Paradoxically, during the same period, there has been extensive expansion of the scope of practice. This has strengthened optometry’s position as a medical eye care provider, and as a valued healthcare profession.

The implications to optometric education of the paradoxical evolution of the profession of optometry are profound:

1. Is the current 8 years of education unnecessarily long for Retail Practice? See: Optometric Education in Crisis, Slide 15, Enhance Appeal for Careers in Commercial, Office Practice and Medical Eye Care.
2. Does the current curriculum adequately prepare graduates for expanded scope practice? See: Three Critical Elements for Expanded Scope of Optometric Practice.
3. There has not been an increase in the optometry student applicant pool in a decade. See: An Analysis of the Optometric Applicant Pool Relative to Matriculants.

The above fundamental issues present a significant challenge to the optometric educational enterprise.

The post The Paradoxical Evolution of Optometry appeared first on Charles F. Mullen.

• While the University of Chicago’s NORC surveys indicate optometry is considered a high prestige profession, the increased visibility of Retail Optometry is projecting an image different from potential applicants’ expectations of what it means to be a “doctor.”
• Association with the selling of eyeglasses: Is an optometrist a health care provider or a merchant?
• While the applicant pool has not increased in 10 years, less qualified matriculants have increased thereby diluting the quality of the optometric workforce.
• New schools of optometry exacerbate the situation of less qualified matriculants.

See: An Analysis of the Optometric Applicant Pool Relative to Matriculants

Income to Debt Ratio

• A high percentage of income is required to pay educational debt: 15% of income is the highest of all health care professions.
• Starting income is relativity low when loan payments are considered.
• Income growth accrues primarily to private practice owners. Retail optometrists’ and employed optometrists’ income remains effectively level throughout their careers.
• The magnitude of debt takes years to repay.

Oversupply of Optometrists

• Lewin Survey Finds Large Optometry Surpluses

Education

• Concern education is too long and too costly for return on investment?
• No Federal support for costly optometric clinical training.

Optometric Practice

• Paradoxical Evolution of Optometry.
• When scope of practice does increase additional education/clinical training is required.
• No profession-wide recognized Specialty Certification Boards. The public considers Board Certification as the “Gold Standard” for quality practitioners. See: Optometry Specialty Certification Boards Provide a Uniform Indicator of Advanced Knowledge and Skills.

Recommendation

The first step in solving any problem is to honestly identify the cause or causes. Once the causes are identified then the task of implementing corrective measures should commence.

The post Potential Factors Contributing to a Decade of No Growth in the Optometry Student Applicant Pool appeared first on Charles F. Mullen.

Medical Education leads the Medical Profession by developing the educational structure and clinical training programs in advance of new patient care initiatives. In contrast, State Optometric societies lead the Optometric Profession with Optometric Education reacting to the States’ expanded scope of practice initiatives with specific educational programs. Consequently, there is not a comprehensive educational structure nor a uniform indicator of an optometrist’s knowledge and clinical skills to support all of the States’ expanded scope of practice initiatives.

Requiring postgraduate clinical training in medical eye care for optometrists is not only essential preparation for Expanded Scope of Practice, but also positions optometry for inclusion in the $18 billion Graduate Medical Education Program (GME).

These are the three missing components that need to be developed:

1) Necessary Capacity for Advanced Clinical Training in Medical Eye Care

• In 1931 Medicine acknowledged that clerkships contained within the four year medical school curriculum were inadequate preparation for rapidly changing medical practice, and instituted mandatory postgraduate clinical training.
• Even though optometric practice has dramatically and rapidly expanded encompassing medical eye care, clerkships within the four year optometry curriculum remain the only required clinical training component.
• The current four year curriculum does not provide optometry graduates with the types and quantity of clinical teaching encounters necessary to practice expanded scope of practice in all States.
• Postgraduate clinical training in medical eye care is now essential preparation for advanced optometric practice.

