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.

Click here to see the fullscreen presentation.

To download this presentation (as .ppt or .pdf) maximize the slideshow (small box next to slide numbers) and choose “Actions”

Additional Resources:

• NEEI Compliance Protocol to Meet Medicare Guidelines for Optometric Training Programs
• Graduate Medical Education (GME), Medicare and Optometry
• Optometry Students, Medicare Regulations and Third Party Plans
• Development of a New Clinical Training Model
• Ideas Submitted to President Obama’s Citizens’ Briefing Book

The Medicare Regulations are written for the teaching hospital and its medical residency training model and translating the regulations language to the optometric clinical training model is difficult. Medicare generally does not recognize student-provided services as billable. (1)

Application of Medicare Regulations

Examination procedures performed by optometry students cannot be billed to Medicare and some third- party plans, with the exception of the student collected Review of Systems data (e.g. any heart problems, breathing problems, allergies etc?) This is the only element of the examination that does not have to be repeated by the billing physician.

Students may “practice” by performing the entire examination but their findings cannot be used or referred to in order to bill Medicare with the exception of student collected Review of Systems data.

The billing physician (preceptor) must repeat the examination with the exception of Review of Systems, ignoring the student’s findings, and document all findings and the management plan in his/her hand writing or by computer entry using the preceptor’s entry code. (2)

Comments Related to Applying Medicare Regulations as Written

“Incident to” or physician extender rationale does not apply, since students are usually not employed or compensated and the regulations are clearly addressing student participation. However, if a student on an externship is employed by the billing physician, the physician extender or the services “incident to” rules may apply.

There is no recognition in the regulations for optometry’s competency-based progression of students in their clinical training program. All optometry students must be supervised in the same manner whether they are in their 2nd, 3rd or 4th professional year of clinical training. The regulations prevent billing for the gradual increase in student responsibility for patient evaluation and management. Medical students who receive some of their patient management training in clinical clerkships during the 3rd and 4th year of medical school are also not eligible for Medicare payment. However, post graduate residencies in medical specialties are recognized as contributing to the diagnosis and treatment of patients and Medicare permits teaching physicians to bill for services provided by residents. In contrast, optometry students must be prepared to practice after completion of their fourth professional year and are currently not eligible for participation in the Medicare program.

The regulations do not apply to procedures performed by the student in the course of the “practice examination” that are not billable to Medicare, e.g. refraction.

Implications of Applying Medicare Regulations as Written

If examination of a Medicare patient is “complaint driven,” it is billable to Medicare but a one physician to one student supervision ratio would be required. The other option is that the billing physician repeats the entire examination.

Repeating the examination places an extraordinary burden of time and personal inconvenience on the Medicare Beneficiary which would likely force the Beneficiary away from a source of accessible eye care.

Patient services revenues would be reduced because of the extra time required to repeat the examination by the billing physician. One to one supervision would not be financially feasible since most optometry schools operate their own clinical training program for at least one class of students. The financial implications of increases in the clinical work force and reduction of revenues would be significant for many schools and colleges of optometry.

The financial implications of applying the Medicare regulations also would likely result in the Medicare population being restricted in optometric teaching clinics; resulting in reduced access to care for Medicare Beneficiaries and a clear detriment to the students’ clinical education.

Institutional externship sites such as Federal facilities and established medical institutions have their own student supervision directives. In general schools and colleges of optometry generally do not always know if private practice externship sites strictly apply Medicare regulations, although it is recommended that externships follow Medicare regulations and the externship sites supervise optometry students accordingly.

Conclusion

There does not appear to be an easy solution to the issues described above without a major change in Medicare policy or the optometric clinical training model. (3)

For further details please see: Development of a New Clinical Training Model.

Footnotes:

(1) Department of Health and Human Services (DHHS) Program Memorandum, AB-01-56, 04/11/2001, Change Request 1498, “Q & A Regarding Payment of Therapy Student Services Under Medicare Part B”

DHHS Medicare Carriers Manual, Transmittal, 1780 Section 15016, C2 Evaluation/Management Service Documentation Provided by Students

(2) Under Medicare policy, optometrists are considered physicians and billing physician as used above refers to licensed optometrists including licensed optometric residents (preceptors).

(3) Mullen, Charles F. “Development of a New Optometric Clinical Training Model”
Journal of Optometric Education, Fall 2006

Additional Resources: Commitment to Excellence; The Road to Excellence; The Inauguration of Dr. Charles F. Mullen

Full Transcript
Dr. Henry, faculty, students, staff, family members, and honored guests.

Today is a bittersweet occasion for me as I bid farewell to this fine institution and to many valued colleagues, students, and friends.

Let me begin by saying how proud I am of your many achievements during the six years of my tenure. Through the combined outstanding effort of our faculty, administration, students and staff we have worked together to strengthen the College for today and for decades to come.

Together, we have created a new culture at ICO. It is a culture that encourages innovation and creativity; it recognizes personal initiative as well as individual and collective accountability. It calls for improved outcomes and heightened productivity. It is a culture that demands we be models of ethical behavior and integrity. A culture committed to growth and improvement.

Avenues of dialogue among all ICO constituencies have been opened. Faculty, staff, and students are positively engaged in strengthening the institution. As the Accreditation Council on Optometric Education stated during their visit to our campus earlier this year “a commitment to excellence was evident at all levels of the institution.” It was clear to the Accreditation Council, as it has been clear to me, that you are always reaching for the next level – not satisfied with second best. You have much to be proud of.

I would like to highlight the extraordinary achievements of our years together as well as share the challenges and opportunities that lie ahead.

First to Dean Scharre and the entire ICO faculty, I extend my sincerest appreciation for your tireless commitment to excellence in securing the College’s legacy for the future. Your contributions to our academic culture have been enormous and far-reaching.

In the past six years, the College has undergone three major accreditation reviews while five residency programs were evaluated. In all cases, the strength of ICO’s academic and clinical programs was reaffirmed by external reviewers. For example:

• Performance of ICO Students on the National Board of Optometry examinations is the best ever.
• The student externship program was expanded from just 9 sites to 144, providing over 160,000 additional clinical teaching encounters.
• Individual student’s clinical encounters increased from 500 to over 1260 by graduation.
• The IEI census increased by 47% providing 70,000 clinical encounters each year.
• Faculty scholarly presentations, publications, and grant submissions are at an all-time high.
• ICO’s affiliation with the University of Chicago’s Department of Ophthalmology and Visual Science was developed. This relationship has continued to succeed both academically and clinically.
• Faculty membership in the American Academy of Optometry increased from 48% to 92%.
• Student retention rate reached an all-time high of nearly 99%.
• Students on the Deans list increased to over 50% for some classes.
• We initiated several research projects at the College’s new small animal research lab.
• Faculty governance was strengthened to include a voting member on the Board of Trustees.

