Business Aspects of Optometry 3rd

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 B978-1-4377-1586-6.00049-X, 00049

Contents

Introduction 1 19. Human Resources: Evaluating, Managing,

and Dismissing Office Staff 215
20. Computer Business Systems and Internet
Section 1: Preparing for your ­Resources 222
Professional Career 7 21. Recall Systems 234

1. State of the Profession 9

2. Personal and Professional Goal Setting 18 Section 5: Practice Administration 239
3. Ownership (Self-Employment) 29
4. Employment 42 22. Ethics in Optometric Practice 241
5. Resumes and Interviews 56 23. Professional Liability Insurance and Risk
6. Debt Management 64 ­Management 251
7. Principles of Negotiation 77 24. Quality Assurance 262
25. Insurance 272
26. Patient Communication 287
Section 2: Purchasing a Practice 81 27. Marketing: External and Internal 295

8. Valuation and Purchase of an Eye Care

­Practice 83
9. Principles of Practice Transfer: Adding an
­Associate/Partner 95
Section 3: Developing a Business
Plan: New Practice, Expansion, and
Acquisition 103
10. Deciding Where to Practice 105
11. Elements of an Office Business Plan, Practice
Financing, and Obtaining a Business Loan 122
12. Understanding Premises Leases 137
13. Office Design 143
14. Instrumentation and Equipment 153
15. Controlling Cost of Goods 159
Section 4: Office Administration and
Human Resource Issues 169
16. Office Organization, Structure, and Systems 171
17. Human Resources: Hiring and Training
­Office Staff 186
18. Human Resources: Managing and Motivating
Office Staff 205
Section 6: Evaluation and Management
of Specialty Services 303
28. Ophthalmic Dispensing 305
29. Specialty Practice in Optometry 313
30. Contact Lens Specialty Practice 325
31. Binocular Vision and Vision Therapy Specialty
Practice 343
32. Interprofessional Relations 350
Section 7: Financial Aspects 359
33. Fees, Credit, and Collections 361
34. Managed Care, Third Party Reimbursement, and
Audits 372
35. Coding and Billing 390
36. Analysis of Practice Economics and
Growth 399
37. Financial and Estate Planning 409
38. Financial Decision Making 428
39. Taxes 438
40. Exit Strategies: Planning for Practice Transfer
and Retirement 474
Index 481
ix

APME, 978-1-4377-1586-6
Introduction

Lawrence Thal

Those who cannot remember the past are condemned to repeat it.
George Santayana The Life of Reason

A
lthough “optometry” is a uniquely American inven­
tion, the profession’s antecedents reach back to antiq­
uity and to the science of optics.
The early Greeks possessed some knowledge of optics;
Plato, Aristotle, and Euclid all wrote about it.
Plato’s comments on optics date back to 400 bc. Aristotle
seemed familiar with what we know today as myopia.
Archimedes discovered the relationship between a sphere and
a cylinder. He was aware of the importance of this discov­
ery, attested to by the fact that he directed that a sphere and
a cylinder be engraved on his tombstone. Archimedes was the
ingenious Greek who destroyed the Roman fleet by the use of
burning mirrors.
Ptolemy of Egypt knew and wrote about refraction in the
second century. He wrote 13 volumes on the refraction of light
and the function of vision. In the 11th century, Alhazen, an
Arabian philosopher, wrote about the anatomy of the eye and
about optics.
The Chinese claim that the use of spectacles began in China
in very ancient times. However, the Englishman Roger Bacon FIGURE 1 Etching of Friar Roger Bacon, by William H.W.
(Figure 1) was the first to write about convex lenses for pres­ Bicknell, after a painting by Howard Pyle. (Reprinted with
byopia (“old sight”), describing their use in 1276. He may have permission from the New York Public Library, New York.)
invented the use of lenses for near vision. Allasandre de la
Spina, an Italian monk, is credited with “perfecting spectacles”;
however, an inscription on the tomb of Salvino D’Armato possibility that a loved one might spend eternity in purgatory
(in 1317, the date of his death) credits him with the invention. unless that person received proper death rites was a tremen­
Actual credit therefore is uncertain, but spectacles appeared in dous force in predominantly Christian Europe.
Europe sometime between 1275 and 1285. In time, the common activity that bound members of
The clinical application of the science of optics began in guilds together became more and more important and led to
Europe. Christopher Scheiner, a Jesuit priest, is often called the establishment of craft guilds in the 14th and 15th centu­
the “Father of Optometry.” He described the vision of myopic ries. These guilds set up standards and price controls for their
individuals in 1625. products, to which each guild member had to adhere. They
The ancestors of optometrists in the United States are also set up an educational system so that the skill of the craft
the European opticians who, like other skilled craftsmen of could be continued from year to year and to maintain a limit
the time, organized themselves into guilds. The origin of the on the number of skilled men in that craft. One learned a craft
guilds is lost in the history of the Dark Ages. It is certain that by first becoming an apprentice to a master. The number of
originally guilds were organizations of congenial people, tied apprentices each master could have was limited. The length
together by some common activity or background, for the of time and the condition of servitude as an apprentice were
purpose of ensuring that fellow members received a Christian carefully established. When the apprenticeship was success­
burial when they died and that their widows and orphans fully concluded, the worker became a journeyman. His skill
received adequate care. In the 11th and 12th centuries, the was attested to by the guild. As a journeyman, he had some
1
2 Introduction
freedom of employment and under certain conditions could
change from one master to another. After serving as a journey­
man for a definite period, a skilled craftsman could present his
masterpiece to the guild. If it was accepted and approved, he
became a master and could establish his own shop.
Apparently the first separate spectacle makers’ guild
was established in France in 1465; the second was begun in
Germany in 1577. This does not mean that there were no spec­
tacle makers before this time but merely that spectacle mak­
ers were members of other guilds. An example of such a guild
was the Worshipful Company of Spectacle Makers, an English
guild chartered by King Charles I in 1629 (Figure 2).
In April 1628, Robert Alt, citizen and brewer, in concert
with 15 other London Spectacle Makers—12 of whom were
members of the Brewers’ Company—petitioned the King in
Council for a charter of incorporation. This petition reads,
in part:
“To the Kings Most Excellent Majesty:
The humble petition of Robert Alt on behalf of himself and
other poor spectacle makers in and about the City of London.
Most humbly shewing: That whereas the mystery of making
spectacles hath been and still is of good esteem and repute
as well in foreign parts beyond the seas as within this Your
Majesty’s Realm of England: and daily doth increase; and many
who have served as Apprentices thereunto; and others who
have remained some small time apprentices and afterwards
departed from their Masters service; having by indirect and
private means attained unto some small insight of the same
FIGURE 2 Coat of Arms of the Worshipful Company of
Spectacle Makers, found in the Crypt, Guildhall, London. (Reprinted
with permission from CJ Eldridge: The Worshipful Company of
Spectacle Makers. J Am Optom Assoc 50[4]:481-487, 1979.)
profession, Do now use many deceipts in the said mystery
in making and uttering bad and hurtful wares whereby Your
Majesty’s subjects are not only merely cosened, but some-
times much prejudiced; and Your Petitioners who have served
seven years apprenticeship to the same profession and are
good true workmen (of whom some are charged with wives
and children) much wronged in their credit, their profession
vilified, and they thereby almost utterly undone, unless Your
Majesty’s ­gracious favor be extended towards them for their
relief herein. In ­tender consideration whereof and forasmuch
as all such trade m ­ ysteries and manufactures are incorporated
into a body ­politic do still subsist in a comely and commendable
manner and those subject to no certain ordinances, rules or
government are found by experience to be in short time utterly
subverted. And for that your Petitioners conceive a Corporation
amongst them to be a means for redress of these their
grievances.”
It is apparent that little of this petition would need chang­
ing to make it suitable for placement on the agenda of an
American Optometric Association (AOA) meeting.
The charter granted to “The Master Wardens and Fellowship
of Spectacle Makers of London” gave the company very broad
powers. It established a means of government for the company,
allowed the company to establish standards, and set up search and
seizure provisions for substandard spectacles and for the punish­
ment of those violating any of the rules set down by the company.
Generally, persons became members of the guild by servi­
tude through apprenticeship. However, sons of members could
become members directly by patrimony. Later on, certain indivi­
duals were allowed to purchase membership, called redemption.
During the 15th century, both on the continent of Europe and
in Great Britain, it was almost essential that a craftsman of any
kind be a freeman of the city in which he practiced his craft. The
only way a person could be a freeman of the city was to obtain
this status through membership in a guild. Therefore, before the
Worshipful Company of Spectacle Makers was formed, spectacle
makers had to be members of some other guild. A nucleus was
found in the Brewers’ Company, probably through the action of
the law of patrimony. It is known that the father of Robert Alt,
for example, was a member of the Brewers’ Company.
As the number of journeymen increased and as knowledge
regarding the mysteries of the various crafts spread, the guilds
began to lose power; eventually, their ability to control their
craft was lost. The guilds in Great Britain gradually became
largely social institutions, until near the close of the 19th cen­
tury, when the old companies began again to take an inter­
est in regulatory activities. The spectacle makers established
an examination that ophthalmic opticians could take volun­
tarily. Those who passed the examination became members of
the company, but—more important—their competency was
attested to by the Worshipful Company of Spectacle Makers.
Much of the craft background in spectacle making was lost
by the craft’s mere transfer from Europe to America. In the US,
spectacles were sold primarily by travelling eyeglass salesmen,
with customers selecting their own glasses by trial and error
while selecting from multiple pairs of glasses from a suticase
full of spectacles. Refractive testing of the eye did not make its
appearance as a scientific application of optics until the 19th
century. The primary advances occurred in Europe.