2) Federal Funding to Support Advanced Clinical Training

• Optometry is not included in the $18 Billion Graduate Medical Education Program (GME) because clinical education takes place primarily within the four year curriculum, and not in postgraduate residencies.
• Inclusion in GME, the educational component of Medicare, would not only encourage the development of new residency positions in Medical Eye Care by providing funding to host facilities, but also by providing funding to directly support advanced clinical training.
• Optometric Education needs to change from providing clinical education within the current four year curriculum to a Postgraduate Clinical Training Model to qualify for GME.
• Like medicine, clinical clerkships or rotations would take place within the final years of the curriculum.

3) Nationally Recognized Certification Board to Provide a Uniform Indicator of an Optometrist’s Advanced Knowledge and Skills to Practice Expanded Scope of Practice Optometry

• The American Board for Certification in Medical Optometry (ABCMO) is a well-established Board that meets GME expectations. However, ABCMO serves mostly Department of Veterans Affairs (VA) optometrists, and needs to be recognized by the entire Optometric Profession.

More Information

• The State of Optometry Specialties and Subspecialties
• Optometry Scope of Practice in the United States
• Changes Necessary to Include Optometry in the Graduate Medical Education Program (GME)
• The American Board of Certification in Medical Optometry (ABCMO)
• Principles to Follow in Developing Specialties and Subspecialties
• Required Postgraduate Clinical Training for Optometric License
• American Board of Optometry Specialties (ABOS)

The post Three Critical Components for Expanded Scope of Optometric Practice appeared first on Charles F. Mullen.

Osteopathic Health Sciences Centers across the Nation currently offer innovative curricula in medical and other health care professions’ education, and now have a unique opportunity to develop and offer an innovative program in optometric education and residency training that would prepare optometrists to provide medical eye care. Such a new program would replace the traditional optometric curriculum where clinical training is contained within the four year degree program. Having no requirement for postgraduate clinical training, optometry is not eligible for the multi-billion dollar Graduate Medical Education (GME) program.

Optometrists are classified as physicians under Medicare and are judged by medical standards including specialty clinical training and board certification. Optometric education must now align with national standards and guidelines derived from medical education.

Such a proposed restructuring plan is politically challenging with numerous sensitive professional and educational issues. Implementation of the plan requires bold leadership. I look to Osteopathic Health Sciences Centers with their tradition of leadership and innovative programs to lead the change in optometric education. This proposal recommends restructuring optometric education and postgraduate training by placing it in parallel with medicine.

New Program

Three Years for OD Degree + One Year Postgraduate Training = Licensure

Three years of classroom education, laboratory and clinical clerkships to earn the Doctor of Optometry (OD) degree followed by one year of postgraduate clinical training for licensure in General (Traditional) Optometric Practice. This would replace the current 4th year which essentially is the first year of residency training.

One Additional Year of Specialty Clinical Training to Provide Medical Eye Care.

One year of additional specialty clinical training in medical eye care and Board eligibility required by State Optometry Regulatory Boards to provide medical eye care.

Advantages of the New Curriculum and Clinical Training Model Include:

1. The new model would encourage specialty clinical training and board certification as emphasis would shift from General (Traditional) optometric practice to primarily medical eye care.
2. By restructuring the curriculum and requiring postgraduate clinical training, optometry would become eligible for Graduate Medical Education (GME) payments to address clinical training costs.

Actions Required

1. Apply for a Center for Medicare/Medicaid Services (CMS) Innovation Grant to Fund Implementation, Entitled — “Restructuring of Optometric Education and Clinical Training To Meet Unmet Need for Medical Eye Care in Medicare/Medicaid Populations”
2. Amend States’ optometric licensing laws/regulations to require a minimum of one year of postgraduate, residency training in General/Traditional optometry for licensure.
3. And require an additional one year of training in specialty medical eye care with Board eligibility to practice medical eye care.
4. Amend the Social Security Act to include optometry in the Graduate Medical Education Program (GME) and expand GME support of residency training to all optometric clinical training venues.

