Two consequential decisions have delayed by 30 years the comprehensive development of specialty clinical training and board certification for optometrists, denied eligibility for Federal support for postgraduate residency training, and placed Schools and Colleges of Optometry in a tenuous position with increasing clinical educational costs, increasing student debt, and a static student applicant pool.
In 1987 with Optometry’s Inclusion in Medicare, It Was Decided Not to Pursue Inclusion in the Graduate Medical Education (GME) Program, the Educational Component of Medicare.
It was decided not to pursue Optometry’s inclusion in GME, the multi-billion dollar educational component of Medicare which supports postgraduate residency programs. Optometry receives no direct Federal assistance for clinical training, and schools and colleges of optometry continue to pass along the high cost of clinical education to students in the form of high tuition and significant debt.
Recognizing their need for postgraduate clinical education, 30% of new graduates now enroll in residency programs, many in the Specialty of Medical Optometry funded by the VA. Inclusion in GME would increase residency and fellowship training opportunities for optometrists, not only in the Specialty of Medical Optometry and its associated subspecialties (Cornea/External Disease, Glaucoma, Neuro, Retina), but also in Pediatrics and Low Vision.
Podiatry wisely decided to seek inclusion in GME in 1972, and later changed its State practice laws requiring postgraduate training for licensure, revised the curriculum and clinical training model, and developed Certification Boards to qualify for GME payments. Podiatry was successful in creating new residency positions to accommodate their graduates, many in the VA. Podiatry currently receives $111,000 per resident per year in GME payments.
Seeking inclusion in GME will be politically more challenging now than in 1987, but achievable with conformance to GME postgraduate training standards as Podiatry so aptly accomplished, and by a persistent and professional lobbying effort. It should be stressed to Members of Congress that there is a growing need for residency trained optometrists as the number of ophthalmologists is not adequate to meet the increased demand for medical eye care and low vision rehabilitation. It will also be challenging for Optometry to create additional resident positions, however, GME payments would provide an incentive for potential host institutions in the private sector to offer Optometry residency programs.
At the 1992-93 Georgetown Conference on Optometric Education, It Was Decided Clinical Training Would Continue to Take Place Within the Four Year Curriculum.
Clinical training is the most expensive component of the Optometry four year curriculums resulting in high tuition and significant educational debt. Optometry graduates now face the highest debt repayment as a percentage of income of all professions at 14.9%. Twice the payments of medicine. Applicants for admission to Optometry Schools and Colleges have essentially not increased in 10 years, and educational debt as compared with potential income is likely a causative factor.
The decision to keep clinical education in the four year curriculum also delayed Optometry’s development of postgraduate specialty clinical training model which is necessary to qualify for inclusion in the multi-billion dollar Graduate Medical Education (GME) Program. If included in GME, clinical training with the exception of clerkships would be moved from the four year curriculum to postgraduate residencies, significantly reducing the cost of the optometric curriculum, and providing Federal support for postgraduate clinical education.
Regain decades of lost opportunities to the Profession of Optometry and Optometric Education by reversing the above two decisions, and by
- Amending State practice laws to require postgraduate clinical training for licensure
- Restructuring the four year curriculum by moving clinical education to postgraduate specialty residencies
- Adding new residency positions
- Developing additional specialty certification boards
Clerkships or rotations to health care facilities would take place in 2nd and 3rd years. Current 4th year would become the first postgraduate year (PG-1).