Thanks to our administrators and staff, ICO continues to function from a strong financial and operational position. You, too, should be proud of your many achievements, as follows:

• A strategic and tactical planning process was implemented which is open, consultative and collaborative, employing a performance-based monitoring of progress. The plan is actively employed in the management of the institution.
• Student tuition was frozen for four years, helping to control student debt, and scholarships were increased. The work study program was doubled in size.
• ICO has been approved as a participating lender in the Federal Family Education Loan Program, which will result in projected annual revenue of $735,000 for FY2003.
• We successfully restructured the College’s overall debt by issuing $45 million in variable rate tax exempt bonds.
• ICO investment assets increased by $6.7 million, despite a serious downturn in the stock market.
• IEI patient services revenue increased 59%.
• We completed the IEI construction project in addition to $8.5 million in physical plant, equipment and information systems technology improvements.

To the student body, I wish to commend you on your many contributions to the College and profession.

• ICO students’ participation in scholarship and leadership activities at AOSA, Academy and AOA meetings has been most impressive.
• Students continue to play an exemplary role in supporting neighborhood community service programs, the VOSH program, and Special and Junior Olympics.
• Students initiated a campaign to raise scholarship funds through their annual golf outing.
• The student representatives to the Board of Trustees, until recently Mr. Steinmetz and now Ms. McCann, have participated in Board activities with poise, dedication and professionalism.
• Student participation in the College’s Annual Play and International Night reflects a spirit of enthusiasm and pride.

Governance has grown ever stronger through the Board of Trustees efforts to increase its size and diversity.

• We continue to build a productive, solid relationship with our neighbors through our Community Advisory Board.
• We have strengthened our outreach and built better relationships with other health care professionals and community organizations.

The Illinois Eye Institute with its outstanding administrators, faculty, and staff has made outstanding progress in the past six years. Patient satisfaction at IEI is at an all-time high as measured by external surveys.

In particular, I want to acknowledge the very successful Vision of Hope program, which provides eye care to the uninsured and underinsured citizens of Illinois. Initially launched with a $250,000 grant from the Illinois State Legislature, we added private foundation grants and additional state support. Already we count this program among our most successful endeavors. Of the 1,700 patients examined, more than 70% exhibit some type of untreated serious eye condition.

We also completed a comprehensive review and reorganization of our Institutional Advancement office. We reenergized the College’s development, alumni affairs and public relations programs. Results have been most encouraging.

These are the accomplishments we can feel proud of, but the picture would be incomplete without noting the challenges which lie ahead.

• Meet the challenge of continued program growth as projected in our “Commitment to Excellence” strategic plan, while facing uncertain stock market conditions, a slowing economy and a decrease in the student applicant pool.
• Continue our commitment to recruitment and admittance of the most qualified students during the current applicant decline.
• Maintain tuition at a competitive level, while ensuring the availability of scholarship funds.
• Continue to recruit and retain outstanding faculty and staff.
• Keep pace with the changing regulatory standards imposed on health care and research institutions.
• And implement an institutional compliance plan and comprehensive risk assessment program.

But with these challenges come numerous opportunities. These include the potential to:

• Increase Illinois State appropriation to ICO.
• Increase the number of state contracts to support out of state student tuition.
• Qualify for Federal Graduate Medical Education (GME) funding for student clinical training.
• Build investment assets “endowments” by increasing gifts from alumni, friends, and foundations.
• Implement a Faculty Group Practice Plan in order to reduce the cost of clinical education, increase faculty income and enhance faculty retention.
• Strengthen the College’s research infrastructure.
• Secure additional grant funding for the clinical care of indigent patients.
• Establish an ambulatory ophthalmic surgi-center in partnership with the University of Chicago and qualify for Part A Medicare reimbursement.
• Achieve accreditation from the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) for the Illinois Eye Institute and proposed ambulatory surgi-center.

Now I would like to turn to many well deserved “thank yous”

Let me first thank the members of our outstanding faculty and ICO’s dedicated Academic Administration.

Also, I personally appreciate the support and always constructive approach of the Faculty Executive Committee.

I would like to recognize and further encourage the excellent cooperation and support of the student leadership. The Student Association goes to great effort to help us maintain a positive professional and social culture at ICO. The student body deserves much credit for the dedication and pride they bring to the pursuit of academic and clinical excellence.

I would also like to thank the many Operating Units of the College for the support they provide the faculty, students and administration.

The Office of Student Affairs has again been successful in recruiting academically gifted women and men to ICO. The office has also done an outstanding job to maintain a positive and supportive culture for our student body and has set a high standard for student services.

The Student Financial Services Office has again efficiently assisted our students in obtaining funds necessary to make their optometric education possible, simplifying loan processing.

Institutional Advancement has enhanced and supported fund raising efforts through the offices of Development, Alumni Affairs, and Public Relations.

Through the efforts of Human Resources staff, the College and the Eye Institute attract talented faculty and dedicated staff. They help ensure our environment is fair, friendly, and productive.

The Business Office continues to achieve a high level of operational efficiency and assists other College units in a professional and responsive manner.

Information Systems Staff completed the 22 major technology projects including the most sophisticated library system. A Faculty Technology center was developed to facilitate the use of advanced technology in teaching.

The Facilities Staff always does an outstanding job in maintaining one of the finest campuses in health professions education.

We would not achieve our goals without the uncompromising services and dedication from the Library, Registrar, Instructional Media, Biomedical Services, Institutional Health, Academic Support, Fitness Center, Food Services, Security, Mailroom and Bookstore. Thank you all for a job well done.

A special thanks to the alumni for serving as role models for our students through your success, and dedication to patients and the profession. Your role in identifying talented students for admission to ICO is greatly appreciated.

I would also like to thank our Alumni Council for their outstanding leadership. The Alumni Council plays a significant role as the College’s representatives to the Alumni. The Illinois Optometric Association has provided invaluable support the past six years.