The post A Unique Opportunity for Osteopathic Health Sciences Centers to Develop an Innovative Optometry Degree Program and Postgraduate Residency Training appeared first on Charles F. Mullen.

Paper/Presentation

Understanding the Cost of Optometric Clinical Education (PDF)
Understanding the Cost of Optometric Clinical Education (PPTX)

Supporting References

Understanding the Cost of Optometric Clinical Education – References (PDF)
Understanding the Cost of Optometric Clinical Education – References (DOCX)

The post Understanding the Cost of Optometric Clinical Education appeared first on Charles F. Mullen.

Optometry schools and colleges now face the similar effects of oversupply (12,672 FTE excess) of optometrists including declining student applicants and declining full time employment opportunities. There were seven new optometry schools added and increased enrollments at existing schools in the last six years without a demonstrated increase in demand. Full time positions with sufficient income to service educational debt are difficult to find, and now 40% of recent graduates practice at two or more part time locations. Even for those employed or self employed optometrists function at only 68% of their practice capacity. Like the legal profession, there are no signs of abatement in the poor full-time employment market or decline in optometry school applicants. The decline in applicants is exuberated by continuing expansion of new optometry schools.

To mitigate the effects of an oversupply of optometrists, optometry schools and colleges’ leadership must immediately acknowledge and directly address the serious challenges impacting on the stability of optometry schools and colleges including:

• Current and future oversupply of optometrist: 12,672 FTE excess now and oversupply remains at 9,000 FTE in the future.
• Increase in number of optometry schools and increased enrollments at existing schools: Seven new schools added in last 6 years while graduates increased from 1127 in 1997, when supply equaled demand, to 1600 now. At full enrollment of all schools, graduates will increase to over 1800.
• Decline in the student applicant pool – less than 1.5 applicants per entering seat, while number of entering seats has increased from 1160 to 1763 in six years.
• High graduate debt – over $200,000 for many graduates vs. income potential to service debt.
• Decline in college age students – .5 million less than in 2012.
• Decline in full-time employment opportunities for recent graduates. 40% of graduates practice at multiple part time locations.
• Lack of Federal support for clinical training, scholarships and loan repayment – Optometry excluded from $11.5 billion Graduate Medical Education Program, National Health Service Corps and Title 7 programs.

In view of the data in the Rand, Abt. and Lewin Optometric Manpower Studies indicating a substantial excess of optometrists, it would be prudent to mitigate the effects of a decline in full time employment of graduates and decline in applicants for admission by the following actions:

Action 1: Proactively Address the Oversupply of Optometrists

• Reduce enrollments at all schools and colleges of optometry and adjust corresponding revenue and expense projections.
• Demand clarification and correction of Bureau of Labor Statistics (BLS) projections. It appears these projections are significantly contributing to the oversupply of optometrists by encouraging the development of new schools of optometry. Conflicting data on optometric manpower: Rand Study-1995, Abt.Study-2000 and Lewin Study-2014 all indicated significant surpluses. Meanwhile the Bureau of Labor Statistics (BLS) projects high demand for optometrists. In view of all the evidence and studies to the contrary, it is logical to assume the BLS based their projections on inaccurate or obsolete data.
• Insist the Accreditation Council on Optometric Education (ACOE) develop quantitative standards similar to medicine and dentistry for evaluating accreditation for new and existing school and colleges of optometry. Only accredit new schools when the quality and quantity of student clinical training opportunities can be demonstrated.
• Increase demand for optometric services by addressing the underlying public health need for eye care in inner-city and rural areas. Only 20% of federally qualified community health centers provide optometric services. However, Boston community health centers have made a successful and sustained 40 year effort to address unmet need for optometric services in inner-city Boston. See: New England College of Optometry Clinical System. Inclusion of optometry in Federal incentive programs (loan forgiveness, scholarships, National Health Service Corps, etc) is essential to providing optometric services in rural and inner-city America.
• Conduct cost analysis of all clinical training venues and adjust clinical training placements to reduce overall operating costs. Review Relative Costs per Clinical Teaching Encounter: Campus-based clinics are by far the most costly. ($100-350). Affiliated facilities less ($10-30). Externships least costly ($.50-1.00).
• Visit/Revisit the advantages of a Faculty Practice, integrated with clinical training, in terms of increased IEI revenue, supplemental faculty income, faculty recruitment/retention and compliance with Medicare/Medicaid Guidelines for Teaching Physicians. Faculty Practice also addresses the Center for Medicare/Medicaid Services (CMS) compliance vulnerabilities by changing from a Student-Centered Clinical Training Model to a Physician-Centered Program. Students cannot provide billable services to Medicare and other insurance plans. Two Optometry Schools fined for violations with current Student-Centered Training Model. Combined fines are nearly $1.0 million.
• To provide full-time employment for graduates, optometry schools and colleges should fund government related fellowships. These positions would be used to provide experience to graduates in Federal and State health care policy.

