OptometricPhysician®

2009-07-30T15:20:00.001-07:00

Please Join the Association of Concerned Optometrists Today

www.concernedoptometrists.org

NOA Tells the Truth About Not Listening to Members

2009-07-30T15:09:00.006-07:00

What I love about this letter from the President of the Nevada Optometric Association is that he clearly admits the the majority of NOA members were against board certification and that among their reasons were a very valid concern with the proposal's credibility. He then goes on to say that in spite of this, the NOA delegates voted for the proposal and then says - and this really gets me, "Despite the outcome of the vote, your input was greatly needed and appreciated." If the NOA leadership didn't bother to listen and did what they wanted to do regardless, how was membership needed or appreciated? Give me a break...

Board Certification Letter

Dr. Cory Rath, O.D.

Dear NOA Members,

I would like to thank those of you that took the time to voice your opinion about board certification. While not everyone put forward an opinion, approximately 40 NOA members gave input on the issue of developing a board certification process for optometry. Within the state of Nevada, the majority of members that gave input were against board certification. While there were multiple reasons for this rejection of board certification, the overwhelming reasons given were a lack of evidence for the need of board certification and the credible process involved with obtaining board certification.

I would also like to thank our Nevada delegates, immediate past president, Dave Leonard, OD, as well as our president elect Lara McKnight, OD, for their time away from practice and family to represent Nevada optometrists in Washington, DC at the AOA House of Delegates. The issue of board certification encompassed the entire debate at the House of Delegates on Thursday, June 25, 2009. Dave and Lara participated in the debate and voiced many of the concerns that NOA members had raised. Various amendments and multiple proposals were presented for discussion in over 8 hours of debate, and after each debate our Nevada delegates voted “no” on each of 7 amendments regarding board certification, in keeping with the general consensus of NOA members.

In the end, the final decision to support board certification came down to 3 important factors. I believe these factors address the main reasons for rejecting board certification. First there is little disagreement from any area that our profession needs some format for maintenance of competency/certification (MOC) in order to be effective and involved in the national healthcare arena. In the recent days and weeks it has become evident that some type of national healthcare reform is coming. While no one yet knows how national healthcare will look, there is little doubt that congress will seriously look at ways to prove MOC for inclusion in any federally funded healthcare program. Optometry cannot afford to be left out of the loop as the only Medicare recognized physicians without board certification and MOC.

Secondly, the amended resolution gives the AOA greater influence over the creation, implementation, and governance of the American Board of Optometry (ABO) than previous resolutions provided. The AOA will be able to withdraw its endorsement of the ABO at any time and the ABO will be primarily made up of practicing optometrists (4 out of 7 members). This allows for greater assurance that the board certification process will be credible, attainable, and defensible for all practicing optometrists.

Finally, board certification is currently and will remain a VOLUNTARY process. MOC is not meant to be tied to state licensure. It is a process designed to show continued competency in a unifying way across the nation. Choosing not to become board certified will not prevent continued licensure within any given state. The ABO will not in any way interfere with nor limit the professional activities of any duly licensed optometrist who is not certified by the ABO.

Some key points about board certification and maintenance of certification/competency:

Prior to the development of the ABO there is not a mechanism in place to recognize or prove continued competency
Board certification will be a voluntary process. You may choose not to pursue board certification. This will not affect your ability to continue to practice as you do now.
There is a real threat to continued acceptance on insurance panels and adequate reimbursement for services if there is not a process for maintenance of certification in place. Board certification is the best means to that maintenance of certification.
Maintenance of certification is not meant to be tied to state licensure. It is a process designed to show continued competency.
There will be several routes to achieve certification for those who choose to apply.
The recommended model calls for 150 points to be attained within three (3) years of application for certification. The points may be gained via residency, fellowships, continuing education, distance education, and other CE. Applicants are given five (5) points per year of active licensure for up to all 150 points for those who apply for board certification within the first three (3) years from the date on which the ABO accepts applications.
After initial application for certification and attainment of 150 points, the model calls for completion of a board certified examination weighted toward your areas of interest. Other board certified medical specialties report passage rates of 97% to 98% on these exams.
Board certification will be conferred for 10 years.
The process of board certification begins with the formation of the American Board of Optometry (ABO).

Organized optometry at the national level is on the front line protecting and expanding the everyday optometrist’s ability to practice, and this issue of board certification fell under the umbrella of "access to participation", a landscape which is changing rapidly under this current administration. Please read the final version of the resolution that passed from the AOA website to obtain the complete wording and the message from Dr. Randolph Brooks about the board certification issue.

