Charles F. Mullen

Challenges and Opportunities in Optometry and Optometric Education

The Paradoxical Evolution of Optometry

For the past several decades there has been a significant increase in Commercial/Retail Optometry. Some lament Optometry’s returning to its mercantile roots.

Paradoxically, during the same period, there has been extensive expansion of the scope of practice. This has strengthened optometry’s position as a medical eye care provider, and as a valued healthcare profession.

The implications to optometric education of the paradoxical evolution of the profession of optometry are profound:

  1. Is the current 8 years of education unnecessarily long for Retail Practice? See: Optometric Education in Crisis, Slide 15, Enhance Appeal for Careers in Commercial, Office Practice and Medical Eye Care.
  2. Does the current curriculum adequately prepare graduates for expanded scope practice? See: Three Critical Elements for Expanded Scope of Optometric Practice.
  3. There has not been an increase in the optometry student applicant pool in a decade. See: An Analysis of the Optometric Applicant Pool Relative to Matriculants.

The above fundamental issues present a significant challenge to the optometric educational enterprise.

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

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:

  1. 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.
  2. 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

  1. 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”
  2. Amend States’ optometric licensing laws/regulations to require a minimum of one year of postgraduate, residency training in General/Traditional optometry for licensure.
  3. And require an additional one year of training in specialty medical eye care with Board eligibility to practice medical eye care.
  4. 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.

by Charles F. Mullen

Guest Editorial: Medical Optometry Certification and Recognition

Excerpt from Medical Optometry Recognized by Credentialing Bodies by Dr. Kenneth Myers, President of The American Board of Certification in Medical Optometry (ABCMO).

Recognition of Medical Optometry

Formed in 2009, the American Board of Certification in Medical Optometry is now recognized by credentialing committees at over 100 Joint Commission accredited medical facilities across the nation that have appointed ABCMO certified optometrists as specialists in medical optometry. Specialists hold Level 2 credentials after completing an accredited specialty residency, passing a national specialty examination and certification by a recognized specialty board.

This acceptance of ABCMO certification established medical optometry as a recognized specialty and resulted from its adoption of specialty requirements analogous with those required of specialists in medicine, osteopathy, dentistry and podiatry.

Facilities Recognizing ABCMO Certification

Accredited medical facilities recognizing ABCMO specialty certification include:

  1. Federal hospitals: Department of Veteran’s Affairs medical centers and clinics, Army-Navy-Air Force hospitals and clinics, Walter Reed Medical Center and Indian Health Service of the US Public Health Administration. (79 facilities to date)
  2. State Licensed Hospitals: Notably the Mayo Clinic and University Hospitals. (24)
  3. Credentialing documenters: CHG Healthcare, Air Force Centralized Credentials Verification Office, CVS, Valforce, VeriPoint, Merrit-Hawkins, Aperture. (7)
  4. Private eye practices. (26)
  5. Academic teaching facilities. (7)

To read the full article please visit the ABCMO link below:

Medical Optometry Recognized by Credentialing Bodies

by Charles F. Mullen