In the early 1800s the English scientist Thomas Young
(Figure 3) discovered astigmatism; in 1827 Sir George Beddell
Airy, an English astronomer, measured the astigmatism in his
own eyes and had a cylindrical lens ground.
In 1843, Christoph Fronmüller of Germany invented the
trial lens case, making possible the use of subjective exami­
nation and the creation of custom-made spectacles. Edward
Jaeger, in 1854, published his reading card. In the middle of
the 19th century the principles of skiascopy (retinoscopy)
were discovered and explained, and in the latter part of the
century, Hermann Snellen (Figure 4) invented his squared test
FIGURE 3 Thomas Young. (Reprinted with permission from
CG Mueller, M Rudolph: Light and Vision. New York, 1966, Time.)
FIGURE 4 Hermann Snellen. (Reprinted from Graefe’s Archives
of Ophthalmology 667[3];379, 1980.)
Introduction 3
type. Another key event was the invention of the direct oph­
thalmoscope by Hermann von Helmholtz in 1850.
Medicine entered the field around 1860, with the Dutch
physician Frans Donders publishing his seminal book, On the
Anomalies of Accommodation and Refraction of the Eye, in 1864.
Until this time, eye physicians—called oculists—opposed the
fitting of spectacles except for “old sight.” Oculists began to
take an interest in refraction during the late 1800s, and it was
urged by some that the important matter of fitting glasses
should not be left to opticians. The jealousies that were started
then have yet to be outlived.
During the middle of the 19th century, American com­
panies began to produce lenses and frames on a large-scale
basis; leading companies included American Optical, Bausch
& Lomb, and Shuron. Some of these early manufacturers set
up training courses for medical and nonmedical refraction­
ists as a means of boosting the sales of their frames and lenses.
Courses ran from 1 to 2 weeks, with the awarding of a gold-
embossed certificate at graduation.
Early courses in refraction were a far cry from those
found in today’s professional curricula. One of the most
advanced courses was given by the Northern Illinois College
of Ophthalmology and Otology in 1895; it required 3 months.
The Johnston Optical Institute offered four courses, each
complete in itself, and maintained that all four together con­
stituted “a university course of instruction in optics” that
taught “everything up to the use of the ophthalmoscope.” The
Klein Optical School (the present New England College of
Optometry) had a tuition fee of $25 for the full term. In June
1896, Dr. Theodore F. Klein announced a course of lectures to
be given in a tent in a pine grove at the edge of a lake near his
summer home. A camping outfit could be purchased for $10,
and fish and berries were plentiful, so the students could bring
their families while incurring very little expense in their quest
to become refracting opticians.
As in medicine, numerous correspondence courses were
available, and diplomas were awarded on successful comple­
tion of the course of study.
Despite these shortcomings, by the close of the 1800s,
refracting opticians had become firmly established as tech­
nical experts who were providing a needed and previously
neglected service required by modern civilization. The medical
profession had almost completely ignored and even opposed
this necessary service.
Charles F. Prentice (Figure 5) has been called the “Father
of Optometry” in the US. He was a mechanical engineer, opti­
cian, and refractionist. He led the fight for the legal recog­
nition of optometry in New York. His efforts were based on
the conviction that the refractive services of the time were
entirely inadequate, that the refractionists—both medical
and nonmedical—were in general incompetent, and that it
was necessary to establish a professional group separate from
medicine to take care of the needs of the public in the field of
vision care.
That modern optometry’s career has always been attended
by controversy is not at all surprising for the profession was
born in controversy. In 1892 Prentice referred a patient to
4 Introduction
s­ eparated from the organization, and it became necessary to
FIGURE 5 Charles Prentice. (Reprinted from CF Prentice:
Legalized optometry and memoirs. Seattle, 1926, Casperin
Fletcher Press.)
Henry D. Noyes, MD, a leading ophthalmologist and otolo­
gist in New York City, for care of an inflammation of one eye.
Noyes sent Prentice a letter, ostensibly thanking him for the
referral, but in fact reprimanding him for having charged the
patient a fee for refractive services in addition to the charge for
glasses. Noyes held this to be a serious matter, one that would
antagonize the oculists, since they would consider Prentice’s
actions to have put him in competition with them. Noyes fur­
ther objected that, by charging for services, Prentice would
cause the public to assume that he had the qualifications that
entitled him to a fee for advice.
The controversy gained momentum, and the New York
Medical Society agreed to adopt a resolution to expel any
member who would send patients to opticians for a refraction.
When Prentice and his colleagues submitted to the New York
Legislature a bill to regulate the practice of optometry in the
state, the medical society vigorously opposed it, ensuring that
it would not pass.
Despite the bill’s defeat, the idea of legislative recognition
caught on among optometrists, and in 1901 Minnesota became
the first state to enact an optometry law. After 12 years of con­
tinuous effort, led by Andrew J. Cross and Prentice, in 1908 the
New York Legislature passed an optometry law. The last juris­
diction, the District of Columbia, completed the “legalization”
of optometry by enacting a law in 1924. The many arguments
put forth by Prentice and his colleagues during these legislative
struggles are well worth reading and are as valid today as they
were a century ago.
Before 1903, the AOA was known as the American
Association of Opticians, an organization that included in
its membership both refracting opticians (the precursors
of optometrists) and dispensing opticians (known today as
“opticians”). By 1903, however, the dispensing opticians had
find a name for the refracting opticians. In 1904 the terms
“optometry” and “optometrist” were adopted and a campaign
was started to popularize them. In 1919 the organization
changed its name to the American Optometric Association.
With the advent of the optometry laws, schools and col­
leges of optometry were chartered to provide students with
the education and training necessary to meet the requirements
set forth in these laws for the practice of optometry. Standards
continued to improve as optometry elevated itself through
education, organized legislative efforts, and the adoption of
codes of practice and codes of ethics.
Today, optometry in the US has reached a position of rec­
ognition and acceptance that is closely equaled only in Britain,
Australia, and Canada. Optometry is recognized as a health
care profession in all US states and by agencies of the fed­
eral government. Use of ophthalmic drugs by optometrists
is approved in all states. Optometrists and ophthalmologists
work together in schools, multidisciplinary clinics, the mili­
tary, referral centers, and private practice. Interprofessional
referrals between members of the two disciplines have become
common. Despite the professional jealousies and political dif­
ferences between the two professions, they have in fact come
to more closely resemble one another, with optometry emerg­
ing as the provider of primary care and ophthalmology con­
tinuing to emphasize training for secondary and tertiary care.
In fact, the difference between the two in most states in which
optometrists treat glaucoma and the majority of ocular dis­
ease is simply that optometrists, unlike ophthalmologists,
are not trained to perform other than the most basic surgical
procedures.
Today, optometrists can best be defined as the primary
health care professionals for the eye. Optometrists examine,
diagnose, treat, and manage diseases, injuries, and disorders of
the visual system, the eye, and associated structures, as well as
identify related systemic conditions affecting the eye.
Optometrists render a vital service that was borne of med­
icine’s refusal to recognize the widespread public need for
refractive care. The profession has always acknowledged an
obligation to examine for pathologic factors when render­
ing this care, an obligation that now includes the treatment
of pathologic conditions. Optometrists have every right to
be proud of the unique heritage that has led to this combi­
nation of knowledge and skills. Optometry cannot be consid­
ered a restricted form of ophthalmology; it is a primary health
care profession with its own body of knowledge and with
unmatched expertise in the area of vision care.
Today’s optometry school graduates receive an enlightened
and unexcelled education in vision science and in the art and
science of health care. Optometry’s position that the dispens­
ing of ophthalmic materials is an integral part of this care and
is best performed by the practitioner who has examined the
patient has withstood the test of time. Even so, emphasis on
health care services continues to grow, challenging practitio­
ners to maintain an adequate balance between the traditional
refractive services of the past and the health care services of the
future. Graduates who seek to enter the practice of o ­ ptometry

will find career choices significantly affected by this dichotomy
in services. Some career opportunities will emphasize the sale
of ophthalmic materials, with vision and health care services
minimal and incidental to the sale; others will emphasize eye
and vision care services, with little or no attention paid to the
dispensing of ophthalmic materials; and still others will offer a
balance between the two skills. Graduates must choose between
these options, which are the hallmark of a free-enterprise sys­
tem. The challenge for optometric educators is in ensuring
that graduates of optometry school are knowledgeable with
regard to the variety of ­ophthalmic ­materials ­(spectacle lenses
Bibliography
Arrington E: History of optometry, Chicago, 1929, White Printing House.
Champness R: A short history of the Worshipful Company of Spectacle
Makers, London, 1965, Apothecaries’ Hall.
Classé JG: Legal aspects of optometry, Boston, 1989, Butterworth.
Cox M: Optometry: the profession, Philadelphia, 1947, Chilton.
Eldridge CJ: The Worshipful Company of Spectacle Makers, J Am
Optom Assoc 50(4):481–487, 1979.
Introduction 5
and contact lenses), refractive skills, and health care services
(pathologic and diagnostic) and in ensuring that they under­
stand the importance of maintaining an adequate balance
between those skills in providing for their patients.
It is the intent of this book to explore some of the vital
issues necessary to the making of these choices and to con­
sider the alternative ways by which graduates may engage in
the practice of optometry. In so doing, it is hoped that gradu­
ates will be better able to meet their responsibilities to the
public and to more adequately serve the health care needs of
our country.
Gregg J: The Story of Optometry, New York, 1965, Ronald Press.
Gregg J: A history of the American Optometric Association, St. Louis,
1972, American Optometric Association.
Hirsch M, Wick R: The optometric profession, Philadelphia, 1968,
Chilton.
Hofstetter H: Optometry, St. Louis, 1948, Mosby.
Prentice CF: Legalized optometry and memoirs, Seattle, 1926, Casperin
Fletcher Press.
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 1
Section

