What do you, as former president of a private college of optometry, consider the most important issues facing the profession of optometry?

The absence of a current optometric manpower study and a comprehensive assessment of the state of optometric education.

The last optometric manpower study was completed in 1999 by Abt Associates, Cambridge, Massachusetts. The last study of optometric education was in 1993 at the Georgetown Summit. A current optometric manpower study and a comprehensive assessment of the state of optometric education are needed given the expanded scope of optometric practice, proliferation of new schools of optometry, national health care reform, the aging population and uncertain optometric manpower needs.

The high cost of optometric education.

Private optometry colleges’ endowments and sources of revenue other than tuition are not sufficient to support college and clinic operations and increased costs are often passed on to the student in the form of higher tuition, resulting in higher educational debt. This may also apply to public institutions although my experience is largely in private colleges. Currently, the cost of an optometric education is a sound investment, however continuing increases in educational costs measured against the income potential of optometrists will likely diminish the attractiveness of an optometric career in the future. Graduate debt is excessive, over $200,000 at some optometric institutions.

Why are optometric educational institutions so dependent on student tuition to support clinical training when medicine and podiatry receive substantial federal support?

At the Georgetown Conference (1992-1993), a meeting of all constituents of the optometric profession to discuss the optometric curriculum/clinical training programs, it was decided that optometric education would remain a four year curriculum with no requirement for post-graduate training for entry level into the profession. This conclusion meant that increases in the scope of practice for optometry and the resultant demands on the curriculum and clinical training requirements and related costs had to be contained in the four year educational program.

The four year optometry program is unlike medicine which requires post-graduate clinical training for licensure due to the expanded educational requirements for entry level medical practice. Graduates of medical and podiatry programs are not eligible for licensure until satisfactory completion of post-graduate clinical training. Because medicine and podiatry require post-graduate training, these two professions along with post-graduate dentistry are eligible for $9.5 billion annually in Graduate Medical Education (GME) Residency Program funds while optometry programs are not eligible.

What are the contributing factors to the high cost of optometric education?

Clinical education is the most easily identified cause of increased operating costs and the most significant. There are numerous factors contributing to higher clinical training costs:

Unlike the successful medical patient care and clinical teaching approach, optometry’s clinical model is student centered rather than patient centered. A student centered model increases the patient examination cycle, decreases patient satisfaction and limits faculty practice growth.

Since the 1970’s with the introduction of pharmaceuticals and advanced clinic. procedures, optometry has been in a state of transformation. Optometric education has evolved in response to the expanded patient care management and treatment responsibilities of optometric practice, significantly increasing training requirements and related costs.

Clinical education is inherently inefficient when compared with the provision of care in non-teaching sites and patient services revenues are inadequate to cover the deficit of clinic operations. Unlike medicine, dentistry and podiatry, optometry is not eligible for federal funds (GME) to compensate for training inefficiencies and increased training requirements and costs.

When the amount of charity care provided by college optometry clinics and patient services payment sources are taken into consideration, state, foundation, corporate and alumni support are currently also inadequate to fund clinic operating deficits. (The cost of clinical education is not always considered in the clinic operations accounting model.)

Clinical faculty incentives and/or expectations to increase patient services revenues are usually not usually components of employment contracts and maximizing revenue is not considered a priority by faculty members nor rewarded by colleges. Providing efficient patient services is not emphasized. Faculty and staff training in patient services coding and billing procedures is inadequate.

What are your suggestions to reduce the cost of clinical training?

Federal support for optometric clinical training would have a dramatic and lasting impact on the cost of optometric education. Efforts to include optometry in the Graduate Medical Program (GME) and other federal programs, such as the National Health Service Corps should be intensified. However, in order to qualify for the current GME Residency Program significant changes in the clinical education model would be necessary. Post graduate clinical training (residency), as a requirement for licensure, would need to be included in the optometric clinical education model. A Certification Board would be needed as well. Numerous issues involving state licensing boards, national examining boards, accreditation groups, etc would need to be addressed. The Social Security Act amended to include optometry in the Graduate Medical Education Program GME).

Radical new thinking about optometric patient care and clinical teaching is recommended. A major paradigm shift is required where clinical faculty/attending optometrists are in charge of the patient rather than faculty in charge of the care of the student.

Emphasis needs to be placed on patient care during clinical education sessions. Everything that occurs in the exam room should be to the benefit of the patient and patient satisfaction. Great clinical teaching can only occur in the context of great doctoring and role modeling of exceptional care. If this is the norm, then patient cycle time will be decreased and faculty will retool their thinking to be attending optometrists in charge of the patient rather than faculty in charge of the care of the student. This is the successful medical clinical training approach.

The expectations of these attending optometrists are different than academic optometrists. They are expected to drive the performance of the clinical program, both with volume and revenues and their performance evaluations should be strongly linked to their clinical and operational performance. This enables an institution to recruit and retain the best practitioners at market rate salaries with expectations that their income will be paid through their clinical performance resulting in increased revenues from clinical services.

All clinicians should be held accountable to compliance rules and regulations regarding documentation and clinical testing. Regular training sessions should be held pertaining to patient services coding and billing.

Large campus-based clinical facilities are costly and operating costs often passed on to the student in the form of higher tuition. Colleges should consider less expensive affiliations with proximal health care facilities such as community health centers, medical centers, federal facilities and externship placements for clinical training. New colleges of optometry should not build expensive campus based clinics, but rather establish networks of clinical training sites in existing health care facilities.

