Residency Programs
Group Health Cooperative - Tacoma, WA

Established: 2009

Positions: One

Group Health Cooperative
Tacoma Eye Care Center
5821 S. Sprague Ct.
Tacoma, WA 98409

Program Faculty
Coordinator: Terrence Clark, O.D., F.A.A.O.

Attendings

• Cany Arias Ceja, O.D.
• Carol Hsiao, O.D., F.A.A.O.
• John Merslich, O.D.

Mission Statement

The Group Health Cooperative Residency Program 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 residents 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 residents will develop an appreciation of the patient as an individual faced with multiple life and health care challenges.

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; secondary and tertiary eye care; and ocular manifestations of systemic disorders and medications.
4. To gain experience as an integral member of a multidisciplinary health care team with the interactive skills and knowledge base for successful communication with non-ophthalmic health care disciplines; to recognize the importance of a multidisciplinary, coordinated approach to health care delivery; and to develop an appreciation of the patient as an individual faced with multiple life and health care challenges.
5. To develop the resident’s ability to present ophthalmic information to health care professionals, as well as to the lay public.
6. To develop the resident's appreciation for scholarly activities and lifelong learning.

Program Objectives

1. To experience numerous direct clinical encounters consisting of primary and secondary eye care of varying complexity with a population of diverse patient demographics, and requiring proficiency in advanced ophthalmic skills, ophthalmic imaging, knowledge of laboratory and radiographic testing, and other medical support systems.
2. To develop the ability to formulate appropriate ocular differential diagnoses, implement treatment plans, and manage patients with ocular disease and systemic disorders with ophthalmic manifestations, including infectious processes, vascular disorders, ocular inflammatory disease, ocular trauma, post-surgical eye care, and glaucoma.
3. To utilize and contribute to the electronic medical record system to form a global picture and understanding of each patient’s overall health status and multiple health care issues; to complete thorough and accurate records of examination; and, perform appropriate coding for medical procedures and diagnoses, all of which become part of the comprehensive, multidisciplinary electronic medical record (EMR) system.
4. To gain additional experience and skills in the disciplines of contact lenses and low vision care.
5. To successfully communicate with ophthalmic and non-ophthalmic medical colleagues, medical support staff, and patients for the delivery of optimal and coordinated patient care.
6. To develop public speaking skills via case presentations for rounds and lectures to ophthalmic colleagues, non-ophthalmic medical providers, and the lay public.
7. To attend continuing medical education courses, complete assigned readings and audiotapes, and review the ophthalmic and medical literature and reference resources on a regular basis in order to expand the resident’s knowledge base and remain abreast of new developments.
8. To complete a required, publishable quality research manuscript or patient report as partial fulfillment of the residency requirements.

The Residency Experience

• Each resident will examine approximately 1,200 patients belonging to Group Health Cooperative. 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 in contact lens care and will observe and participate in the care of low vision patients at the Community Services for the Blind and Partially Sighted Low Vision Clinic.
• 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 Group Health Cooperative'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, 8:00 a.m. – 5:00 p.m., with one hour for lunch time. 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 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. Choice of call weeks is negotiable.

A typical monthly schedule may resemble the following:

Each clinic day, at least 30 minutes will be set aside for case discussions and review of required reading assignments. The resident will 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.

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 and patching, dilation and irrigation of the lacrimal system, non-ophthalmic injection techniques (IV, IM and subQ), and interpretation of fluorescein angiography.

Scholarly training is emphasized through monthly regional case conferences and weekly local clinic meetings; attendance at GHC Eye Care continuing education meetings; and required completion of 50 hours of Washington State Board of Optometry approved continuing optometric education. Additionally, residents are encouraged to attend multidisciplinary GHC 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 monthly regional optometric rounds. Additionally, each resident will prepare and deliver a topical lecture or poster at a major optometry meeting; to a non-ophthalmic health care audience within the Cooperative; and to a lay audience comprised of Cooperative patients.

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.

Program Duration, Stipend and Benefits

The residency will be 12 months in length, beginning August 1st of the calendar year, and continuing through July 31st of the following calendar year, or through completion of 12 months training.  Start and end dates might be altered based on extenuating circumstance, such as a death in the family or unforeseen circumstance.

The annual stipend will be $ 30,000, 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 productivity of the resident. In addition to the annual stipend, the resident is awarded $1,000 annually for approved continuing education costs and travel. An additional $600 is available annually for professional society dues. There is no state income tax for residents domiciled in Washington State.

Comprehensive group health and dental coverage is offered, with premiums deducted each pay period. Professional liability is covered by Group Health Cooperative.

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 Group Health Permanente, 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 SCCO, residents will also be afforded additional benefits as indicated in the SCCO Residency Manual and/or Administrative Guide. These may include free attendance at SCCO-sponsored continuing education programs on a space available basis, use of SCCO Multi-Media Services for approved residency presentations, research design assistance, library services and discounts from the SCCO Campus Store.

Eligibility Criteria and Application Process

• Attainment of the O.D. 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 3 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 Group Health Cooperative/Group Health Permanente.

Applications are made through the National Matching Service, NMS. Match ranking will be made a week before the match deadline.