I know that many of you are disappointed and even angry at the outcome of the voting process at the House of Delegates. This was, unfortunately, a divisive issue and one that your NOA board members agonized over making. Despite the outcome of the vote, your input was greatly needed and appreciated. There will be further opportunities to influence the design of the model as the process moves forward. The NOA’s commitment is to provide up to date information as the ABO is put into place and to provide input on your behalf to the AOA and ABO regarding the process. The NOA is also committed to helping any NOA member understand the process, accomplish what needs to be done, and to make it as convenient and cost effective as possible for any member who desires to seek board certification.

Sincerely,

D Cory Rath, OD

President
Nevada Optometric Association

Correction MediCal

2009-07-02T19:06:00.004-07:00

Thanks to Dr. Stuart Gooderman for bringing this to my attention:

Basic MediCal vision services have been eliminated for adults only. They are still available for those under 21 and for pregnant women. All other cuts, unfortunately, are indeed true. And now that the Governor has declared a state of emergency, no other government work can be attended to until the budget is dealt with. Since the Governor refuses to allow any tax increases, the only way to remove the deficit is to either cut labor or cut services.

Why I Did Not Speak at the HOD

2009-07-01T23:24:00.005-07:00

The following was originally posted on optcomlist.

Dear colleagues:

I have something I need to clear up. I am aware that a number of people and at least two state associations have suggested that I WILLINGLY chose to not speak at the HOD. That is not true.

To my experienced eye, it would seem that the letters from Illinois and Kansas were drafted by the same PR firm. One impugns me by name and the other impugns me by inference. Both are intentionally disparaging and apparently derive from the same source - a source that doesn't understand how the internet works and one that clearly underestimates the intelligence of the average AOA member. Those of you who know me, know that I say exactly what I think and I do it with absolutely no hesitancy. So why didn't I get up at the HOD?

Jay's comments are partially correct. I assumed that pretty much everyone already knew my position. Anyone who didn't know my position should not have qualified to serve as a delegate, but that isn't the only or even the main reason why I didn't get up to speak.

The entire meeting was carefully crafted to favor the pro-BC side. The only person who was allowed to formerly speak against the proposal was Rich Schamerloh, President of the Indiana Optometric Association. As the two associations almost identically say, Rich did a wonderful job under very difficult circumstances, but he was given just 10 minutes after Trustee and devout BC advocate David Cockrell spoke and was immediately followed by strongly BC-positive past-Presidents John McCall, Harvey Hanlen, Tommy Crooks and finally by Les Walls.

From that point on, every speaker was limited to a maximum of 3 minutes followed by possible rebuttal. Had I been asked to speak and given sufficient time I would have gladly accepted. However, I was not invited to do so. Three minutes would have accomplished nothing and I was concerned that the almost certain attack that would follow might scare off some of the delegates that had supposedly committed to voting against the proposal.

Despite the rosy picture that some are painting, I do not feel that the process was balanced or fair. For it to have been fair, equal time should have been allotted to both sides and a real debate of the issues provided for the delegates. That did not happen. The only debate was on implementation not rationale. Trust that it was not easy for me to sit there and watch this train wreck unfold. To those who would suggest that I was somehow responsible for the outcome, give me a break! Take responsibility for your own actions.

The reality is that whether I spoke or not it would have made no difference. I realized that just minutes into the session. I believe that the vote was decided before the HOD even began. But that is besides the point. The real issue, is not whether I took 3 minutes to briefly and inadequately summarize a complex topic that deserved extensive discussion and debate, one that I had already written about ad nauseum, but why the real voices that are the AOA (and that is all of you) were simply ignored.

I have been criticized for using a bully pulpit unfairly while the AOA PR machine ran overtime and over budget. I am certain if I was in favor of the AOA proposal there would have been no complaint. The polls I conducted were described as "push" polls and unscientific. However all were IP limited so only one vote per person was possible and all were statistically sound. Did they reflect feelings of the majority of ODs, many of whom are AOA members? Well take a look at the links below and decide for yourselves.

I am thankful for the incredible support and kindness that I've received. I have been buoyed by your intelligence and commitment. I never intended to be the spokesperson for this cause. My editorials reflected my opinions and echoed what I was hearing from hundreds of our colleagues.