Are there other causes for the high cost of optometric education?

Yes, there are issues involving the academic program and research. Academic leadership is often slow to react to advances in the clinical practice of optometry and reluctant to make significant changes in the curriculum including addressing course redundancies. Course material remains in the curriculum even though it could be made a pre-optometry requirement and not taught in the core optometric curriculum.

State of the art technology such as distance learning is available, however faculty are reluctant to embrace new teaching methods. More emphasis should be placed on self learning by the student.

The current tenure process at private colleges of optometry greatly restricts the institutions ability to react to changing economic conditions and imposes long term financial obligations. Private colleges of optometry do not reserve funds to meet future obligations imposed by tenure.

What solutions do you propose to reduce the costs of the academic program?

A comprehensive review of the curriculum is suggested, specifically to remove redundancies and course material that could be changed to a pre-optometry requirements, more fully utilize current technology and consider distance learning for selected courses. A national faculty of recognized scholars could provide much of the classroom component of the curriculum via distant learning technology.

When the curriculum is completed, regardless of length, post-graduate training would be required. The post-graduate requirement would therefore make optometric education an exact parallel with podiatry and medicine and position optometry to qualify for Federal support (GME).

Private colleges of optometry should review the long term financial liability that tenure imposes, offer alternatives to tenure such as contract tenure or discontinue tenure. Colleges should calculate the long term financial obligation of tenure already granted and apprise the governing board of the magnitude of that commitment. Consideration should be given to reserving funds to cover tenured faculty.

Why do you believe research at private institutions may be contributing to the cost of optometric education?

Meaningful research programs are costly to develop and maintain. External funding is highly competitive and failure to secure new and ongoing funding may lead to absorbing the costs of research personnel and related expenses in the operating budget. Since the budget is largely funded by student tuition, in the absence of external research funds, increases in student tuition would likely be needed or funds would need to be diverted from the core educational program to support research.

What measures should private colleges take to prevent research programs being funded by student tuition should external funding not be available.

Caution should be exercised in investing in expensive research infrastructure as a return on investment can not be assured.

Translational scholarship such as publications, book chapters, presentations and posters at the AAO, leadership positions in the profession, appointments to NBEO and ACOE Boards, community service could replace traditional research as an expectation of faculty.

It should be clear when appointing faculty who are primarily researchers, that he/she must support all research activities and research personnel with external funding. If funding is lost, continued employment can not be guaranteed.

Caution should also be exercised in granting traditional tenure to research faculty.

Are there other matters you would like to discuss?

Even if all the above recommendations were implemented, revenue would still not be sufficient to support quality optometric education without regular increases in student tuition resulting in higher student debt. It is essential that alumni support their alma maters. Financial support from alumni is far from its potential and is critical to sustaining the quality of optometric education and for attracting the best and brightest students. Both are vital to the prestige and long term success of the profession of optometry.

Strategic alliances among the private colleges of optometry are suggested as a means to reduce costs, stabilize enrollments and strengthen their position in a finite student market. Affiliations with public universities should be considered. Affiliations with medical school departments of ophthalmology provide consultation and surgical services for the college’s clinic patients as well as cost effective clinical teaching encounters for optometry students and residents.

Private colleges should not always count on a robust student applicant pool or increased class size to develop operating budgets. The student applicant pool is cyclical and in combination with increased competition for students from new schools, it could leave the college with unfunded expenses without sufficient tuition revenue.

Colleges should consider reorganizing their clinical program into a separate subsidiary of the college. The advantages of this structure are:

• Provides for a reasonable separation of risk.
• Facilitates the appointment of Board members with skills in health care administration.
• Provides for more focused attention to the respective missions of education and patient care.
• Enhances the ability to solicit funds from foundations and other funding sources which do not contribute to educational institutions.
• Participation in GME would require a separate legal structure as payment are made to the clinical entity and not the college.

Externship sites need strict guidelines and oversight. Consideration should be given to the establishment of a central clearing house for extern placements. Only extern sites that comply with guidelines should be included. Some form of accreditation is needed for individual sites.

2011 ICO Commencement Video | Photos

[Transcript of Full Commencement Address:]

Thank you for this high honor.

Trustees, President Augsburger, colleagues, honored guests and above all doctoral degree candidates.

I know you are eager to receive your degrees and celebrate your hard earned achievements, however, as tradition dictates, there will be no degrees until the old guy speaks.

Congratulations on earning your Doctor of Optometry degree.

Today, I join with your families and friends in sharing the pride of your outstanding accomplishments.

Your future is bright with unparalleled practice opportunities.

You have been fortunate for the past four years to be touched by the uncommon power of the ICO experience.

This experience ensures your success in a changing health care environment.

An outstanding faculty has prepared you well for opportunities in the areas of public health, patient care and clinical education.

In the area of public health there is an increasing awareness of unmet visual health needs in medically underserved areas.

And there are opportunities for you to meet the needs of special populations: for those who live in poverty, the homeless, the frail elderly, the homebound, the developmentally disabled and the visually impaired.

The Illinois Eye Institute’s community outreach to the underserved population of Chicago serves as an outstanding example of collaborative medical care.

I hope you will use your ICO training to help others in need.

In patient care, opportunities are available to you in interdisciplinary care as optometrists manage more complex clinical conditions and diseases, requiring close coordination with other professionals.

Also, telemedicine technologies and electronic health records provide the means for more effective patient management.