Action 2: Address High Graduate Debt vs. Income Potential

• Reduce student debt by shortening the length of overall education for the OD degree. Eight medical schools (DO & MD) have or are developing three year programs. Salus University/PCO is piloting a three year program. NECO has in the past offered a 3-year program.
• Encourage accelerated admissions from undergraduate institutions.
• Remove course redundancies and move selected course work to undergraduate prerequisites.
• Reduce student debt by qualifying for Federal scholarships and loan repayment programs, such as the National Health Service Corps and Title 7, Section 747 through a comprehensive Federal advocacy strategy.

Action 3: Federal Funding for Clinical Training

Create eligibility for the $11.5 billion Graduate Medical Education (GME) program by restructuring the curriculum, changing state licensing requirements and aggressive advocacy to amend the Social Security Act to include optometry. Restructure the curriculum to potentially qualify for GME, the educational component of Medicare: New model would consist of 3 years for OD degree + final year of postgraduate training to qualify for licensure and board eligibility. Social Security Act amended to include optometry and training in outpatient facilities. GME pays an average of $100,000 per medical resident annually to hospitals. Requiring postgraduate training for state licensure along with Board Certification would place optometry in parallel with medicine and enhance qualification for the GME program. “Best Practices” model would parallel medicine and consist of degree + postgraduate training = licensure + specialty board certification. See: Changes Necessary to Include Optometry in the GME Program.

• Apply for a Center for Medicare/Medicaid Services (CMS) Innovation Grant to fund a pilot project of the new curriculum/clinical training model (3 years for OD + 1 year of postgraduate training).

Action 4: Investigate Alternative Strategies to Prevent Financial Crises at Schools and Colleges

• Explore mergers of optometry schools and colleges.
• Diversify educational offerings to the high demand professions such as:
• Primary Care Medicine (MD) or (DO)
• Physicians Assistants
• Consider innovative programs with established universities or Health Sciences Centers (HSC). See: ICO and University of Chicago Affiliation and Opportunity for Osteopathy to Develop Innovative Optometry Degree Program.

Primary References

The Legal Profession

• Lowering the Bar: Law Schools Compete for Students Many May Not Have Admitted in the Past. Inside Higher Ed. 2015.
• Crop of New Law Schools Opens Amid a Lawyer Glut. Jennifer Smith, The Wall Street Journal. 2013.
• Job Market for Would-Be Lawyers Is Even Bleaker than It Looks. M Hansen, American Bar Association Journal. 2013.
• In Defense of Law Schools Hiring Their Own Graduates. Above the Law, by David Lat. 2013.
• Law School Transparency (lawschooltransparency.com)

The Optometry Profession

• Report on 2012 National Eye Care Workforce Survey of Optometrists. The Lewin Group. 2014.
• Eye Care Workforce Study: Supply and Demand Projections. The Lewin Group. 2014.
• A Quantitative Analysis of Optometry Density. K J Myers, Ph.D., O.D. Editorial. 2014.
• Lewin Survey Finds Large Optometry Surpluses. K J Myers, Ph.D., O.D. Editorial. 2014.
• Unresolved Matters of Importance to Optometric Education. C Mullen, L Walls. 2011.
• Assessing the Need for On-Site Eye Care Professionals in Community Health Centers. P Shin, B Finnegan, George Washington University. 2009.
• Reducing Visual Health Disparities in At-Risk Community Health Center Populations. Journal of Public Health Management. S Pimo, R Wilson, et al. 2009.
• Abt. Associates Inc., Workforce Study of Optometrists. A J White, C White, T Doksum. 2000.
• RAND, Estimating Eye Care Provider Supply and Workforce Requirements. PP Lee, CA Jackson, DA Rolles. 1995.