A note of appreciation to my office staff for their loyalty and dedication.

Thank you to all of ICO’s partners – attorneys, accountants, bankers, and vendors for your excellent service and support to the College.

And finally, I would like to recognize Chairman Lawless and the Board of Trustees for providing the leadership the College requires to achieve our Commitment to Excellence goals. Thank you for your time, dedication and generous financial support.

ICO has a history and tradition that will guide the College through the future fulfillment of its mission – the pursuit of excellence in health care education, patient care, scholarly activity; and the development of leaders for the profession and society.

Yes, we’ve had an extraordinary six years together. ICO has an extraordinary future ahead as it continues in the pursuit of excellence. It is through your leadership that we will be able to continue ICO’s dramatic progress and to face the challenges that are ahead with determination and optimism.

As I stated in my inaugural speech in 1997. I was both humbled and honored to be appointed President of ICO. I only hope you are as proud as I am of the strength and integrity of this institution as well as its opportunities and hopes for the future.

Also, I stated that the measure I would use to judge our years together would not be what we have gained but what we have given to others. But I never envisioned the gifts that I personally would receive through these six years.

• The loyalty and support provided to me by my colleagues and of all those with whom I have worked.
• The trust that I put in our mutual vision is now not a dream but a reality, based on measured success and the evaluation of others.

These gifts are greatest of all. I strongly believe the last six years has changed ICO for the better, and changed each of us for the better. These gifts are invaluable treasures that we take on our respective journeys.

I had the opportunity to recently brief President-designate Augsburger on the State of the Institution. I am confident that he will not only sustain the excellence we have built, but will lead the institution to even greater levels of achievement.

Finally I would like to conclude my farewell address with an expression I have not used in over 40 years. As a young naval officer, on the bridge of the Radar Picket Ship Searcher underway in the North Atlantic, it was customary to brief the oncoming watch officer with the ship’s course, speed, position as well as other important data. And once he nodded his understanding of the status of the ship, I would render a snappy salute and say – Sir, I stand relieved!

Thank you.

Charles F. Mullen, O.D.
Presidential Farewell Address
Illinois College of Optometry
September 13, 2002

A CONTINUED HISTORY OF THE ILLINOIS COLLEGE OF OPTOMETRY
1997 – 2000

PREFACE
The conclusion of the book Optometry in America (1872-1995) offered a glimpse at the Illinois College of Optometry’s bright future. In February 1995, the College received a positive accreditation review by the American Optometric Association Council on Optometric Education (COE). Also that same year, the first stage of an ambitious campus expansion was completed in the building of a new residential complex on Indiana Avenue at 33rd Street.

By March 1996, however, the school’s bright future was overshadowed by controversy. A politically motivated article appeared in a Springfield, Illinois newspaper. This news item was picked up and published by the Associated Press. These two events triggered a series of allegations and investigations that resulted in the resignation of ICO President, Dr. Boyd B. Banwell.

Upon Banwell’s departure, a management team was formed by the Board of Trustees that included: Board Chairman Dr. John E. Brandt, Chairman-Elect Dr. Albert H. Rodriguez, Jr., and Trustee Dr. Joseph Henry. The team worked to maintain the daily operations of the college and assuage the concerns of faculty, students and staff. They also worked with legal counsel to satisfy the Office of the Illinois Attorney General, the Internal Revenue Service and the College’s financiers.

A search committee, chaired by Dr. Henry, initiated the recruitment of a new college president. This team included representatives from the Board of Trustees, faculty, staff, and students. After an exhaustive search, Dr. Charles F. Mullen – who was serving as the Director of Optometry Service at the Department of Veterans Affairs in Washington, D.C. at that time – was appointed the Illinois College of Optometry’s fourth president. Taking office on November 1, 1996, the college that Dr. Mullen encountered was not quite the utopian institution which many – both inside and outside the college – believed existed.

Dr. Mullen quickly realized that although a plan had been developed for the physical expansion of the campus, a more comprehensive plan was required that encompassed improvements in ICO’s academic culture, administrative operations, financial health, institutional image, revenue streams, as well as the physical plant. Working with the President’s Advisory Council, an administrative team assembled from existing faculty and senior staff, Dr. Mullen began the Herculean task of putting the college back on course and preparing it to meet the challenges dictated by the rapid changes in the health profession’s educational requirements.

Recording the events that took place since Dr. Mullen took office, The Road to Excellence serves as a supplement to Optometry in America, chronicling – in his own words – Dr. Mullen’s first four years at Illinois College of Optometry.

INTRODUCTION
Given the Illinois College of Optometry’s historically prominent position within the field of optometric education, I was concerned when I learned of the difficulties the college was experiencing in 1996. I believed these matters had the potential to harm not only ICO, but possibly even the profession of optometry itself. When I was offered the position of president, I felt it was my responsibility to my profession to accept this role. I was confident that, in a relatively short period of time, I could redirect the college’s resources and energies, creating a culture in which all members of the ICO community were actively engaged in strengthening the institution.

We immediately made a philosophical shift from emphasis on facility development to emphasis on programmatic improvements and on the personal service provided to our students, patients and alumni.

We set out to realize a culture at ICO that was based on innovation and creativity: where personal initiative coupled with individual and collective accountability are the norm. Our goal was to develop an institution managed by fact and outcome measures, resulting in heighten productivity; a model of ethical behavior and integrity; and a culture committed to growth and improvement.

The pages that follow document our progress in realizing this new culture at ICO.

CHAPTER ONE
DEFINING EXCELLENCE
Documented in the 1996 book Optometry in America, the Illinois College of Optometry (ICO) can trace its origin to 1872. ICO, however, has only existed under its present name only since 1955: the result of the merger of the Northern Illinois College of Optometry and the Monroe College of Optometry.

Between 1955 and the present, ICO has had only four presidents: Eugene W. Strawn, O.D. (1955-71), Alfred A. Rosenbloom, O.D. (1972-82), Boyd B. Banwell, O.D. (1982-96) and now, Charles F. Mullen, O.D. (1996 – present).

The ICO Board of Trustees appointed Dr. Mullen as President on November 1, 1996. He assumed his duties on a full-time basis one month later. Mullen brought with him twenty-six years of administrative experience. He had served as Special Assistant to the President for Clinical Development (1970-76) at New England College of Optometry; as Executive Director, The Eye Institute (1976-1990) at Pennsylvania College of Optometry; and as Director of Optometry Service of Veterans Health Administration (1990-96) at the Department of Veterans Affairs, Washington, D.C.

