GME Archives - Page 3 of 7 - Charles F. Mullen

Optometric Education in Crisis

COVID-19, Racial and Ethnic Unrest Making the Situation Worse

Higher Education including Optometric Education is in crisis because of declining enrollments. There is too much student capacity and not enough demand. There are 2.9 million fewer college age students than 8 years ago. Ninety-three colleges and universities have closed or merged since 2016, and Clayton Christensen of Harvard predicts 50% of the 4000 colleges and universities will be bankrupt, close or merge by 2035.

Schools and Colleges of Optometry must act now by developing and implementing strategies to deal with the Crisis. The following Power Point slides delineate:

Causes of Higher Education Crisis
Causes of Crisis in Optometric Education
COVID-19 Pandemic is Making a Fragile Situation Worse
The New Normal in Optometric Education
Contingency Plans Needed to Address Virus Spread and Violence
Racial and Ethnic Unrest
Financial Concerns
Structural Issues Contributing to Crisis
Marketing and Advocacy Initiatives
Innovative Strategies
Fragmentation in the Practice of Optometry
Issues Facing Optometry
Re-Imagine Optometric Education
Enhance Appeal of a Career in Optometry
Elements of a New Educational Model
Partnering With Ophthalmology Residency Programs

Crisis in Optometric Education (PowerPoint)
Crisis in Optometric Education (PDF)

Additional Resources

Opportunities Lost – Opportunities Regained

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.

Decision One

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.

Decision Two

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.

Opportunities Regained

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

Notes

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).

A Unique Opportunity for Osteopathic Health Sciences Centers to Develop an Innovative Optometry Degree Program and Postgraduate Residency Training

The expanded use of technology will significantly alter the traditional role of optometrists over the next 10 years. Large corporations with sophisticated marketing will dominate the multi-billion dollar eye care market. However, there is unmet need for medical eye care in the Medicaid and Medicare populations, and with changes to optometric education and clinical training, this unmet need can be addressed. State and Federal legislative/regulatory advocacy would need to be initiated concurrently with the development of the new optometric educational model.

Osteopathic Health Sciences Centers across the Nation currently offer innovative curricula in medical and other health care professions’ education, and now have a unique opportunity to develop and offer an innovative program in optometric education and residency training that would prepare optometrists to provide medical eye care. Such a new program would replace the traditional optometric curriculum where clinical training is contained within the four year degree program. Having no requirement for postgraduate clinical training, optometry is not eligible for the multi-billion dollar Graduate Medical Education (GME) program.

Optometrists are classified as physicians under Medicare and are judged by medical standards including specialty clinical training and board certification. Optometric education must now align with national standards and guidelines derived from medical education.

Such a proposed restructuring plan is politically challenging with numerous sensitive professional and educational issues. Implementation of the plan requires bold leadership. I look to Osteopathic Health Sciences Centers with their tradition of leadership and innovative programs to lead the change in optometric education. This proposal recommends restructuring optometric education and postgraduate training by placing it in parallel with medicine.

New Program

Three Years for OD Degree + One Year Postgraduate Training = Licensure

Three years of classroom education, laboratory and clinical clerkships to earn the Doctor of Optometry (OD) degree followed by one year of postgraduate clinical training for licensure in General (Traditional) Optometric Practice. This would replace the current 4th year which essentially is the first year of residency training.

One Additional Year of Specialty Clinical Training to Provide Medical Eye Care.

One year of additional specialty clinical training in medical eye care and Board eligibility required by State Optometry Regulatory Boards to provide medical eye care.

Advantages of the New Curriculum and Clinical Training Model Include:

The new model would encourage specialty clinical training and board certification as emphasis would shift from General (Traditional) optometric practice to primarily medical eye care.
By restructuring the curriculum and requiring postgraduate clinical training, optometry would become eligible for Graduate Medical Education (GME) payments to address clinical training costs.

Actions Required

Apply for a Center for Medicare/Medicaid Services (CMS) Innovation Grant to Fund Implementation, Entitled — “Restructuring of Optometric Education and Clinical Training To Meet Unmet Need for Medical Eye Care in Medicare/Medicaid Populations”
Amend States’ optometric licensing laws/regulations to require a minimum of one year of postgraduate, residency training in General/Traditional optometry for licensure.
And require an additional one year of training in specialty medical eye care with Board eligibility to practice medical eye care.
Amend the Social Security Act to include optometry in the Graduate Medical Education Program (GME) and expand GME support of residency training to all optometric clinical training venues.

Transformation of Optometry – Blueprint for the Future

Introduction

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.

Schools and Colleges of Optometry Must Lead the 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)

State Optometric Societies and State Optometry Regulatory Boards

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.

AOA/State Societies: Optometry Advocacy

8. Medical services provided by optometrists recognized by third party payers. This will require persistent monitoring by optometry advocacy groups.

Conclusion

ASCO, AOA and related organizations should initiate discussions among their respective members regarding the transformation of optometry from traditional practice to medical eye care.

Transformation of Optometry (Power Point)