The post Is Optometry on the Same Path as the Legal Profession? – Full Article appeared first on Charles F. Mullen.

Medical, dental and podiatric education all benefit from Federal financial support while optometry does not, placing optometric education at a competitive disadvantage. Federal financial support will not address all of optometric education’s challenges. However, Federal assistance in financing an optometric education will certainly make optometry a more attractive career option.

The following are serious challenges facing optometric education:

• Stagnate Optometry Student Applicant Pool: Currently 1.5 applicants per entering seat—qualified for admission likely 1:1. Projection models suggest an actual decline in number of applicants per seat.
• Significant Increases in the Number of Entering Seats from New Schools and Increased Enrollments at Others: Applicant pool not increasing, although the number of entering seats has increased from 1160 to 1763 or 52% in a decade. Number of entering seats likely to exceed 2000 by 2015-16.
• Decline in Undergraduate College Enrollments: College enrollment declined by one-half million students in 2012.
• Optometric Manpower Uncertainty: Conflicting data on optometric manpower: Rand Study-1995 and Abt.Study-2000 both predicted significant surpluses. Meanwhile the Bureau of Labor Statistics projects high demand for optometrists. Hopefully, AOA’s Lewin study-2013 will clarify the matter, but the study has not been released.
• Full Time Employment Concerns: Anecdotal concerns expressed by recent graduates about the shortage of full time positions with sufficient income to service education debt. — Increases in law school enrollments, without corresponding increases in demand for lawyers, have resulted in that only 55% of recent law graduates can find full time employment.
• High Graduate Debt vs. Potential Income: Not unusual for student debt to exceed $200,000, while potential annual income averages $95,000. Thus the importance of the opportunity for Federal scholarships, loan forgiveness programs or stipends during final clinical year.
• High Cost of Clinical Training: Increases in clinical training costs are passed on to the optometry student in the form of higher tuition. Colleges of optometry are burdened by high fixed cost campus-based clinics. Relative costs per Clinical Teaching Encounter: Campus-based clinics are by far the most costly. ($100-350), Affiliated facilities less ($10-30). Externships least costly ($.50-1.00).
• Medicare Compliance Concerns: Current optometric Student-Directed Clinical Training Model is not compatible with “Medicare/Medicaid (CMS) Guidelines for Teaching Physicians, Residents and Interns (Students)”. Students can not provide billable services to Medicare beneficiaries and other insured patients. Two university- based optometry schools paid significant fines for Guidelines’ violations with the current Student-Centered Training Model.
• No Standardization of Certification Boards: Newly formed optometric certification boards have different criteria for board certification. It is essential that all boards operate with standardized criteria for recognition by Federal and private agencies and insurers. Medicine has such an oversight board, the American Board of Medical Specialties (ABMS).
• Lack of Federal Financial Support: Optometric education receives no financial support for clinical training because its clinical training model does not meet Graduate Medical Education (GME) expectations. Furthermore, optometry does not qualify for Federal scholarships and loan forgiveness programs, because the profession is not designated as a Primary Care Profession.

Immediate Action Required

The implementation of the Affordable Care Act (ACA) presents a unique opportunity to pursue Federal financial support for optometric education by:

Aggressively advocating and pursuing optometry’s inclusion in key Federal patient care, educational, scholarship and loan forgiveness programs.