Three years after he took office, Dr. Mullen discussed his initial impressions and objectives in a guest editorial that appeared in the Journal of the American Optometric Association (September 1999):

“Although I found there was an understandable sense of uncertainty regarding the immediate future of the College, morale was surprisingly good. It was my perception 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.”[1]

To achieve his objectives, Dr. Mullen formed the President’s Advisory Council (PAC) that included senior administrative management for the College and the Illinois Eye Institute (IEI),which is the school’s clinic facility. The PAC began to develop a strategic plan that defined the term “excellence” as it relates to ICO. The plan, titled Prescription for Excellence, contained five major goals, accompanying appropriate action, identification of departmental responsibility for each goal and designated completion dates.

CHAPTER TWO
PRESCRIPTION FOR EXCELLENCE
YEAR ONE
Dr. Charles Mullen understood the importance of open communication between internal and external constituencies in both the planning process and the implementation of each designated strategy in the Prescription for Excellence. As part of this process, President’s Advisory Council (PAC) members were given the opportunity to voice their opinions and concerns on a variety of subjects and to experience full responsibility for the achievement of each department’s goals. To begin their work, PAC commissioned surveys that addressed alumni and alumnae needs and concerns and student satisfaction. The compiled results had immediate impact on Dr. Mullen’s Prescription for Excellence.

In order to establish improved dialog with the community and to include them in the planning process, Dr. Mullen established a Community Advisory Board (CAB). Leaders of neighborhood organizations, school principals, clergymen, representative of community-targeted government agencies and senior ICO administrators were invited to join this team. The CAB continues to consider such issues as employment opportunities, real estate transactions, and minority student recruitment that have a direct impact on both ICO and its surrounding community.

In the Journal of the American Optometric Association (September 1999), Dr. Mullen discussed his strategic plan in great detail:

“It was now our task to channel these processes into a tangible plan of action. With input generated through countless meetings, reviews, evaluations, and re-evaluations, we created a 70-page document, the Prescription for Excellence. It contains five major goals, each with detailed, quantifiable action steps and completion dates. These 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…

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

1. Provision of excellence in education and scholarly activity.
2. Creation and maintenance of reputation as an institution that is characterized by exceptional accountability.
3. Provision of excellence in service, as defined by our students, patients, alumni, and employees.
4. Provision of excellence in health care.
5. 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.”[2]

The results of that first year of implementation were noteworthy. Dr. Mullen reported those achievements to the ICO community at his first “State of the College Address” in October, 1997:

“What I have to share with you today is important to all members of the Illinois College of Optometry community. Today’s address deals with where we are at this point in time …and what our future course needs to be.

ACADEMIC CULTURE
“We have made steady progress in evaluating and improving the quality and cost effectiveness of our external clinical affiliations and our satellite facilities with a goal of achieving budget neutrality. Contracts have been renegotiated (and) as a result…we have reduced the net cost of our satellite programs by approximately $172,000. At the same time, we were achieving these reductions in costs, we have expanded our community based clinical affiliations from a handful to 75 (collaborations), providing more than 210 student rotations annually.

We have made several significant changes in ICO’s curriculum. The focus was changed to give students an overview of an optometric examination with a greater emphasis on technical skills. The optometry sequence has been modified…to complete the teaching of technical skills by the end of the winter quarter of the second professional year. This will make room…for closely supervised clinical experiences prior to the more independent work done during the third professional year…An interpersonal skills course has been added to the spring quarter of the second year including topics (such as) inter -and intra-professional communication.

A summer curriculum will be added to the third professional year beginning in May, 1998. The benefits (of which)…will include a smoother transition from pre-clinical training to actual patient care experience and more patient care experiences for third year students.

An agreement has been reached with the Department of Ophthalmology and Visual Science at the University of Chicago to coordinate clinical, medical, educational and research programs with ICO. This is only the second such agreement between a college of optometry and a university ophthalmology program in the country…Among its benefits will be the creation of an O.D./Ph.D. program; increased opportunities for collaborative research; shared lecturers; and an expanded clinical base.

(The) faculty now has a voice in the deliberations of ICO’s Board of Trustees through elected representatives. A Faculty Council has been created with a written constitution and leadership provided through an elected Executive Committee.

In our efforts to develop external funding for research, we have made significant progress in improving our opportunities with various Federal Agencies by making certain we are in compliance – or making substantial progress toward compliance – in several areas from institutional protocols to record keeping.

ADMINISTRATIVE ISSUES
“We have thoroughly reviewed our organizational structures. We will shortly be submitting to the Board a revised organizational chart that reflects functions rather than individuals and is organized in a way to maximize our efficiency and service to our students and our patients.

Simultaneously with this review, we have taken steps to review all personnel and initiate changes to improve their efficiency. These include the creation of the ‘President’s Advisory Council’ to assist me in managing ICO. We are committed to diversity in our staff, faculty and student body and have taken steps to ensure a diverse ICO community.

FINANCE
“We have reorganized the Business Office to improve our financial management. We have completed a structured budgeting process with time lines and approval processes built in to insure that all ICO needs will be addressed in the budget process and properly prioritized within our educational and patient service commitments ….(and) to improve accountability.

We have also constructed a long-term debt management plan. ICO currently has an outstanding tax-exempt variable rate of indebtedness of $37 million dollars. We have been successful in negotiating productively to refinance this debt in a way that minimizes its burden on ICO and maintains our position of excellence in optometric education.

INSTITUTIONAL IMAGE
“How we see ourselves to a very large extent projects how others view us. For that reason, I have made improving internal communications (among faculty and staff) a high priority during the past year and will continue to do so.

We have attempted to address the information needs of our external constituencies, especially our alumni…This was the impetus for the creation of a quarterly newsletter. We are also in the process of creating an Internet mailing list of our alumni and developing a web site for ICO’s alumni and friends. We have initiated a mentoring program with the Illinois Optometric Association to link optometry students with practicing optometrists in Illinois, the majority of whom are graduates of ICO, furthering the ties between the College, our students and our alumni.

We have also created a public relations program with specific goals and objectives in the areas of media relations, community relations and greater visibility in professional journals and optometric associations. The public relations program contains a strong marketing component, chiefly (involving) the Illinois Eye Institute.