PreParing for your

Professional Career
This page intentionally left blank

State of the Profession
Morton Silverman and Janice Mignogna
O
ptometry is a clinical discipline primarily composed
of private practitioners but not necessarily solo prac-
titioners. The overwhelming majority of optometry
school students consider entering private practice immedi-
ately after graduation; however, student debt, lack of investi-
gation, and the desire to be associated with an ophthalmology
or disease related practice play some role in the eventual
selection of mode of practice. To understand the opportuni-
ties available in optometry today it is necessary to examine
current demographic information, particularly the number
and distribution of optometrists, type of services optom-
etrists offer; income optometrists receive, and practice pat-
terns of optometry school graduates. The data presented in
this chapter are primarily based on surveys conducted by the
American Optometric Association (AOA), the Association of
Schools and Colleges of Optometry (ASCO), the Association
of Practice Management Educators (APME), AOA-funded
surveys conducted by Silverman and Woodruff, and combined
information from Practice Academy for Eye Care Professionals
and Key Metrics of Optometric Practice, 2008 editions, both
produced by the Management & Business Academy for Eye
Care Professionals.
NUMBER AND DISTRIBUTION
OF OPTOMETRISTS
The number of practicing optometrists has grown steadily
during the past few decades. In 1978, there were fewer
than 20,000 practitioners, but according to the Optometric
Workforce Study in 2002, there were 33,825 practicing optom-
etrists, which increased to 35,855 by 2005 and is estimated to
exceed 39,000 in the next couple of years. Ophthalmology, by
contrast, lists approximately 16,000 practitioners, of which
nearly half are in specialty practice (glaucoma, retina) and
slightly over half are in general practice.
The major demographic change during these decades has
been an increase in the proportion of female optometrists.
In 1973, only 3% of practicing optometrists were women, and
in 1995, for the first time, the majority of Doctor of Optometry
(OD) recipients were women. This is most reflected by
admissions to academic institutions. In the academic year
1
chapter
2002-2003, the percentage of females entering colleges of
optometry had reached 58.6%. The number of females enter-
ing optometry schools has continued to increase each year,
and by the academic year 2007-2008, females represented
63.6% of the entering class. In the academic year 2007-2008,
the percentage of woman enrolled in the fourth year class in
the 17 schools and colleges of optometry in the United States
represented 65.3% of total enrollment. For optometrists
younger than age 40, 48.2% are women, compared with less
than 13% of optometrists age 40 and older. The other signifi-
cant changes have been in the percentage of Asian-American
students enrolled in OD programs, which rose from 5.4% in
1981 to a high of 24.2% in 1999. In the academic year 2007-
2008, the percentage of full-time Asian-American students
enrolled in all optometry professional programs was 24.9%.
During the past 4 years, an average of 1,288 optometry stu-
dents graduated annually and entered the practice of optom-
etry from the 17 schools and colleges of optometry in the US.
(This figure is adjusted for the number of foreign students
who graduate but do not practice in the US.) With three new
optometry schools implementing a new optometry program
in the fall of 2009, it is estimated that the average number of
optometry school graduates will increase to approximately
1,350. As of 2000, an estimated 550 optometrists retired annu-
ally and the number of projected retirees should continue
to increase each year, reaching more than 800 by 2015 and
steadily increasing through 2030. This recent projection may
change because of the financial crisis of 2008-2009.
Based on these projections, the number of practicing
optometrists should continue to grow moderately during the
next few decades, and depending on the number of students
graduating from the new optometric educational institutions,
there may be some increase in these projections. The num-
bers may not increase significantly if total student enroll-
ment remains approximately the same because some existing
schools may experience a reduction in student matriculation
as a result of additional programs. The economy has changed
dramatically, and it remains to be seen if these changes may
affect choice of profession or choice of school.
The distribution of optometrists varies across the coun-
try, with the heaviest ratio of optometrists-to-population in
9
10 section 1 Preparing for your Professional Career
the Midwest (13.8 per 100,000 population) and West (13.6
per 100,000) and the lowest ratio in the Northeast (12.9 per
100,000) and South (10.1 per 100,000). The growing popu-
larity of the West and the Northwest during the past two
decades has affected practice patterns in those areas, reflected
in the growing number of employed optometrists and the
trend toward partnership and group practices. The overall
­optometrist-to-population ratio in the US is 12.3 per 100,000.
As of 2007, the majority of optometrists (38.5%) practiced
in areas of 25,000 to 100,000 population, 21.7% practiced in
areas with less than >25,000 population and 25.2% in areas
with 100,000 to 250,000 population; the smallest percentage
of optometrists (14.6%) practiced in areas with a population
greater than 250,000.
MODES OF PRACTICE
The private practice of optometry has traditionally been the
individual practitioner or entrepreneur who invests the capital
to begin a practice and serves as its sole owner and clinician.
During the 1960s, more than seven out of ten optometrists
were in solo practice. During the subsequent decades, how-
ever, the preeminence of individual proprietorships waned,
declining to less than half of practices by 2005. The major shift
in practice patterns has been toward partnerships and group
practices, which have increased in popularity from less than
10% in the 1960s to almost 40% by 2007. According to the
2008 AOA report “Caring for the Eyes of America,” 31.4%
of practicing optometrists were in partnerships with two to
four practitioners, 3.6% were in partnerships of five or more
practitioners.
The AOA Economic Survey of 2001 indicated that the num-
ber of self-employed optometrists in solo practice in 1964 was
approximately 71%. Table 1-1 contains data that show that solo
practice now only represents 31.5% of self-employed optom-
etrists. These changes have been dramatic. The 2008 Primary
Practice Survey also states that 72.7% of optometrists report
TABLE 1-1
Surveyed OD Primary Practice Type, 2008:
Self-Employed
Self-Employed % ODs (not affiliated w/optical company)
Practice owner (1 OD, not affiliated w/optical company) 31.5
Practice owner (2-4 ODs, not affiliated w/optical company) 26.2
Practice owner, (5+ ODs, not affiliated w/optical company) 2.4
Franchisee, (1 OD, affiliated w/optical company 0.7
Franchisee, (multi. ODs, affiliated w/optical company) 0.8
Lessee (1 doctor, affiliated w/optical company) 3.4
Lessee (multi. ODs, affiliated w/optical company) 1.4
Independent contractor 4.5
Other self-employed 1.8
Total 72.7
From Edlow RC, Marcus GR: Highlights: 2008 AOA Scope of practice survey. Optometry
80(5):267-270, 2009.
that they are self-employed, down from 92.1%, as reported in
the survey of 2005. These figures may also include optome-
trists who have lease arrangements with retail establishments
or corporations and therefore consider their practices to be
private solo practices.
The 2008 survey also indicates that 10.8% are employed
by optometrists, 7.3% employed by ophthalmologists, 1.0%
employed by health maintenance organizations (HMOs),
2.9% are employed by hospitals, clinics, or multidisciplinary
institutions and 0.5% in educational institutions. The ­figures
for retail optical chains are difficult to determine because
independent contractors can be included in both categories
(Table 1-2).
THE OPHTHALMIC MARKET
There are approximately 147 million wearers of corrective
lenses (either eyeglasses and/or contact lenses) in the US, rep-
resenting about 55% of the population. The 2007 AOA State of
the Profession Survey estimated that the size of the ophthalmic
market in 2007 was approximately $29.25 billion. This repre-
sents a significant increase over a 16-year period. In 1989, the
estimated size of the ophthalmic market was approximately
$14.5 billion;. It has continued to increase in $1- and $2-bil-
lion increments over the past 16 years (Figure 1-1). The AOA
estimates that $7.76 billion of the $29.25 billion ophthalmic
market represents expenditures for comprehensive eyes exam-
inations, follow-up eye care visits, and the treatment of ante-
rior segment conditions by optometrists. The growth in the
market between 2005 and 2007 is due to many factors, includ-
ing the steady but moderate growth of the economy during
these years and volume of services provided by optometrists,
expansion in private third-party and governmental cover-
age of vision and eye care services, growth in the population
needing eye care, and the public’s enhanced awareness of the
TABLE 1-2
Survey OD Primary Practice Type, 2008:
Employed by Others
Employed by Others %
8.1
ODs (affiliated w/optical company) 2.7
Ophthalmologist (s) 7.3
HMO 1.0
Hospital/clinic/other multidisciplinary setting 2.9
Armed forces/VA/USPHS 2.5
Educational institutions 0.5
Local/state/federal government 0.3
Optical/ophthalmic manufacturer/wholesaler 0.2
Non-optometry-owned independent franchise/optical 0.3
Other, retired, unemployed 0.9
Total 27.5
From Edlow RC, Marcus GR: Highlights: 2008 AOA Scope of practice survey. Optometry
80(5):267-270, 2009.
 State of the Profession Chapter 1 11

$30.00 $29.25
$27.21
$25.00 $25.6
$23.4
$20.9
$20.00 $19.0
$17.5
$14.5 $15.5
$15.00

$10.00

$5.00

$0.00
1989 1991 1994 1996 1998 2000 2003 2005 2007
FIGURE 1-1 Estimated size of ophthalmic market. (From Edlow RC, Marcus GR: State of the profession. Optometry 79(6):337-343, 2008.)

importance of good eye health care. It is not known if these

trends will continue with fluctuations in economic markets,
nationally and globally. The major share of this ophthalmic Private
market has been by optometrists in private practice, who in opthalmology
2007 earned 44.37% of market income (Figure 1-2). 7%
It is estimated that 88 million primary eye care examina-
Private optometry
tions were performed in the US and optometrists conducted 44% Managed
approximately 70% of them. Because of the effects of presby- care/clinics
11%
opia on the “baby boom” generation, it is anticipated that most
growth in eye care will involve persons in the 45 years old and
older bracket. Corrective lens wear will inevitably be affected
by the aging of this generation; currently, 42.7% of lenses sold
Optical chains/mass
by optometrists are single vision, 23.0% are bifocals and trifo- merchandisers
cals, and 34.3% are progressive lenses. Progressive lenses are Private 32%
the fastest growing part of the market (Table 1-3). opticians
As of 2000, there were about 34 million contact lens ­wearers 6%
in the US, which is an increase of 8% in soft lens wear from
the previous year. The contact lens market had not been
expected to expand significantly in the next few years, primar-
ily because of the impact of refractive surgery. The 2002-2006 Private optometry 44.37%
period demonstrated that the contact lens retail market growth Private ophthalmology 7.36%
averaged 10% annually, more than twice the rate of growth of Managed care/clinics 11.15%
the overall optical market, which was flat. Over 95% of retail Optical chains/mass merchandisers 31.55%
sales of contact lenses are soft lenses. Gas permeable lenses con- Private opticians 5.57%
tinue to slowly lose market share. Over the past 20 years, dis- FIGURE 1-2 Ophthalmic market shares, 2007. (From Edlow
posable soft lenses replaced every 2 to 4 weeks have come to RC, Marcus GR: State of the profession. Optometry 79(6):337-343,
dominate the market, accounting for nearly 85% of retail sales 2008.)

TABLE 1-3

Spectacle Lenses Dispensed by Type, Mean Percentage, 1994-2006

Lens Type 1994 (%) 1998 (%) 2000 (%) 2002 (%) 2004 (%) 2006 (%)

Single vision 43.7 43.0 44.2 41.6 40.9 42.7

Bifocal (nonprogressive) 30.3 24.3 20.2 20.0 19.6 17.6
Trifocal (progressive) 6.6 6.1 6.1 6.1 5.7 5.4
Progressive 19.4 26.6 29.5 32.3 33.8 34.3
All lens types 100 100 100 100 100 100
From Edlow RC, Marcus GR: 2007 AOA Optical Dispensing Survey. Optometry 78(10):550-553, 2007.
12 section 1 Preparing for your Professional Career

currently. In addition, over the past 5 years, silicone hydrogel SERVICES OFFERED BY OPTOMETRISTS
lenses have become the dominant lenses and are projected to
surpass all traditional soft lens materials in the US by 2012. With respect to services offered by optometrists, 2006 ­figures
Laser vision correction (each eye considered as a separate indicate that contact lens services are the most common and
procedure) in the US in 2000 was estimated to be 1.55 million, are provided by 96.9% of practicing optometrists. These
up from 1999 projected figures of 980,000, and in 2000, approx- ­figures show that 91.2% of optometrists provide ­dispensing
imately a $2.5 billion industry. Interestingly, in a 6 month services (spectacles). It is estimated 36.2% of ­optometrists
refractive surgery survey that was conducted in 2008, optom- offer some low vision services and 25.4% vision therapy.
etrists reported that 10.1% of their patients showed an inter- It is also ­estimated that 88.1% of optometrists prescribe
est in refractive surgery, 37.5% reported a decline in interest, ­pharmaceutical agents for therapeutic purposes.
and 52.4% reported that patient interest in refractive surgery AOA surveys also reported that as of 2006, 52.8% of
remained unchanged. Twenty-three percent of the US popula- optometrists incorporated within their practice lens tinting,
tion with vision correction wears contact lenses. Contact lens 48.3% some lens edging, 36.9% provided coatings for ultra-
examinations comprise about 52% of all comprehensive eye violet protection, and 17.1% also provided coating for scratch
examinations administered each year by private optometrists resistance of ophthalmic lenses. Approximately 5.7% and
and 35% of those by corporate-affiliated ODs. Contact lens 5.5% incorporated lens surfacing and lens casting, respec-
product sales account for 16% of gross revenue in the average tively. These figures indicate that widespread use of in-office
private practice. finishing laboratories is a development that has been quite
consistent, and this development represents a response to
consumer demand for speedier delivery of eyewear products
NUMBER OF ANNUAL EYE EXAMINATIONS (Table 1-5).
The number of complete eye examinations performed annu-
ally by optometrists has grown steadily since the mid-1980s, Income
when parity legislation passed by the US Congress gave optom-
etrists the same standing as physicians under Medicare. This The 2007 AOA Economic Survey (which reported income for
amendment of the Medicare legislation allowed optometrists the year 2006) indicated that the individual mean net income for
to receive reimbursement for medical eye services ­performed all optometrists was $131,197. This figure is an increase from the
for Medicare-eligible patients. Before the amendment, only 1996 survey that was published in the first edition of this text,
ophthalmologists were eligible to provide these services under
Medicare provisions.
According to the AOA surveys, as of 1990, the mean volume
TABLE 1-5
of eye examinations per year per optometrist was 1,867. In 1999,
the mean number of eye examinations per year per optometrist ODs Who Perform In-Office Optical Lens
was 2,335, and by 2004 it had dropped to 2,134. In 2006, they Finishing by Procedure, Mean
had increased to 2,229. An explanation for the increase could Percentage, 2006
be that the average number of complete eye examinations per
hour worked (1.18) was slightly more in 2006 than in 2004. Procedure Yes (%)
Optometrists, however, had been working fewer hours;
Lens tinting 52.8
the number of hours worked in 1999 was 1,941, and by 2004, Lens edging 48.3
the number of hours had dropped to 1,867. The number of Coating for ultraviolet 36.9
hours per OD increased slightly in 2006 to 1,894 per year. The Coating for scratch-resistance 17.1
mean (average) number of all “other exams” per year dropped Lens surfacing 5.7
from 1,073 in 2001 to 855 in 2006 (Table 1-4). It is expected Lens casting 5.5
to rise as the number of services performed by optometrists
From Edlow RC, Marcus GR: 2007 AOA Optical Dispensing Survey. Optometry
expands because of changes in the scope of practice and 78(10):550-553, 2007.
acquired expertise by all optometrists. OD, Doctor of Optometry.