On or before February 1 of the residency year, applicants should have on file with the Optometry Residency Program Coordinator (Dr. Terrence Clark):

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 feel free to contact the Residency Program Coordinator by phone, e-mail or US mail:

Terrence Clark, O.D., F.A.A.O. Optometric Residency Program Coordinator Group Health Cooperative 5821 S. Sprague Ct., Suite 102 Tacoma, WA 98409 253.396.4264 (this phone number is for residency inquiries only) .(JavaScript must be enabled to view this email address)

Selection Process

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

• Statement of Interest (10%)
• Curriculum Vitae (10%)
• Letter of Interest (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%. Each of the residency faculty independently assesses and ranks 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 ORMS before the match date.

Program Accreditation

We are formally and completely accredited by the ACOE, with 2009-2010 being our inaugural year.

The Residency Locations

The Tacoma Eye Care Center is located a few miles south of downtown Tacoma and a short distance from two of Group Health’s Medical Centers. 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, 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 four optometric physicians, of which three are Fellows of the American Academy of Optometry. Personal interests range from travel and international healthcare to mushroom foraging, cooking, literature, and the arts. Each O.D. will be involved in residency training and supervision.

• Terrence Clark, O.D., F.A.A.O., Residency Program Coordinator at GHP Tacoma Residency – Graduated Pacific University College of Optometry, 1978; M.A., University of Washington, 1973; staff optometrist, Group Health Cooperative, 1986 to present; chief, Tacoma Group Health Eye Care Services, 1995 – present; 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; member, Lecturer at AAO and at Tacoma Community College; professional interest in general diagnostic acumen and glaucoma. Outside interests: forestry, landscaping, hiking, speech and language, and history.
• Candy Arias Ceja, O.D. – Graduate of Nova Southeastern University College of Optometry 2010; Primary Care Residency at Group Health Permanente, Tacoma, Washington 2010-2011; Member of the American Optometric Association; Staff Optometrist at Bellevue Group Health Medical Centere 2011 to present. Special interest in theology, teaching, and family.
• Carol Hsiao, O.D., F.A.A.O. – A graduate of the University of California Berkeley School of Optometry, 2000; Research Fellow in Cornea and Contact Lenses, U. C. Berkeley School of Optometry, 2005-2006; staff optometrist, Group Health Cooperative, 2001 to present; chief, Group Health Contact Lens Service, 2008 to present; Fellow, American Academy of Optometry; presenter of multiple posters, ARVO and AAO annual meetings; member, VOSH – Northwest; professional interests in contact lenses, pediatric optometry, and dry eye; personal interest in hiking, Chinese and Taiwanese language, and travel.
• Scott Horvath, O.D. –  University of Wyoming 1990-1994 graduating with a Bachelor of Science in Zoology.  Pacific University College of Optometry 1994-1998 graduate.  Idaho Eye Care Center, Boise, Idaho 1998-2004 with emphasis on primary eye care, contact lenses and refractive surgery co management.  Group Health Eye Care 2004 to present.  Emphasis on primary eye care and geriatric eye care.  I enjoy commuting to work by bicycle and being a Dad.

Group Health Cooperative

Group Health is a nonprofit, multidisciplinary health care system that provides both medical coverage and care. About 540,000 members are covered by health plans offered by Group Health.

Group Health Cooperative, together with its subsidiary Group Health Options, Inc., operates in all or parts of 20 counties in Washington and two counties in North Idaho. Group Health Cooperative was opened in 1947 by a community coalition dedicated to making quality health care available and affordable. Today it is one of the few health care organizations in the country governed by consumers rather than internal executives. Its 11-member board of trustees — all Cooperative members elected by other members — work closely with management and medical staff to ensure that the organization's policies and direction put the needs of patients first.

The Group Health family of organizations includes Group Health Cooperative (1947) with its research arm — the Group Health Center for Health Studies (1983), Group Health Options, Inc. (1990), Group Health Permanente medical group (1997), and Group Health Community Foundation (1983). These organizations — and the 8,300 staff who support them — share a common purpose to transform health care, working together to improve the care and well-being of members, patients, and communities.

The Medical Staff have played a key role in Group Health Cooperative's history and continue to oversee every aspect of clinical care and quality. Their commitment to family medicine and prevention has shaped a broad approach to care at Group Health, one that focuses on the whole patient, not just an illness or condition, one that focuses on evidence-based medicine, not just a traditional approach.
Eye Care at Group Health Cooperative falls under the aegis of the Group Health Permanente Consultative Services Division, with optometrists and ophthalmologists who work cooperatively to deliver cost-effective, coordinated care. Optometrists at Group Health are not employees, but active, equal members of the Medical Staff along with our physician colleagues. The chief 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 rainfall is less than Boston, Atlanta, Charlotte, and most 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 Experience Music Project 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.

Tacoma Location and Driving Instructions

Free Parking

Driving Directions
From I-5 South:

Take the S 56th ST exit (exit #130)
Turn Left on TACOMA MALL BLVD
Turn Left on S SPRAGUE CT

From I-5 North:

Take the S 72ND ST exit
Turn Left on S 72ND ST
Turn Right TACOMA MALL BLVD
Turn Right on S SPRAGUE CT