OPERATIONS
“The future of both health care and education will be greatly influenced by developments in communications. Without a significant increase in capital spending, ICO has moved forward aggressively in this arena through the efforts of our Information Systems Department.

Personnel management has been enhanced through greater accountability. Formal performance agreements have been created for each member of the administration, creating an objective measurement against which (each employee can be evaluated for his or her) performance.

PHYSICAL PLANT
“We are continuing to make necessary improvements to our (physical) plant. We recently installed exterior signage, increasing our visibility in the community and improving the marketability of our (Illinois) Eye Institute. We will shortly be changing our internal signage as well, making it more informative, user friendly, consistent and within Federal regulations.

Renovation of the Illinois Eye Institute is nearly complete. When finished, we will have a facility whose exterior and interior appearance matches the outstanding qualities of those who serve there.

At the same time, we have carefully evaluated the existing construction master plan, not only in terms of our needs but also within the framework of sound financial considerations and the need to maintain a competitive economic stance. As a result of this review, we have reduced the previous master plan by more than $23 million dollars over the next five to seven years.

REVENUE STREAMS
“We have made significant progress in increasing (the number of) alternative sources of revenue for ICO…(because) we cannot afford to neither compromise excellence nor over-burden our students with significant tuition increases.

We have begun with the creation of a marketing plan for the Illinois Eye Institute that recognizes that in addition to its educational mission the IEI must be competitive in its efforts to attract patients.

We have reinvigorated our commitment to fundraising, or ‘development,’ – so named in recognition of the fact that the creation of a significant philanthropic base is a developmental process (that occurs) over time.

In order to better fulfill our educational role to practicing optometrists – and to improve our revenue stream through education – we have adopted a more user-friendly stance toward continuing education or CE. We are in the process of creating a CE program (that will be) systematically planned and timed to coincide with the two-year cycle of CE requirements for licensure renewal in Illinois and one that stresses advanced competency.

We are also strongly committed to enhancing our efforts at student recruitment and retention, but please let me emphasize that this must not ever come at the expense of quality.

Our focus this year was to move admissions from a paper oriented (process) to more of a people-oriented process. In August, we held an open house for prospective students. An aggressive schedule of visits to undergraduate campuses for recruiting purposes has begun. Before the year is out, members of our faculty and staff will have visited more than 50 colleges and universities.

STRATEGIC PLANNING
“A Strategic Plan for an institution such as ICO…must do more than chart a course for the future. It must reflect the collective wisdom of the College. We have created such a plan and named it the Prescription for Excellence. It is now in the process of some final revision before being presented to our Board. It is available to all who wish to review it in its entirety. It is a living document in that it is intended to be amended as conditions and opportunities warrant. It addresses all aspects of our continued growth as an institution of health care education. And, as its name implies, it requires excellence as the standard of all our efforts. This is not a mere title, but a recognition of our potential and also of what will be required of those who will thrive in today’s health care environment…..I am confident that ICO and its students, faculty and staff will be among those who excel.”[3]

During this same month, Dr. Mullen was installed as Illinois College of Optometry’s fourth president at a ceremony that was held on October 18, 1997 in the Rockefeller Chapel on the University of Chicago campus.

CHAPTER THREE
PRESCRIPTION FOR EXCELLENCE
YEAR TWO
During Dr. Mullen’s second year at ICO, the benefits of his mandate for openness and communication among the student body, faculty, staff, alumni and administration became more apparent. Working closely with Janice E. Scharre, O.D., M.A., who had been appointed Dean/Vice President for Academic Affair in November 1997, a faculty opinion survey was developed and distributed to determine the College’s perceived strengths and weaknesses. The information was gleaned and processed into a series of positive actions that were designed to enhance ICO’s academic culture.

A similar survey was sent to students, requesting input on virtually every aspect of student life. Improved communication among the student body, faculty and administration produced a more user-friendly Student Guide; increased flexibility in student leave policies; and an expanded and simplified work study program.

The responses to an alumni-directed questionnaire would result in an initiative to freeze tuition, increased funding for scholarships and incremental reduction of entering class size.

In his second “State of the College Address,” which he presented on October 2, 1998, Dr. Mullen detailed some of the accomplishments achieved during the year.

FINANCE
“Let me start with our successful bond issue of $45 million dollars (in variable-rate, tax-exempt bonds by which ICO was able to successfully restructure the College’s debt. This freed $22 million in assets, which were previously held as collateral. Those assets were freed up to be applied to more flexible investments). This guarantees the sound financial footing we need to successfully continue ICO’s tradition of excellence into the next century…But the real significance of the bond issue is not in dollars, but in the confidence the financial community demonstrated in ICO’s future.

STUDENTS
“I am pleased to be able to report that the state of our student body – whose progress in advancing the profession is the yardstick by which we are all ultimately measured -remains extremely strong…We have implemented several new avenues for their input. Town hall meetings were instituted. The Dean’s Advisory Group has been reinvigorated and a student satisfaction inventory was administered last month, seeking input form every ICO student about virtually every aspect of student life.

(To enhance the students’ educational experience,) ICO continues an aggressive expansion of the externship program…(which has) grown from 13 sites in 1996 to 79 (sites which are) currently located throughout the United States and abroad…We have implemented an evaluation and monitoring process for our sites…(and) taken care to remain fiscally prudent during this period of expansion. We will continue to analyze our community-based sites, seeking to renegotiate financial arrangements when possible; increase patient volumes; and modify our time commitment to individual sites when desirable. External sites, such as (the ones) we have developed, allow students a greater breadth of experience. They allow students to choose diverse locations and types of clinical settings, better preparing them for the realities they will face as practicing optometrists.

FACULTY
“The state of the faculty is also strong. A revised Faculty Handbook, which consolidated the old handbook and academic policy manual – was developed cooperatively by the faculty and the Dean. During the past year, significant emphasis was placed on faculty scholarly activity….Faculty attendance at professional meetings increased by 71 percent during the past year…Twenty-seven faculty presented (papers) at last year’s American Academy of Optometry meeting. Publications by junior faculty have increased significantly.

The faculty has also made a concerted effort to increase research, specifically in securing external research funding. ICO received over $100,000 in external research grants in fiscal year 1997-98, including significant grants from the Pearle Vision Foundation and the Illinois Society for the Prevention of Blindness. To insure that progress continues in this area, we have been sending faculty members to AOA grant writing workshops as well as the Academy Research Symposium.