The last serious effort by ASCO/AOA to include optometry in GME was in 2007 and the proposal was rejected because the optometry clinical training model does not meet GME expectations. There also have been periodic efforts to include optometry in Federal scholarship and loan forgiveness programs.

To be effective, advocacy must be organized, consistent, well-funded and managed by knowledgeable individuals, preferably Deans and Presidents of optometry schools and colleges. Unlike optometry, leadership in the medical profession emanates from the Academic Medical Centers and has significantly contributed to success of both medical education and the medical profession.

Specific Initiatives

1. Create eligibility for the $11.5 billion Graduate Medical Education (GME) program by restructuring the curriculum, changing state licensing requirements and aggressive advocating to amend the Social Security Act to include optometry and its training facilities.
   • Restructure the curriculum to potentially qualify for GME, the educational component of Medicare: New model would consist of 3 years for OD degree + final year of postgraduate training to qualify for licensure and board eligibility.
   • Requiring postgraduate training for state licensure along with Board Certification would place optometry in parallel with medicine and enhance qualification for the GME program. “Best Practices” model would parallel medicine and consist of degree+ postgraduate training = licensure+ board certification. GME pays an average of $100,000 per medical resident annually to hospitals.
   • Eight medical schools (DO & MD) have or are developing three year programs. Salus University/PCO is piloting a three year program. NECO has in the past offered a 3-year program. Only Arkansas and Delaware currently require postgraduate training for licensure.
   • Persuasive leadership is required to convince schools/colleges, state licensing boards, residency programs, certification boards and accreditation groups of the necessity of collaboration in restructuring clinical training.
2. Apply for a Center for Medicare/Medicaid Services (CMS) Innovation Grant to fund a pilot project of the new curriculum/clinical training model (3 years for OD + 1 year of postgraduate training).
3. Qualify for the National Health Service Corps (NHSC) by achieving Designation of Optometry as a Primary Care Profession and by Federal Legislative Amendment.
   • Provides loan repayment and scholarships to health care professionals providing primary care in underserved areas.
4. Include optometry in all aspects of Title VII, Section 747 by designation of optometry as a Primary Care Profession and Federal Legislative Amendment.
   • Provides scholarships and loan repayment to students who agree to work in underserved areas. Also, supports minority graduates, residents and faculty.

The post Federal Support for Optometric Education is Essential appeared first on Charles F. Mullen.

by Kenneth J. Myers, Ph.D.,O.D.

Introduction

Teaching methods at optometry schools, like undergraduate counterparts, have changed little. While a revolution in communications began over a century ago, didactic educational teaching remains essentially unchanged in spite of increasing tuition costs. While professors no longer wear gowns, students still sit in lecture halls taking notes and essentially teaching themselves by reading those notes, textbooks and talking with other students. Those lecturing them are often part-time faculty or graduate assistants since about one-half of undergraduate credit hours are not taught by senior faculty who are, instead, occupied with research and consulting.

But clinical training demands real-time, on-site teaching, personal supervision by licensed practitioners and personal interaction with patients; a form of the guild-system adapted to medical training. In this model, those doing the training are practitioners earning their living caring for patients.

Recently, some universities have offered MOOC [Massive Open Online Courses] programs or accelerated training programs. Since 1972 the New England College of Optometry has offered, and state licensing boards have accepted, a two year OD program open to selected candidates holding Ph.D. degrees in allied fields. Recently 47,000 students at Ohio State University signed up for a calculus MOOC and there is no reason knowledge sets in optometry can not be made prerequisites, “tested out”, eliminated if seldom part of modern practice or taught online by “master teachers” to students at cooperating, sponsoring schools.

My point is that most non-clinical training can be better, more cost-effectively taught and additional funding sources found for clinical teaching, thereby reducing tuition costs.

Already, many optometry schools devote the 4th academic year to off-campus, clinical training rotations at medical facilities such as the VA with didactic and initial clinical training limited to the first 3 years at the school and its campus clinic.

