Distinct and Separate Legal Structures for Clinical Programs of Schools and Colleges of Optometry

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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…

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Beginning of a National Model for Optometric Clinical Education and Community Service (Video)

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

Issues Facing the Profession of Optometry Related to Clinical Education

• There is need to “forecast” the future of the profession given the dynamics in the eye care marketplace, rapidly changing demographics of the profession, high graduate debt and continued expansion of the scope of practice so that the schools and colleges can adjust their curricula accordingly to adequately prepare the graduate to succeed in this changing environment.
• Uncertainty concerning eye care manpower needs in the United States.
• Need to clarify the future direction of optometric residencies including specialization and advanced competency certification.
• Expansion of college-affiliated clinics into urban and suburban areas will lead initially to increased tensions between academia and private practitioners. However, cooperative approaches will evolve.

Emerging Trends in Optometric Clinical Education and Applied Research

• There will be a decrease in dependency upon large campus-based facilities for the clinical training of optometric students. Driven by economic considerations and the need for greater diversity of clinical experiences, community-based training sites will replace the need for large single-purpose and costly campus-based clinics.
• It will be imperative that the private optometric colleges reduce the cost of campus-based clinical education in order to keep student tuition competitive.
• Cost-effective technology assisted patient simulation laboratories and other innovative means will provide early clinical training for beginning optometric students rather than the large campus clinics.
• Smaller academic eye centers of excellence staffed by college faculty will be positioned proximal to the college of optometry. These centers will operate incentive based faculty compensation plans that integrate student and resident training.
• Interdisciplinary clinical education will emerge as the new standard.
• The Department of Veterans Affairs, the Armed Forces and the U.S. Public Health Service will continue as a major resource for clinical training of students and residents. Federally-sponsored fellowship programs will be expanded.
• Private practice externships and other extern sites will continue as a component of clinical training for students and residents. However, site selection and evaluation criteria will become more stringent.
• Private practice externships will emerge as the vital resource to provide students with practice management experience.
• There will be an increased emphasis on clinical education in low vision, pediatrics and traumatic brain injury and associated vision problems.
• A national clearinghouse and placement service for externships in optometry will be established. Through the clearinghouse, all institutions of optometric education will fully share in the enormous national resource and each site will be appropriately and fully utilized. National standards for externships will be more stringently applied and will lead to accreditation for participating sites.
• Clinical faculty will increasingly take advantage of the large and diverse clinic population to expand clinical research in contact lenses, ophthalmic pharmaceuticals, traumatic brain injury, strabismus and refractive error.
• Schools and colleges will formally recognize community-engaged scholarship and it will apply to the review, promotion and tenure processes for community-engaged faculty members.
  Medicare regulation pertaining to student participation in billable services will require a change in the curriculum model and nomenclature. Current student fourth professional year will be changed to first residency year. More information can be found in: Development of a New Clinical Training Model.

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