For the professions of Law, Optometry, and Pharmacy too many schools and too many graduates have resulted in declining employment opportunities and declining applicants for admission. Current efforts to address this often complex and highly political issue of oversupply have been inadequate.
The following interview was published in Optimum VA, The Official Newsletter of the National Association of Veterans Affairs Optometrists (NAVAO), Summer 2015.
Upon being asked to be featured in the NAVAO Optimum VA Newsletter, Dr. Mullen expressed the following:
“Thank you for your kind invitation to share my experiences in VHA and also to offer recommendations for the future of VA Optometry. It is an unexpected privilege to recall my tenure as Director,
VA Optometry Service (1990-96). In reviewing my files in preparation for this interview, I remembered the many outstanding VA optometrists whose dedication and support were essential in developing and implementing the objectives of the Optometry Service Strategic Plan. It was an honor to have such outstanding clinicians and educators as colleagues.”
How did you first become actively involved with VA Optometry?
In the 1970s, while serving as the Director of NECO’s clinical program, Dr. Ken Myers, Founding Director of the VA Optometry Service, called and asked if NECO was interested in sponsoring a VA funded residency program at the Boston VA OPC. After establishing the OPC residency program and agreeing to further development of residency programs at other Boston VA facilities, I then served on Dr. Myers’ Advisory Group for a number of years. Ken and I shared a similar view on the importance of optometrists practicing in collaboration with physicians. I became increasingly interested in the potential that VA Optometry could offer in advancing the Profession of Optometry in patient care, clinical education and research. When Dr. Myers resigned as Director in 1990, I enthusiastically agreed to succeed him.
What contributions to VA Optometry have you participated in that you feel proud of?
After arriving at VACO, I soon learned that Dr. Myers had built a solid foundation for the VA Optometry Service. His meticulous attention to detail in working with the AOA Washington Office positioned VA optometrists in Title 38 along with physicians and dentists. Dr. Myers wrote the Qualification Standards which established very high standards for the appointment and promotion of optometrists. He also developed the first optometry residency program and academic affiliation with a college of optometry, and later established numerous clinical training programs for optometry students and residents. He wrote the Optometry Service’s first Plan and encouraged the development of NAVAO. Although my contributions pale in comparison to the significant accomplishments of Dr. Myers, I am proud of the following:
- Appointed the first Optometry Field Advisory Group.
- In collaboration with NAVAO, ASCO and the AOA, I updated and enhanced the Optometry Service Strategic Plan. ASCO forwarded the Plan to VACO and the Undersecretary for Health instructed me to implement the key elements of the Plan including the addition of 53 centrally-funded optometry positions, 21 residents and the necessary eye care equipment.
- At the invitation of the Undersecretary for Health, briefed the senior administration of VHA on all aspects of the Optometry Service and gained standing in VACO for the Optometry Service.
- Standardized the optometry clinical education program in cooperation with ASCO.
- Disseminated numerous clinical guidelines including preferred practice patterns, credentialing and privileging, eye care space criteria, staffing models and productivity standards.
- With assistance from several NAVAO members, conducted a system-wide inventory of all VHA eye care (optometrists and ophthalmologists) manpower, facilities and training programs. The results were presented to SMAG by the Optometry Representative along with recommendations to further increase eye care manpower, facilities and equipment.
- At the request of the VHA senior administration, interviewed and recommended for appointment the first ophthalmological consultant to VHA, and effectively advanced an agenda of cooperation between the two eye care disciplines.
- Appointed by the Undersecretary for Health to a high level Eye Care Advisory Group consisting of nationally recognized optometrists and ophthalmologists. In consultation with the Group, advised the Undersecretary on policy to improve collaboration between the two eye care disciplines in patient care, education and research.
- Stimulated research in low vision rehabilitation with $6 million in funded research projects.
- Reduced the average waiting time for primary eye care services by 30%.
- Initiated a nation-wide recruitment effort to reach under-represented groups for placement in VA optometry staff and residency positions resulting in a significant increase in female staff and residency appointments.
What advice would you give to new ODs entering the profession?
Complete a Specialty Residency Program and achieve Specialty Board Certification preferably in Medical Optometry. The most challenging and rewarding positions in optometry will be within hospitals and other medical facilities and specialty credentials will be required for appointment.
What would you like to see happen in the future of VA Optometry?
Dr. Townsend has done an outstanding job in increasing the number of VA optometrists, residents and students on clinical rotation. He has instituted innovative programs such as research fellowships while significantly expanding low vision programs. He has developed the VA Optometry Service into one of the most productive in VHA. The Eye Care Handbook he authored has positioned optometry as a major patient care and clinical training component in the VA as an equal partner with ophthalmology. The Handbook is considered the model for all optometry programs located within medical facilities.
Despite the impressive progress, more needs to be done. I would like to see the following completed in the next two years.
- Optometry Qualification Standards updated to include requirements for Specialty Residency Training and Specialty Board Certification in appropriate sections.
