When Dr. Mishee Goyal began her optometry career, she booked one patient an hour. Not because she moved slow in the exam room, but because of everything else around her. OHIP questions. Referral workflows. File completion. The operational rhythm of running an actual clinic. “Surprisingly, it wasn’t the exam itself or the clinical testing that proved challenging,” she says. “It was everything outside of that.”

Optometry school teaches you how to examine eyes. It does not teach you how to carry the weight of a functioning clinic all at once. That integration is what defines the first real year out of school.

Now practising in Ontario since 2015, Dr. Goyal runs Blink Better Optometry in Burlington, a cold-start clinic she is building from scratch. What she learned in those early months forms a clearer picture of what the profession actually demands beyond the exam lane—and what new graduate optometrists would be wise to understand early.

What to Expect After Optometry School

Before graduating, billing is one subject. Patient communication is another. Clinical technique is its own stream. And that’s the difference between optometry school and real practice—the latter isn’t so compartmentalized.

The one-patient-per-hour approach gave her time to see these connections forming instead of being buried by them. But a second decision changed how her clinic actually operated. She asked her staff to stop silently fixing recurring workflow breakdowns and start flagging them instead. Problems began getting solved at the root rather than patched over every afternoon.

The clinical knowledge holds. The operational knowledge must be built deliberately. Graduates who build it fastest are the ones who treat it as a discipline in its own right, rather than something to figure out on the fly.

What Patients Actually Need from You

But while the operational side can be systematised, the human side of patient care is less predictable. It’s something Dr. Goyal took a deliberate effort to develop.

Early on, it was tempting to stay facing the computer and type while talking to patients. She made a conscious decision to stop, now turning her body fully toward the patient when speaking. She asks non-clinical questions before and during the exam, about work, family, what’s happening in their life outside the chair. She learned to pause and let silence sit rather than rushing to fill it.

“Even something as simple as saying, ‘That sounds really stressful,'” she says. “Those moments matter so much.”

Every patient brings their own story into the exam room: grief, illness, stress, and life transitions. Learning how to connect and show empathy can play a big part in making the correct diagnosis.

How to Manage Administration in Optometry

These human connections are what turn first-time visits into long-term patient relationships. It requires presence, but presence that isn’t always so easy to find in your first year.

Files, referrals, reports—the volume starts on day one and doesn’t ease up. Many new graduates find themselves working past their last appointment just to stay current, often while learning a new EMR platform at the same time.

“You have to learn to adapt quickly,” Dr. Goyal says. “Those breakdowns can be stressful, especially early in your career.”

Her solution was to stop trying to complete every chart perfectly during the appointment. She separated clinical time from documentation time, dedicating a block at the end of the day to finishing files. She also invested time in learning basic equipment troubleshooting—changing a slit lamp bulb, recalibrating minor issues, managing small tech disruptions without calling for service. All of it reduced the daily friction that makes managing an optometry clinic demanding in those first few years.

Having the right technology helps, too. Dr. Goyal uses Optosys, OSI’s optometry practice management software, which consolidates her EMR, billing, and workflow systems into one platform, reducing the scattered administrative work that once stretched into her evenings. When systems don’t speak to each other, you become the bridge between them—and that invisible labour is what often burns new graduates out fastest.

Building Your Optometry Support Network Early

Of course, streamlining workflow and choosing the right tools requires judgment most new graduates are still developing. And judgment is difficult to build in isolation.

“You can’t do this job alone,” Dr. Goyal says.

Early in her career, before she had a formal advisory structure around her, she was deliberate about ensuring she didn’t operate alone. She maintained group chats with a small circle of optometrist friends she trusted—a mix of clinical questions, operational questions, and the kind of honest conversations that are hard to have with people who don’t understand the work.

She was also fortunate to practise in a multi-doctor setting where she could walk down the hall and ask a quick question when something came up. Even company representatives became a resource. They interact with dozens of clinics and can offer perspective that isn’t visible from inside a single practice.

But the biggest shift, she says, was internal.

“Isolation often comes from the belief that you’re supposed to have all the answers. Once I accepted that growth involves uncertainty, asking for help became easier.”

What Structured Optometry Business Support Looks Like

When Dr. Goyal began planning her cold-start clinic, there were many unknowns.

“Clinically, we may feel confident,” she says. “But on the business side of optometry practice, it’s a completely different world.”

With that uncertainty in front of her, she reached out to the OSI Group and was paired with Practice Advisor Jas Ryat, a dedicated coach who works one-on-one with independent optometrists during key transition points like ownership and expansion.

What followed wasn’t a one-off consultation, but rather an ongoing working relationship. She found guidance on business formation, a sequenced approach to operational decisions, and support in evaluating technology with long-term implications.

Jas was someone who had seen the process before—her expertise turned what could have been months of guesswork into informed choices. And behind that advisory relationship sat the OSI Group itself, functioning as a single access point for the all the big questions: choosing an EMR, evaluating business structures, or how to start a cold-start optometry clinic. They also help find the right specialist when a specific issue requires deeper expertise.

“If they don’t have the answer immediately, they guide you to someone who does,” she says.

What She’d Tell You Now

If she could go back to her first year, Dr. Goyal wouldn’t change her decisions. She’d change how she carried them. “I felt like I needed to know everything. Every billing rule, every referral pathway, every clinical nuance. When I didn’t, I doubted myself.” What she knows now is that no one arrives with all the answers, and no one is expected to. The graduates who thrive are the ones who give themselves permission to grow into the role rather than expecting mastery on day one.

Part of that growth, she says, is seeing how other people do it. “Work in at least two different practices early in your career.” Not for the CV line, but because seeing how different clinics handle operations and patient flow gives you a foundation for knowing what you’d build yourself. “Enjoy the ride,” she adds. “Optometry keeps evolving, the scope keeps expanding, and you’ll never be bored.”

Support For New Optometry Graduates Starts Here

The transition from school to practice doesn’t require you to choose between excellent patient care and sound operations. With the right optometry business support, you can build both from the beginning.

Clinical skill gets you started. Support, systems, and guidance help you sustain momentum.

Ready to turn inspiration into action?

Connect with a Practice Advisor to explore your next step—whether that’s starting an optometry practice, evaluating opportunities, or asking the right questions early.

Reach out to Jas Ryat at jryat@opto.com and begin shaping what’s next.