Tuition costs-per-credit hour meanwhile have skyrocketed, outstripping inflation rates, and minimum wages have lagged to the point it takes three-times the number of minimum wage hours for one tuition hour compared to 25 years ago thereby reducing the value of student part-time employment. University optometry schools have not been exempt from large tuition increases as most states have reduced their funding by as much as 60%, leading one state university president to remark his university is no longer “state-supported” but “state-associated”.

Many optometry graduates carry such large student debt it excludes their starting a private practice; practicing in underserved or rural areas or practicing within an existing optometry office as a potential partner or practice buyer since most “entry-level” salaries may not service student debt.

Federal and private student loans laid the ground work for this “education bubble” and total student debt now exceeds total US personal credit card debt. Unlike the home mortgage “bubble”, federal student loans can not be discharged by bankruptcy and can haunt graduates like Caesar’s ghost and influence career decisions.

Purpose of Article

This article outlines a more efficient optometry educational model which will reduce the costs of non-clinical training and develop new revenues sources for clinical training via federal Graduate Medical Educational (GME) support for clinical teaching facilities training residents and billing Medicare.

Proposed by Dr. Mullen, this model reflects his experiences introducing optometry teaching clinics into neighborhood health clinics, serving as Director of an Eye Institute, Director of the VA Optometry Service and president of an optometry college.

Current Optometry Model

An undergraduate degree in a related physical or biological science degree is generally required for admission with the O.D. degree awarded after 4 years of which not all are 12 months long.

Unlike medicine and osteopathy, which limit classroom training mainly to two years, most optometry schools continue classroom instruction well into the 3rd year and some require attendance at campus courses in the final, 4th year thus restricting student travel to distant clinics.

Until the 1970’s, clinical training was conducted solely at school campus optometry clinics and students had little (or no) opportunity to train with medical students, interns and residents. This changed when the U S Department of Veteran Affairs, in 1976, by an Act of Congress, formed an Optometry Service, and began the first optometry residency programs for graduates and student clerkships.

As a result, the VA now trains optometry students and residents in the same manner it trains medical, osteopathic, and dental students and residents. Without this VA support, some optometry schools might have been unable to provide the type and breath of clinical training required by the expanding scopes of practice granted ODs by licensing statues since the 1970s.

Now the largest clinical trainer of 4th year optometry students and optometry residents, the VA operates 73 optometry residency programs totaling 170 residents while over 1,200 4th year students serve a VA clerkship rotation. Over 700 full-time VA ODs see a million-plus unique patients. Funding for staff, equipment and resident stipends to support VA clinical optometry training is separate and distinct from the GME system and can not be used to support training within other medical systems or at the schools.

All schools, however, operate campus teaching clinics which generally do not recover operating costs from patient fees nor provide the degree of medical-related eye conditions found at VA teaching clinics. This means student tuition must underwrite campus clinics despite the massive VA in-kind support since 1976 as a result of PL 94-581 and students serving VA clerkships continue to pay tuition to the schools which incur practically no expense to operate these clerkships.

GME can not support optometry residency training at this time because optometry state licensing boards do not require residency training for licensing (all medical licensing boards require a residency for licensure).

GME supports medical-osteopathic residents via supplemental Medicare payments to facilities training medical residents. This means residency programs at optometry schools that bill Medicare are not now eligible for GME support.

New Educational Model

Dr. Mullen presents a cost-effective educational model in which the OD degree is awarded in 3-years with a one-year, postgraduate residency in general practice optometry required for licensure and general practice. With this model, a student still receives the OD degree and is eligible for state licensure after 4 years but has also completed a residency, become eligible for board certification in general practice and the school’s residency programs could apply for GME funding and thereby reduce the cost of its clinical operations.

A 3-year MD system is now being implemented at several medical schools.

Some existing optometry schools could readily adopt this new model as they already devote most of the 4th year to clinical training. Meanwhile, optometry specialty residencies have existed since 1976, originating in the VA medical system. [About 18% of graduates serve specialty residencies, most in medical optometry]

This new model would be especially effective at schools co-located with medical or osteopathic schools chiefly because:

1. Low marginal costs of sharing infrastructure and teaching of basic science and clinical courses.
2. Enhanced clinical teaching and GME support of optometry residents.