TABLE 1-4

Mean Volume of Other Examinations, 1996-2006

1996 1999 2001 2003 2004 2006

Other exams/year 896 994 1073 963 916 855

Other exams/week 18.1 20.1 21.9 19.6 18.7 17.4
Other exams/hour 0.45 0.51 0.57 0.51 0.49 0.45
From Edlow RC, Marcus GR: State of the profession. Optometry 79(6):337-343, 2008.
 State of the Profession Chapter 1 13

in which the figure was $92,637. The figures for the year 2000
indicated that the mean (average) total individual net income
was $138, 846, and for some unexplained reasons it dropped
to $130,273 in 2002; but it did recover to $136, 898 in 2004.
Again, there was a drop in individual net income in 2006 to
$131,197. As previously stated, working hours for optometrists
had decreased but again increased slightly in 2006 (Table 1-6). In
addition, during the later part of the decade, mean net income
increased by more than 41%. For self-employed practitioners,
the mean gross income in 2006 was $530,914, compared with a
1996 figure of $348,134. This figure represented an increase of a
little over 52% during a 10-year period (Table 1-7).
The 2007 survey also found that the total individual net
income of female optometrists was about 28.6% less than
that of male optometrists ($119,000 for men and $85,000 for
women). The difference has consistently lessened through-
out the years: in 1992, female ODs earned 31% less than male
ODs; in 1994, 29% less; in 1996, 27% less; in 1998, 24% less;
and in 2000, 25% less. In 2004, the difference was 22% less,
but it went up to 28.6% in the latest survey. This could be
attributed to more practicing female optometrists taking
time off or working part-time to devote time to the needs
of family.
Two reasons have been offered for this disparity in gender
differences related to income; first and perhaps the most impor-
tant is the length of time that male and female optometrists
who responded to the economic surveys have been in practice.
The median number of years in practice for male respondents
at the end of 2006 was 20 years and for female respondents, the
median number was only 8 years. Data from economic sur-
veys show that mean and median incomes generally rise for
ODs with more years of professional practice. The second fac-
tor affecting the gender gap is that female ODs are more likely
than their male counterparts to be employed by others, and as
noted, employed ODs generally earn less than self-employed
optometrists.
AOA economic surveys have consistently shown that
optometrists in partnerships or groups earn more gross and
net income than individual practitioners, and the 2008 survey
confirms that trend is continuing. The mean net income in
the year 2006 ranged from $134,094 for solo practitioners to
$179,205 for a practice composed of three to five partners.
For employed optometrists, the mean net income for the
year 2006 ranged from a high of $115,250 for employment
by an ophthalmologist to a low of $102,981 for employment
by an optometrist. Interestingly, the AOA survey also indi-
cated that optometrists associated with the Armed Forces, the
US Department of Veterans Affairs (VA), and the US Public
Health Service (USPHS) were in the middle range compared
with all other modes of practice (Table 1-8).
For optometrists beginning solo practice, 6 to 10 years
are generally required before net income begins to reach the
national mean. This length of time is usually needed to build
a patient base and pay off educational debts and the costs of
­initiating a practice. Peak years for income are approximately
16 to 30 years in practice, after which time the average indi-
vidual practitioner begins to reduce the time spent at work
(Table 1-9). From 30 to 40 years, earnings decrease somewhat,
but it is apparent that optometrists may expect to enjoy a
lengthy professional career, if they choose to do so.

TABLE 1-6

Mean Total Individual Net Income

Current Median 1996 Income, Difference in Income in 1996 Difference in 1996
Year Income CPI Adjusted Current Dollars Dollars Dollars

1996 $92,637 $92,637 $0 $92,637 $0

1998 $108,262 $96,239 $12,023 $104,210 $11,573
2000 $138,846 $101,670 $37,176 $126,510 $33,873
2002 $130,273 $106,217 $24,056 $113,618 $20,981
2004 $136,898 $111,471 $25,427 $113,767 $21,130
2006 $131,197 $119,029 $12,168 $102,107 $9,470
From Edlow RC, Marcus GR: National highlights: 2007 AOA Economic Survey. Optometry 78(12):674-677, 2007.
CPI, Consumer Price Index.

TABLE 1-7

Self-Employed Mean Gross Income, 1996-2006

1996 1998 200 2002 2004 2006

Practice $494,117 $523,645 $648,923 $630,890 $630,654 $742,020

OD $348,134 $364,942 $415,623 $523,608 $429,956 $530,914
From Edlow RC, Marcus GR: National highlights: 2007 AOA Economic Survey. Optometry 78(12):674-677, 2007.
OD, Doctor of Optometry.
14 section 1 Preparing for your Professional Career

TABLE 1-8 EXPENSES OF PRACTICE

Total Individual Net Income by Practice The expenses of self-employed optometrists in private prac-
Type, 2006 tice may be divided into the following categories: laboratory
costs; wages, benefits, and commissions for employees; rent or
Mean Net Median Net mortgage expense; and other costs of doing business.
Income Income
A practice’s net income is the amount remaining after these
SELF-EMPLOYED expenses have been paid. The percentage of gross income
Solo $134,094 $115,000 devoted to laboratory expenses has changed relatively little
Partnership or group (2 person) $176,944 $149,000 during the past few years. In 1996, these expenses constituted
Partnership or group (3-5 person) $179,205 $141,000 28.0% of gross income, whereas subsequent surveys reported
Partnership or group (6 or more) $159,300 $92,500 that laboratory costs ranged from 27.2% in 2004 to a low of
Optical chain franchise or lease $100,704 $90,000 24.4% in 2006. The wages, benefits, and commissions paid to
Independent contract $94,520 $94,000 employees have ranged from a low of 15.3% to a high of 18.3%.
Other self-employed $128,400 $64,000
The cost of rent or mortgage payments, including utilities and
EMPLOYED BY telephone services, has been rising. This cost represented 6.7%
Optometrist(s) $102,981 $85,000 of gross income in 1996 and has increased consistently to
Ophthalmologist(s) $115,250 $100,500 11.0% as of 2006 (Table 1-10). The most important statistic,
HMO $107,125 $104,000
the ratio of net-to-gross income, has consistently ranged from
Hospital/clinic/other multidiscipline $101,867 $98,000
setting
approximately 30% to 33%.
Optical chain $91,400 $91,000 In 1994, the AOA survey’s gross earnings figures for optom-
Armed forces/VA/USPHS $101,579 $84,000 etrists indicated that income was derived from the following
Other employed $106,000 $95,000 three principal sources: examination fees, the sale of specta-
cles, and the fitting and sale of contact lenses. The approximate
From Edlow RC, Marcus GR: National highlights: 2007 AOA Economic Survey, Optometry
78(12):674-677, 2007.
breakdown of these sources of income indicated that exami-
HMO, Health Maintenance Organization; VA, Veterans Affairs; USPHS, United States nation, diagnosis, and treatment of patients produced 45% of
Public Health Service. income; the sale of ophthalmic lenses and frames generated
35% of income; and the fitting and sale of contact lenses pro-
vided 20% of income. In 1998, statistics from “Jobson’s Eye Care
Independent 1998 Survey” reported significant differences in
TABLE 1-9
the breakdown of services and materials. This survey divided
Total Individual Net Income by Years income into the following four sources of revenue: examina-
in Practice, 2006 tion fees, including fees for therapeutic care, 29%; spectacles,
36%; contact lenses, 23%, and prescription and Plano sun
Years in Practice Mean Net Income Median Net Income wear and accessories, 12%. These figures indicated that 71%
of income in private practice was derived from the dispensing
5 or less $99,187 $87,000
6 to 10 $104,866 $98,000
of some type of ophthalmic materials. Both of these surveys
11 to 15 $135,900 $110,000 illustrate the significance of ophthalmic dispensing and con-
16 to 20 $171,644 $141,000 tact lens services, which continue to provide the majority of
21 to 25 $145,603 $127,000 income in private practices. These percentages could change
26 to 30 $177,179 $140,500 in the future since according to the AOA Information & Data
31 to 35 $132,235 $111,000 Committee’s 2008 Scope of Practice Survey, “Optometrists
36 to 40 $94,714 $97,000 have long been very active in the providing of medical eye care
41 or more $104,250 $110,000 to their patients, but the survey results confirm they have now
From Edlow RC, Marcus GR: National highlights: 2007 AOA Economic Survey. Optometry become even more important as providers of medical eye care
78(12):674-677, 2007. in their communities.” Reimbursement from patients’ ­medical

TABLE 1-10

Median Percentage of OD Gross Practice Income Selected Expenses Categories 1996-2006*

Expense 1996 (%) 1998 (%) 2000 (%) 2002 (%) 2004 (%) 2006 (%)

Laboratory 28.0 26.8 28.0% 27.7% 27.2% 24.4%

Non-OD wages 15.3 15.3 16.4% 17.3% 18.1% 18.3%
Rent 6.7 6.8 6.3% 6.5% 6.7% 11.0%
From Edlow RC, Marcus GR: National highlights: 2007 AOA Economic Survey. Optometry 78(12):674-677, 2007.
OD, Doctor of Optometry.

