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Residency Profile: Kaiser Permanente, Tacoma, WA*

Residency in Primary Care Optometry
Kaiser Permanente - Tacoma, WA

*Formerly Group Health Cooperative Residency in Primary Care Optometry 

Established: 2009

Positions: One

Kaiser Permanente
Tacoma Eye Care Center

5821 S. Sprague Court #102
Tacoma, WA 98409

Coordinators:

  • Candy Arias Ceja, OD

Attendings:

  • Brian Pietrantonio, OD, FAAO
  • Rodney Jacob Gunn, OD, FAAO

Mission Statement
As a primary health care provider, optometric physicians serve as an entry point to the health care system. The Kaiser Permanente Washington Residency in Primary Care Optometry program seeks to provide the optometry resident with the experience, skills, knowledge, and understanding necessary to work effectively as an integral part of a patient’s multidisciplinary health care team.

The resident will receive advanced clinical training and experience in the diagnosis and management of ocular health and visual function, as well as the ophthalmic manifestations of systemic disease and medications. The resident will gain knowledge, interactive skills, and experience in communicating effectively with other health care professionals, as well as the lay public; and, the resident will develop an appreciation of the patient as an individual faced with multiple life and health care challenges.. 

Blue Eye Public Market Sign Ferry Eye Image

Program Description

Program Goals

  1. To enhance the resident’s clinical experience in primary and secondary optometric care.
  2. To enhance the resident’s skill set in primary and secondary optometric care.
  3. To expand the resident’s skills, experience, and knowledge base in ocular disease detection, diagnosis, management, as well as ocular manifestation of systemic disorders and medications.
  4. The resident will participate as a member of a multidisciplinary health care team; gain exposure to and develop interactive skills with non-ophthalmic health care disciplines; recognize the importance of a multidisciplinary, coordinated approach to health care delivery; and, develop an appreciation of the patient as an individual faced with multiple life and health care challenges.
  5. To develop the resident’s interests and abilities in scholarly activity and lifelong learning.

Program Objectives

  1. The resident will experience numerous direct patient care encounters consisting of primary and secondary eye care.
  2. Provide the resident with complex and challenging cases that present in a large multidisciplinary setting.
  3. The resident will participate in weekly literature review sessions with a member of the faculty, as well as quarterly case presentations. 
  4. The resident will develop an understanding of and ability to work with other health disciplines outside of eye care.
  5. The resident will appropriately and effectively utilize technology and incorporate it into patient care. 
  6. The resident will develop an understanding of the various ophthalmologic specialties and surgeries.
  7. The resident will develop a comprehensive understanding of interdisciplinary health care.
  8. The resident will develop an understanding of support services available within a complex medical system.
  9. The resident will meet the SCCO and MBKU mandated deadlines and requirements.
  10. The faculty will instruct and advise the resident in clinical presentations.
  11. The resident will develop interests in and experience elements of an optometric educator.

Completion requirements

The residency completion certificate will be awarded when:

  1. A minimum of 1200 patient encounters have occurred.
  2. 25 hours of continuing education have been completed.
  3. The resident continuing education presentation has been completed, which usually occurs in March. Quarterly rounds presentations will also have been completed.
  4. The publishable quality case report or research paper is complete and approved by the residency coordinator.
  5. At least one presentation to a non-eye care forum is completed.
  6. Assigned rotations to various providers have been completed.
  7. Four weeks 'on call' have been completed.
  8. All administrative criteria are met: Criteria includes: All patient care and curriculum requirements, all reporting requirements including log sheets and final evaluation, approved final version of case report or research project, proof of returned resources including loaned equipment multi-media and library loans.

The Residency Experience

  • Each resident will examine approximately 1,200 Kaiser Permanente patients. Residents 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 residents will participate to a significant degree in contact lens care. 
  • Residents will acquire 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 residents will participate in outpatient clinic “first call” for urgent care ophthalmic presentations to Eye Care; and accompany supervisory staff in quarterly after-hours and weekend call.
  • Our residents will initiate appropriate urgent and non-urgent referrals for ophthalmologic care, develop management and co-management strategies with optometric and ophthalmologic colleagues and, directly observe ophthalmologic secondary and tertiary care with general ophthalmologists as well as subspecialists in retina, oculoplastics, glaucoma, and other fields.
  • As an integral part of the health care team, the residents will develop an understanding of common acute and chronic health problems and the coordinated, multidisciplinary nature of patient care.
  • Our residents will gain experience in the evaluation and management and/or co management of ophthalmic manifestations of systemic disease and medications. The residents 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, residents 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, including pediatrics, dermatology, neurology, laboratory medicine, cardiology, and rheumatology. Additional rotations are encouraged and may be arranged with endocrinology, vascular clinic, rehabilitative medicine, diabetic education, social work, speech/language/learning services and other specialty areas 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 Schedule
The usual weekly hours of the resident's attendance will be Monday through Friday, 8 a.m. – 5 p.m., with one hour for lunch. The resident is required 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 8 a.m. on Friday and extends to 8 a.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. Choice of call weeks is negotiable.