ICO’s commitment to excellence in patient care is affirmed by grant awards from prestigious organizations and corporations.

The College’s network of over 150 clinical training sites in 47 states and abroad is one of the most extensive in optometry.

In clinical education, there are opportunities for you, as preceptors, by sharing your experiences in: patient-centered education and cooperative clinical training between optometry and ophthalmology.

ICO’s support from external sources for clinical training is the highest of all optometric institutions and is an acknowledgement of the College’s excellence in clinical education.

My education, like yours, prepared me not only to be a competent clinician but also to contribute to the profession’s future.

Your professional status will also provide entree to numerous social, civic and political activities.

In the past, it has been the foresight and persistence of many dedicated individuals to move the profession forward.

You are now called upon to make such a contribution.

Given the aging population, uncertain optometric manpower needs and the impact of national health care reform, there is a need for broad based strategic planning including professional, academic and corporate participation.

I encourage your active involvement at the local, state or national level in planning for your profession’s future.

Current Board Certification and Continued Professional Competency initiatives require your attention and understanding of their place in your profession.

There are unprecedented opportunities for optometry to seek inclusion in three major Federal programs while the federal budget is being re-structured.

These programs could potentially benefit the current generation of optometrists as well as future optometric students, residents and graduates.

The first initiative which is already in progress is the expansion of optometry’s impact in the community health care system.

Community health centers provide accessible and cost effective primary medical care to 20 million Americans in rural areas and poor urban neighborhoods.

However, only 20% of federally qualified health centers offer eye care services, despite the growing need in rural and inner-city America.

Federal funding is required to establish optometric services in all of the Nation’s community health centers.

It is estimated that 5,000 optometrists would be needed in the Nation’s underserved areas over the next decade providing not only new practice opportunities, but also additional student and resident clinical training placements.

The second program is the National Health Service Corps.

Efforts must be made to attract more optometrists to medically underserved areas through financial incentives, such as tax free student loan repayment, by including optometrists in the National Health Service Corps.

Classification of optometry by the Federal government as a Primary Care Profession is a necessary next step to qualify for this program.

Third and long overdue, is optometry’s inclusion in the Graduate Medical Education program, GME, the clinical educational component of Medicare.

Optometrists have been included in the Medicare program since 1987 and currently provide $970 million in services annually to Medicare beneficiaries.

Now it is time to join medicine, dentistry and podiatry as a recipient of GME funding for clinical training.

Optometry’s inclusion in the $9.5 billion program would address: the increasing costs of clinical training and the need for workforce development as the scope of optometric practice continues to expand and growth in the demand for eye care services by the Medicare population.

Although the work ahead will be challenging, inclusion in these three major Federal programs would provide visual health care to tens of thousands of underserved individuals, strengthen the profession of optometry’s position at the national level and forever change the financial landscape of optometric education.

I am confident that the profession’s future leaders are in this Chapel today.

And as those before you, you must move forward with a balance of discretion and audacity.

Be willing to take risks with innovative approaches.

In whatever you do, follow the example of your Alma Mater and strive for pinnacles of excellence.

For in the final analysis, it is neither about financial rewards nor power, but pride in your professional and personal achievements.

Character and contribution will define your success.

Thank you and congratulations.

[May 21, 2011]

Dr. Mullen has served the profession with great distinction since earning his doctor of optometry degree in 1969 from the New England College of Optometry. He has tirelessly advocated for the interdisciplinary approach to clinical education and patient care, and he successfully led the initiative to certify the first American optometrists in the use of pharmaceutical agents.

Under his leadership at ICO, Dr. Mullen increased the College’s externship sites from 9 to 144, significantly improved students’ performance on national board examinations, affiliated ICO with the University of Chicago, and developed and implemented a performance-based strategic plan that positioned ICO for future success.

Dr. Mullen has received more than 30 prestigious honors and awards, including being inducted into the National Optometry Hall of Fame for lifetime contributions to the profession. Dr. Mullen serves on the boards of NECO and the Blind and Vision Rehabilitation Services of Pittsburgh and has previously served as chair of the board of directors at the New England Eye Institute.

About the Illinois College of Optometry

The Illinois College of Optometry, founded in 1872 by Dr. Henry Olin, provides excellence in optometric clinical education and is among the world’s leading urban optometric institutions. Located in Chicago, ICO has a distinguished legacy of providing aspiring optometrists the education and experience needed to meet the challenges of a changing health care environment and become leaders who will champion their patients and the profession alike. For more information please visit the Illinois College of Optometry website.

Background
In a decisive effort to move into the mainstream of health care and to address concerns about the legal exposure of an educational institution providing services to Medicare and Medicaid beneficiaries, The New England College of Optometry (NECO) in 2002 spun off its clinical system and its assets into a separate subsidiary corporation, the New England Eye Institute (NEEI). This was the first time a private college of optometry was to form an optometric analog to the medical school/teaching hospital structure. The new clinical corporation has its own Articles of Incorporation, By-laws, Board of Directors and administration similar to those of a teaching hospital. NEEI’s governance documents reflect considerable oversight by NECO. A detailed position description for the CEO was written which incorporated the elements of the incorporation documents. NEEI has made significant progress in realizing the potential of this new structure and has demonstrated that the oversight mechanisms in place have been effective. This summary outlines the advantages of a separate clinical corporation, supports the advantages with available data, restates the College’s oversight processes to assure added value and mission alignment, and notes concerns and misunderstandings that need further discussion…

To continue reading the full article click here.

