Charles F. Mullen

Challenges and Opportunities in Optometry and Optometric Education

Principles for Optometry to Follow in Developing Specialties and Subspecialties

The following principles have proven to be effective by Medicine in the administration of Specialties and Subspecialties. The principles are widely recognized by accrediting groups, insurance carriers, health care institutions and providers:

  • Nomenclature
    • The name of the Residency Program must be the same as the Clinical Specialty, e.g. Family Optometry, Pediatric Optometry, Low Vision Optometry, and Medical Optometry.
    • The name of the Post-Residency Fellowship must be the same as the Clinical Subspecialty, e.g. Glaucoma, Retina, Cornea/External Disease, Neuro-Ophthamic, Sports Vision, Geriatric Vision, Adolescent Vision, etc.
  • Each Specialty must have its own Certification Board.
  • The Certification Board determines the requirements for Specialty and associated Subspecialty certifications.
  • Only the Specialty Certification Board can grant Specialty and Subspecialty Certifications.
  • Residency Trained clinicians must first be certified in the Specialty by the parent Specialty Board before qualifying for Subspecialty Certification.
  • Only clinicians who are Board Certified in a Specialty may use the title, Specialist, and only those certified in a Subspecialty may use the designation of Subspecialist.
  • Each Specialty Certifications Board submits to oversight by an independent third party*.

*In Medicine, Specialty Boards are overseen by the American Board of Medical Specialties (ABMS). In Optometry, Specialty Boards are overseen by the American Board of Optometry Specialties (ABOS).

by Charles F. Mullen

Three Critical Components for Expanded Scope of Optometric Practice

Introduction

Medical Education leads the Medical Profession by developing the educational structure and clinical training programs in advance of new patient care initiatives. In contrast, State Optometric societies lead the Optometric Profession with Optometric Education reacting to the States’ expanded scope of practice initiatives with specific educational programs. Consequently, there is not a comprehensive educational structure nor a uniform indicator of an optometrist’s knowledge and clinical skills to support all of the States’ expanded scope of practice initiatives.

Requiring postgraduate clinical training in medical eye care for optometrists is not only essential preparation for Expanded Scope of Practice, but also positions optometry for inclusion in the $18 billion Graduate Medical Education Program (GME).

These are the three missing components that need to be developed:

1) Necessary Capacity for Advanced Clinical Training in Medical Eye Care

  • In 1931 Medicine acknowledged that clerkships contained within the four year medical school curriculum were inadequate preparation for rapidly changing medical practice, and instituted mandatory postgraduate clinical training.
  • Even though optometric practice has dramatically and rapidly expanded encompassing medical eye care, clerkships within the four year optometry curriculum remain the only required clinical training component.
  • The current four year curriculum does not provide optometry graduates with the types and quantity of clinical teaching encounters necessary to practice expanded scope of practice in all States.
  • Postgraduate clinical training in medical eye care is now essential preparation for advanced optometric practice.

2) Federal Funding to Support Advanced Clinical Training

  • Optometry is not included in the $18 Billion Graduate Medical Education Program (GME) because clinical education takes place primarily within the four year curriculum, and not in postgraduate residencies.
  • Inclusion in GME, the educational component of Medicare, would not only encourage the development of new residency positions in Medical Eye Care by providing funding to host facilities, but also by providing funding to directly support advanced clinical training.
  • Optometric Education needs to change from providing clinical education within the current four year curriculum to a Postgraduate Clinical Training Model to qualify for GME.
  • Like medicine, clinical clerkships or rotations would take place within the final years of the curriculum.

3) Nationally Recognized Certification Board to Provide a Uniform Indicator of an Optometrist’s Advanced Knowledge and Skills to Practice Expanded Scope of Practice Optometry

  • The American Board for Certification in Medical Optometry (ABCMO) is a well-established Board that meets GME expectations. However, ABCMO serves mostly Department of Veterans Affairs (VA) optometrists, and needs to be recognized by the entire Optometric Profession.

More Information

by Charles F. Mullen

Six Required GME Structural Elements – Postgraduate Clinical Programs/Residencies in the Specialty of Medical Optometry

1. Inclusion In the Graduate Medical Education (GME) Program

2. Mandatory Postgraduate Residencies Facilitate Specialty Training Followed by Board Certification

3. Accreditation

4. Definition of the Specialty of Medical Optometry and Associated Subspecialties

5. Medical Optometry Specialty Certification Board

6. Oversight Board for All Specialties

by Charles F. Mullen

Recommended Briefing Points for Advocates of Optometry’s Inclusion in GME

Background

  • Optometry is a significant provider of medical eye care services to Medicare beneficiaries ($1.33 billion annually) for conditions such as glaucoma, cataracts and retinal diseases, but is not included in the Graduate Medical Education Program (GME), the educational component of Medicare.
  • Medicine, Podiatry and Specialty Dentistry receive $18 billion in GME support annually for postgraduate clinical education. Podiatry was included in GME in 1972 by amendment, and changed its clinical training model in 1990. Podiatry now receives regular GME payments to support resident training.
  • It will be necessary to include Optometry in GME by amendment to appropriate laws/regulations or by inclusion in proposed legislation in advance of the introduction of a new optometry postgraduate clinical education model.

Clinical Training of Optometrists

  • Optometry has traditionally provided clinical education within the four year optometry school curriculum with postgraduate clinical training being optional, thus, optometry’s current clinical education model does not meet GME requirements.
  • Costly, optometric clinical education receives no Federal Support, and is largely financed by student tuition contributing to high graduate debt of approximately $200,000.
  • Optometry graduates have the highest loan payments as a percentage (14.9%) of income of all professions.
  • High debt is a contributing factor in that applicants to optometry schools and colleges have not effectively increased in 10 years.

Reasons Optometry Should be Included in GME

  1. Nationwide expansion of the scope of optometric practice by numerous changes to State Practice laws.
  2. A steadily increasing demand in providing Medicare beneficiaries with medical eye care services – Optometrists currently provide $1.33 billion in services annually managing serious eye conditions of Medicare recipients.
  3. A major increase in optometric management of serious eye conditions will accompany the proposed addition of refractive care (refraction, eyeglasses and contact lenses) in Medicare.
  • The above will require the schools and colleges of optometry to restructure their traditional clinical education approach into a Postgraduate Medical Clinical Educational Model in order to provide the quantity and diversity of clinical teaching encounters necessary to properly prepare optometry graduates for clinical practice.
  • In 1930 Medicine adopted required postgraduate clinical training because the 4 year medical school curriculum did not provide the quantity and diversity of clinical encounters to properly train physicians.
  • Postgraduate optometric clinical education can be provided in cost effective outpatient facilities. GME’s hospital-based training requirement needs to be waived.

Optometry’s Inclusion in GME is Necessary

  • GME is needed to support optometry’s postgraduate clinical education to meet current and future demand for well-trained optometrists in advanced medical eye care practice.
  • GME support will ensure a sufficient number of well-trained optometrists to meet current and projected demand for eye care services of Medicare beneficiaries.

See Also

by Charles F. Mullen