I believe the AOA/JBCPT proposal is flawed and damaging to optometry and the process by which the ABO was formed was beneath our profession. But frankly I am weary of talking about it. I am tired of being attacked by people who don't even know me or worse yet, people falsely claiming to be among my friends. I am tired of the apologists and the revisionists. Lets just be honest and either move on or do what we need to do.

For those of you in states that voted the consensus of their membership I urge you to continue to support your organizations and your colleagues as they have courageously supported you. Serving as a volunteer is hard work. Our volunteers are, or at least should be our trusted friends.

For those in states whose delegations clearly violated your trust and did what THEY decided was best and not what you TOLD THEM TO DO, you are doctoral level professionals and you are entitled to do what you wish. Personally, I would not quit, but work with your like-minded colleagues to take back your organizations from those who believe that they are somehow smarter or better than you are. Our organizations should not be run by individuals who believe what they think is more important than what you think. Whatever you decide to do, please just don't sit there and do nothing.

The July 4th weekend is only a few days away. I am taking off early. I wish all of you a safe and peaceful holiday while you enjoy the freedoms that so many have sacrificed so much for. From here on, may your vote always count.

OP polls:

1) Original poll on board certification
2) Last poll on board certification for general ODs
3) Poll examining preference for AOA involvement in BC

Art

Finally caught up!! - more reader mail...

2009-05-31T22:08:00.005-07:00

Art,
I want to thank you for your series on the “board certification” proposal set forth by the project team. Although, unlike most optometrists, I do believe there is a need in our profession for a valid mechanism to certify continued competence and a need for specialty board certification, this proposal actually does neither and, what’s worse, confuses the issue.

I apologize for the length of this e-mail, and I must note that I write this not as [[DELETED TO PROTECT IDENTITY]] and as a result have some knowledge of licensing assessments and what the terms “board certification,” “continued competency,” and “advanced competency” mean in health care.

Dr. Ken Myers is absolutely correct when he writes that the JBCPT proposal is not a proposal for real board certification. He is correct that, despite the PR push to the contrary, general dentistry does not have a functioning, well-accepted mechanism for board certification. It is true that podiatry has board certification, but that credential is board certification in its commonly-understood sense – it is awarded only after four years of podiatry school, a surgical residency, several years of clinical practice documented by case submissions, an oral examination, and a written examination. This is the same model used by dental specialties, veterinary specialties, and medical specialties. So the claim that we are the only prescribing profession that does not have a board certification mechanism is disingenuous. Only specialties have board certification, not entire health care professions, with the exception of podiatry, which is a surgical profession that requires post-graduate residencies for all its practitioners.

The JBCPT also touts the approval from the president and CEO of the American Board of Family Medicine. In fact, the JBCPT acknowledges that their proposal was modeled after the ABFM mechanism for certification of continued competence. (It cannot be modeled after their mechanism for board certification, because ABFM, as they say over and over again in their web site, is a medical specialty and board certification requires completion of a three-year, post-graduate residency.) Yet, optometrists should understand that this specialty is the least popular choice among medical school graduates, having the fewest US medical graduates ranking that specialty as their first choice per position offered (NRMP 2007 report). Part of the reason is certainly that it is not a glamorous specialty (plastic surgery has the highest ratio of first choice rankings per position), but pediatrics, another primary care specialty, ranks in the middle of all specialties. Perhaps another reason is the re-certification process is considered by many to be onerous, and was very difficult for “practice-qualified” (as opposed to residency-trained) family practitioners to maintain during the initial years of that process (Lewigh T. Performances of family practice diplomats on successive mandatory recertification examinations, Academic Medicine, 68:12 (Dec 1993) pp 912-9.) Would an optometric recertification model based on that same model, clearly ignoring the lessons that could be learned from current and past ABFM struggles, be any more successful? I don’t see how. And to try to force our independent health care profession, one that does not require any residency training to practice at the entry level, to conform with a model based on an allopathic medicine specialty that requires three years of post-graduate specialty training, seems ill-considered at best.

Again, I want to emphasize that I agree with the JBCPT that some assurance of continued competence in optometry would be a good thing for the general public. I also would like to see board certification of specialties within our profession. Both these measures might help us in the coming storm of change in health care management in the US. But the proposed mechanism gets it almost all wrong, from the justifications offered (they ignore or misrepresent independent health care professions), to the name (ABO already stands for the American Board of Opticianry), to the description (it is not board certification), to the mechanism. I believe that nothing less than the future of our profession depends on getting this right.

