Charles F. Mullen

Challenges and Opportunities in Optometry and Optometric Education

A Unique Opportunity for Osteopathic Health Sciences Centers to Develop an Innovative Optometry Degree Program and Postgraduate Residency Training

The expanded use of technology will significantly alter the traditional role of optometrists over the next 10 years. Large corporations with sophisticated marketing will dominate the multi-billion dollar eye care market. However, there is unmet need for medical eye care in the Medicaid and Medicare populations, and with changes to optometric education and clinical training, this unmet need can be addressed. State and Federal legislative/regulatory advocacy would need to be initiated concurrently with the development of the new optometric educational model.

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.

by Charles F. Mullen

NAVAO Founding Member Spotlight: An Interview with Dr. Charles Mullen

The following interview was published in Optimum VA, The Official Newsletter of the National Association of Veterans Affairs Optometrists (NAVAO), Summer 2015.

Seal of the US Department of Veterans Affairs

Upon being asked to be featured in the NAVAO Optimum VA Newsletter, Dr. Mullen expressed the following:

“Thank you for your kind invitation to share my experiences in VHA and also to offer recommendations for the future of VA Optometry. It is an unexpected privilege to recall my tenure as Director,
VA Optometry Service (1990-96). In reviewing my files in preparation for this interview, I remembered the many outstanding VA optometrists whose dedication and support were essential in developing and implementing the objectives of the Optometry Service Strategic Plan. It was an honor to have such outstanding clinicians and educators as colleagues.”

How did you first become actively involved with VA Optometry?

In the 1970s, while serving as the Director of NECO’s clinical program, Dr. Ken Myers, Founding Director of the VA Optometry Service, called and asked if NECO was interested in sponsoring a VA funded residency program at the Boston VA OPC. After establishing the OPC residency program and agreeing to further development of residency programs at other Boston VA facilities, I then served on Dr. Myers’ Advisory Group for a number of years. Ken and I shared a similar view on the importance of optometrists practicing in collaboration with physicians. I became increasingly interested in the potential that VA Optometry could offer in advancing the Profession of Optometry in patient care, clinical education and research. When Dr. Myers resigned as Director in 1990, I enthusiastically agreed to succeed him.

What contributions to VA Optometry have you participated in that you feel proud of?

After arriving at VACO, I soon learned that Dr. Myers had built a solid foundation for the VA Optometry Service. His meticulous attention to detail in working with the AOA Washington Office positioned VA optometrists in Title 38 along with physicians and dentists. Dr. Myers wrote the Qualification Standards which established very high standards for the appointment and promotion of optometrists. He also developed the first optometry residency program and academic affiliation with a college of optometry, and later established numerous clinical training programs for optometry students and residents. He wrote the Optometry Service’s first Plan and encouraged the development of NAVAO. Although my contributions pale in comparison to the significant accomplishments of Dr. Myers, I am proud of the following:

  • Appointed the first Optometry Field Advisory Group.
  • In collaboration with NAVAO, ASCO and the AOA, I updated and enhanced the Optometry Service Strategic Plan. ASCO forwarded the Plan to VACO and the Undersecretary for Health instructed me to implement the key elements of the Plan including the addition of 53 centrally-funded optometry positions, 21 residents and the necessary eye care equipment.
  • At the invitation of the Undersecretary for Health, briefed the senior administration of VHA on all aspects of the Optometry Service and gained standing in VACO for the Optometry Service.
  • Standardized the optometry clinical education program in cooperation with ASCO.
  • Disseminated numerous clinical guidelines including preferred practice patterns, credentialing and privileging, eye care space criteria, staffing models and productivity standards.
  • With assistance from several NAVAO members, conducted a system-wide inventory of all VHA eye care (optometrists and ophthalmologists) manpower, facilities and training programs. The results were presented to SMAG by the Optometry Representative along with recommendations to further increase eye care manpower, facilities and equipment.
  • At the request of the VHA senior administration, interviewed and recommended for appointment the first ophthalmological consultant to VHA, and effectively advanced an agenda of cooperation between the two eye care disciplines.
  • Appointed by the Undersecretary for Health to a high level Eye Care Advisory Group consisting of nationally recognized optometrists and ophthalmologists. In consultation with the Group, advised the Undersecretary on policy to improve collaboration between the two eye care disciplines in patient care, education and research.
  • Stimulated research in low vision rehabilitation with $6 million in funded research projects.
  • Reduced the average waiting time for primary eye care services by 30%.
  • Initiated a nation-wide recruitment effort to reach under-represented groups for placement in VA optometry staff and residency positions resulting in a significant increase in female staff and residency appointments.

What advice would you give to new ODs entering the profession?

Complete a Specialty Residency Program and achieve Specialty Board Certification preferably in Medical Optometry. The most challenging and rewarding positions in optometry will be within hospitals and other medical facilities and specialty credentials will be required for appointment.

What would you like to see happen in the future of VA Optometry?

Dr. Townsend has done an outstanding job in increasing the number of VA optometrists, residents and students on clinical rotation. He has instituted innovative programs such as research fellowships while significantly expanding low vision programs. He has developed the VA Optometry Service into one of the most productive in VHA. The Eye Care Handbook he authored has positioned optometry as a major patient care and clinical training component in the VA as an equal partner with ophthalmology. The Handbook is considered the model for all optometry programs located within medical facilities.

Despite the impressive progress, more needs to be done. I would like to see the following completed in the next two years.

  • Optometry Qualification Standards updated to include requirements for Specialty Residency Training and Specialty Board Certification in appropriate sections.
  • Optometry Service Strategic Plan Updated in collaboration with NAVAO, ASCO and AOA and submitted to the Undersecretary for Health with specific recommendations.
  • Restrictions or caps on optometrists pay removed to encourage retention of the most experienced clinicians.
  • Optometry Service Field Advisory Group to brief the new Optometry SMAG Representative on the challenges and opportunities in VA Optometry.
  • Encourage more active involvement of academic affiliates with VA facilities including participation on Deans Committees and other advisory groups.
  • Appointment of a VA representative to the ACOE.
  • Continue VA Optometry’s leadership in Specialty Training and Board Certification by ABCMO. Encourage the development of the American Board of Optometry Specialties (ABOS) similar to the American Board of Medical Specialties (ABMS). This oversight board would establish and ensure high standards for all Specialty Certification Boards.

Thank you for the opportunity to share my VA experiences with NAVAO.

by Charles F. Mullen