As a result, this model can be viewed as an attractive alternative to the traditional 4 year curriculum and exist in parallel with the current 4-year career path leading to licensure as a general practice optometrist. In this new model, the residency following the 3-year degree would equate to the PG-1 level and those serving 1 year specialty residencies after licensure would equate to the PG-2 level as used in the medical-osteopathy model.

Implementation

State licensing boards require a candidate for licensure to have completed an accredited OD program and passed specified written and clinical examinations administered by the National Board of Examiners in Optometry. The 18% who now proceed to serve specialty residencies after graduation can continue to so in this new model as a PG-2 trainee.

To conform to the medical educational model and be eligible to apply for GME residency support via Medicare billings, the following changes are necessary:

1. All didactic course work and basic clinic training completed in 3 calendar years with award of O.D. degree. By agreement with state licensing boards, holders of the 3-year OD degree would not be eligible for licensure at this juncture. (Most licensing boards do not stipulate the length of required training for the OD degree.)
2. The 3-year OD must then successfully complete an accredited one-year residency in general practice to become eligible for licensure and board certification in general practice optometry. This process could be accomplished via the National Board of Examiners in Optometry.
3. Those wishing to specialize can, as now, then proceeds to an existing specialty residency as a PG-2 resident and then seek board certification in that specialty by a specialty board. Specialty residencies have existed since 1976 and the specialty of medical optometry has a specialty board that issues board certifications recognized by credentialing committee at Joint Commission accredited health care organizations. [abcmo.org]
4. It is likely that, in time, additional specialty boards will be created as the Association of Schools and Colleges of Optometry list 10 areas suitable for residency specialty training.

Results

In the 3-year OD model, licensed ODs will have completed a PG-1 residency in general practice optometry and, based on today’s numbers, about 18% will proceed into a PG-2 specialty residency. Schools using this new model will become more closely aligned with the traditional medical educational model.

The 3-year plus 1-year residency in general practice will reduce the costs of education to both students and their clinical training facilities via opening the door to apply for GME funding while requiring no major changes to the current system of granting degrees and licensures.

As in medicine and osteopathy, many schools may continue with the current 4-year model and students will be able to choose between the two models, which will allow for a gradual increase in general practice residencies needed for this model.

A school must not, however, be permitted to convert to, or originate, a 3-year plus residency program without having secured sufficient PG-1 residency programs to allow its graduates to serve a one-year residency in general practice since such a residency will be required for licensure of their graduates.

Dr. Myers was founding Director of the VA Optometry Service, dean of an optometry school and currently president of the American Board of Certification in Medical Optometry.

The post Guest Editorial: Better Optometry Training Model Needed appeared first on Charles F. Mullen.

New England Eye is the Patient-Centered Care and Clinical Education Affiliate of the New England College of Optometry.

The Teaching Compliance Protocol for New England Eye (PDF) describes the practical implementation of NEE Health Insurance Teaching Compliance Policy.

Authors: Senior Management Staff, NEE.

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If optometry is to maintain its position as the Nation’s leader in primary eye and vision care in a rapidly evolving health care system… we have a responsibility to frame our own future.

Abstract

The following slide presentation describes an eight step plan to comprehensively restructure the profession of optometry to meet the expectations of private, Federal and State insurers, external certifying agencies, and credentialing and privileging boards by placing optometry in parallel with medicine.

Significant changes to optometric education, clinical training, licensure requirements, board certification and accreditation are described (1) to qualify optometry for inclusion in the Graduate Medical Education Residency Program (GME), a $10 billion annual program which currently funds post graduate training for physicians, dentists and podiatrists, and (2) to meet Federal insurance compliance guidelines for teaching programs.

A Strategic Framework for Optometry and Optometric Education (PDF)

A Strategic Framework for Optometry and Optometric Education (PPT)

Charles F. Mullen
Janice E. Scharre
David S. Danielson

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