading.

Eye Care at Kaiser Permanente Washington is organized under the Ancillary Services Division, with departments of optometry and ophthalmology working cooperatively to deliver cost-effective, coordinated care. Optometrists at Kaiser Permanente are not employees, but active, equal members of the Medical Staff along with our physician colleagues. The current Physician in Chief and Director of Eye Care is an optometrist.

Housing
Seattle has a wide range of housing options available, including a large rental market of apartments, condominiums, houseboats, and homes.

Local Activities & Attractions
Seattle is one of the most naturally beautiful cities in the world, nestled between the incredible mountain ranges of the Cascades and the Olympics. Mount Rainier peeks out over the skyline on most days, and along with the San Juan Islands and Puget Sound, makes Seattle a destination for those who like the outdoors.

Seattle is also a sophisticated center for the arts, with a symphony, opera, multiple theaters, sports venues, concert halls, and film festivals. The Museum of Pop Culture reveals the city's rich musical heritage. Nearby Woodinville, Washington hosts a community of celebrated wineries. Although Seattle's image is one of dreary rain, the annual average rainfall is just 38 inches – that's less than Boston, Atlanta, Charlotte, and much of the state of Hawai'i. While there are a few overwhelming downpours, Seattle's winter is often gray and mild, with frequent drizzles (but usually you can walk between the raindrops!) that don’t keep most Seattleites indoors for very long. 

Contact Info
Gelea Ice, OD
Optometry Residency Program Coordinator
Kaiser Permanente Eye Care
9720 Fourth Ave NE
Seattle, WA 98115
Phone: 206-302-1606 • Email: gelea.n.ice@kp.org

Judy W.H. Tong, OD, FAAO
Assistant Dean of Residencies
Southern California College of Optometry at
Marshall B. Ketchum University
2575 Yorba Linda Blvd.
Fullerton, CA 92831-1615
714-463-7568 • Fax:  714-872-5683 • Email: jtong@ketchum.edu

Also See
Kaiser Permanente physicians web site 
Kaiser Permanente Eye Care web site