Healthcare Archives - Page 3 of 7

Testimony in Support of Senate Bill 1255, An Act Relative to the Modernization of Optometry

I am Charles Mullen. I am a graduate of the University of Virginia and received my Doctor of Optometry degree from the New England College of Optometry. I have over 36 years of experience in optometric education at three institutions. I am the former President of the Illinois College of Optometry and former Director of the Department of Veterans Affairs Optometry Service, the largest optometric patient care and clinical training program in the Nation. Currently I serve on the Board of Trustees of the Pennsylvania College of Optometry and the Board of Directors of the New England Eye Institute. I am also an Adjunct Clinical Professor at the State University of New York.

My remarks today pertain to the impact that the current restriction on Massachusetts optometrists treating glaucoma has on the clinical education of students enrolled at the New England College of Optometry. From a national perspective, this restriction places the College and its faculty at a competitive disadvantage for the best and brightest applicants for admission. Upon learning of the restriction in the treatment of glaucoma, many highly qualified applicants and, for that matter, many highly qualified optometrists seeking a faculty appointment at the New England College of Optometry choose other Colleges of Optometry – simply because Massachusetts cannot offer the comprehensive opportunities they are seeking. No other optometry school across the country faces this problem.

Forty-nine states permit optometrists to treat glaucoma. It is now the national expectation; if not the standard. Students of the New England College of Optometry are expected upon graduation to be fully prepared to treat eye disease; including, the management of patients with glaucoma. Yet, without the ability to practice in Massachusetts, the New England College of optometry must seek training venues outside the Commonwealth or in federal facilities where the treatment of glaucoma is permitted. This is ironic given that Massachusetts is known to be a world leader in health care education. Forty-nine states and the federal system allow for optometrists to treat glaucoma, but the home state of one of the best optometry schools does not. Again, no other optometry school in the Nation is so limited.

Nationwide, optometrists provided $846 million in eye care services to Medicare beneficiaries in 2006. As the incidence of glaucoma increases with age and with the onset of the “baby boomer” retirement, graduates of the New England College must be fully prepared to meet the health care needs of the rapidly growing elderly population. This means they must be able to treat glaucoma.

I can assure you that optometric education and the profession of optometry are constantly evolving. Advances in the biomedical and visual sciences impact both the methods of treating patients and the methods of educating students. Given this quickly changing environment, it is essential that optometrists in Massachusetts be granted the authority to treat glaucoma – allowing both the New England College of Optometry and its students to remain competitive on a national level.

Thank you for the opportunity to testify before the Joint committee on Public Health. Accordingly, I respectfully request that this Committee release SB 1255 with a favorable report.

Testimony of Charles F. Mullen, O.D.
Delivered May 2, 2007

My Best Day in Optometric Education: Signing the Affiliation Agreement Between the Illinois College of Optometry and the University of Chicago

In 1996, I accepted the position of president, Illinois College of Optometry (ICO) and brought with me nearly thirty years of experience in collaborative relationships between optometry and ophthalmology. My conviction of the importance of cooperation between the two professions began at the New England College of Optometry in Boston’s community health centers, was carried forward at the Pennsylvania College of Optometry with the affiliation with Hahnemann University’s Department of Ophthalmology. It was tempered by my federal government experience as the director of optometry service at the VA and was fully realized with the signing of a comprehensive patient care, education and research affiliation between ICO and the University of Chicago (UofC).

Thus, October 16, 1997 was my best day in optometric education and reinforced my conviction that cooperation between the two disciplines presents numerous opportunities for enhancing patient care and clinical training for students and residents, and for fostering a better understanding and respect between the two professions, while reinforcing their natural synergism. The affiliation continues to this day, as a vibrant patient care and clinical education collaboration.

Although I remain convinced that affiliation with academic medicine will significantly enhance both clinical education and patient care for both optometry and ophthalmology, there are other challenges that also need to be addressed before optometric clinical education can reach its full potential. Some schools and colleges of optometry have addressed several of these challenges, but much still needs to be done. With continued support from the American Optometric Association (AOA) and the Association of Schools and Colleges of Optometry (ASCO), many of these objectives can be achieved within the next five years.