Interview commissioned by the Massachusetts League of Community Health Centers and conducted by James Hooley.

See also:

• The New England College of Optometry Clinical System
• Affiliation Between Hahnemann University and the Pennsylvania College of Optometry
• Illinois College of Optometry and the University of Chicago Affiliation Agreement
• Charles F. Mullen’s Speech at the Kennedy Library
• Distinct and Separate Legal Structures for Optometric Clinical Programs

Today’s optometry students take for granted their ability to train at settings including neighborhood health centers and Department of Veterans Affairs (VA) facilities as part of their clinical education. Yet, these doors were not always open to them. While there were many people who contributed to this welcome change, the man with the vision to know where the profession was going and how to get there is Dr. Charles F. Mullen ’69.

Dr. Mullen, who recently retired as President of the Illinois College of Optometry, spent his entire career designing and reshaping the delivery of clinical education for optometry students and residents. He has advanced clinical education with his keen foresight and forceful leadership. In doing so, he has opened up eye care services to many previously underserved patients.

From 1970-1976 Dr. Mullen served President William Baldwin at The New England College of Optometry (then Massachusetts College of Optometry) as Special Assistant for Clinical Development. Baldwin appointed him shortly after his 1969 graduation.

Between 1976-1990, Dr. Mullen served as executive director of the Eye Institute at the Pennsylvania College of Optometry (PCO). He then directed the Optometry Service at the Department of Veterans Affairs in Washington, DC, from 1990-1996 and in 1996 was selected president of the Illinois College of Optometry (ICO).

Beginning with NECO, Dr. Mullen was able to plant the seeds of moving optometry into the forefront of primary eye care by developing a system that optimally served patients. Perhaps best known for clearly seeing the potential of expanding the scope of the practice of optometry, Dr. Mullen recognized in the early 1970’s that optometrists would be treating eye disease and the necessity for students in the clinical system of NECO to develop new skills. Think of how difficult this was without a single diagnostic or therapeutic drug law in place…

Working to implement new clinical protocols, Dr. Mullen creatively developed teaching affiliations with Boston’s system of neighborhood health centers and other multidisciplinary settings. He did this by partnering with a progressive team of optometrists and ophthalmologists in caring for patients in special and underserved populations as a way of enhancing the education of future doctors of all disciplines.

In the words of Dr. Mullen, “We had a need and wanted to enrich the students’ clinical experience and give them more exposure… we also saw an opportunity to provide eye care services to those who were underserved in the Boston area.”

Breaking Down the Barriers
To reflect back on the 1970s, when Dr. Mullen began his career in optometry, is to see a radically different time than today. Co-management was not the norm, as it is today. Diagnostics and therapeutic pharmaceuticals were the sole province of the medical profession.

Early in his career, Dr. Mullen understood that ophthalmology and optometry were complementary. However, integrating a different model in a resistant health care field would require both conviction and persistence. He and other clinicians saw an opportunity to introduce a primary care system into clinical education and, in 1970, circumstances allowed him to begin his mission.

In 1972, the College was commissioned by the State of Rhode Island to develop the clinical curriculum and certify its Optometric State Board in the use of diagnostic and pharmaceutical agents. Dr. Mullen directed the implementation of the clinical component for the first diagnostic pharmaceutical course and along with Dr. Matt Garston ’66 certified the first diagnostic pharmaceutical certified optometrist in the United States.

Following that milestone, Dr. Mullen collaborated with a team of neighborhood health care and public policy leaders: Tres Blake of the South End Community Heath Center; Bob Morgan of Dimock Community Health Center and the Harvard School of Public Health; Mark Richman, M.D. of Boston University and the South End Community Health Centers; and David Miller, M.D., of Beth Israel and Harvard Medical School. All were committed to enhancing ophthalmologic clinical education and services.

The ophthalmic community and private optometric practitioners were skeptical, but the group stayed the course. Over time, local neighborhood health centers formed partnerships with the College and integrated optometric services and students into their clinical programs. Dr. Mullen is still viewed as the architect of the local model used in Boston and duplicated elsewhere to this day.

Dr. Barry J. Barresi ’77, Vice President for Clinical Care and Services at New England Eye Institute (NEEI), testifies to that fact. “Even today as we meet with Boston’s health care leaders to further expand the NEEI system of community-based clinical sites, many of them vividly recall the innovative leadership of Dr. Mullen some 30 years ago. With his colleagues, he built a strong foundation of community health partnerships. Today these collaborations are fueling continued innovation and growth in the College’s mission of excellence in patient care, clinical education and research.”

Dr. Gerald Selvin ’73, Professor of Optometry at NECO and National Education Chair for the Optometry Service Field Advisory Group of VA Central Office considers Dr. Mullen to have had the largest impact on his development than anyone else in optometry. While still a student, he remembers two particular proclamations made in 1972 which not only greatly influence his practice life but all of optometry.

“Optometrists will be treating eye disease routinely, so we are going to start to teach you how now.”;

“There are no welfare patients, no poor patients, no rich patients… there are only patients, and each individual will be treated with dignity and respect.”

These principles are what Dr. Charles Mullen has always placed above all else…take care of patients compassionately and with expertise. Never having lost sight of these principles is what made Dr. Mullen the visionary he is. And those optometrists who have had the good fortune to be directly influenced by him can imprint these values on a new generation of doctors, continuing his legacy.