- Optometry Service Strategic Plan Updated in collaboration with NAVAO, ASCO and AOA and submitted to the Undersecretary for Health with specific recommendations.
- Restrictions or caps on optometrists pay removed to encourage retention of the most experienced clinicians.
- Optometry Service Field Advisory Group to brief the new Optometry SMAG Representative on the challenges and opportunities in VA Optometry.
- Encourage more active involvement of academic affiliates with VA facilities including participation on Deans Committees and other advisory groups.
- Appointment of a VA representative to the ACOE.
- Continue VA Optometry’s leadership in Specialty Training and Board Certification by ABCMO. Encourage the development of the American Board of Optometry Specialties (ABOS) similar to the American Board of Medical Specialties (ABMS). This oversight board would establish and ensure high standards for all Specialty Certification Boards.
Thank you for the opportunity to share my VA experiences with NAVAO.
Law schools waited too long before taking action to address the oversupply of lawyers and now face the crisis of a serious decline in student applicants and underemployment and unemployment of recent graduates.
To read the full article, including complete references, click here.
Law schools waited too long before taking action to address the oversupply of lawyers and now face the crisis of a serious decline in student applicants and underemployment and unemployment of recent graduates. Many law schools face serious financial issues, staff and faculty layoffs. Lower-tier law schools are merging and at least one school plans to close. Increases in law school enrollments (53 new law schools opened since 1973) without corresponding increases in demand have resulted in 45% of recent law graduates unable to find full time employment. The top 14 law schools now find it necessary to employ from 4-17% of their graduating classes. As a result, applications to law school continue to decline – down 37% from 2010.
Optometry schools and colleges now face the similar effects of oversupply (12,672 FTE excess) of optometrists including declining student applicants and declining full time employment opportunities. There were seven new optometry schools added and increased enrollments at existing schools in the last six years without a demonstrated increase in demand. Full time positions with sufficient income to service educational debt are difficult to find, and now 40% of recent graduates practice at two or more part time locations. Even for those employed or self employed optometrists function at only 68% of their practice capacity. Like the legal profession, there are no signs of abatement in the poor full-time employment market or decline in optometry school applicants. The decline in applicants is exuberated by continuing expansion of new optometry schools.
To mitigate the effects of an oversupply of optometrists, optometry schools and colleges’ leadership must immediately acknowledge and directly address the serious challenges impacting on the stability of optometry schools and colleges including:
- Current and future oversupply of optometrist: 12,672 FTE excess now and oversupply remains at 9,000 FTE in the future.
- Increase in number of optometry schools and increased enrollments at existing schools: Seven new schools added in last 6 years while graduates increased from 1127 in 1997, when supply equaled demand, to 1600 now. At full enrollment of all schools, graduates will increase to over 1800.
- Decline in the student applicant pool – less than 1.5 applicants per entering seat, while number of entering seats has increased from 1160 to 1763 in six years.
- High graduate debt – over $200,000 for many graduates vs. income potential to service debt.
- Decline in college age students – .5 million less than in 2012.
- Decline in full-time employment opportunities for recent graduates. 40% of graduates practice at multiple part time locations.
- Lack of Federal support for clinical training, scholarships and loan repayment – Optometry excluded from $11.5 billion Graduate Medical Education Program, National Health Service Corps and Title 7 programs.
In view of the data in the Rand, Abt. and Lewin Optometric Manpower Studies indicating a substantial excess of optometrists, it would be prudent to mitigate the effects of a decline in full time employment of graduates and decline in applicants for admission by the following actions:
Action 1: Proactively Address the Oversupply of Optometrists
- Reduce enrollments at all schools and colleges of optometry and adjust corresponding revenue and expense projections.
- Demand clarification and correction of Bureau of Labor Statistics (BLS) projections. It appears these projections are significantly contributing to the oversupply of optometrists by encouraging the development of new schools of optometry. Conflicting data on optometric manpower: Rand Study-1995, Abt.Study-2000 and Lewin Study-2014 all indicated significant surpluses. Meanwhile the Bureau of Labor Statistics (BLS) projects high demand for optometrists. In view of all the evidence and studies to the contrary, it is logical to assume the BLS based their projections on inaccurate or obsolete data.
- Insist the Accreditation Council on Optometric Education (ACOE) develop quantitative standards similar to medicine and dentistry for evaluating accreditation for new and existing school and colleges of optometry. Only accredit new schools when the quality and quantity of student clinical training opportunities can be demonstrated.
- Increase demand for optometric services by addressing the underlying public health need for eye care in inner-city and rural areas. Only 20% of federally qualified community health centers provide optometric services. However, Boston community health centers have made a successful and sustained 40 year effort to address unmet need for optometric services in inner-city Boston. See: New England College of Optometry Clinical System. Inclusion of optometry in Federal incentive programs (loan forgiveness, scholarships, National Health Service Corps, etc) is essential to providing optometric services in rural and inner-city America.