Include optometry in the federal programs of Graduate Medical Education (GME) and the National Health Service Corps (NHSC).
Increase collaboration with community health care programs and increase commitment to public health responsibilities.
Downsize large single purpose and costly campus-based clinics and replace with smaller referral centers and community-based training sites.
Achieve Joint Commission for the Accreditation of Health Care Organizations (JCAHO) accreditation for campus-based and college-operated clinical facilities.
Reorganize the colleges’ clinical programs into separate legal entities with their own administrations and governing boards.
Implement incentive-based compensation (IBC) plans for faculty that integrate student and resident training.
Develop and operate ophthalmic surgi-centers in partnership with medical school affiliates.
Establish a national clearinghouse and placement service for optometric externships.
Fund the Regional Centers of Eye Care Excellence (RCEE) within the Department of Veterans Affairs (VA) and expand the Vision Impairment Centers to Optimize Remaining Sight (VICTORS).

Dr. Mullen was president of the Illinois College of Optometry from 1996 to 2002. He is currently on the Board of Trustees at the Pennsylvania College of Optometry and on the Board of Directors of the New England Eye Institute.

Journal of Optometric Education, 2006

Charles F. Mullen’s Speech at the Kennedy Library: Development of NECO’s Community Based Education Program

Thank you, Barry, for the warm welcome and your kind remarks. It is a pleasure to be back in Boston to celebrate a commitment to excellence in community collaboration and the creation of the New England Eye Institute.

Honored guests.

This morning, I would like to share with you the beginnings of optometry’s first program to collaborate with community health centers to improve access to eye and vision care services and enrich optometric clinical training.

I will attempt in my brief remarks to relate the common elements of the initial program to the new corporate structure and community governance model of the New England Eye Institute. I plan to outline the challenges which, I believe, still lie ahead for the new organization and finally, with your permission, offer a few observations or suggestions from my years of experience in interprofessional cooperation.

In the late 60’s and the early 70’s, the New England College of Optometry decided to expand and enrich the clinical training environments to which its students had access.

We knew that optometry students would benefit from health care environments in which the optometrist was one of many health care professionals contributing to the care of the patient.

Inner-city demographic data suggested that students would have the opportunity to participate in the care of patients with serious eye and vision problems unlike the university students they typically examined at the College’s Kenmore Square Clinic.

We wanted students to learn in a quality health care environment and not a teaching clinic as was customary at that time. Quality clinical training could only be achieved in a quality health care setting.

Coincident with our educational mission and not at all incompatible with it was a commitment to providing eye and vision care services to inner-city residents who were unable to meet this health care need in their own communities.

We concluded that the most promising scheme for fulfilling both our educational and community service objectives was to form an innovative network of affiliations with existing health care centers. Innovation was an important element in the development of the clinical network as it is today for the New England Eye Institute.

As we began to develop the program, any illusions we may have had about the ease of executing our new strategy were quickly dispelled. We learned a lot about skills we thought had nothing to do with eye care or optometric education: about convincing skeptics, compromising, introducing safeguards, planning, and negotiating.

In the first place, there was a reluctance on the part of health center administrators to permit students to participate in their programs.

Historically, the health center community was disenchanted with receiving its health care in the emergency rooms of large teaching hospitals and our proposed program, they thought, was precisely what they were seeking to escape.

Our second problem revolved around the reluctance of medical staffs at some health centers to work directly with optometrists, since the physicians had little experience working with us.

It was necessary to convince the medical staff at a very fundamental level of the ability of optometrists to function in and contribute to an interdisciplinary environment.

We also encountered considerable political pressure from the ophthalmological society which opposed cooperation between optometry and ophthalmology in the new eye and vision care model to be developed in the community health centers.

I am always reluctant to single out individuals for fear of omissions, but I would be remiss without citing the bold leadership of a few who were responsible for the success of the 70’s community eye care initiatives: Health Center administrators, Jim Hooley, Dorchester House, Mel Scovell and Tris Blake of the South End Community Health Center and Bob Morgan of the Dimock Community Health Center in Roxbury. Bill Baldwin, President of the New England College of Optometry for granting me the opportunity to participate in the development of the clinical network.

The optometrists who were willing to pioneer a new approach to interprofessional collaboration: faculty from the New England College of Optometry–Ralph Levoy, Jerry Selvin, Matt Garston, Jeff and Neal Nyman and the young Barry Barresi.

And, three courageous ophthalmologists, David Miller from Beth Israel Hospital and Harvard and Marc Richman and Andre Quamina from Boston University, who believed in the new model and were committed to providing comprehensive eye and vision care to the community health center clients. They withstood the persistent political pressure and the new optometric-ophthalmological interactional model was implemented at the South End and Dimock Community Health Centers and the Dorchester House for the first time in the United States. Bold leadership was as important then as it is now.

This eye care protocol has now evolved throughout the country, more recently into a comprehensive affiliation among the Illinois College of Optometry, the University of Chicago Medical School and its University Hospital System for the provision of ophthalmic care, medical and optometric education and research.