The Eye Institute
Then it was time for another professional challenge. In 1976, Dr. Norman Wallis, former president of Pennsylvania College of Optometry (PCO) and now executive director of the National Board of Examiners, approached him about developing an integrated clinical system at PCO for the soon to be built Eye Institute. Dr. Wallis felt that Dr. Mullen was the only person capable of handling this daunting assignment. Dr. Wallis explained to Perspective that PCO’s objective was to establish an enterprise that resembled an “eye hospital.” It would combine the three O’s (opticianry, optometry, and ophthalmology) under one roof. This innovation in eye care education would completely change the character of the clinic, and – ultimately – eye care delivery.

With his characteristic methodical approach, Dr. Mullen set out to implement the model, which would greatly expand the scope of educational and training resources available at PCO. Dr. Wallis recalls why it was so successful.

“Charlie organized the clinic like a military campaign. Every aspect was covered to the greatest detail. It was like Operation Desert Storm.”

In the 1980’s, Dr. Mullen saw changes taking place in the profession and made great efforts to merge the interests between optometry and the medical community. He wrote that, “the impetus comes from outside parties – particularly third-party payers, health care policymakers and legislators – who will attempt to define the roles each profession will play in the future of eye care provision if the two professions do not actively define the roles themselves.”

He knew that the mutual interests could form a bond. Therefore, he initiated several affiliations with medical facilities in the Philadelphia region. The hallmark would be PCO’s affiliation with Hahnemann University, a Philadelphia-based medical college. The two combined their resources and worked to develop “unique approaches to ophthalmic education, eye care provision, and optometric research.”

Meeting More Professional Challenges
In 1990 Dr. Mullen left PCO to head the Optometry Service of the Department of Veterans Affairs in Washington, DC. With this post, he became the highest-ranking civilian optometrist employed by the government. A former Navy officer himself, he was familiar with the need for change in the VA system. True to from, he began a process of systematic restructuring. Under his stewardship, he implemented protocols for clinical privileging and standardized the educational component system-wide at the VHA. These guidelines are the principle force driving policy decisions today. He was also responsible for the sizable growth of the student and residency programs.

Many colleagues, including those at the Department of Veterans Affairs, feel that he was a perfect representative for the optometric profession in Washington. Described as a “visionary,” a “poised ambassador,” and an “executive’s executive,” he based his entire career on teamwork. When asked about his leadership style, Charles Mullen credits Dr. Wallis. “Norman taught me the ability to empower the people who work for you – to trust them and how to delegate authority.”

Another term that is often used in reference to Charles Mullen is “turn-around specialist.” In 1996, he accepted the challenge of the presidency at the Illinois College of Optometry. The institution had gone through a difficult time and needed to be restored to its previous stature.

Dr. Mullen confronted the issues head on, turning ICO into a thriving and stable institution. He implemented a strategic management plan, “Commitment to Excellence,” which restructured the college to address the challenges of the future.

Commenting on what he views as the most significant transformation at ICO during his tenure, Dr. Mullen is quick to state that “it has been the institutional culture. We initiated the process by focusing on the CORE four-year program and utilized tools to evaluate outcome assessment and national board performance. Change has permeated the institution.”

The list of accomplishments at ICO is noteworthy. ICO has increased its endowment, raised its clinical revenues, significantly improved student national board performance, frozen tuition, improved its student retention rate and increased student and faculty involvement in institutional governance. The outcome of Dr. Mullen’s taking charge is remarkable.

You can also see his trademark in the clinical programs at ICO. When he arrived there were only nine clinical affiliates. That number has grown to 137 sites throughout the United States and abroad. This has significantly impacted students’ access to patient encounters. In 1997, ICO formed an affiliation with the University of Chicago that has strengthened both institutions. ICO is now in the process of expanding that relationship further and plans are underway to move the University of Chicago’s ophthalmic surgical practice to the ICO campus.

With his retirement recently from ICO, you might expect Dr. Mullen to contemplate his golf handicap or other hobbies. But instead, he is thinking of returning to federal service. You can expect that wherever he heads next, his vision and leadership will do nothing short of transforming that entity.

The New England College of Optometry
Perspective Magazine. Spring 2002.

On June 10th ICO President Dr. Charles Mullen represented the Deans and Presidents of America’s Schools and Colleges of Optometry and spoke at the installation of Alan Laird Lewis, O.D., Ph.D., as incoming President of the New England College of Optometry (NECO). Inasmuch as the challenges and opportunities envisioned apply to ICO as well as NECO, Alumni Matters is pleased to reproduce Dr. Mullen’s brief remarks in their entirety.

Dr. Lewis, Chairman Spector, members of the Board of Trustees, distinguished members of the New England College of Optometry faculty and administration, colleagues and honored guests.

It is indeed a pleasure and a privilege for me to be here today as the representative of the Deans and Presidents of America’s Schools and Colleges of Optometry, as a friend and colleague of Dr. Lewis, and to return to my Alma Mater.

Over the years Dr. Lewis and I, to some extent, followed similar paths. We are both graduates of the New England College of Optometry. We both served as officers in the United States Navy and we both pursued careers in optometric education.

As Director of the Optometry Service at the Veterans Health Administration, I had the opportunity to work with Dr. Lewis while he was Dean at the Michigan College of Optometry. We worked closely during those years to expand clinical training for optometric students at various Department of Veterans Affairs medical facilities.