insurance plans could significantly add to an optometrist’s
income, especially if third-party insurance plans reduce pay-
ment for eyewear and refractive services.
An important factor affecting examination income is the
influence of third-party reimbursement plans (e.g., Medicare,
Medicaid) and nongovernmental vision medical eye care
plans (e.g., vision or medical insurance plans, Vision Service
Plan [VSP], etc). Although the influence of these plans varies
from community to community, the 2008 AOA survey indi-
cated that 50.5% of a typical optometrist’s patients are covered
by private plans, 29.1% are covered by public programs (such
as Medicare or Medicaid), and 20.4% have no third-party cov-
erage for optometric services (Table 1-11). According to the
2008 survey, revenue from private plans represented 43.3% of
total practice income, whereas 24.5% was from public plans
and 32.2% was from out-of-pocket payments (including cost-
sharing amounts from patients covered by third parties).
PRACTICE PATTERNS OF BEGINNING
PRACTITIONERS
Optometry school graduates may choose any of several paths
when they enter the profession: they may go directly into pri-
vate practice as self-employed practitioners; they may seek an
employment position with other practitioners, in institutions,
with government or industry, or by a practitioner associated
with a corporate practice; or they may decide to continue
their education by selecting a residency position. The rea-
son for making a particular career choice obviously varies
from ­person to person, but according to surveys conducted
by APME, most optometry school graduates seek to become
private ­practitioners in a partnership setting in medium-sized
communities and most of them believe it will require 5 or more
TABLE 1-11
Patients Covered by and Revenue from
Third-Party Sources Mean Percent, 2007
Source Patients (%) Revenue (%)
VSP 22.0
Other self-directed vision 9.7
plans
HMOs (private sector) 6.4
Other managed care 8.4
Other private indemnity/ 4.0
discount plans
Medicare HMOs 4.4
Medicare fee-for-service 13.3
Medicaid 8.8
Other government plans 2.6
No third-party coverage 20.4
Patient out-of-pocket — 32.2
payments
Total 100
From AOA: 2008 Third Party/Managed Care Survey National Highlights.
HMOs, Health Maintenance Organization; VSP, Vision Service Plan.
State of the Profession Chapter 1 15
years to realize this opportunity. This finding indicates that
many optometry school graduates do not enter the practice
opportunity they would prefer immediately after graduation.
In 2005, Silverman, Woodruff, and Rumsey completed an
AOA funded survey of graduates from the 17 schools and col-
leges of optometry during the prior 5 years. This study, titled
“A Survey of Recent Optometry Graduates,” indicated that
the initial practice modes for graduates were retail (34.3%);
employed by OD (23.8%) or physician (10.8%); group/part-
nership (8.7%); solo practice/self-employed (6.5%); residency
(5.7%); federal service (4.5%); education (2.0%); hospital or
clinic (1.8%); HMO (0.9%); and optical/ophthalmic industry
(0.9%).
Self-Employment
Although most graduates aspire to become self-employed,
only about 8.7% do so immediately after graduation. Among
the most significant factors influencing the ­decision to become
self-employed are age, previous business ­experience, amount of
educational debt incurred, and family ­obligations. Male grad-
uates are more likely to enter directly into ­self-employment
than female graduates. The individual who intends to enter
into self-employment immediately must devote time to
­planning and preparation while in school and must have
financial resources necessary to begin practice or be able to
secure the credit necessary for such an undertaking. In this
arena of changed financial circumstances throughout our
country, more intense investigation and determination may
be needed to secure the financing for either buying an exist-
ing practice or starting a practice. Various optometric knowl-
edgeable loan companies are available. In an article published
in 2004 based on an earlier AOA-funded survey, Silverman,
Woodruff, and Hardigan were able to establish that the great
majority of students that were about to graduate would prefer
private practice, if they were not in debt or could match with
existing practice opportunities.
Employment
Approximately 77.2% of optometry school graduates enter the
18.0 practice of optometry through employment positions. Because
8.8 of the greater availability of positions in ­commercial settings
and the relative ease (as compared with professional positions)
5.2 with which they may be found, this type of employment is
7.8 commonly chosen by optometry school graduates. The 2005
3.5
survey by Silverman, Woodruff, and Rumsey indicated that
3.5
34.3% of optometric graduates choose retail; however, 34.6%
12.2 choose employment by an OD or MD. Ophthalmology posi-
6.6 tions offer the best economic benefits. In the past, there have
2.2 been relatively few of them available to new graduates, but
— this opportunity has been increasing. Employment with an
optometrist may be preferred because such employment is
often the means whereby a graduate eventually joins the prac-
100 tice as a co-owner. Finding such an opportunity, however, can
require a significant investment of time. It also may be time-
consuming to locate available positions in ­multidisciplinary
16 section 1 Preparing for your Professional Career
clinics, HMOs, or industry. Optometry students who do not
begin efforts early to locate and make themselves familiar to a
prospective employer are in general not as successful in obtain-
ing these positions as students who take these steps. Location
is still the main consideration for new graduates. Investigation
into where a prospective graduate would find their best match
takes time and diligence. These investigations should begin
well before graduation. Time is important and should be
divided between the crucial aspects of clinical and didactic
studies, as well as the realization that time goes quickly and
the future is now!
Residencies
According to a study by ASCO, about one-third of optom-
etry students express an interest in residency training. As of
2005-2006, there were 179 optometry graduates participating
in the more than 150 residency programs. Approximately 14%
of optometry school graduates choose to participate in them.
Female graduates are more likely than male graduates to select
residency training.
Residency training better prepares optometrists for pri-
vate practice—particularly in specialty areas—and may
be a requirement for a career in education and may also be
required for association with the VA or other government ser-
vice. A residency should not be considered to just delay decid-
ing where or how to practice. Competition for residencies can
be highly rigorous and planning for acceptance into the resi-
dency of choice should be considered early on in the student’s
clinical training.
Selection of Practice Opportunity
According to APME surveys, about one-third of optometry
school graduates do not select a practice opportunity until
after graduation from optometry school. These surveys indi-
cate that more female graduates wait until after graduation to
choose a practice opportunity than male graduates. Women
are more likely to enter into employment positions and also
are more willing to work in two or more modes of practice
than men. Since many optometry students are married, deci-
sions on how and where to practice are dictated possibly by
consideration of the spouse.
Location of Practice Opportunity
APME surveys have indicated that the majority of optometry
school graduates seek to work in areas with <100,000 popu-
lation. Approximately two-thirds of optometrists currently
practice in areas of this size.
First-Year Income
The 2005 AOA-funded survey, “A Survey of Recent Optometry
School Graduates,” covered graduates from 2000-2004. It was
determined that in the class of 2000, over a third (34.6%) made
$60,000 or less in their initial optometric position, whereas
5 years later, only 15.3% were making $60,000 or less per year.
For the same class, only 6.4% were making over $100,000 in
their initial position, and nearly a third (28.5%) were making
over $100,000 at the time of the survey. The lowest income was
earned by residents, and the highest by employees of hospitals,
clinics, multidiscipline practices, and ophthalmologists.
The 2007 AOA Economic Survey indicated that optome-
trists in practice 5 or fewer years had a mean net income of
$99,187, and from 6 to 10 years, the income was reported at
$104,866. Many graduates look at the mean net income of
all optometrists and assume that should be their first-year
income. There is a need to investigate more thoroughly and
review all avenues of income, including benefits and other
perks that add to the basic income.
Indebtedness at Graduation
Statistics compiled by ASCO for the academic year 2007-2008
indicate that 91% of students enrolled in colleges of optome-
try received financial aid, usually in the form of student loans.
The statistics also indicated that an average 11% were covered
under state contracts (states without optometry schools). The
average indebtedness for all students in the 2007-2008 academic
year varied from school to school and ranged from $14,100 to
152,500; the median debt was $92,755. Graduates of private
schools tend to have higher levels of indebtedness than graduates
of state-supported schools. The effect of debt on practice choices
has become a concern of AOA and ASCO, which has led them to
sponsor educational programs for optometry school students to
assist them in making good choices in limiting debt.
Identifying Practice Opportunities
The process of identifying a practice opportunity should begin
in optometry school, with a planned, systematic effort to deter-
mine the personal and professional needs of the individual
student (see Chapter 2). This process should come to fruition
at graduation, permitting a smooth transition from student to
practitioner. To realize such an ambitious goal, however, a new
licensee must make the following key decisions:
● Where to practice
● Whether to begin as an employer or employee
● How to satisfy the debts of education while starting or
buying a practice
● Determine goals (including career, family, financial,
physical, mental, social, and spiritual goals)
Individual decisions should be based on personal prefer-
ences and an understanding of the relevant facts. Research is
usually necessary to obtain information on a location or com-
munity. The status of the state law defining the practice of
optometry also is an important consideration. Students must
be aware of the constraints of a particular state that would
restrict them from practicing to their full scope of training.
Investigation of the community and its economic standing
is important in considering the capacity of a community to
absorb another practitioner or to support an optometrist.
Visits to the community and to individual practitioners are

often crucial. Selecting an extern site in the area of possible
consideration of practice should be considered, if applicable
to the particular selection process at the student’s institution.
The decision to practice initially as an employee is usually
based on economic necessity or recognition of the need for
experience before initiating an individual practice. Graduates
should consider carefully the advantages and disadvantages of
employee arrangements; if employment is determined to be
the best option, a systematic effort to locate a practice oppor-
tunity should be started while the student is in optometry
school. For graduates who desire immediate self-employment,
meticulous planning, the use of competent advisors, and care-
ful financial decision-making are obligatory.
Indebtedness should not be permitted to adversely influ-
ence goals and career plans. Maintaining educational debt at
a minimum is a prerequisite for all graduates (see Chapter 6).
Indebtedness influences earning capacity and the ability to
secure loans needed to purchase equipment for the start of
a practice, to buy a house and automobile, or to respond to
unexpected financial emergencies.
Planning should be initiated in school so that personal and
professional goals can be attained more easily after graduation.
A wealth of reference materials is available to students or recent
graduates, and these materials should be consulted. The AOA
has a practice placement service and provides technical infor-
mation to optometry students and association members. In
addition, many schools and colleges of optometry have websites
for opportunities, as well as other independent sites. Optometry
school alumni associations also may be used as a resource. The
most important resource, however, is the initiative of indi-
vidual students. Visiting practices, going to national,state and
local association meetings, assessing communities, and compil-
ing information about practice options are essential tasks that
should be performed during optometry school.
The prepared graduate is more likely to find an opportu-
nity and to take advantage of it. This alone is reason to devote
the necessary effort to the task.
CONCLUSION
In the chapters that follow, the process of beginning a practice,
organizing it, and operating it efficiently are described. It should
always be kept in mind, however, that individual initiative is the
primary consideration for any practice and that success more
often depends on initiative than any other factor. Our patient
population base is changing. Even though the number of new
ODs entering the workforce each year is expected to increase
through 2015 and beyond, the need for care by patients is also
increasing. The number of presbyopes and the older popula-
tion with increased eye care needs (diabetes, hypertension, glau-
coma) is growing, and the need for early childhood exams will
all place more demands on the optometric workforce. In addi-
tion, we have a diverse cultural population that is increasing each
year in the US. Consideration of ­locations for successful prac-
tice should include the d ­ emographics of minority groups.
State of the Profession Chapter 1 17
Data from AOA surveys suggest that women optometrists
are underrepresented among the respondent population, and
therefore the importance of female optometrists in the cur-
rent workforce is understated. Only 27% of female optome-
trists responded to the recent technology survey. More than
half of optometry graduates are female, and this number is
projected to continue or increase. We need to encourage all
female optometrists to respond and give definite input to AOA
surveys and current statistics. This response would validate the
positive influence of female optometrists and different future
dynamics of the optometric profession.
ACKNOWLEDGMENTS
The authors of this chapter in the first edition of Business
Aspects of Optometry were John G. Classé and Jack Bennett.
The authors of this chapter in the second edition of Business
Aspects of Optometry were Morton W. Silverman and John G.
Classé.
BIBLIOGRAPHY
American Optometric Association: Workforce study of optometrists,
St. Louis, 2000, American Optometric Association: National
Highlights 2007 Economic Survey.
American Optometric Association: 2008 State of the Profession (Edlow
RC, Markus GR, editor).
American Optometric Association: Caring for the Eyes of America, A
Profile of the Optometric Profession, 2008.
American Optometric Association: 2008 AOA Scope of Practice Survey.
American Optometric Association: Optometry: the primary eye care
profession, St. Louis, 2000.
First Practice Academy for Eye Care Professionals, CIBA Vision,
Essilor of America, 2008.
Association of Practice Management Educators: Annual APME
Surveys 1990–2001, Birmingham AL, 2002.
Association of Schools and College of Optometry: Annual Student
Data Report, academic year 2007–2008, Rockville, MD, 2006.
Career Advocate for the New Practitioner: Sponsored by American
Optometric Association, presented by Williams Group, 2007–2008.
Key Metrics of Optometric Practice: Management & Business
Academy for Eye Care Professionals, 2008.
Optometric Management: How to build a culturally aware practice,
2009.
Review of Optometry: Eye Care Across Countries and Cultures, 2009.
Silverman MW, Woodruff C, Hardigan PC: The future of optometric
practice? The results of a survey of optometrists and optometry
students. Optometry 75:615–21, 2004.
Websites
www.aoa.org. Website for the American Optometric Association.
www.opted.org. Website for the Association of School and Colleges
of Optometry.
www.mba-ce.com. Website for the Management & Business Academy
for Eye Care Professionals.
www.firstpractice-ce.com. Website for the First Practice Academy.
www.optometricmanagement.com
www.revoptom.com
 Personal and Professional
2
chapter
Goal Setting
Peter Shaw-McMinn, Mark Wright, Charles Bailey, and Dan Runyan
You can’t have everything. Where would you put it?
P
reparing for your professional career begins with know-
ing what you want to experience during your life. Career
management requires setting personal and professional
goals so you can make decisions most likely to reach these
goals. Setting goals can be the most difficult step to managing
your career. Logic tells us, “If we don’t know where we want
to go, how are we going to make decisions that allow us to get
there?” Although this seems to be common sense, many of us
do not set goals.
This chapter will explain why goal setting is important to
career management, what a goal is, why people do not set
goals, and how to set goals. The reader should be able to
prepare a plan for a full career in optometry that provides
desirable personal and professional outcomes and alter it
according to new circumstances that may occur during one’s
life.
TYPICAL PHASES IN THE LIFE
OF AN OPTOMETRIST
As a young graduate fresh out of school, you are concerned
with paying off loans, buying a car, perhaps purchasing your
practice or your first home, and eating something besides
fast food. Other goals may include traveling, joining the local
country club, or owning a vacation home at the beach.
As a recent graduate, the main resource you lack is money.
Recognizing this, the first decision you may make related to
your professional practice is to choose a practice opportunity
that provides this resource. The recent graduate asks himself
or herself, “How can I get the money I need to get what I want
and to do what I want?”
The young graduate may initially work for someone and
then eventually develop a private practice. Income gradu-
ally increases, and goals change. During this period, the per-
sonal goals the optometrist initially set often take a back seat
to the family’s needs: a large home, a swimming pool for the
kids, trips to the grandparents, baseball equipment, dance les-
sons, soccer leagues, church, braces, and finally, college tuition.
Suddenly the doctor realizes he or she is on the downside of
life and has not sailed around the world or taken that much
discussed tour of Europe.
18
Steven Wright
As optometrists, most of us start to notice this in our early
forties. For years, you tell your patients, “The lens inside your
eye is stiffening, making it difficult for you to change focus.”
The patient indignantly replies, “You mean I’m getting old!”
And you respond, “No, you are not getting old . . . our eyes do
not change focus as well after age 40.” (Really you are think-
ing, “Of course you are getting old. For goodness sake, look
at yourself in the mirror!”) Then the day comes when the
phoropter dials are blurry in the dim light of the examination
room. Guess what? You are the one getting old!
You remember your youthful goal of sailing around the
world. At some point you realize that although you now have
the money to do what you want, the main resource you lack
is time. Who is going to watch the office? Who will see the
patients? Who will pay the bills? Who will buy the practice
when you retire? These questions go through the minds of
optometrists who want to pursue the dreams of their youth.
Align your professional goals in Appendix A with your per-
sonal goals to provide the time and the income to reach your
life’s goals.
GOAL SETTING IS A KEY TO SUCCESS
By focusing on personal and professional goals, we can plan
for a fulfilling life. Getting the most out of your optometric
career requires careful planning. Have you ever sat down and
set goals for your life? Did you write them down? Most of us,
if asked, would like to be successful in our life. Being a success
means different things to different people. Success may mean
owning an optometric practice or a new Ferrari. Perhaps you
have always dreamed of having a home overlooking the ocean.
Or success may be having five kids and coaching their baseball
and soccer teams.
Actress Carol Burnett defines success as “getting a good seat
in a restaurant, eating marvelous food, meeting an awful lot
of nice people, being able to go to the dentist twice a year and
being quoted in magazines. Best of all, success means having
enough closet space!” Garfield, our favorite cat, defines success
as “Being able to eat 20 pizzas without throwing up!”
How would you define success in your life? One way of sim-
plifying what we mean by success is by using the definition:

