Charles F. Mullen

Challenges and Opportunities in Optometry and Optometric Education

A New Paradigm for Optometry

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

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

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

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

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

See also: Changes Necessary to Include Optometry in GME

by Charles F. Mullen

Eight Steps to Ensure the Professional Standing of Optometry

Introduction

Threats to Traditional Optometric Refractive Practice Weaken Optometry’s Professional Stature.

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

State Legislatures and Regulatory Boards

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

Core Curriculum and Postgraduate Clinical Training

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

Recognition by Profession of Optometry

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

Federal Government

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

by Charles F. Mullen

Awaken the Profession of Optometry and Its Educational Institutions Again

Introduction

Beginning in the 1970’s, a complacent profession and its educational institutions were awakened by bold leadership with innovative initiatives including:

  1. Rhode Island changed the Optometry practice law, and certified the first American Optometrists in the use of pharmaceuticals which led to all states eventually adopting and expanding their use.
  2. The VA Optometry Service was founded, the largest clinical training program in advanced practice for Optometry students, residents and fellows.
  3. Changed the way optometry students received clinical experience by expanding training to Community Health Centers, VA, Military and USPHS facilities and other health care facilities
  4. Recognized Specialties in Optometry
  5. Established academic MD/OD cooperative patient care/educational programs.

Threat

The Profession of Optometry now faces a major challenge as Traditional Refractive Practice is threatened by economics, technology, automation and expanded commercialization. There is a responsibility of the Professional and Academic leadership to again awaken the Profession and its Educational Institutions by addressing the threat with innovative initiatives. Postgraduate clinical training guided by Certification Boards is one of these critical initiatives.

Opportunity

Medically trained optometrists are needed to treat the high incidence of eye disease and other eye conditions in the growing elderly population. There are not enough ophthalmologists nor are there plans to significantly increase the number of ophthalmology residency positions.

New Initiatives

Address the threat to Traditional Optometric Refractive Practice by (1) restructuring the curriculum to a three year OD program and re-designating the current 4th year as first year postgraduate residency. (2) A restricted Training Permit would be granted after earning OD degree and acceptance in a medical eye care residency program. (3) After completing all residency requirements and achieving Board Certification in the Specialty of Medical Eye Care by either the American Board of Certification in Medical Optometry (ABCMO) or the American Board of Ophthalmology (ABOP) an Expanded Optometric Practice State license would be granted.

Board Certification would entitle optometrists to practice Medical Eye Care in States with current and future optometric expanded practice laws (such as South Dakota and Montana which require physicians to complete residency training for license), qualify Board Certified optometrists for medical staff appointments and position optometry residency programs for inclusion in the multi-billion dollar Graduate Medical Education (GME) program. Board certification is recognized by State and Federal Legislatures, Governmental Agencies, Hospital Credentialing Committees and Insurance Companies as the “Gold Standard” for advanced competency and specialization. It demonstrates to the public that the optometrist’s clinical training is above and beyond minimum requirements.

See Also: Changes Necessary to Include Optometry in the Graduate Medical Education Program (GME)

New Certification Boards in Pediatric Optometry and Low Vision Rehabilitation

The American Board of Optometry Specialties (ABOS) has recommended the establishment of additional Specialty Boards in the Specialties of Pediatric Optometry and Low Vision Rehabilitation. Once the Boards are operational, optometrists can achieve Board Certification in these Specialties in addition to Medical Eye Care.

Subspecialties

Also, Certification in Medical Eye Care Subspecialties recognizes additional advanced clinical training and fulfillment of additional requirements in six highly specialized areas: (1) Cornea and External Disease, (2) Emergency Eye Care, (3) Glaucoma, (4) Laser and Surgical Procedures, (5) Neuro-Ophthalmic Disorders and (6) Vitreo-Retinal Disease.

See Also: ABOS Member Boards/Specialty and Subspecialty Certificates

by Charles F. Mullen

Optometric Education in Crisis

COVID-19, Racial and Ethnic Unrest Making the Situation Worse

Higher Education including Optometric Education is in crisis because of declining enrollments. There is too much student capacity and not enough demand. There are 2.9 million fewer college age students than 8 years ago. Ninety-three colleges and universities have closed or merged since 2016, and Clayton Christensen of Harvard predicts 50% of the 4000 colleges and universities will be bankrupt, close or merge by 2035.

Schools and Colleges of Optometry must act now by developing and implementing strategies to deal with the Crisis. The following Power Point slides delineate:

  1. Causes of Higher Education Crisis
  2. Causes of Crisis in Optometric Education
  3. COVID-19 Pandemic is Making a Fragile Situation Worse
  4. The New Normal in Optometric Education
  5. Contingency Plans Needed to Address Virus Spread and Violence
  6. Racial and Ethnic Unrest
  7. Financial Concerns
  8. Structural Issues Contributing to Crisis
  9. Marketing and Advocacy Initiatives
  10. Innovative Strategies
  11. Fragmentation in the Practice of Optometry
  12. Issues Facing Optometry
  13. Re-Imagine Optometric Education
  14. Enhance Appeal of a Career in Optometry
  15. Elements of a New Educational Model
  16. Partnering With Ophthalmology Residency Programs

Crisis in Optometric Education (PowerPoint)
Crisis in Optometric Education (PDF)

Additional Resources

by Charles F. Mullen