I have the greatest respect for Dr. Lewis’ abilities as an administrator and as an educator. He possesses those rare and most desirable talents of a keen intellect with the ability to comprehend and act on the larger issues, challenges and opportunities along with an appreciation for the importance of detail.

The challenges and opportunities all of us in optometric education will face during Dr. Lewis’ tenure as president are numerous.

We will see a lessening of our dependency upon campus-based facilities for the clinical education of students. Perhaps initially driven by economic considerations, the greater diversity of educational experiences provided by externships will increase pressure for more community-based training sites. The New England College of Optometry maintains a leadership role in the development and management of community-based sites and is already meeting this challenge.

College based clinics will play a significant role, however, as faculty practice becomes more important as a means for enhancing faculty income and improving our ability to recruit and retain highly qualified clinicians.

We will see a movement away from traditional classroom teaching toward more technology assisted self-learning through the rapid advances being made in communications and computer-based technology.

There will be an increased recognition that the function of a school or college of optometry is to prepare graduates for a lifetime of learning. We will redefine the entry-level attributes of our students and modify our curriculum to emphasize a lifelong commitment to learning. Students will learn to commit to a philosophy that emphasizes the acquisition of knowledge over mere information absorption and memorization.

We will recognize our responsibility to expose our students to a wide variety of practice opportunities.

We must also be prepared to offer meaningful advanced competency education to practicing optometrists as a core value of institutions of optometric education.

And, we must be ready to assist our faculty in adapting their teaching strategies to reflect this new paradigm.

And, finally we must find ways to reduce the level of indebtedness students face upon graduation, perhaps by controlling tuition increases and by providing increased scholarship support.

I also believe that the future direction of optometry will be fueled more than ever by the economics of the managed care marketplace. Quality assurance programs, appropriate advanced competency certifications and accreditation of clinical facilities will become increasingly important.

Consultation among professionals and the national academic eye centers of excellence will take advantage of advanced technology to become a standard practice. Precise retinal images and other data will be instantly transmitted from one point to another in real time.

We will see the development and utilization of a national faculty in several disciplines linked through developing technology. Schools and colleges of optometry will be able to access a faculty of our finest educators.

In such an environment, made possible by advances in technology and made necessary by economic imperative to be as efficient as possible, there will be unprecedented pressures to work together in a cooperative spirit. In this environment Dr. Alan Lewis, who has earned the respect and admiration of his peers will be indispensable as a leader.

I am confident that his contributions to the College, optometric education and the profession will be numerous and his leadership exceptional.

I pledge to Dr. Lewis my personal support and that of his fellow Deans and Presidents of Schools and Colleges of Optometry, and I wish him continued success as the President of The New England College of Optometry.

Thank you.

Alumni Matters – Summer 2000
Illinois College of Optometry
Charles F. Mullen O.D.

Why did you accept the position of President of the Illinois College of Optometry?

Given ICO’s historical position of prominence within optometric education, I was concerned when I learned of the difficulties the college was experiencing in 1996. I believed these difficulties had the potential to harm not only ICO, but possibly even the profession of optometry itself. When approached by the Search Committee, I felt a responsibility to my profession of thirty years to interview for the position. Since I had extensive experience in health care management and clinical education, I felt confident that with the support of the Board of Trustees, faculty, and staff, we could redirect the resources and energies of the college toward programmatic improvements and that in a fairly short time we could create an institutional culture in which faculty, staff, and students were positively engaged in strengthening the institution.

The interview process for the presidency began in the summer of 1996. I met with the faculty. The faculty provided anonymous evaluations of my potential as ICO’s new president. The returns were favorable. By November, I was commuting between Washington, D.C. and Chicago. In December 1996, I assumed the presidency of the Illinois College of Optometry.

What were your expectations and initial objectives when you arrived at ICO?

Although I found there was an understandable sense of uncertainty regarding the immediate future of the College, morale was surprisingly good. It was my perspective that faculty and staff were not only willing, but eager, to “right the ship” and to positively engage in strengthening and improving the institution. I felt confident I could immediately assemble a capable administrative team from the existing faculty and staff.

My initial objectives included:

• Initiation of a strategic and tactical planning process.
• Enhancement of the academic culture by increasing support for faculty development, research, and scholarly activity.
• Expansion of the clinical educational program by initially adding 50 community-based training sites.
• Initiation of a search for a new Dean/Vice President for Academic Affairs.
• Review and modification, as appropriate, of the administrative organization.
• Enhancement of the institutional culture, by improvement of services to students, patients, alumni, and employees.
• Ensurance of the financial stability of the institution, including the enhancement of revenue streams.
• Review and modification of the master buildings and facilities program.
• Improvement of management information systems.
• Enhancement of personnel management.
• Development and implementation of public relations and fund-raising programs.
• Redirection of resources formerly allocated to an ambitious building program into programmatic improvements.

I believed that it was vital that our planning process promote open avenues of dialog with internal and external constituencies. I knew from my PCO experiences that each graduate of ICO is important to the college. I needed their perspective, but – even more importantly – I had to make them part of the decision-making process. I commissioned a survey of alumni/alumnae needs and concerns that not only had an immediate impact on our strategic planning, but led to the creation of ongoing communication channels that continue to affect our strategic planning. One very dramatic outcome of alumni input was ICO’s recent decision to freeze tuition, increase scholarship funding, and reduce the entering class size.

