Charles F. Mullen

Challenges and Opportunities in Optometry and Optometric Education

Recommended Briefing Points for Advocates of Optometry’s Inclusion in GME

Background

  • Optometry is a significant provider of medical eye care services to Medicare beneficiaries ($1.33 billion annually) for conditions such as glaucoma, cataracts and retinal diseases, but is not included in the Graduate Medical Education Program (GME), the educational component of Medicare.
  • Medicine, Podiatry and Specialty Dentistry receive $18 billion in GME support annually for postgraduate clinical education. Podiatry was included in GME in 1972 by amendment, and changed its clinical training model in 1990. Podiatry now receives regular GME payments to support resident training.
  • It will be necessary to include Optometry in GME by amendment to appropriate laws/regulations or by inclusion in proposed legislation in advance of the introduction of a new optometry postgraduate clinical education model.

Clinical Training of Optometrists

  • Optometry has traditionally provided clinical education within the four year optometry school curriculum with postgraduate clinical training being optional, thus, optometry’s current clinical education model does not meet GME requirements.
  • Costly, optometric clinical education receives no Federal Support, and is largely financed by student tuition contributing to high graduate debt of approximately $200,000.
  • Optometry graduates have the highest loan payments as a percentage (14.9%) of income of all professions.
  • High debt is a contributing factor in that applicants to optometry schools and colleges have not effectively increased in 10 years.

Reasons Optometry Should be Included in GME

  1. Nationwide expansion of the scope of optometric practice by numerous changes to State Practice laws.
  2. A steadily increasing demand in providing Medicare beneficiaries with medical eye care services – Optometrists currently provide $1.33 billion in services annually managing serious eye conditions of Medicare recipients.
  3. A major increase in optometric management of serious eye conditions will accompany the proposed addition of refractive care (refraction, eyeglasses and contact lenses) in Medicare.
  • The above will require the schools and colleges of optometry to restructure their traditional clinical education approach into a Postgraduate Medical Clinical Educational Model in order to provide the quantity and diversity of clinical teaching encounters necessary to properly prepare optometry graduates for clinical practice.
  • In 1930 Medicine adopted required postgraduate clinical training because the 4 year medical school curriculum did not provide the quantity and diversity of clinical encounters to properly train physicians.
  • Postgraduate optometric clinical education can be provided in cost effective outpatient facilities. GME’s hospital-based training requirement needs to be waived.

Optometry’s Inclusion in GME is Necessary

  • GME is needed to support optometry’s postgraduate clinical education to meet current and future demand for well-trained optometrists in advanced medical eye care practice.
  • GME support will ensure a sufficient number of well-trained optometrists to meet current and projected demand for eye care services of Medicare beneficiaries.

See Also

by Charles F. Mullen

Implications for Optometry if Vision Care, Eyeglasses and Contact Lenses are Included in Part B of Medicare

Introduction

In 1965 Medicare was enacted by the US Congress providing health insurance to American seniors that covered most medical/health conditions, however, vision care, eyeglasses and contact lenses were omitted from the law. Now 78% of older voters demand Vision Care be included in Medicare. There is considerable interest by the Democratic congressional leadership to include Vision Care. The implications of inclusion of vision care, and prescribed eyeglasses and contact lenses in Medicare follow:

1) The demand for optometric services will increase significantly. Optometrists will not only provide more refractive services, but also more medical eye care services for an elderly population with a high incidence of eye conditions requiring medical management.

2) The Social Security Law will be opened for amendment to include Vision Services providing optometry the opportunity to include optometry in the Graduate Medical Education Program (GME) language. Once optometry’s clinical training model meets GME expectations, then optometric residency programs would be eligible to receive GME payments. ASCO and AOA should have a joint plan if the opportunity arises to include optometry in GME language.

3) Corporate optical retailers, anticipating a dramatic increase in demand for eyeglasses, and with difficulty in placing optometrists in certain retail locations, will likely lobby State/Federal Governments to authorize technicians, utilizing automated devices, to measure refractive error suitable for prescribing eyeglasses.

See Also

by Charles F. Mullen

A New Paradigm for Optometry

Transition to a new paradigm for optometric education began 50 years ago with the expanded scope of optometric practice in Rhode Island, and the introduction of optometric postgraduate clinical training. All states now authorize some form of expanded scope of practice, and there has been an increase in the number of postgraduate/residency positions. The creation of the Specialty Certification Board (ABCMO) in Medical Optometry was the first attempt at ensuring adequate and uniform preparation for expanded scope of medical practice.

Optometry is on the same path followed by medicine for specialty training and Board Certification; however, there is an important difference between optometry and medicine regarding postgraduate clinical training and licensure. Medicine requires postgraduate clinical training for licensure while optometry does not, although most States require additional education and/or clinical experience to meet requirements of expanded optometric scope of practice laws. These additional requirements are simply not adequate preparation for the expanded responsibilities of modern, expanded scope optometric practice.

Expansion of practice capabilities for optometrists requires formal postgraduate clinical training in Medical Optometry. Mandating postgraduate training in Medical Optometry for licensure would:

  1. Facilitate adequate and uniform preparation of optometrists for expanded scope of practice
  2. Initiate the process for Specialty Board Certification
  3. Position optometry for inclusion in the multi-billion dollar Graduate Medical Education Program (GME) and
  4. Enhance the prestige of the profession of optometry.

By converting the current 4th year in the optometry school curriculum to the first year of postgraduate clinical training with emphasis in Medical Optometry, the immediate need for a significant increase in Medical Residencies could be met while simultaneously expanding the current network of optometric medical residencies.

See also: Changes Necessary to Include Optometry in GME

by Charles F. Mullen

Eight Steps to Ensure the Professional Standing of Optometry

Introduction

The increasing demand for medical eye care services along with implementation of the steps below would ensure the professional standing of Optometry for decades to come:

State Legislatures and Regulatory Boards

  1. All State Practice Laws Modified to Permit Optometrists to Practice Comprehensive Medical Eye Care Without Restrictions.
  2. States to Mandate Postgraduate Clinical Training in Medical Eye Care for Licensure.

Core Curriculum and Postgraduate Clinical Training

  1. Optometry Schools Curricula to Emphasize Medical Eye Care and Facilitate Their Graduates’ Transition to Postgraduate Clinical Training.
  2. Residency Programs in Medical Eye Care Significantly Increased. Current Titles and Descriptions of Residency Programs Consolidated and Revised. Residency Title Must Correspond with Name of Specialty.

Recognition by Profession of Optometry

  1. Board Certification in Optometry Medical Eye Care Widely Recognized.
  2. Optometry Specialties and Subspecialties Widely Recognized.
  3. Oversight Board for All Specialties/Subspecialties Recognized.

Federal Government

  1. Optometry to Qualify for the Graduate Medical Education Program (GME) Program.

by Charles F. Mullen