“Success is getting what you want.” Once you determine what
you want, you will be able to measure whether you are suc-
cessful. It follows that the first step in becoming successful is
to set your goals. Although your goals are sure to change with
time, it is easier to plan once you have an idea of the final des-
tination. No doubt many of you would like to own your prac-
tice and be among the top 10% of wage earners in the United
States. A closer look at the following simple facts from indus-
try consultant Harry Jones of Achieve Max, Inc, will help you
recognize how you can be in the upper percentile of success-
ful people:
● The average person is out of school 4 years before he or
she starts thinking about goals . . . and usually is married
with one child.
● less than 5% of the population sets goals.
● less than1% of those who have goals write down their goals.
By setting goals and writing them down, you can become
a member of an elite group of people who have a plan for
success.
What happens to the average person who graduates from
college but does not set goals? Of all college graduates, the
average person leaves his or her first job within 18 months.
Many have not thought through what it is they are really look-
ing for in a career. Because of this, it is not until 18 months
have gone by that some realize that this job is not what they
want. Good planning and well-chosen strategies can help you
avoid the experience of going from one practice situation to
another, starting over again at each stop.
WHY GOAL SETTING IS IMPORTANT
TO CAREER MANAGEMENT
Optometry was chosen as a career for many reasons. One
reason is that optometry offers the best opportunity to get
what one wants from life. One of the greatest advantages of a
career in optometry commonly cited is that optometry offers
a variety of ways to practice. According to the Association of
Schools and Colleges of Optometry (ASCO), optometry will
enable you to “have the luxury of combining a prestigious pro-
fessional career with a very satisfying personal life.”
Setting goals allows you to be efficient in reaching them by
focusing your efforts and decision making. Being more effi-
cient means reaching goals quicker with less effort and mis-
use of resources. In the final analysis, being more efficient will
allow you to achieve more and experience more with your
abilities and resources.
The first step to career management is setting your per-
sonal goals. Once you have a good idea of what goals you want
to achieve in your personal life, you can design your profes-
sional goals to help you reach them.
A life design exercise, used by many life planners, career
planners, and therapists, takes only a few minutes and can
get you started in setting goals. It will stimulate your think-
ing, force you to confront some of your ambivalences, and
assist you in figuring out who you are and what you want.
Spend about 6 minutes completing the life design exercise in
Box 2-1.
Personal and Professional Goal Setting Chapter 2 19
Box 2-1
Life Design Exercise
Write on a piece of paper your lifetime goals. List everything you
want to have someday. List everything you want to do.
Shorten the time frame and list your goals for the next 3 to
5 years.
Finally, put down your goals for the next 6 months, assuming
that is all the time you have left on the planet. How would you
want to play out your life if you had just 6 months to go?
After completing the exercise, ask yourself the question,
“What did you learn about yourself from listing your goals?”
People usually discover that they may not be using their
time now on the things that they say are really important.
When asked how their goals had changed when the frame
was shortened from a lifetime to 6 months, most have a simi-
lar response, “Give up on monetary goals and focus on rela-
tionships.” One first year optometry student said, “I would
change from things to people.” Another said, “I’d go to the
seashore and invite all my friends and family to be with me.”
Completing this exercise allows you to recognize what is most
important in life. It allows you to learn what you value most.
In the end, most of us value personal relationships.
Of course, first-year students typically give many other
answers for what is really important. There are the death-wish
answers: bungee jumping, parasailing, hiking Mount Everest,
or racing dragsters. (I mean if you are going to die anyway you
might as well go out with a bang!) Then others are more into
hedonistic pleasures: all the sex I can get, max out the credit
cards, eat lots of bad food, and borrow as much money as
I can. (Who cares if someone has to pay for all my indulgences,
I’ll be gone!) Finally, there are the sweet answers: marry my
fiancé, tell mom I love her, and ask my girlfriend to marry me.
(“Hi honey, let’s get married I’m dying in six months!” Do you
have to be dying to tell your mother you love her? Call her
right now! Tomorrow is promised to no one.)
Revisit this exercise from time to time and share it with
those you care about. It will keep things in perspective for you
and motivate you to set your goals using a more meaningful
process discussed later in this chapter.
WHY PEOPLE DO NOT SET GOALS
The four main reasons people do not set goals are as follows:
1. They do not understand the importance of goals.
2. They do not know how to set goals.
3. They fear rejection.
4. They fear failure.
They Do Not Understand the
Importance of Goals
Research studies on success show that goal setting is the most
important step to success. Articles are written in newspapers
and magazines on a regular basis touting that success begins
20 section 1 Preparing for your Professional Career
with goal setting. As mentioned earlier, you cannot measure
success until you set goals to achieve. An article from Success
Magazine illustrates the importance of goal setting with the
title, “Act Now—or Die. Why You Must Plan Beyond Yourself
to Succeed Today!” Leon A. Danco, Chief Executive Officer
of the Center for Family Business, has spent the past 35 years
advising thousands of family-owned businesses. He explains,
“Anybody who wants to be a success has got to think about
the end before he gets engaged in the beginning . . . you have to
commit to the longevity of your business.”
The number of small US businesses has surged in this
decade but so has the rate of failures. Fortunately, optometry
is ranked as the second most risk-free business in the US. Our
success, however, depends on our plans. The first of a five-part
series on ways to help a small enterprise succeed begins with
“Big Step into Small Business Begins with a Plan.”
You would not build a building without plans. You would
not attempt to decorate an office without plans. Why would
anyone want to put a life together without plans?
Setting goals does not end with an initial plan. The article,
“Evaluation and Re-evaluation in Ophthalmology Manage­
ment” explains “Unlike New Year’s resolutions that are resolved
once and never accomplished, our career and life’s resolutions
must be reviewed periodically. As we get older, our needs may
change. We must evaluate our careers and ask ourselves if they
are helping us achieve our long-term goals.”
They Do Not Know How to Set Goals
Besides being the most important step to success, this is the
most difficult step. Setting goals requires a process, procedure,
or talent that is acquired through learning. As we look at what
is a goal and the process of planning goals, you will see what is
required. It is helpful to keep in mind that you have already set
goals in the past to some extent. You had the goal to get into
optometry school . . . and you succeeded!
The process of developing goals will require you to answer
several questions. What do I want to get out of my career?
What is my vision for the future? How compatible are my per-
sonal goals with my professional goals? How compatible are
my goals with my spouse’s or my family’s goals?
One way of beginning your life plan is by answering the ques-
tions, “If you could write the inscription on your tombstone and
if you were limited to three words, what would you write?” This
is tough to answer. One person answered: “He Helped People.”
If this was your epitaph, what career goals would you need to
achieve to justify those three words? Others you may prefer are:
“She Taught Others,” “He Improved Lives,” “She Gave Vision,”
“He Loved Us,” or “She Served God.” The actual process of set-
ting goals is much more complicated than planning what is to
be printed on your tombstone. Practice the process outlined
later in this chapter and you will know how to set goals.
They Fear Rejection
Achieving goals often means making mistakes. Sometimes we
have to try things to see what works. We may be required to
apply for a desired position ten times before you are finally
accepted. Imagine the actor auditioning over and over again
trying to get a part in movies or television. Many of us are
afraid of being turned down. To attain certain goals, persis-
tence is the most important personal attribute. Not being
afraid of rejection opens you up to many more possibilities
in this world.
They Fear Failure
Others are fearful of never reaching their goal. It takes a level
of confidence and bravery to declare a goal. Some think to
themselves, “What will people think if I don’t make it? What
will they say when I fail?” A professional golfer is successful
if he or she wins one tournament on the pro tour. They fail
over and over trying to win. They fail over and over during
a typical round. Tiger Woods hits the ball into the trees and
misses putts in front of millions every tournament. Some
goals require dealing with failure. Thomas Edison failed over
1,000 times trying to make the first light bulb!
One way to look at failing is a quote from Lou Holtz, the
well-known college football coach and ESPN analyst. “If we
succeed 100% of the time, we are not trying hard enough. We
are conservative. Failure is a normal fact of achievement.”
Success plans that include goals actually produce fewer dis-
appointments. As you focus on your goals, you will be able to
monitor your progress. You will gradually become aware of the
inability to reach a goal instead of suddenly feeling like a fail-
ure. Planning to reach goals actually prepares you for setbacks.
You will have a good understanding of why the goal was not
reached. This will lead to reevaluating future goals and strate-
gies and produce more consistent results, quicker outcomes,
and more rewarding accomplishments.
Achieving the steps toward a major goal will motivate you
toward trying harder. An example is losing weight. Losing
weight is difficult. But once you start to lose weight, get quicker
on the tennis court, or fit into clothes you have not worn in
years, you will be motivated to continue . . . with enthusiasm!
A sense of accomplishment can encourage you on to greater
feats and achievement.
Having goals allows you to measure your progress. Goals
are necessary to answer the question, “How is it going?” Ask
yourself if you have made progress toward your life’s goals. If
the answer is yes, you can say, “Things are going well!”
DEFINITION OF A GOAL
Goals are future realities that you commit to in the present.
A goal may stem from a wish, a desire, a hope, a dream, a
want, or a need. But a goal differs from all of these in that it
is a planned commitment. To achieve it requires active effort
in a positive direction. A desire to change something that
is not acted on is merely a wish or a complaint. A desire to
change that commits energy, and action to that change is a
goal. You may wish you did not smoke, but unless you com-
mit to taking the positive steps of reducing or stopping, it
remains only a wish.