A typical monthly schedule may resemble the following:

Monday Tuesday Wednesday Thursday Friday
Primary and contact lens care Ophthalmology rotation Patient care, and rounding Primary and contact lens care Primary care and administrative duties
Primary and contact lens care Primary care and contact lens care Medicine rotation (e.g. neuro, derm, etc.) Primary and contact lens care Primary care and administrative duties
Primary and contact lens care Primary care and contact lens care Medicine rotation (e.g. neuro, derm, etc.) Primary and contact lens care Primary care and administrative duties
Primary and contact lens care Primary care and contact lens care Ophthalmology rotation Primary and contact lens care Primary and contact lens care

 

Faculty have time held each clinic day to support the resident and to engage in discussion about cases. 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. Once a week a one hour session is scheduled with a faculty member for literature review and case discussion.

Our residents 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/HRT testing and interpretation, foreign body removal, dilation and irrigation of the lacrimal system, and interpretation of fluorescein angiography.

Scholarly training is emphasized through monthly regional case conferences and weekly local clinic meetings; attendance at Kaiser Permanente Eye Care continuing education meetings; and required completion of 25 hours of Washington State Board of Optometry approved continuing optometric education. Additionally, residents are encouraged to attend multidisciplinary Kaiser Permanente clinical presentations, continuing education, and lectures that are given almost weekly during the year.

Residents will be asked to prepare and present a different case, journal article, or ophthalmic topic at regional optometric rounds. Additionally, each resident may prepare and deliver a topical lecture or poster at a major optometry meeting or to a non-ophthalmic health care audience within Kaiser Permanente. The resident will present a major topic to the Optometrists at Kaiser Permanente in the spring of each year; this will be done in concert with the resident at our sister program in Seattle. 

A case report or research paper suitable for publication in a peer-reviewed journal is required. Residents will also be encouraged to submit a poster presentation and attend the annual meeting of the American Academy of Optometry.

Poster Image Eye

 

Program Duration, Stipend and Benefits
The residency will be 12 months in length, beginning in July—exact date dependent on credentialing and negotiated with incoming resident—and continuing through completion of 12 months training. Start and end dates might be altered based on extenuating circumstance, such as personal illness,  a death in the family, or other unforeseen circumstance. Note that the resident may also complete a medical mission during the residency, which is treated as an extended rotation.

The annual stipend will be $32,896, 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 to be used 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.

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 Years 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 which 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, residents 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. Letters may be electronically transmitted. 
  • A personal interview is required. 
  • Applicants chosen for the program will need to submit formal application materials for employment by the 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). 

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

  1. A current curriculum vitae (CV).
  2. 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.
  3. Official transcripts of work completed in professional school.
  4. NBEO transcripts of completed sections.
  5. 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, sexual orientation, race, color, creed, age, national origin or non-disqualifying physical disabilities.

If you would like more information, please contact:

Candy Arias Ceja, OD
Optometry Residency Program Coordinator
Kaiser Permanente Eye Care
5821 S. Sprague Ct., Suite 102
Tacoma, WA 98409
253.396.4256
candy.c.ariasceja@kp.org

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

  • Statement of Interest (10%) 
  • Curriculum Vitae (10%) 
  • Letter of Recommendation (10%) 
  • GPA, Grade Point Average (15%) 
  • NBEO, National Board Scores (15%) 
  • Interview (40%)

Each of the above elements are weighted as indicated above with the Statement of Interest, Curriculum Vitae, and Letter of Interest all receiving a 10% weighting; GPA and NBEO scores each receiving a 15% weighting; and the interview is most heavily weighted at 40%. 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 ranking. A group meeting is held to reconcile any differences. The final ranking is then submitted to ORMatch before the match date.

Program Accreditation
The Accreditation Council on Optometric Education (ACOE) continued the status of “accredited” for the program in 2010. The next currently scheduled site visit for re-accreditation is May, 2017.

The Residency Location
The Tacoma Eye Care Center is located a few miles south of downtown Tacoma and a short distance from two Kaiser Permanente Medical Centers. See map and driving directions here. The outpatient population is comprised of a diverse socioeconomic, educational, and ethnic mix. Low vision care is offered at the Community Services for the Blind and Partially Sighted clinic in Seattle.

