Affiliation with a medical school presents numerous opportunities for enhancing the education and clinical training of optometric students, residents and practitioners. The advantages of medical school affiliation seem to be easily outlined while the disadvantages are somewhat less apparent.
The decision-making process concerning affiliation must include a careful cost benefit analysis. Evaluation should include a best and worst case scenario, and a timetable for implementation, perhaps in a step-like fashion to permit both parties to assess the effectiveness and impact of the relationship.
Analysis should be of sufficient depth so as to insure that all facets of the affiliation have been thoroughly explored in both quantitative and qualitative fashion, as it relates not only to educational and patient care factors, but also to finance, research and public relations.
Obviously, the most desirable affiliation for an educational and public image perspective would be with the most prestigious medical school. Geographical accessibility is another factor. Financial strength and quality of medical and ophthalmological staff and resultant patient care are also important factors.
The integrity and qualifications of the administration and faculty who are involved in negotiating the agreement and who will be directly involved in the joint programs are of paramount concern in order to protect the college of optometry from an adverse outcome in either the short or long-run.
Benefits of a Medical School Affiliation
Education
- Increased access by optometric students and resident to patients with eye disease, systemic disease and pre- and post-ophthalmic surgical cases.
- Increased interaction by students, residents and faculty with ophthalmic and other health care professionals via grand rounds, workshops, seminars, conferences and observation.
- Lectures by medical school faculty in areas not currently taught by optometric faculty, and in areas currently taught where qualitative and/or quantitative improvement is possible – eye disease management, patient interviewing, gerontology.
- Increased educational opportunities and research capabilities through the creation of joint centers or institutes in such areas as glaucoma, neuro-ophthalmic disease, cataract/aphakia, corneal physiology/contact lenses; immunology/allergy; pediatric and geriatric eye care.
- Opportunities for advanced specialty training for optometric students, residents and faculty.
- Expanded continuing education program in eye disease management through increased ophthalmological participation.
- Medical school faculty appointments for optometric faculty.
Patient Care
- More effective management of surgical patients, whether the surgery is performed at the medical school/hospital or at the optometric facility.
- More effective back-up for true ocular and general medical emergencies.
- Increased and more readily available access to sub-specialty care.
- Enhanced control and direction for optometry school’s medical staff in areas such as patient care protocols, quality assessment/assurance mechanisms, credentialing.
- Hospital privileges for optometrists.
Constituent and Public Relations
- An enhanced image which can have a positive effect on student and faculty recruitment, fund raising, grantsmanship, community relations, and professional relations.
Economic Impact
- Increased census in primary care and optometric specialties.
- Sharing of revenue from surgical services provided at the medical school/hospital or out-patient surgical facility of the optometry school.
- Increased practitioner referrals both from the optometric and medical communities.
- Opportunities for sharing of plant, capital equipment, people, and resources.
Research
- Increased potential for joint research projects utilizing respective strengths of optometry and medical schools. Access to special populations.
Concerns of a Medical School Affiliation
- Erosion of optometry school’s mission to train primary eye care clinicians.
- Competition among optometric students/residents and ophthalmological residents for primary care patient encounters.
- Danger of optometry being placed in a subordinate position related to ophthalmology.
- Some loss of control over optometry school’s ophthalmological group/faculty.
- Restriction on referral patterns due to implied exclusivity of agreement.
- Loss of opportunities for affiliation with other institutions.
- Possible negative reaction by alumni or other constituencies.
- Negative public relations if affiliation does not succeed.
The Affiliation Agreement
The elements of an affiliation agreement or, if a step-by-step process is desired, a memorandum of understanding with intent to affiliate may be broadly stated with detailed attachments added as the various aspects of affiliation are realized. The following elements should be present in the initial document.
- Statement of support for each other’s educational mission, particularly as it related to the expanding scope of optometric practice.
- Mutual desire to meet the health care needs of the community in a cooperative manner, desire to provide mutually beneficial and cost effective means for educating health care practitioners, and a recognition of the public benefits of collaborative research in visual and related sciences.
- Actively encourage and cultivate inter-institutional endeavors in education, research and patient care.
- Recognize each other’s autonomy as it relates to overall institutional mission, structure and governing authority.
- Those terms contained in the agreement which specify financial arrangements should not become effective until such arrangements have been mutually agreed to in writing.
- Facilitate inter-institutional cooperation in education by such means as faculty exchange, discussions on curricula development, teaching and evaluation techniques, seminars, workshops or symposia.
- The faculties of both schools agree to participate in education programs such as didactic lectures, clinical preceptorship, seminars, electives, grand rounds, and continuing and post-graduate education as deemed appropriate.
- Encourage cooperative research efforts and the application for external funding in the basic and clinical sciences by means of faculty exchange, sharing of laboratory resources and sharing of technical expertise.
- Develop a cooperative arrangement in clinical education by reciprocally granting credentialed individuals faculty rank and/or clinical privileges, and by integrating medical and optometric staff, fellows, residents and students into appropriate clinical activities at each other’s institution.
- Optometry school agrees to recognize the hospital and clinical faculty of the medial schools as the preferred providers of general medical and surgical care, ophthalmic surgical care and associated ancillary services for optometric patients.
- Medical school agrees to recognize school of optometry and its clinical faculty and residents as the preferred providers of optometric care.
- Optometry school agrees to make available members of its faculty to provide optometric services at medical school/hospital in accordance with mutually approved policy, protocol and procedures. This would include endorsement and signing of standing orders by appropriate medical director to allow optometric staff to treat eye disease if not permitted by state statue.
- Medical school agrees to make members of its faculty available to provide onsite services at college of optometry’s clinical facilities.
- Medical school agrees to make members of its faculty available to provide 24-hour emergency consultation and support services for optometric staff and residents.
The following should also be considered:
- Use of an external consultant experienced in hospital/institution mergers to review the affiliation structure.
- Creation of a third entity for administration of the various joint programs and for resources development purposes, e.g., The Foundation for Optometric/Medical Eye Care.
- Jointly sponsored grant application should be considered to offset start-up costs.
Conclusion
I have attempted in this brief presentation to outline the benefits and potential costs of medical school affiliation. Although there many be alternative means of enhancing optometric education and training with less political risk, affiliation appears to offer an immediate opportunity for quantitative and qualitative improvement in our ability to prepare optometrists to treat eye disease.
Journal of Optometric Education.
Volume 12, Number 2. 1986.
Charles F. Mullen, O.D.