And, the fourth problem had to do with the antagonism our new eye care model aroused among private optometric practitioners, many of whom were our own alumni and friends. They felt that we were intruding into an area that is rightfully theirs.

I was pleased to learn that this issue has been largely resolved through the leadership of the Massachusetts Society of Optometrists.

The common element that emerged throughout the development process was the importance of effective collaboration among all of the constituencies. Community health center boards and community advocacy groups at first were skeptical, then later became strong supporters of the effort. Their support was critical to the success of the program.

The College and health center collaboration soon began to develop into a successful story of mutual respect and aligned missions. These were the key ingredients in improving community access to eye and vision care services in the 70’s, as they are today.

After successfully negotiating a mutually acceptable agreement with the Dorchester House Multi-Service Center and after strengthening our affiliation with the U.S. Public Health Services Hospital in Brighton, we went on to develop additional relationships in Boston. The South End Community Health Center, Dimock Community Health Center, Eye Research Unit of the Joslin Diabetic Foundation, the Kennedy Hospital in Brighton, Cotting School for Handicapped Children, Department of Veterans Affairs Outpatient Clinic, and the Gundersen Eye Clinic at Boston University.

Other institutions, upon hearing of the success of our collaboration and new eye care model, asked for assistance in establishing eye and vision services. These included: the Massachusetts Institute of Technology, Harvard Community Health Plan and the University of Massachusetts at Amherst.

All of these organizations were willing then to take the risks of new programs and innovative approaches to community eye and vision care as the New England Eye Institute member organizations are willing to take the risks of new programs and innovative approaches in this exciting new venture.

In 1976, upon leaving for Philadelphia, I wrote in an article later published in the Journal of the American Optometric Association on my assessment of the initial phase of the program.

We have reason to believe that we have achieved most of our clinical development goals to a greater degree than we ever could have anticipated.

Over 45,000 eye visits were provided to community residents in 1976. Many community residents had never before received eye or vision care.

Our students are seeing more challenging patients than their predecessors saw.

They have learned from and worked effectively with ophthalmologists and with professionals in pediatrics, internal medicine, nursing, psychology, and low vision.

Faculty and students were successful in convincing many that optometrists can make an important contribution in an interdisciplinary health care setting.

A very workable eye care protocol involving technicians, optometrists and ophthalmologists was developed and implemented.

Our graduates have very different professional aspirations as a result of their community health center experience. Some went on to work in community health centers and some have become deeply involved with the whole issue of public health and some are seeking to broaden their education and assume roles in health care policy. We have a living example here today in Barry Barresi.

A new level of innovation and collaboration has been introduced in the 21st century to build on a program created in the 70’s.

A major step was taken by the New England College of Optometry by reallocating its clinical assets into a community governed organization. Even with a history of over 30 years of collaboration, much work is still needed to be done to truly transform the New England Eye Institute into a leading community services organization for Greater Boston and a model for other cities around the country. Several challenges can be identified.

Educational programs need to be expanded to include trainees not only in optometry, but also ophthalmology, medicine, nursing, and other health care professionals, such as occupational therapists, social workers, low vision and blind rehabilitation specialists.

It will not be sufficient to provide only eye and vision services, for the New England Eye Institute needs to embrace a community oriented approach to health promotion and prevention.

The new organization must be flexible and integrated to truly meet the public need. It must position the Institute to meet the needs of special populations – the homeless, the frail elderly, the home bound, the developmentally disabled, the severely visually impaired, and others.

The quality of care must be monitored and maintained with appropriate mechanisms and oversight.

And, development efforts need to be aggressive in seeking the necessary operating and capital funds to support the Institute.

Finally, I would like to conclude with a few observations based on my many experiences in interprofessional collaboration that could be applied to the New England Institute.

The key ingredients in any successful collaboration are mutual respect and aligned missions.

Innovation must be proceeded by careful planning and boldness tempered by fiscal reality.

There are few cities better positioned than Boston to achieve excellence in collaboration to meet the public need in eye and vision care services, in health professions education, and health promotion and prevention.

I urge the many collaborators in this new initiative to reflect on the approaches and successes of a few bold individuals who in the 70’s were willing to take risks of new programs and innovative approaches and apply the same persistence, commitment and risk taking to the New England Eye Institute.

Thank you for remembering me.

Dr. Charles F. Mullen
Kennedy Library, Boston, MA
May 14, 2003

Dr. Charles F. Mullen – Clinical Architect

Dr. Charles F. Mullen – Clinical Architect (PDF)

Today’s optometry students take for granted their ability to train at settings including neighborhood health centers and Department of Veterans Affairs (VA) facilities as part of their clinical education. Yet, these doors were not always open to them. While there were many people who contributed to this welcome change, the man with the vision to know where the profession was going and how to get there is Dr. Charles F. Mullen ’69.

Dr. Mullen, who recently retired as President of the Illinois College of Optometry, spent his entire career designing and reshaping the delivery of clinical education for optometry students and residents. He has advanced clinical education with his keen foresight and forceful leadership. In doing so, he has opened up eye care services to many previously underserved patients.

From 1970-1976 Dr. Mullen served President William Baldwin at The New England College of Optometry (then Massachusetts College of Optometry) as Special Assistant for Clinical Development. Baldwin appointed him shortly after his 1969 graduation.

Between 1976-1990, Dr. Mullen served as executive director of the Eye Institute at the Pennsylvania College of Optometry (PCO). He then directed the Optometry Service at the Department of Veterans Affairs in Washington, DC, from 1990-1996 and in 1996 was selected president of the Illinois College of Optometry (ICO).

Beginning with NECO, Dr. Mullen was able to plant the seeds of moving optometry into the forefront of primary eye care by developing a system that optimally served patients. Perhaps best known for clearly seeing the potential of expanding the scope of the practice of optometry, Dr. Mullen recognized in the early 1970’s that optometrists would be treating eye disease and the necessity for students in the clinical system of NECO to develop new skills. Think of how difficult this was without a single diagnostic or therapeutic drug law in place…

Working to implement new clinical protocols, Dr. Mullen creatively developed teaching affiliations with Boston’s system of neighborhood health centers and other multidisciplinary settings. He did this by partnering with a progressive team of optometrists and ophthalmologists in caring for patients in special and underserved populations as a way of enhancing the education of future doctors of all disciplines.

In the words of Dr. Mullen, “We had a need and wanted to enrich the students’ clinical experience and give them more exposure… we also saw an opportunity to provide eye care services to those who were underserved in the Boston area.”

Breaking Down the Barriers

To reflect back on the 1970s, when Dr. Mullen began his career in optometry, is to see a radically different time than today. Co-management was not the norm, as it is today. Diagnostics and therapeutic pharmaceuticals were the sole province of the medical profession.

Early in his career, Dr. Mullen understood that ophthalmology and optometry were complementary. However, integrating a different model in a resistant health care field would require both conviction and persistence. He and other clinicians saw an opportunity to introduce a primary care system into clinical education and, in 1970, circumstances allowed him to begin his mission.

In 1972, the College was commissioned by the State of Rhode Island to develop the clinical curriculum and certify its Optometric State Board in the use of diagnostic and pharmaceutical agents. Dr. Mullen directed the implementation of the clinical component for the first diagnostic pharmaceutical course and along with Dr. Matt Garston ’66 certified the first diagnostic pharmaceutical certified optometrist in the United States.

Following that milestone, Dr. Mullen collaborated with a team of neighborhood health care and public policy leaders: Tres Blake of the South End Community Heath Center; Bob Morgan of Dimock Community Health Center and the Harvard School of Public Health; Mark Richman, M.D. of Boston University and the South End Community Health Centers; and David Miller, M.D., of Beth Israel and Harvard Medical School. All were committed to enhancing ophthalmologic clinical education and services.

The ophthalmic community and private optometric practitioners were skeptical, but the group stayed the course. Over time, local neighborhood health centers formed partnerships with the College and integrated optometric services and students into their clinical programs. Dr. Mullen is still viewed as the architect of the local model used in Boston and duplicated elsewhere to this day.

Dr. Barry J. Barresi ’77, Vice President for Clinical Care and Services at New England Eye Institute (NEEI), testifies to that fact. “Even today as we meet with Boston’s health care leaders to further expand the NEEI system of community-based clinical sites, many of them vividly recall the innovative leadership of Dr. Mullen some 30 years ago. With his colleagues, he built a strong foundation of community health partnerships. Today these collaborations are fueling continued innovation and growth in the College’s mission of excellence in patient care, clinical education and research.”

Dr. Gerald Selvin ’73, Professor of Optometry at NECO and National Education Chair for the Optometry Service Field Advisory Group of VA Central Office considers Dr. Mullen to have had the largest impact on his development than anyone else in optometry. While still a student, he remembers two particular proclamations made in 1972 which not only greatly influence his practice life but all of optometry.

“Optometrists will be treating eye disease routinely, so we are going to start to teach you how now.”;

“There are no welfare patients, no poor patients, no rich patients… there are only patients, and each individual will be treated with dignity and respect.”

These principles are what Dr. Charles Mullen has always placed above all else…take care of patients compassionately and with expertise. Never having lost sight of these principles is what made Dr. Mullen the visionary he is. And those optometrists who have had the good fortune to be directly influenced by him can imprint these values on a new generation of doctors, continuing his legacy.

The Eye Institute

Then it was time for another professional challenge. In 1976, Dr. Norman Wallis, former president of Pennsylvania College of Optometry (PCO) and now executive director of the National Board of Examiners, approached him about developing an integrated clinical system at PCO for the soon to be built Eye Institute. Dr. Wallis felt that Dr. Mullen was the only person capable of handling this daunting assignment. Dr. Wallis explained to Perspective that PCO’s objective was to establish an enterprise that resembled an “eye hospital.” It would combine the three O’s (opticianry, optometry, and ophthalmology) under one roof. This innovation in eye care education would completely change the character of the clinic, and – ultimately – eye care delivery.

With his characteristic methodical approach, Dr. Mullen set out to implement the model, which would greatly expand the scope of educational and training resources available at PCO. Dr. Wallis recalls why it was so successful.

“Charlie organized the clinic like a military campaign. Every aspect was covered to the greatest detail. It was like Operation Desert Storm.”

In the 1980’s, Dr. Mullen saw changes taking place in the profession and made great efforts to merge the interests between optometry and the medical community. He wrote that, “the impetus comes from outside parties – particularly third-party payers, health care policymakers and legislators – who will attempt to define the roles each profession will play in the future of eye care provision if the two professions do not actively define the roles themselves.”

He knew that the mutual interests could form a bond. Therefore, he initiated several affiliations with medical facilities in the Philadelphia region. The hallmark would be PCO’s affiliation with Hahnemann University, a Philadelphia-based medical college. The two combined their resources and worked to develop “unique approaches to ophthalmic education, eye care provision, and optometric research.”

Meeting More Professional Challenges

In 1990 Dr. Mullen left PCO to head the Optometry Service of the Department of Veterans Affairs in Washington, DC. With this post, he became the highest-ranking civilian optometrist employed by the government. A former Navy officer himself, he was familiar with the need for change in the VA system. True to from, he began a process of systematic restructuring. Under his stewardship, he implemented protocols for clinical privileging and standardized the educational component system-wide at the VHA. These guidelines are the principle force driving policy decisions today. He was also responsible for the sizable growth of the student and residency programs.

Many colleagues, including those at the Department of Veterans Affairs, feel that he was a perfect representative for the optometric profession in Washington. Described as a “visionary,” a “poised ambassador,” and an “executive’s executive,” he based his entire career on teamwork. When asked about his leadership style, Charles Mullen credits Dr. Wallis. “Norman taught me the ability to empower the people who work for you – to trust them and how to delegate authority.”

Another term that is often used in reference to Charles Mullen is “turn-around specialist.” In 1996, he accepted the challenge of the presidency at the Illinois College of Optometry. The institution had gone through a difficult time and needed to be restored to its previous stature.

Dr. Mullen confronted the issues head on, turning ICO into a thriving and stable institution. He implemented a strategic management plan, “Commitment to Excellence,” which restructured the college to address the challenges of the future.

Commenting on what he views as the most significant transformation at ICO during his tenure, Dr. Mullen is quick to state that “it has been the institutional culture. We initiated the process by focusing on the CORE four-year program and utilized tools to evaluate outcome assessment and national board performance. Change has permeated the institution.”

The list of accomplishments at ICO is noteworthy. ICO has increased its endowment, raised its clinical revenues, significantly improved student national board performance, frozen tuition, improved its student retention rate and increased student and faculty involvement in institutional governance. The outcome of Dr. Mullen’s taking charge is remarkable.

You can also see his trademark in the clinical programs at ICO. When he arrived there were only nine clinical affiliates. That number has grown to 137 sites throughout the United States and abroad. This has significantly impacted students’ access to patient encounters. In 1997, ICO formed an affiliation with the University of Chicago that has strengthened both institutions. ICO is now in the process of expanding that relationship further and plans are underway to move the University of Chicago’s ophthalmic surgical practice to the ICO campus.

With his retirement recently from ICO, you might expect Dr. Mullen to contemplate his golf handicap or other hobbies. But instead, he is thinking of returning to federal service. You can expect that wherever he heads next, his vision and leadership will do nothing short of transforming that entity.

The New England College of Optometry
Perspective Magazine. Spring 2002.