When we are driven by the desire to achieve goals and
locked in by a commitment to work for them, goals become
powerful forces drawing us in the direction of personal suc-
cess. A goal is a prelude to action, driven by the motivation that
expects to see it realized. Commitment is the key component
to a goal; it is the ingredient that makes goals attainable and
at the same time, sets them off from mere wishing. By estab-
lishing a goal or objective, we give purpose and direction to
our efforts, focusing our efforts rather than having them scat-
ter in all directions. We are all working and living every day;
goals permit us to know exactly what we are working toward.
Frankly, if after a few years you have not progressed toward a
goal you set, it really was not a goal at all. You failed the first
attribute of a goal: it is a planned commitment.
Another attribute of a goal is that it is specific, observable,
and measurable. “I will feel better about my business” is not
a goal nor is “I want to handle money better” or “I’ll have
time for a hobby.” You must be able to measure your progress
and say with great certainty that the goal has or has not been
achieved; it is a clear yes or a clear no or you do not have a
measure of your success. Such things as X dollars, X number
of rooms, specific make of car, specific title, and X number
of days are measurable since you can count them or point
to them. Commonly, students will state the goal “I want to
be happy,” which certainly is not unreasonable but not spe-
cific and measurable. Choose goals that are specific and mea-
surable that will contribute to being happy in your particular
case. For example, “I will be married with three children by
2015.”
Time is an important part of every goal. The specific time
by which the goal will be accomplished must be part of the
goal statement. To say that you will learn another language
“someday” is not a goal until you put a realistic time frame on
it. Because some goals take a very long time to accomplish, it is
often necessary to create subgoals or short-term goals to serve
as checkpoints for determining progress toward the main goal.
In fact, it is a good idea to examine your long-term goals for
ways to break them up into steps that you can achieve piece-
meal, monitoring progress step-by-step on your way toward
achieving the larger goal. Figure 2-1 is a sample goal sheet that
can serve as a template for you to focus on achieving larger
goals.
Everyone is different as to how far ahead they can plan.
One of the amazing outcomes of goal setting is reaching life-
time goals so quickly. Goals you list for your entire life may
be reached within 10 or 15 years. For many people, it is rec-
ommended that a majority of goals be no more than 5 years
out, with the highest percentage of goals being located in the
2- to 3-year time frame. Any longer and they tend to be more
difficult to focus on, less powerfully motivating, more subject
to change (a great deal can happen in your life and your fam-
ily in a decade), and less consistently achieved. Intermediate
goals are generally viewed as encompassing 1 year. Short-term
goals encompass 2 to 3 months. Short and intermediate goals
are usually viewed in terms of being steps along the way that
contribute to the major mission, or long-term goal. With time,
you will learn what time period works best for you.
Personal and Professional Goal Setting Chapter 2 21
How many goals a person should have is a matter of indi-
vidual choice. Try to have enough goals that allow you to plan
a fulfilling and complete life for yourself.
Once set, goals may change if the reason is a good one. There
is fluidity about life that needs to be reflected in our goals. No
one should adhere so rigidly and blindly to their goals that
they sacrifice all happiness to attain them. The whole purpose
of goal setting is to make our personal and professional lives
more rewarding. A too-rigorous, stubborn clinging to out-
dated goals in a circumstance that has dramatically changed
the appropriateness of the goals defeats the primary purpose
of the goal-setting process, which is to achieve rewarding and
meaningful success. Remember, life is replete with change. As
we grow and change, our visions and goals change too, reflect-
ing our personal and professional growth.
On the other hand, goals that are constantly being changed,
dropped, altered, revised, or frequently forgotten are not true
goals. To abandon goals that you have set is to cheat on the
greatest commitment you can possibly make—a contract
with yourself. A goal is a promise to work in a given direction,
toward a known result. The promise is to oneself.
A goal is defined as a planned commitment that is specific,
measurable, observable and has a time element. To put your
goals into perspective, check to see if they pass the following
“SMART” test. In this test, your goals should be:
Specific: “I know what I have to do.”
Measurable: “I’ll know when I’ve reached the goal.”
Achievable: “I think it can be done.”
Realistic: “I know the goal is reasonable and appropriate.”
Time bound: “I know when it must be done”
THE PROCESS OF GOAL SETTING
It might seem that setting goals should be easy: just sit down
and do it. But randomly selecting a direction to go, an objective
to shoot for, or simply listing every desire you have on a piece
of paper and calling them goals is not an effective approach.
A practical approach is to begin with an assessment of who, what,
and where you are now. Before you start looking at goals for the
future, you must assess the present. Inventory your strengths
and weaknesses; analyze your age, family condition, energy level,
and general outlook. Take stock of your health, background, and
heritage. Get a fix on all the “building materials” you have at
your disposal—family, friends, associates, geography, finances,
degrees, and professional and personal history. Realistic goal
setting means knowing who you are so that as you shape the
future toward specific objectives, you know the challenges and
rewards that are likely to occur. The process of goal setting
consists of going through the f­ ollowing five practical steps:
1. Selection
2. Analysis
3. Support
4. Feedback
5. Imaging
This process is the same for establishing personal, as well as
professional, goals and cuts across all areas of activities, including
sports, finance, family, leisure, health, housing, or any other area.
22 section 1 Preparing for your Professional Career

Today’s Date

Specific Goal:

• Specific benefits of reaching goal:

Target date:

Where am I today with regard to the goal?

Obstacles to achievement:

Checkpoint dates:

• Intermediate Goal #1:

• Intermediate Goal #2:

• Intermediate Goal #3:

• Intermediate Goal #4:

Plans for surmounting obstacles:

Specific actions to take to form new habits:

Date Goal was Met:

FIGURE 2-1 Sample goal sheet.