Continued improvement of faculty teaching effectiveness is a high priority. We have created a Faculty Teaching Circle, in which informal monthly meetings focus on various teaching topics. One outcome of these meetings has been the creation of student-faculty colleague groups. A faculty retreat featured guest speakers from the University of South Carolina and the University of Chicago who spoke on the importance of developing effective feedback mechanisms from students so educational techniques might be refined and improved at ICO.

CONTINUING EDUCATION
“Through our Institute for Advanced Competency, 197 practicing optometrists received 358 hours of continuing education. In this fiscal year, we have already provided 323 hours of continuing education for 270 optometrists. We have also entered into agreements with various members of the ophthalmic community to provide CE. Included are: Cole Vision, EyeQuest, Consolidated Vision Group, Vistakon and TLC.

ILLINOIS EYE INSTITUTE
“The Illinois Eye Institute continued to make great progress in successfully marketing its services to the community. Through a fiscally conservative strategy…including print and radio advertising, direct mail and an increased presence at health fairs and neighborhood events, IEI (patient visits) increased by 4 percent in 1997-98, while producing a 10 percent increase in revenue. Through the first two months of this fiscal year, figures indicate that patient encounters are up by 16 percent as compared to the same period one year ago.

Various venues for patient feedback gave been created, such as surveys and a telephone comment line. Responses are being analyzed and changes in IEI resource allocation will be influenced by patient response.

In the realm of managed health care, the College is committed to enhancing the role of the optometrist as the primary eye-care provider. Along with our affiliate, the University of Chicago, we are in the process of developing a university-based, comprehensive eye-care product.

TECHNOLOGY
“While focusing on human elements, we have not neglected the bricks and mortar side of ICO during the past year, as well as computer software and hardware. Compulink, a new clinical software system, is about to enter the testing and training phase. Our target date to have this system “live” is late January of 1999. The CARS system, our financial and administrative system, is approximately 75 percent complete. We have upgraded all of our desktop computers with the addition of Windows 95 and Office 97. (And) Internet access was provided to most desktop computers. Currently, a new library system us under evaluation and selection. The long anticipated One Card System, which will allow ICO students (to use) a single card for security access, identification and purchasing, is on schedule and will be implemented in 1999.

BOARD OF TRUSTEES
“With the support of our Board, we remained fully committed to increasing diversity at ICO last year. One outcome of this commitment was the appointment of ICO alumna, Dr. Millicent Knight, to the Board the first female African American to so honor her alma mater.

COMMUNITY
“(ICO has) successfully reached out to the community. The recently created Community Advisory Board is comprised of eleven individuals, representing area churches, schools, community groups, government agencies, and members of ICO Administration. (Its purpose) is to discuss areas of mutual concern and to formulate plans for improving the quality of life for all the residents of our community.

Our students have played a significant role in strengthening our ties to the community. Through patient care in the IEI and also through such neighborhood projects as unity day, the literacy program and donating toys for Christmas, students have helped show our care and concern for our neighbors on a very real, one to one basis.

ALUMNI
“As the largest college of optometry in the country, ICO benefits from having the largest number of alumni of any of the schools or colleges of optometry. Through newsletters, direct mail, individual and group meetings and receptions at various professional meetings, we continue to forge strong bonds with our alumni.

A benefit to our students, we hope, will be an increased commitment on the part of the alumni to the ICO Endowment Fund. We are aggressively pursuing deferred and major gifts from our alumni and our friends in the ophthalmic industry to add to our endowment.

OPHTHALMIC INDUSTRY
“We are continuing to reach out to our partners in the ophthalmic industry. The Practice Opportunities Symposium (which took place) this past spring was enthusiastically endorsed by representatives from a wide range of practice options. (This symposium provides the students with the opportunity to learn about all modes of optometric practice.) Through both… our alumni and our partners in the ophthalmic community, we have realized over $300,000 in pledges and gifts this year.

ACCREDITATION SITE VISITS
“During this past fiscal year, we benefited from two highly successful accreditation site visits: the Council on Optometric Education Interim Site Visit and the Primary Care Residency Reaccreditation. The COE visit confirmed that recommendations and suggestions made in its earlier report had been accomplished. The Primary Care Residency Reaccreditation was also highly successful as the accrediting team reported that all nine of its standards had been fully complied with. Preparations are now underway for the North Central Association accreditation visit in March of 1999…I am fully confident we will benefit from this examination and once again exceed expectations.

One year ago, I stood before you and announced that we had completed a strategic plan, our Prescription for Excellence (which would be) a living document to guide us through the coming year and into the next century….To date, of the 798 action items contained in the plan, 438 (items) or 55 percent have been completed. (Although) the Prescription for Excellence will continue to be our guide for the coming year…we have already begun the next phase of planning – identifying outcome measures, adding baseline data, and revising the plan to include new initiatives and linking a five-year operational budget to the plan.

As you know, this year we officially began our observation of our 125th anniversary as America’s oldest college of optometry. Over the years, the manner in which our profession is practiced and the way in which it is taught, has changed, but through it all our commitment to excellence has remained firm. With that continued commitment, I am confident that our progress over the next 125 years will be just as exciting.”[4]

It was during this academic year that Dr. Mullen led the school on a two-year journey toward excellence.

CHAPTER FOUR
JOURNEY TO EXCELLENCE
YEAR ONE
ICO’s 125th anniversary year (1998-99) marked not only a celebration of the College’s long history and its stature in the optometric profession. It also commemorated the beginning of momentous changes which would positively position the school as it entered the twenty-first century.

At the spring Interim Board Meeting, the Board of Trustees acted upon an alumni-inspired initiative and approved freezing tuition at the 1998-99 level ($22,668), while simultaneously increasing allocated funds for scholarship aid to $400,000 and gradually reducing entering class size for five years beginning in 2000. These directives had a crucial impact on ICO’s budget planning process, requiring mandatory expense reduction in order to maintain a balanced budget.

An ambitious $8.5 million campus capital improvement program – funded with revenues from the restructure of ICO’s debt – was completed during that year. The program included renovations to the physical plant; the purchase of new ophthalmic equipment; and the installation of extensive informational systems technology. With improvements to the campus’ external appearance along with other college-owned property, ICO participated in the continuing resurgence of community development.