We also brought the broader community into the planning process. The Illinois Eye Institute had a long and well-recognized record of serving the community and we wanted to be even better neighbors. We appointed a Community Advisory Board (CAB). This Board includes leaders of neighborhood organizations, school principals, representatives of government agencies serving the community, clergymen, and members of ICO’s senior administration. We deal with various issues of mutual interest to ICO and the community, such as employment opportunities, construction projects, real estate transactions, and minority student recruitment.

It was now our task to channel these processes into a tangible plan of action. With input generated through countless meetings, reviews, evaluations, and reevaluations, we created a 70-page document, the Prescription for Excellence. It contains five major goals, each with detailed, quantifiable action steps and completion dates. Thee action steps also identified the department responsible for their implementation. Regular monthly meetings were scheduled to evaluate our progress. These meetings – which continue today – are open to all members of the ICO community.

The Prescription for Excellence was immediately effective. The goals and directions we established continue to be important, but even more important is the process we created whereby each member of every ICO constituency has the opportunity to be meaningfully involved in the planning process. The Prescription for Excellence is now in its second generation, as the Journey to Excellence.

Several important themes emerged during the planning process that have helped created a new culture at ICO. Through the planning process, five major goals were crystallized:

• Provision of excellence in education and scholarly activity.
• Creation and maintenance of reputation as an institution that is characterized by exceptional accountability.
• Provision of excellence in service, as defined by our students, patients, alumni, and employees.
• Provision of excellence in health care.
• Achievement of recognition as a center of influence within the profession and the community.

These goals are now the basis for the performance agreements that exist between every member of senior administration and the President, as well as an agreement between the Board of Trustees and the President. These agreements are what each of us is measured by; they are the basis for budgeting and for departmental planning.

What progress have you made in addressing your objectives and have your expectations been met?

Strategic planning has been very successful at ICO and not just by our own measurement. Nearly 70% of the initial action items contained in the original plan have been completed. The following are all the direct outgrowth of ICO’s planning process:

• Appointment of Janice E. Scharre, O.D., MS, as Dean/Vice President for Academic Affairs.
• Achievement of continuing accreditation by the North Central Association of Colleges and Schools, without stipulation or monitoring.
• Creation of open dialog with key constituency groups.
• Achievement of strong financial position for the institution.
• Diversification of the Board of Trustees, including the appointment of faculty representatives and minority representation.
• Achievement of increase in patient encounters at the Illinois Eye Institute.
• Successful restructure of ICO’s debt through the issuance of $45 million in variable-rate tax-exempt bonds, which allowed more flexible investment of $22 million in assets.
• Institution of numerous financial controls and safeguards.
• Reorganization of the administrative team, including the formation of a President’s Advisory Council
• Improvement of student services and culture by response to a comprehensive student satisfaction survey.
• Affiliation with the Department of Ophthalmology and Visual Sciences at the University of Chicago.
• Expansion of externships from 9 sites to 97 sites in the United States and abroad.
• Completion of $8.5 million in campus capital improvements, including renovations to the physical plant, purchase of new ophthalmic equipment, and installation of extensive informational systems technology.
• Achievement of an all-time high student retention rate of 97.1%.
• Participation in the continued resurgence of the neighborhood development around the College by improvement of the external appearance of the college campus and other college-owned property.
• Reinstatement of a faculty practice plan.
• Enhancement of employee and trustee communications by issuance of a comprehensive Employee Manual, a revised Faculty Handbook, and a Board of Trustees compendium of Resolutions and Action Items.
• Receipt of a report from the Council on Optometric Education, during an interim site visit in 1998, that ICO had addressed all previous recommendations and suggestions.
• Revision and improvement of the Practice Management course, including the initiation of an annual practice opportunities symposium, in which students have the opportunity to learn about all modes of optometric practice.
• Enhancement of faculty governance with creation of the faculty executive committee and expansion of the committee structure.
• Achievement of increased student-patient care encounters by 68%.
• Development and implementation of a course for University of Chicago second-year medical students in basic eye care procedures.
• Expansion of ICO’s residency program to include residencies in cornea/contact lenses and anterior segment/refractive surgery.
• Achievement of increased quality of entering students, as measured by average GPA and OAT scores over the past three years.
• Settlement of all outstanding legal matters.
• Freeze of the tuition at FY98-99 level.
• Achievement of increased scholarship funding.
• Improvement of relations with the corporate community.

I can honestly say that my expectations have been greatly exceeded. I attribute this to the dedication, hard work, and perseverance of ICO’s Board of Trustees, faculty, staff, and student leadership for their support and willingness to adjust to my management style.

I am very proud of our affiliation with the Department of Ophthalmology and Visual Sciences at the University of Chicago. It came about, in part, as a result of the account of my earlier experiences with cooperative efforts between optometry and ophthalmology that had appeared in Archives of Ophthalmology. Terrance Ernest, M.D., Ph.D., chairman of the Department of Ophthalmology and Visual Sciences at the University of Chicago, had read the article I co-authored with Myron Yanoff, M.D. in 1990 on the affiliation between Hahnemann University and PCO. Dr. Ernest believes – as I do – that there is tremendous potential for further cooperation between optometry and ophthalmology. Now that I was at ICO, Dr. Ernest approached me with the possibility of a similar agreement with the University of Chicago. The proposed affiliation quickly became part of our planning process. In October 1997, Dr. Ernest and I signed the affiliation agreement as one event of my inaugural-week activities. The affiliation continues to be highly successful as the relationship expands and new elements are added to the basic agreement.

What is the future direction of ICO, optometric education, and the profession of optometry?