- Conduct cost analysis of all clinical training venues and adjust clinical training placements to reduce overall operating costs. Review Relative Costs per Clinical Teaching Encounter: Campus-based clinics are by far the most costly. ($100-350). Affiliated facilities less ($10-30). Externships least costly ($.50-1.00).
- Visit/Revisit the advantages of a Faculty Practice, integrated with clinical training, in terms of increased IEI revenue, supplemental faculty income, faculty recruitment/retention and compliance with Medicare/Medicaid Guidelines for Teaching Physicians. Faculty Practice also addresses the Center for Medicare/Medicaid Services (CMS) compliance vulnerabilities by changing from a Student-Centered Clinical Training Model to a Physician-Centered Program. Students cannot provide billable services to Medicare and other insurance plans. Two Optometry Schools fined for violations with current Student-Centered Training Model. Combined fines are nearly $1.0 million.
- To provide full-time employment for graduates, optometry schools and colleges should fund government related fellowships. These positions would be used to provide experience to graduates in Federal and State health care policy.
Action 2: Address High Graduate Debt vs. Income Potential
- Reduce student debt by shortening the length of overall education for the OD degree. Eight medical schools (DO & MD) have or are developing three year programs. Salus University/PCO is piloting a three year program. NECO has in the past offered a 3-year program.
- Encourage accelerated admissions from undergraduate institutions.
- Remove course redundancies and move selected course work to undergraduate prerequisites.
- Reduce student debt by qualifying for Federal scholarships and loan repayment programs, such as the National Health Service Corps and Title 7, Section 747 through a comprehensive Federal advocacy strategy.
Action 3: Federal Funding for Clinical Training
Create eligibility for the $11.5 billion Graduate Medical Education (GME) program by restructuring the curriculum, changing state licensing requirements and aggressive advocacy to amend the Social Security Act to include optometry. Restructure the curriculum to potentially qualify for GME, the educational component of Medicare: New model would consist of 3 years for OD degree + final year of postgraduate training to qualify for licensure and board eligibility. Social Security Act amended to include optometry and training in outpatient facilities. GME pays an average of $100,000 per medical resident annually to hospitals. Requiring postgraduate training for state licensure along with Board Certification would place optometry in parallel with medicine and enhance qualification for the GME program. “Best Practices” model would parallel medicine and consist of degree + postgraduate training = licensure + specialty board certification. See: Changes Necessary to Include Optometry in the GME Program.
- Apply for a Center for Medicare/Medicaid Services (CMS) Innovation Grant to fund a pilot project of the new curriculum/clinical training model (3 years for OD + 1 year of postgraduate training).
Action 4: Investigate Alternative Strategies to Prevent Financial Crises at Schools and Colleges
- Explore mergers of optometry schools and colleges.
- Diversify educational offerings to the high demand professions such as:
- Primary Care Medicine (MD) or (DO)
- Physicians Assistants
- Consider innovative programs with established universities or Health Sciences Centers (HSC). See: ICO and University of Chicago Affiliation and Opportunity for Osteopathy to Develop Innovative Optometric Educational Model.
The Legal Profession
- Lowering the Bar: Law Schools Compete for Students Many May Not Have Admitted in the Past. Inside Higher Ed. 2015.
- Crop of New Law Schools Opens Amid a Lawyer Glut. Jennifer Smith, The Wall Street Journal. 2013.
- Job Market for Would-Be Lawyers Is Even Bleaker than It Looks. M Hansen, American Bar Association Journal. 2013.
- In Defense of Law Schools Hiring Their Own Graduates. Above the Law, by David Lat. 2013.
- Law School Transparency (lawschooltransparency.com)
The Optometry Profession
- Report on 2012 National Eye Care Workforce Survey of Optometrists. The Lewin Group. 2014.
- Eye Care Workforce Study: Supply and Demand Projections. The Lewin Group. 2014.
- A Quantitative Analysis of Optometry Density. K J Myers, Ph.D., O.D. Editorial. 2014.
- Lewin Survey Finds Large Optometry Surpluses. K J Myers, Ph.D., O.D. Editorial. 2014.
- Study on Establishment of New Optometry Schools. University of North Carolina Board of Governors. December, 2014.
- Annual Student Data Reports. Association of Schools and College of Optometry. 2013.
- Unresolved Matters of Importance to Optometric Education. C Mullen, L Walls. 2011.
- Assessing the Need for On-Site Eye Care Professionals in Community Health Centers. P Shin, B Finnegan, George Washington University. 2009.
- Reducing Visual Health Disparities in At-Risk Community Health Center Populations. Journal of Public Health Management. S Pimo, R Wilson, et al. 2009.
- Abt. Associates Inc., Workforce Study of Optometrists. A J White, C White, T Doksum. 2000.
- RAND, Estimating Eye Care Provider Supply and Workforce Requirements. PP Lee, CA Jackson, DA Rolles. 1995.