Selection
Although there are no limits to what you can do with your life,
there are limits to how many things you can concentrate on at
one time and how many directions you can start off in at once.
To begin this step, list all of the things you would like to do or
have “someday.” List everything that you have dreamed about
achieving “someday.” Brainstorm on all the possibilities you
may be interested in experiencing in your life. You can use the
Future Plans Exercise in Appendix B to assist you in thinking
of areas you may want to set goals within.
Now, go over the list and take time to imagine each one as
a reality. Imagine it as being actual, real, and as though it has
actually occurred. Visualize each in great detail. Then select
one that means the most to you. Allow the individual items
to impact you, to make their own strong, loud case in your
mind. Your task is to choose a goal that really matters to you—
one that motivates you when you consider it mentally, one
that you find overwhelmingly compelling, urgent, strong, and
insistent.
Step 1 is really the process of letting the goal stand out to
you; it selects itself by making the background static or become
less loud and by shining as a strong message that makes the
others on the list look less appealing.
Analysis
“Gut feel” is a fine procedure to use in selecting a compelling
goal; however, rational, practical, and objective analysis will
help strengthen your commitment to that goal, taking it out of
the realm of desires and wishful thinking into the objectivity
and reality of the goal-setting process. Analysis is really asking
yourself the following questions about the goal:
1. Why have I chosen this goal?
2. What rewards are there if I were to successfully achieve it?
The first question asks you to consider how the goal con-
tributes to your personal and/or professional life. What really is
the value or worth to the whole category? How meaningful in
your big picture, your success plan, is this specific goal? Does it
strike an area where you are particularly concerned or eager for
growth? Are you convinced of the need, desirability, and abso-
lute necessity that it be achieved than merely feeling that it is
rather something that would be “nice to have?” Are you willing
to begin to change habits and attitudes to accomplish it?
The second question asks you to expand the value of the
goal to other areas. What does achieving this goal mean to you
in terms of other rewards? If you have accomplished this goal,
what else is made available to you or is more plentiful than
before? Is it time? Money? Recognition? An enhanced sense of
accomplishment?
Support
Step 3 requires building support systems. This step and the
fourth step, feedback, are especially important for reaching
long-term goals, although all steps apply equally well to all your
goals, even intermediate and short-term goals. Ask yourself who
can help you achieve this goal. Ask what ­financial, professional,
Personal and Professional Goal Setting Chapter 2 23
personal, family, and community support you will have for this
effort. No one is alone. Everything that you do affects a great
many others, and they in turn have the opportunity to help
strengthen and support your striving for your goals.
Whether support comes in the form of a mentor from
whom you seek advice, wisdom, encouragement, and knowl-
edge, or from a large support group of specialists, such as
those used by professional athletes, each looking at different
aspects of the whole effort, you should take time to examine
your full range of support. No one does anything totally on
their own. Even the most confident, autonomous, pioneer-
ing spirit, who is strong, independent, self-acting, and self-
actualizing, is still receiving strength from other sources. It
is important to know as you set a goal who is likely to be the
biggest help to you in achieving that goal, what person near
you can reinforce your efforts, and who or what organization
is likely to be your biggest ally with the biggest assets to sup-
port you in achieving it.
Feedback
No goal of even the shortest term should be governed by a dead-
line only. You need to know the progress being made toward
accomplishing the goal on a timely and ongoing basis. When
setting a goal, establish the process, procedures, and systems by
which you will be getting feedback on how you are progress-
ing toward that goal. You need to be able to monitor quickly,
frequently, and accurately where you are in accomplishing the
goal. If your goal is a bank balance, the feedback is easy; you
can watch it grow monthly on the statement. If the goal is more
complex, for example, an addition to the house, divide the goal
into specific events that are measurable and show progress,
such as plans developed, money acquired, contractor contacted,
ground broken, wall framed, roof on, and so forth, until you
reach the completion date. Planning a life is much like planning
a room addition. You need a solid foundation first, then a plan
to build it in logical steps so everything fits together.
Each step in the process toward a goal, each monitoring
checkpoint becomes a mini goal, a small objective necessary
to be achieved on the way to accomplishment of the main goal
(see Figure 2-1).
Without this important step, without a method for check-
ing progress, you will be unsure of exactly how you are doing;
how much closer your goal is to becoming a reality. Goals
that are planned and accomplished do not sneak up on you;
they are the result of a logical step-by-step process in a cho-
sen direction with our full support and effort behind them.
Accomplishments never come as surprises; they are the natu-
ral unfolding of the process that you started in motion when
you first set a goal and committed yourself to its achievement.
You need feedback all along the way.
Imaging
In some ways, this is the easiest yet most important step in
the process of goal setting. All extraordinary accomplishments
come as a result of someone’s being able to imagine them and
24 section 1 Preparing for your Professional Career
then being able to maintain that image as a goal and strive for
it. You must picture your goal; you must anticipate it in your
mind. It was Walt Disney who said, “If you can imagine it, you
can achieve it!”
In your mind, you need to go to the goal already achieved
as you set it down on paper. Begin moving toward that goal
by imagining that it is already accomplished. Picture yourself
involved in that goal. See yourself as already being there as a
result of that goal. Now, look back from the position of the
goal having been reached and see yourself participating in the
process of achieving that goal. Rehearse some of the activi-
ties you had to be involved in to reach the goal. Mentally go
over and over this process until it is fixed with clarity in your
mind. Many athletes use this visualization before attempting
to achieve in sports. Professional golfers visualize the shot and
do not attempt it until it is firmly implanted in their mind.
If the goal is tangible, like a house, car, boat, airplane, or
clinic, go see one, visit it, sit or walk in it, look at it, feel it, and
make it yours. Imagine yourself there until it becomes natural
to you. Visiting optometric practices or model homes can be a
stimulus to working hard to get there yourself.
The mental visualization of a goal accomplished is the most
motivating, powerful influence on reaching the goal. It helps
you become motivated and shapes your behavior in the right
direction, begins to break old habits and attitudes, and triggers
the energy needed to succeed. Nothing you can do daily will
do more to impact the outcome of your efforts than to imprint
the goal on your thought processes. The exact opposite of
daydreaming, this process is the engine starter for each day’s
action, and it will keep you focused on your target. Everyone
needs a reason to get out of bed in the morning. Embracing
the achievement of your goals will motivate you to do so.
Imagine yourself 5 years from now. You wake up in the
morning. What do you see? Is there someone next to you?
What do they look like? How is the room decorated? As you
walk through the house how does the interior of the house
appear? Do children greet you? How are you dressed for the
day? What type of car do you get into? Where do you go? What
does the day hold for you? Imagine what you want your day to
be like, what you will see, hear, smell, taste, and feel. Then, set
up a plan to reach that wonderful day you imagine experienc-
ing. See Appendix C for an exercise to assist you with this.
CONCLUSION
By beginning with your personal goals, you provide the best
possible basis for building professional and career goals that
fit you and your individual, unique situation. No one is exactly
like you; no one else has your desires, dreams, talents, and atti-
tudes toward home, family, leisure, retirement, locale, and so
forth.
Create personal goals and professional goals by completing
the Future Plans Exercise (see Appendix B). Use this exercise to
create a template to build a wonderful fulfilling life. Upgrade
your goals annually. Monitor your progress. And the next time
you are trying to decide what to do with your time or money,
ask yourself the question, “How will this help me reach my
goals?”
Some of you will have a very difficult time writing specific,
measurable, achievable, realistic, and time-bound goals. Those
of you who have difficulties, remember this second quote from
Lou Holtz: “Deep down inside, you better have a dream, have
a goal, or it won’t happen. . . .” Also consider “If you don’t care
where you’re going . . . any road will take you there . . .” Care
where you are going. Your life and the lives of those around
you depend on it.
Bibliography
Shaw-McMinn PG: Personal Goal-Setting for ODs at All Career
Stages, Optometric Economics, Spring, 1996.
Investor’s Business Daily: IBD’s 10 Secrets to Success, 2007.
Sifford D: Getting a Clear Focus on Lifetime Goals, 1989, The Press
Enterprise.
Herring J: Don’t abandon goals once you meet them, The stress buster,
2002, Riverside Press Enterprise, Knight Ridder Newspapers.
Big Step into Small Business Begins with a Plan, 1988, The Press Enterprise.
Jones H: Goal Setting Seminar, Achieve Max, Inc.
Post T: Act Now-or Die, Why You Must Plan Beyond Yourself to Succeed
Today, 1989, Success Magazine.
Optimize Yourself through Personal and Professional Goal Setting,
Professional Enhancement Monograph, 1984, American Optometric
Association.
American Optometric Association: Career Advocate for the New
Practitioner, St. Louis, 2007–2008.
 Personal and Professional Goal Setting Chapter 2 25

APPENDIX A
PROFESSIONAL GOALS

Professional goals can influence which marketing goals and objectives you should focus on. Circle the
professional goals you are interested in. What time and resource commitments are required? How can you
blend these goals with your personal and practice goals?
● Participation in national organizations and associations:

American Academy of Optometry, College of Optometry and Vision Development, Optometric Extension
Program, American Optometric Association, regional optometric associations, Better Vision Institute,
American Optometric Foundation, Contact Lens Society of America, American Public Health Association,
optometry school alumni association, other
● Participation in state organizations and associations committees:

Board of trustees, education, health care delivery, public awareness, membership, legislative, political action,
nominating committee, other
● Local organizations and association activities:

Optometric society officer, education, membership, governmental affairs, political action, bulletin, public
awareness committee, college or university school faculty, optometry school board of trustees, other
● Public service:

Public speaking, writing articles, newspaper contact, political contact key-person, school consultant,
industrial consultant, expert witness, state board member, public school board member, public health
service, Flying Samaritans, Volunteer Optometric Services to Humanity, Vision USA, Special Olympics, other
● Professional services:

Primary care, contact lenses, low vision, visual therapy, sports vision, geriatric vision, orthokeratology,
pediatrics, convalescent hospital care, finishing lab, full service lab, solutions, pre- and post-op care,
other
● In summary, my professional goals are:

1.
2.
3.
4.
5.
26 section 1 Preparing for your Professional Career

APPENDIX B
FUTURE PLANS EXERCISE

This exercise is designed to increase awareness of areas in which you have growth opportunities, assist you in
identifying resources needed to carry out your plans, and encourage you to recognize those areas of optometry
most consistent with your plans. You should do this exercise throughout life; it can give you direction and
motivate you to use your time constructively. This outline will help organize your dreams into concrete goals.
Some categories may not be relevant to you, and you should feel free to add more categories. Each goal is best
expressed as measurable and specific. Include a target date for each. For each goal, write down where you are
today, obstacles to achieving the goal, checkpoint dates, and specific actions to take to form new habits.
I. Educational C. Dining out
A. Interest classes D. Other
B. Postgraduate education VIII. Community activities
II. Optometric practice A. Church, temple
A. Self-employed or employed B. Service clubs
B. Location C. Other
C. Type of practice IX. Political office
D. Scope of practice A. Optometric
III. Teaching 1. Local
A. Public speaking 2. State
B. City college 3. National
C. University B. Public
D. Optometry school 1. Local
IV. Research 2. State
A. Private practice 3. National
B. Industry X. Travel
C. Optometry school A. National
V. Investments B. International
A. Real estate XI. Recreation
1. Home A. Sports
2. Office B. Hobbies
3. Vacation home C. Club membership
B. Practice XII. Family
C. Stocks and bonds A. Marriage
D. Retirement B. Children
E. Insurance C. Children/spouse plans
F. Other XIII. Retirement
VI. Home improvements/construction A. When
A. Interior decorating B. Expected income level
B. Landscaping C. Planned activities
VII. Personal D. Location
A. Cars 1. Local
B. Clothes 2. State
 Personal and Professional Goal Setting Chapter 2 27

APPENDIX C
SAMPLE OUTLINE OF FUTURE PLANS

I. Educational 2. Refractive aniseikonia

A. I will attend one creative interest class a year 3. Declination angle and performance
at Palomar JC in creative writing, sculpture, 4. Binocularity and contact lenses
calligraphy, and cooking starting in 2012. 5. Vertical phoria, fixation disparities, and
B. I will work toward a master’s degree in special contact lenses
education from UCSD in 2010. 6. Vision training techniques
II. Optometric practice 7. A program of in-office and home vision
A. I will be self-employed by purchasing a training to treat:
solo practice or joining a group practice on Amblyopia
graduation in 2010. ARC
B. It will be located in Southern California, in Convergence insufficiency, excess
North San Diego County. Ocular motor dysfunction
C. The practice will be in a medical building or Accommodative infacility
free-standing professional building. 8. Optometry and learning disabilities
D. I will specialize in children and seniors, 9. Treatment and diagnosis of learning
providing vision training, contact lenses, and disabilities
glaucoma therapy. 10. Vision training to treat visual perceptual
III. Teaching problems
A. I will lecture to clubs and associations 6 times V. Investments
a year beginning in 2010 in: A. I will purchase an optometric office by 2009.
Vision and tennis B. I will buy my first home by 2010 and rent it out
Vision and golf when I buy my dream home.
Vision and learning C. I will buy my dream home by 2015.
The eye and sight D. I will open an optical boutique and lab by 2012.
Geriatric vision problems E. I will buy and rent a duplex, then upgrade
High blood pressure, high cholesterol, and every 2 years, doubling the number of units I
the eye have to rent, starting in 2017.
Photography and perspective VI. Home improvements/construction
Art and visualization A. My spouse will decorate the interior of the
B. I will teach the course “Vision and Learning” house, which will have a southwestern
at Palomar JC beginning in 2010. Spanish style decor.
C. I will lecture in the course “Visual Perception B. The exterior of the house will be styled
and Learning Disabilities” at UCSD beginning as a Mexican hacienda with tile roof and
in 2011. balconies.
D. I will be a clinical instructor in vision training, C. I will landscape my home on 5 to 10 acres to
contact lenses, and general optometry include as many of the following as practical:
at SCCO on graduation. After receiving ● Swimming pool
my master’s degree in education, I will be ● Jacuzzi
lecturing as an associate professor in the ● Bench swing
areas of perception and learning disabilities at ● Fire pit
SCCO. ● Waterfall
E. I will volunteer as a high school tennis coach ● Pond
three afternoons a week beginning in 2009. ● Tennis court
IV. Research ● Nursery
A. I will get involved in clinical studies with ● Volleyball court
contact lens and spectacle lens companies, ● Every fruit tree I like
as well as pharmaceutical companies by ● Eucalyptus grove with tree house
2013. ● Barn
B. I will complete one research project every ● Horses
year beginning in 2010 in: ● Chickens
1. The ideal correction, contact lenses vs. ● Patio with cooking stove and oven
spectacles for specific situations

Continued
Another random document with
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 DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI

Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
 FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)

The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
 Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA

I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
 The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.

MAKONDE LOCK AND KEY AT JUMBE CHAURO

 This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
 “We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
 Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
 BRAZIER

Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT

SMOOTHING WITH MAIZE-COB

CUTTING THE EDGE

 FINISHING THE BOTTOM

LAST SMOOTHING BEFORE

BURNING

FIRING THE BRUSH-PILE

 LIGHTING THE FARTHER SIDE OF
THE PILE

TURNING THE RED-HOT VESSEL

NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
 Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK

DRAWING THE BARK OFF THE LOG

REMOVING THE OUTER BARK

 BEATING THE BARK

WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT

MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN