Challenges and Opportunities in Optometry and Optometric Education
To celebrate the Centennial of the Pennsylvania College of Optometry (PCO), Salus University compiled a history of its Founding College.
Below you will find a link to Who’s Who – Dr. Charles F. Mullen a biography about Dr. Mullen’s contributions to PCO and early years of the Eye Institute.
Over the next 10-15 years, the expanded use of technology will significantly alter the traditional role of optometrists. Large corporations with advanced technology and sophisticated marketing will dominate the multi-billion dollar eye care market. With expanded commercialization, the traditional role of the optometric practitioner will be diminished, and the professional standing of optometry threatened.
Fortunately, with unmet medical eye care needs in most areas of the country, an opportunity for optometrists to become primarily medical eye care practitioners has emerged. Leaders in optometric education, and the profession of optometry’s leadership must act now in an comprehensive and coordinated manner to properly transform optometrists into medical eye providers.
I present the following recommendations as a blueprint for the future. Thoughtful planning and timely action by ASCO, AAO, NBEO, State Societies, ARBO and the AOA are essential to the transformation of the profession of optometry, and to ensure optometry’s standing as a major health care profession.
1. ASCO must follow the example of academic medicine, and proactively lead the Profession. Schools and colleges of optometry must revise their basic curriculum and adopt the medical postgraduate clinical training model. The Future of Optometric Education – Opportunities and Challenges
2. There must be a significant expansion of postgraduate/residency programs in medical eye care. Current programs: ORMatch Participating Programs
3. Optometry specialties/subspecialties terminology and qualifications clarified and additional certification boards established. The State of Optometry Specialties and Subspecialties
4. A recognized and credible Specialty Certification Board in Medical Optometry has been established, and is essential to the verification and recognition of medical treatment credentials for optometrists. The American Board of Certification in Medical Optometry (ABCMO)
5. With a medical postgraduate clinical training model in place, optometry should qualify for inclusion in the Graduate Medical Education (GME) Program. Changes Necessary to Include Optometry in the Graduate Medical Education Program (GME)
6. State optometry practice laws amended to authorize comprehensive medical treatment of the eye and adnexa, clinical procedures and prescriptive authority for optometrists. Expanded scope of practice precedents have been established in most states, however, all states must permit comprehensive medical treatment without restrictions.
7. State Optometry Regulatory Boards to require one year of accredited postgraduate clinical training (residency) in medical eye care for licensure. See: Required Postgraduate Clinical Training for Optometry License
Mandatory postgraduate clinical training in medical eye care followed by Board Certification should convince State/Federal officials and legislators that optometrists are thoroughly prepared to comprehensively treat eye disease without restrictions.
8. Medical services provided by optometrists recognized by third party payers. This will require persistent monitoring by optometry advocacy groups.
ASCO, AOA and related organizations should initiate discussions among their respective members regarding the transformation of optometry from traditional practice to medical eye care.
Over the past 47 years, State optometric practice laws have been expanded to include more medical procedures, treatments and management of medical conditions but often with restrictions. Individual State regulatory boards have reacted to expanded practice laws by requiring additional clinical training and/or instruction to perform the new clinical privileges granted. Thus, requirements for optometry practice can often vary by State.
State officials and legislators are reluctant to grant the full range of clinical treatments and procedures to optometrists because of limitations in optometrists’ clinical training. There is concern about the number and diversity of clinical encounters currently experienced in the four year optometric curriculum. Medicine and optometry both have four year basic curricula, however, medicine requires postgraduate clinical training while it is optional in optometry.
The entire optometry curriculum (academic and clinical) must be completed in just 4 years with no required postgraduate clinical training. Consequently, clinical training is limited, especially in the number of medical clinical teaching encounters, and in diversity of encounters to thoroughly prepare the graduate for the provision of current medical procedures, treatments and management. Also, not all optometry schools have access to sufficient numbers of patients with medical conditions necessary for clinical teaching.
Medicine introduced postgraduate clinical training in 1930, as one year internships (now considered first year of residency), to compensate for the limited number of student clinical teaching encounters in the Medical School curriculum. One to three years postgraduate (residency) clinical training is now required for medical licensure. Overall, physicians spend an average of 4 years in postgraduate specialty clinical training leading to specialty board certification. See also American Board of Medical Specialties (ABMS).
It is time for optometry to follow medicine’s example by mandating a minimum of one year postgraduate clinical training (residency) in an accredited medical optometry postgraduate program or equivalent for licensure to compensate for limited student clinical encounters in medical procedures, treatments and management in the optometry school 4 year curriculum, and to ensure uniformity in clinical medical training among all states.
Optometry residency training began 40 years ago and has grown such that today 25% of graduates, prior to entering practice, elect to serve a postgraduate residency (PG-1) in an optometry specialty of which the most popular is medical optometry. This is a significant shift towards postgraduate residency training and a sign the O.D. degree and license, while adequate to insure competence in general practice, can no longer insure competence in all areas of optometry practice. The profession of dentistry began to train and certify dental specialists prior to optometry. Medicine began to develop specialist residencies even earlier, about 90 years ago.
The movement towards optometry specialization began within the U.S. Department of Veterans Affairs in 1975 as an effort to prepare optometrists via residency training for practice within medical facilities in which they would encounter chiefly medical eye conditions, rather than refractive errors, and be trained to make appropriate referrals as required for surgical treatments while providing primary medical eye care.
The Association of Schools and Colleges of Optometry (ASCO) now lists 11 types of optometry specialty residency programs as well as a residency matching service and the Accreditation Council on Optometry Education accredits most optometry specialty residency programs.
At this time only the specialty of medical optometry has in place the accepted 3-step process to certify competence as a specialist required by Joint Commission accredited health care facilities and their credentialing committees. This recognition permits their credentialing as a specialist in medical optometry at accredited health care facilities and is the same as that required for medicine, osteopathy, dentistry, and podiatry specialists by credentialing committees at Joint Commission accredited health care facilities.
Such credentialing of specialists must be utilized for optometry specialists since optometrists are classified by the Centers for Medicare and Medicaid (CMS) as “physicians” for credentialing purposes and the Joint Commission requires this form of credentialing of all independently prescribing members of the medical staff which includes optometrists following a 1986 policy statement by the Joint Commission that authorized placing optometrists on the medical staff of accredited facilities and granting them clinical privileges.
Medicine, osteopathy, dentistry and podiatry have coordinating boards or committees that set the standards and requirements through which defined areas in their professions are recognized as specialties and by which its practitioners can become board certified specialists.
A key requirement of any profession’s specialty coordinating board is that it be free of real or apparent conflicts of interests with trade associations and all bodies responsible for accrediting residencies or preparing and administering specialty written examinations, in order to avoid “regulatory capture” and ensure autonomy of its actions. Such boards must also operate as a nonprofit corporation and have governance that includes representatives of the public.
Optometry has had no such coordinating board for optometry specialties to set the standards by which an optometry specialty is recognized and its practitioners are certified other than for the specialty of medical optometry whose specialty board is now recognized by credentialing committees at Joint Commission accredited health facilities and private practices. Specialty boards for the other optometry specialties have yet to be formed.
The US credentialing system of health care providers recognizes as specialists those practitioners of medicine, osteopathy, dentistry, optometry and podiatry who meet three requirements for recognition by credentialing committees at Joint Commission accredited health care facilities. These requirements are below:
This recognized, national 3-step process is commonly termed “board certification” and those holding such certifications are credentialed as board certified specialists within defined areas of their licensed profession by credentialing-licensing committees at Joint Commission health care facilities. Those completing the 3-step process may refer to themselves as “board certified” in their specialty.
Since specialists often practice within accredited health care organizations and private group practices having credentialing committees, it is highly advantageous to be board certified in one’s specialty.
The incorporators of ABOS believe all optometry specialties should have the same credentialing opportunities now available only to those completing residencies in medical optometry.
The current inequality of career opportunities to pursue one’s chosen specialty requires the establishment of additional specialty boards and written specialty examinations that meet the same high standards required of medical optometry specialists and those of recognized credentialing committees.
The American Board of Optometry Specialties (ABOS) has as its main mission, the encouragement, support and further development of optometry specialty boards and specialty examinations that meet, or exceed, the standards and expectations for acceptance recognition by credentialing committees at Joint Commission accredited health care systems as specialty boards.
To address the lack of specialty boards and written examinations for other optometry specialties ABOS will establish standards to be met by which ABOS will recognize a specialty, its residency programs and written specialty examination.
In addition, ABOS will, upon request, provide counsel, advice, and fiscal support to nascent optometry specialty boards and work with them to acquire ABOS recognition.