Affiliation with the University of Chicago continued to flourish. A course in basic eye-care procedures for second-year University of Chicago medical students was developed and implemented.

In his “State of the College Address,” which he delivered on October 22, 1999, Dr. Mullen reflected on his years at ICO and the challenges that the College would face to maintain its leadership position:

“In preparing this year’s address, I found it useful to reflect back upon my arrival at ICO in 1996. At that time, I said three elements would characterize my presidency. (These were:)

1. The need to recognize the challenges that confront us and to clearly define them.
2. The importance of pervasive and detailed planning so we might marshal our resources and measure our progress in meeting these challenges, making adjustments as necessary.
3. Open and productive dialog among all members of the ICO family … the Board of Trustees, alumni, our many friends and partners in the ophthalmic community and businesses, and the residents of the community in which we are located.

I believe that our commitment to these three concepts provided the basis for significant progress at ICO during the past year. We have now successfully completed over 70 percent of the action items in our original strategic plan, Prescription for Excellence.”

Dr. Mullen further described in this same address some of the noteworthy accomplishments from that year as well as some of the challenges that lay ahead:

“We are in the process of (establishing) a faculty practice plan making ICO more attractive to (present) and prospective faculty.

Thanks to the hard work of our community based education staff, we have continued to expand our externship program…at over 100 sites throughout the United States and abroad. From these sites, combined with the Illinois Eye Institute, our students will benefit from more than 150,000 clinical teaching opportunities, significantly enhancing their educational experience. Student–patient encounters are up 68 percent compared to three years ago.

Our residency program has grown to include residencies in cornea/contact lenses and anterior segment/refractive surgery.

With the support of the Board of Trustees, we have embarked on a bold course to insure our position of leadership…(by freezing) tuition while simultaneously increasing scholarship aid. At the same time we committed to gradually reducing the size of future entering classes, beginning with a reduction by five for the class admitted in the year 2000.

To do this will be a tremendous challenge, but I am confident we can do it. However, these are not the only challenges facing ICO as we prepare for the next millennium. To maintain our position of leadership we must do the following:

• Continue to emphasize strategy and tactical planning with outcome-based assessment as the measure of progress.
• Amplify the voices of students in College affairs, including representation on the Board of Trustees.
• Continue to expand our recruitment of gifted foreign students beyond the confines of North America, while remaining a strong institution of choice for outstanding students from our neighbors to the north.
• Increase the size of the Board of Trustees, furthering its diversification. And recruiting members with needed expertise and philanthropic capabilities.
• Further enhance personnel relations within the ICO family, particularly as it pertains to fostering a positive attitude and respect for one another.
• Restructure the clinical education program to be more cost-efficient while we maintain academic quality.
• Accelerate the upgrade of instructional technology.
• Ensure that our curriculum is consistent with defined entry-level attributes.
• Develop and implement an advanced competency curriculum.
• Significantly increase the revenues of the Illinois Eye Institute.
• Implement a faculty practice plan.
• Continue to improve faculty scholarly activity with more externally funded research, clinical trials and publications.
• In cooperation with the University of Chicago, develop our role as a provider of comprehensive eye care services within the Chicagoland managed health-care market.
• Achieve continuing accreditation from the Council on Optometric Education.
• Achieve accreditation for the Illinois Eye Institute from the Joint Commission on Accreditation of Health Care Organizations, a first for an eye-care facility (that is) affiliated with a college of optometry.
• Launch major capital and deferred-giving campaigns to sustain an ongoing and significant development effort in keeping with our status as America’s largest college of optometry.
• Complete the cultural shift of the institution to one devoted to the continuous improvement of our programs, services and products.

Tomorrow night we will officially conclude our… celebration of our 125th anniversary. The highlight of the evening’s festivities will be the recognition of 125 individuals, organizations and institutions for their outstanding lifetime contributions to optometry. Some have contributed through research, others through practice, some through teaching, and some in the business world. Their contributions are as varied as their numbers…They have witnessed tremendous change in the way optometry is taught and the way it is practiced. They have learned to thrive in an environment of rapid change.

In the last year we have accomplished much…I look forward to reporting further progress in the years ahead.”[5]

Dr. Mullen then devoted the next year to the implementation of additional initiatives that had emerged during the previous identification and developmental period.

CHAPTER FIVE
JOURNEY TO EXCELLENCE
YEAR TWO
The mandate to successfully freeze tuition and increase the scholarship budget while maintaining a balanced budget and preserving the quality of education had a visible impact on ICO. Working on a 5-year budgeting plan, necessary expense reductions were made and continue to be implemented each year to achieve ICO’s goals.

A Voluntary Early Retirement Incentive Program was approved by the Board of Trustees, which took effect on January 1, 2000. Full-time employees with at least ten years of service and who are age 55 or older were eligible. Seven employees accepted the early retirement package. Responsibilities were reassigned so that, in most cases, those employees were not replaced.

The College worked diligently to increase income from non-tuition sources. Assets that could be invested grew by $6.5 million to more than $27 million since 1996. A Vision for the Future Campaign has been launched with the goal of growing the total endowment to $60 million by the year 2010. The Office of Institutional Advancement helped the President raise more than $1 million during the previous year.

Anticipating challenges such as the contracting student applicant pool and the changes in the healthcare industry, the administration tackled each situation head-on. Dr. Mullen reported these changes in his fourth annual “State of the College” address:

“We have had an outstanding year, thanks to every member of the ICO community. I am especially grateful to those who have played important roles in our ongoing strategic planning process. Much of our current and future success stems from those efforts.

It has allowed us to open new avenues of dialogue – within the college and within the profession, the healthcare industry and our constituents at large. It has allowed us to implement performance-based monitoring and measurement of our progress. And it has allowed us to positively engage faculty, administration and students in continuously improving our institution and our performance.”

Dr. Mullen then recounted some of the year’s achievements and strengths.

“Academically, we are stronger than ever. We have expanded externship sites to 118 (current sites) today…The (Illinois) Eye Institute and (these sites) now provide over 180,000 clinical encounters for our students each year. Our students’…pass rate on the National Board exams, at time of graduation, now stands at 94 percent. ICO has historically performed very well on the clinical sections of the National Boards and this year’s performance in Basic Science…significantly exceeded the national average.