Our clinic offers primary eye care and contact lens specialty care services with multiple exam rooms, special testing areas for visual fields, fundus photography, and pachymetry; a contact lens dispensary, inventory, and modification lab; and an optical dispensary. Equipment includes non-contact tonometers, multiple lensometers (both automated and manual), radiuscopes, autorefractors, digital fundus cameras, a pachymeter, OCT, and Humphrey visual field analyzer.

The resident has a designated desk, private phone, personal computer with Internet access, shelves, free parking, etc.

The Residency Faculty
The Residency faculty includes several optometric physicians, of which three are Fellows of the American Academy of Optometry. Personal interests range from travel and international health care to hiking, movies, cooking, literature, and the arts. Each O.D. will be involved in residency training and supervision.

  1. Candy C. Arias Ceja OD: Residency Program Coordinator; staff optometrist, Kaiser Foundation Health Plan of Washington, 2010-present (formerly Group Health Cooperative); Kaiser Permanente Washington Residency in Primary Care Optometry Tacoma, 2011 (formerly Group Health Cooperative); Doctor of Optometry, Nova Southeastern University, 2010; Bachelor of Science, Biochemistry, University of Washington, 2003. Interests: neuro-ophthalmic disorders. Personal interests: family, theology and traveling.
  2. Terrence Clark, OD, FAAO: Adjunct faculty and former residency Coordinator. Graduated Pacific University College of Optometry, 1978; M.A., University of Washington, 1973; staff optometrist, Kaiser Foundation Health Plan of Washington, 1986 to present (formerly Group Health Cooperative); chief, Kaiser Permanente Eye Care Services--Tacoma, 1995 – 2015 (formerly Group Health); adjunct clinical faculty, University of Washington School of Medicine, MEDEX program, 1997 – present; adjunct clinical faculty, Pacific University College of Optometry, 1992 – 2001; adjunct clinical faculty, University of Houston College of Optometry, 1999 – 2001; Commander, US Army, 7229th Medical Support Unit, 2000 – 2005; Fellow, American Academy of Optometry; Lecturer at the University of Washington and at Pacific Lutheran University; professional interest in general diagnostic acumen and glaucoma. Outside interests: forestry, landscaping, hiking, speech and language, and history.
  3. R. Jacob Gunn, OD FAAO: Residency Program Adjunct Faculty; staff optometrist, Kaiser Foundation Health Plan of Washington, 2011-present (formerly Group Health Cooperative); Fellow of the American Academy of Optometry, 2013; Kaiser Permanente Washington Residency in Primary Care Optometry , 2012 (formerly Group Health); Doctor of Optometry New England College of Optometry, 2011; Bachelor of Science University of California Los Angles, 2007; Presenter multiple posters at AAO Meetings; Professional interests include glaucoma, uveitis, and evidenced based medicine; Personal interests include fly fishing, boating, food, and hiking.
  4. Timothy Nivala OD: Residency Program Adjunct Faculty; staff optometrist Kaiser Foundation Health Plan of Washington, 1990 – present (formerly Group Health Cooperative); Doctor of Optometry, Southern California College of Optometry, 1989 ; Bachelor of Science California State University Long Beach - Microbiology, 1982; Professional interests include full scope Primary Care Optometry to include general & medical contact lenses. Personal interests include fishing, hiking and time/activities with my family.
  5. Brian Pietrantonio OD, FAAO: Residency Program Adjunct Faculty; staff optometrist, Kaiser Foundation Health Plan of Washington, 2012 – present (formerly Group Health Cooperative); Residency in Primary Eye Care and Ocular Disease, Boston VA, Brockton Campus, 2012; Doctor of Optometry, The New England College of Optometry, 2011; Masters in Science, University of Massachusetts Lowell – Biology, 2007. Bachelor of Arts, Clark University – Biology, 2005. Professional interests include glaucoma, macular degeneration, and diabetes. Personal interests include soccer, cooking, and travel.

Eye Care at Kaiser Permanente Washington is organized under the Ancillary Services Division, with optometrists and ophthalmologists 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.

Local Activities, Attractions, and Housing
Puget Sound is one of the most naturally beautiful areas in the world, nestled between the 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, its beauty makes our region a destination for those who enjoy the outdoors. Although the Pacific Northwest’s image is one of dreary rain, in reality the annual average Seattle-Tacoma rainfall is less than Boston, Atlanta, Charlotte, and much of the state of Hawaii. While there are a few overwhelming downpours, the winter is often gray and mild, with frequent drizzles that don’t keep most Seattleites indoors for very long.

The Seattle-Tacoma area is also a sophisticated center for culture and the arts, with a symphony, multiple theaters, sports venues, concert halls, and film festivals. Seattle’s Museum of Pop Culture and renowned opera company reveal the city's rich musical heritage, while the Tacoma Museum of Glass reflects the diversity of world-class art found in the Pacific Northwest.

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

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