XXXX XXXX OD

Thanks for the information. Hopefully everyone will read it.
Louisville, KY

Dr. Epstein

Please keep "beating the drum" against the AOA/JBCPT proposed "board certification" for those of us that need a respected, well informed voice! Optometry should get past trying to enhance its image with "mirrors and marsh gas."

Stan Xxxx, OD

Dr. Epstein,

Thank you your latest editorial posting in OP. Your clear and concise argument against BC is a breath of fresh air in this tiresome debate. I only hope that the sentiment that you expressed will be lifted up by the quiet majority so that the "higher-ups" in Optometry will actually begin to listen.

Sincerely,

Dan Xxxxx, OD

Having just read the AOA News reasoning for "Board Certification" and your editorial, I continue to be against this idea. Just to give an idea of who I am . . . I own a private practice, serve as a trustee for the Xxxxx Optometric Association, am the Xxxxx clinical director for <>>, and am also a clinical examiner for NBEO. This is really not a board certification in the sense that medicine understands and does it. COVD is a specialty and has a certification process that more closely mirrors board certification. What the AOA is talking about is continued competency education and examinations. Although I have always been in favor of continuing education, this is overkill of the worst kind. I also believe that at best it is unnecessary extra work and at its worst will be something that will make it harder to attract people to to our profession and will lead to more problems and exclusions.

Xxxx Xxxx, OD

Well written!

I whole heartedly agree.

Richard

This issue reminds me of our attempts for therapeutic
drug use. The program was supported by the majority,
and part of that majority were our older OD's. Once in
place, VSP required any member to be therapeutically
certified. Therefore, many old timers were out because
they did not want it for themselves, just for the profession.
They did not have a choice to stay with VSP, and who
will corral us into the "proper" group who will survive
board certification.

Xxxxx Optometric Association
To the Board:
A few years ago, the “real-doctor-wannabes” of Optometry pushed for board certification. There was overwhelming opposition to that movement at that time. Now, the so-called “leaders” of our profession are trying to push for it again. All of this is under the premise that it will assure the continued competence of all practicing Optometrists. Nothing has changed that will make this a worthwhile endeavor. It will only polarize the profession and lead to discriminatory treatment by third-party payers. The leaders of our professional organizations (and there are far too many of those: AOA, AAO, ARBO, ASCO, AOSA, NBEO – but, that is another issue) seem to think that their own agendas supercede the desires and needs of the rank-and-file Optometrists. They seem to believe that those of us in the real world of practicing Optometry are not smart enough to know what is best for the profession. They also seem to believe that if they keep pushing for board certification, we will eventually give up the fight against it.
The idea that we “need to demonstrate continued and advanced clinical competence to the public” is ludicrous. Those of us in private practice demonstrate our competence every day. If we did not demonstrate competence, we would not stay in practice for long. If “the public, third-party payers and government agencies” do not ask for Board Certification, why in the world would WE pursue this unnecessary goal? If Optometry would end up being the only profession without Board Certification, that would be a worthy distinction. Does the goal always have to be that we are like all the other professions, the REAL DOCTORS? Of course, as usual, we are being told that Board Certification would be strictly “voluntary”. And, of course, in these cases, “voluntary” really means “mandatory”.
All of the “leaders” of the aforementioned organizations should wake up and try to support the private, independent practicing Optometrists, instead of looking for ways to make it even more difficult to stay afloat in this competitive field of vision care. There are always folks in every profession who continually attempt to impress each other with more letters after their degrees, more plaques on their walls, and more certificates. More letters and plaques DO NOT equal “continued competence”. That competence results from continued desire to practice state-of-the-art Optometry and to continue learning in this ever-changing field. Those who do not stay current and competent of their own volition, will, by natural selection (or lawsuit), be thinned from the herd.
Our “leaders” are not serving the real world of Optometry.

Very Sincerely
Xxxxx Xxxxx, OD

Dear Art,

Beautifully written, and well thought out. I totally concur. Don't change one word!

Richard

Dear Dr Art,

I'm not up on all the details, but this whole Board Certification thing sounds like either a) a way for us to be forced to take more CE and get a paper certificate, such like we in California had to do for glaucoma, or even worse, b) a way to exclude people from practicing certain aspects of optometry (i.e., contact lenses, low vision, etc.) much as what VSP did when it required therapeutic certification among its member doctors.

Could you invite someone on the other side to write an opposition statement and publish it in the Opt Physician e-letter?