Although in retrospect I believe I may have underestimated the complexity of the issues facing optometric education when I assumed the presidency of ICO, I remain as optimistic of the future as I did on my arrival. But I do see changes ahead for ICO and optometric education. Indeed, my optimism is grounded in the belief these changes are not only necessary, but inevitable. I believe for ICO to continue to excel, we must:

• Successfully mange the decreasing optometric and health care student pool.
• Reduce student indebtedness.
• Address issues of eye care manpower.
• Restructure the clinical education program to be more cost-efficient while we maintain academic quality.
• Launch major capital and deferred giving campaigns and sustain an intense development effort.
• Significantly increase the Illinois Eye Institute revenues and expand our faculty practice plan.
• Further diversify the Board of Trustees and increase its size by recruiting Board members with needed expertise and philanthropic capabilities.
• Continue to provide students with a voice in College affairs, including representation on the Board of Trustees.
• Improve faculty scholarly activity – specifically, externally funded research, clinical trials, and publications.
• Greatly expand instructional technology.
• Ensure that curriculum is consistent with defined entry-level attributes.
• Continue the emphasis on strategic and tactical planning with outcome-based assessment as the measure of progress.
• Develop and implement an advanced competency curriculum.
• Enhance our position – in cooperation with the University of Chicago – as a provider of comprehensive eye care services within the Chicago-land health care market.
• Develop and implement and O.D./Ph.D. program in cooperation with the University of Chicago.
• Achieve continuing accreditation by the Council on Optometric Education.
• Improve personnel relations with ICO – particularly as it pertains to positive attitude and respect for one another, with a special effort to acknowledge individual and group achievements.
• Expand our foreign student recruitment program to extend beyond North America.

The challenges facing ICO – to a greater or lesser extent – are the same issues that face many of the schools and colleges of optometry. In general, I see the following trends in optometric education:

• We will see a lessening of our dependency on camps-based clinics for the clinical education of third and fourth-year optometry students. Driven initially by economics – but, I believe providing for greater diversity of educational experiences – we will see more community-based training sites or externships for fourth-professional-year students and some third-year students.
• Campus-based clinics will remain valuable for first- and second-year students.
• College-based clinics will serve a significant role as faculty practice becomes more important as a means to enhance faculty income and improve the schools’ and colleges’ ability to recruit and retain highly qualified clinicians.
• We will see a movement away from traditional classroom teaching toward more technology-assisted self-learning through the rapid advances being made in communication and computer-based technology. The college, however, must be prepared to assist the faculty in changing their teaching strategies.
• Acquisition of critical analysis skills will become as important as a solid foundation in the basic and health sciences.
• There will be recognition that the function of a school or college is to prepare doctors of optometry for a lifetime of learning in their field.
• We will have to redefine the entry-level attributes of our students and modify our curriculum to emphasize a lifelong commitment to learning.
• While graduates must learn to be well-grounded in the fundamentals of their profession, the purpose of this grounding must be to position them to continue the learning process.
• Students must learn to focus on the opportunity for interaction with faculty and with one another while on campus – they must commit to a philosophy that emphasizes the acquisition and appropriate application of knowledge over information absorption and memorization.
• We will see the development and utilization of a national faculty in several disciplines, linked through developing technology. All schools and colleges of optometry will be able to access a faculty made up of our very finest educators.
• Cooperation between optometry and ophthalmology – that began at the New England College of Optometry’s Boston clinics and carried forward at PCO with Hahnemann University and at ICO with the University of Chicago – will continue and intensify.
• We must then be prepared to offer meaningful advanced competency education to practicing optometrists as a core value of optometric education.
• Residency programs will continue to increase, but at a more modest rate.
• I believe the future direction of the profession of optometry will be fueled by the economics of the managed care marketplace.
• The cooperative environment among opticians, optometrist, and ophthalmologists that exists at the academic level and – in several instances – in other practice modes will intensify.
• Distinctions in practice modes will continue to blur among the three groups. Economic realities will override emotional opposition and force closer cooperation. Individual claims of priority and historical territorial imperatives will be forced to give way.
• Quality assurance programs and advanced competency certification and accreditation will become increasingly important.
• The expansion of the scope of practice of optometry will consist mainly of amendment and clarification to existing practice laws.
• Ultimately, all states will grant appropriate and extensive prescriptive authority to optometrists.
• The expanded use of laser technology by optometrist will evolve slowly over the next two decades.
• Consultation among practicing professionals will take advantage of advances in technology. Consultations with national eye centers of excellence will become the norm, as precise retinal images and other data are instantly transmitted from one point to another in real time.
• We will see fewer independent, private practitioners of optometry in the future and more multi-practice settings, more optometrists in HMOs, hospitals, and other institutional settings. What is often termed “corporate optometry” will continue to expand for the foreseeable future.
• Schools and colleges of optometry will recognize their responsibility to expose their students to a wide variety of practice modes, and to discuss each opportunity openly and honestly.
• Health care third-party payers will continue to exert enormous influence on the practice of health care – eye care included. In this vein, it is imperative that optometry solidify its position as the primary eye care provider with the managed care market.

We live, learn, teach, and practice in tremendously exciting times. I believe the future of optometry is as great as our ability to translate our vision for the profession into strategic and tactical plans of action – and as promising as our courage and tenacity to implement those plans.

Charles F. Mullen, O.D.
Journal of the American Optometric Association.
September 1999. Volume 70. Number 9.