Our student attrition rate is at an all time low of only 2.7 percent. We have expanded residency programs in cornea and contact lenses, refractive surgery and primary eye care…(We) have built research laboratory facilities and made significant technological improvements in our lecture centers.

Our graduates enter into practice better prepared to succeed thanks to significant improvements in our practice management course and programs such as the Practice Opportunities Symposium, Private Practice Club and ICO Placement Services.

Our affiliation with the University of Chicago’s Department of Ophthalmology and Visual Science stands unique among colleges of optometry. Our collaborative course for medical students speaks directly to our rigorous commitment to the arts and science of both medicine and optometry. We have also formalized our cooperative O.D./M.S. and O.D./Ph.D. programs with the University of Chicago.

Our faculty has enhanced its pursuit of scholarship. During the past year, a total of seven research grant proposals were submitted and six were funded. In addition, 21 articles were published in professional journals. Faculty representation in the American Academy of Optometry at the fellowship and diplomate levels stands at 87 percent up from 48 percent just four years ago.

Clinically, we are stronger as well. (There are) marked improvements in patient satisfaction and a 23 percent increase in Illinois Eye Institute revenues since 1997. Professionally, we have strengthened our outreach and built better relationships with other health care professionals and organizations through our Professional Advisory Board.

Financially, we are stronger than ever. Our (investment-worthy) assets have grown to more than $27 million, up more than $6.5 million in just four years. We have launched our Vision for the Future Campaign, with its goal of growing our total endowment to $60 million by the year 2010. Through a grant from the State of Illinois for $250,000, we have reestablished our indigent patient care program. We expect to reach thousands of high-risk patients in the coming year with this support.

We have also been able to freeze tuition at its level of two years ago (while increasing) the scholarship budget by nearly 50 percent…I want to recognize both the faculty and the students for independently and successfully launching and funding new scholarship programs to benefit students. Governance has grown even stronger through the Board’s concerted efforts to increase and diversify its members. We now have a voting faculty member on the Board of Trustees and student representation as well. But we cannot rest on our achievements and expect to maintain excellence. Challenges lie ahead. We must face them squarely. We can and we will.

Over the next few years, we have pledged ourselves to meet these challenges through continuous refinement of our strategic planning capabilities. Soon we will enhance patient care and clinical education by developing and implementing a Faculty Group Practice Plan.

In the face of a decreasing student applicant pool, we continue our commitment to recruit and admit only the most qualified students and assist them in managing the high cost of a quality education by continuing to freeze tuition and by increasing scholarship support.

Financially, we have committed ourselves to refining our financial planning in line with the goals of our strategic plan, Journey to Excellence. And we will continue to sustain and strengthen our capital and planned giving efforts. We will continue to enhance our academic culture through support of our faculty in their roles as teachers and through expanded opportunities for faculty research and scholarship. We will evaluate and modify our curriculum, striving to maintain an effective entry-to-practice model. We can prove our commitment to excellence in patient care by going forward with seeking accreditation from the Joint Commission on Accreditation of Healthcare Organizations.

The state of the College is strong because of the hard work and dedication of a great many people. Today, I would like to thank all of you…We’ve had an extraordinary year. We have an extraordinary future ahead of us as we continue to provide an outstanding education for future eye care professionals. I look forward to continuing on our Journey to Excellence with each and every one of you.”[6]

By meeting each of the Prescription for Excellence’s goals and applying the strategies in the Journey to Excellence, ICO is now prepared to face the future with confidence and a commitment to excellence.

CHAPTER SIX
COMMITMENT TO EXCELLENCE
WHAT LIES AHEAD

During these early years of the twenty-first century, both optometric education and the profession of optometry are facing new challenges: challenges that are both necessary and inevitable. Dr. Mullen predicted what the profession and Illinois College of Optometry might face in a guest editorial that appeared in the Journal of the American Optometric Association, (September 1999).

“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 campus-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 rotations.
• Campus-based clinics will remain valuable for first- and second-year students.
• College-based clinics will serve a significant role as (the) faculty practice becomes more important as a means to enhance faculty income and improve (both) 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 life-time 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 (Pennsylvania College of Optometry) 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, optometrists, 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 prescription authority to optometrists.
• The expanded use of laser technology by optometrists will evolve slowly over the next two decades.
• Consultation among practicing professionals will take advantage of advances in technology. Consultants 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 within 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 – as promising as our courage and tenacity to implement those plans.”[7]

——————————————————————————–

[1] Excerpted from “Interview with Charles F. Mullen, O.D.” Journal of the American Optometric Association 1999; 70:556-60. (Copyright © 1999 by the Journal of the American Optometric Association. Reprinted with permission.)

[2] Excerpted from Interview with Charles F. Mullen, O.D. Journal of the American Optometric Association 1999; 70:556-60. (Copyright © 1999 by the Journal of the American Optometric Association. Reprinted with permission.

[3] Excerpts from “State of the College Address – October 01, 1997” which was delivered by Dr. Charles F. Mullen.

[4] Excerpts from “State of the College Address – October 02, 1998” which was delivered by Dr. Charles F. Mullen.

[5] Excerpts from “State of the College Address – October 22, 1998” which was delivered by Dr. Charles F. Mullen.

[6] Excerpts from “State of the College Address – October 20, 2001” which was delivered by Dr. Charles F. Mullen.

[7] Excerpts from “Interview with Charles F. Mullen, O.D.” Journal of the American Optometric Association 1999; 70:556-60. (Copyright © 1999 by the Journal of the American Optometric Association. Reprinted with permission.)

First published in 2001 by
Illinois College of Optometry
3241 South Michigan Avenue, Chicago, IL 60616 USA

Cover design:
Anistatia R. Miller
Jared M. Brown

Book design:
Alan Pouch

Photographs:
Ray Reiss, Sparkfactor
Andrew Fils, The Paul Studio
Alan Pouch, Illinois College of Optometry

Preface & commentary:
Barbara B. Renard
Copyright © 2001 by Charles F. Mullen, O.D. and Barbara B. Renard

All rights reserved.
No part of this book may be reproduced, stored in or introduced into a retrieval system, or transmitted in any form or by any means (including electronic, mechanical, photocopy) whatsoever without written permission from the above publisher of this book, except by reviewers who may quote brief passages to be printed be a magazine or newspaper.

ISBN #: 0-9652759-Printed in the United States by Paperback Mfrs.