Also, wouldn't it be nice to have a debate set up that could be broadcast to us via the internet? Sorta like what happened with Jim Cramer vs Jon Stewart.

Dr X

Dr Epstein,
Well said. I hope the AOA does listen. I wasn’t part of that survey you mentioned…but I too would consider dropping out of the AOA if it passes.
SG

Hi Art,

You are to be applauded for your courage to write such a clear opinion piece in opposition to the board certification proposal. I’m sure it is difficult for you both politically and emotionally to express your opposition so openly. I found your comments to be well written, well focused and obviously well thought out. Your voice is heard loud and clear and because of your global influence, this re-invented and still ill conceived concept should be voted down when it comes up for a vote this summer.

Bravo. Keep up the good work.

Sincerely,
David Xxxxx, OD

David

Dear Art,

I wholeheartedly agree with your position on optometric board certification. It may be helpful for us who are not active in the state politics and only give monetary support when asked to let us know what exactly we can do to find out who our delegates to the AOA from each state may be.

Thanks for expressing a position that the majority of us have but have not expressed it.

Steve Xxxxx, OD
Phoenix, AZ

Art,
I appreciate your stand on this important topic.
And I again 100% with you.
May the majority win this battle again the AOA.

--
David Xxxx, OD
NC

Why do we need it?

1. We all have the opportunity to be board certified by the American Academy of Optometry.

2. We all have to take CE to renew our licenses.

3. My Florida License requires 4 hours of transcript quality(TQ)plus 12 to 14 non-TQ
CE every year.

4. We all have to take and pass a state board exam to practice optometry in any state we which we wish to practice.(At the most recent SECO the AOA/JBCPT stated this was only entry level)

It seems to me that the major push for board certification is that we don't keep up with what is new or changing in our chosen profession. Just taking the required CE regular and/or TQ to keep our licenses current would appear to me to be enough to keep us current with all the changes and both therapeutic and technological.

I am a 1966 Optometry School Graduate(SCO),took and passed the Florida Board, received my Fellowship in the Academy in 1977 (which was not entry level certificatiion), took the Tennessee Board and passed in 1990, and took the Arkansas Board and passed in 1999.
In addition I had to take the IAB therapeutic board in early 1990 to receive my therapeutic certification and also had to take the Florida Therapeutics Board in 1990 in order to receive Therapeutic Certification for my Florida License. I think having graduated in 1966 and taking the Tennessee State Board, the IAB, and the therapeutics portion of the Florida board, and passing all three, 24yrs after graduation, and taking and passing the Arkansas Board 33yrs after graduation is a testimony to keeping up with the changes in the profession.
I don't think I am unusual I think most O.D's keep up with the changes in our profession.
Further for those who are concerned with the fact that our certification is not comparable to other professions they state board certification for Optometry is necessary because board certification is the 'common currency' of continued and advanced competence in health care. The Military(i.e. the Federal Government) recognizes Academy Fellowship as the source for allowing Military O.D.'s to receive Board Certification Pay and to annotate their MOS(Military Occupation Specialty){Army&Navy} and AFSC(Air Force Specialty Code){Air Force} that they are board certified. This is the same as for Physicians that have Board Certification such as American Academy of Pediatrics, American Academy of Family Practice or Internal Medicine, etc, etc.
Since some of these other Academies have periodic retesting of there fellows maybe we need periodic retesting by our academy or maybe the Florida requirement to take transcript quality CE or some combination of these might be required, but I don't feel creating a whole new Board Certification Process is necessary for our profession.

Cordially,

BOB

Robert F. Castiglione, O.D., F.A.A.O.
Retired USAF Optometrist

Dear Art

What Optometry needs is not Board Certification but parity between states. What other profession is crippled by the lack of ability to move 10 miles to NJ from NY and vice versa. MD's seem to be able to move very easily. If the AOA wants to work on something let them work on that.

Dan Xxxx, OD

Dr. Epstein,

Thank you for your editorial regarding board certification for optometry. I completely agree with your comments. I was opposed to this already, but reading your comments confirms my belief that this board certification process is wrong for our profession. Thanks for standing up for optometry.

Xxxx Xxxxx, O.D.
Athens, GA

Dear Art-

Thanks for making your voice heard on this subject and presenting evidence in a clear and unbiased manner. Organized Optometry has always made it's strides by presenting a unified front. The current issue at hand stands to fracture our profession and potentially put a process in place that does more harm than good. Rather than polarizing itself over this issue, the profession needs to come together in a frank discussion of how a certification process could best be implemented for the ultimate benefit of the profession as a whole.
It is respected leaders such as yourself that can help motivate and inspire involvement of local groups to come together in a meaningful manner and facilitate action that will continue to advance our profession in a manner that has gotten us to where we are today. Keep up the good work!

Warmest regards,

Xxxx Xxxxx, O.D.
Fort Collins, Co.

Thank you, sir. To affix to your comment the majority of the appropriate clichés, you touched the bases, covered the terrain, and left no major stone unturned…does that mean most OD’s might even take the time to read your column? I sincerely hope so. Will they speak out? That, of course, remains to be seen, but you have done your part in masterful fashion.
Again, thank you.

Xxxxx

Xxxxx Xxxxx, od, faao, mph

Dear Dr. Epstein,

The issue of how to demonstrate continuing (vs. intitial) competency will no doubt prove an interesting debate for our profession in the coming months. I would like to offer a few thoughts from the perspective a practitioner in the state of Washington who has read your editiorial but also has been plugged into this issue since ABOP failed (and for good reason). My intention is not to debate you...but to offer what may be some additional information.

I sat on our state board for six years...starting just after ABOP failed. At that time, I represented our state at an ARBO meeting where the issue of ABOP's failure was commented on by some of ARBO's leadership as a positive thing because, in my opinion, it appeared to allow an opening for that organization to take the cause forward with their ownership. There were several presentations made (by a couple of consumer and professional organizations) about how necessary continuing competency was to the profession, state licensing and assuring state's consumers that their doctors were maintaining high practice standards driven by the profession vs. the legal profession continuing to do so with tort (malpractice) suits. The bottom line was that there seemed to be some behind the scenes movement withing ARBO's leadership (my interpretation although I admit I could have been wrong) that this presented them an opportunity to push this themselves. A few years later, I again attended an ARBO meeting (our state only funds one person to go and we send members on a rotating basis) where this was still being discussed.

I have since had some conversations with some of AOA's leadership who have been involved with this. I felt they were being genuine with me at the time when asked as I brought up why they elected to once again be involved with with such a potentially divisive issue. My belief from that conversation was that they felt it was going to be pushed by ARBO/COPE and that it was better that, based on their experience with ABOP coupled with the newer political realities (that you have said you disagree with), they act as facilitator vs. have this be driven more by a group that has less membership representation. Whether one agrees with their motivation or not...I do feel that having AOA "driving" this, who represents a broader membership group, vs. ARBO in a different coalition of consumer groups with state boards...is healthier for our profession.

Related to the perspective of state legislation...a few years ago their was legislation that was proposed (Washington State) to require MD in all modes of practice to demonstrate continuing competency. Competency standards, where they didn't already exist for a type of practice such as "general" medicine, would be established by the state's department of health. In short, by the government bureaucracy. This legislation did not pass...but it did cause a governor's study group to be formed to continue to look at this issue. It is thought that eventually there very likely will be legislation that comes of this. The cabal of legislators that originally proposed this still exists and if a report recommend this comes out (quite possible) then our state will see mandated continuing competency for MD's...and it is thought that a "trickle down" effect will happen within a few years (if it is not included with the original legislation) for the other professions that don't have it including optometry, nurse practioners, and dentistry (dentistry's is so restrictive that it really only works right out of school somewhat like a residency program which is hardly continuing competency). My thinking is that it would be much better to have a program designed and driven by optometry than one from our state department of health...even in consultation with our optometry board. From what I have seen of the joint project proposals the program suggested, while I think it may need tweaking, appears to be sufficient to our state's needs...and this looks to be voluntary so individuals from other areas can choose but at least it will be available.

Are we the only state where this type thing has been considered? At this point, I believe so. Would we be the last...I doubt it...this appears to be driven in part by some consumer groups (per the one that spoke at ARBO) and should they win in our state...no doubt they will go to others.

There does appear to be another "soft" issue...with third party carriers. In out state, we have a retired OD who we have hired as a consultant to interface with the many third party carriers here. He has many private conversations with carrier representatives. He has shared that it is his understanding that carriers are looking at this issue with optometry...perhaps as a way to have different levels of payment, to limit panels, or to use as an excuse to keep ODs off panels altogether. There is no reason, considering the fact that he is no longer in practice, for him to make these statements unless they are coming up in his conversations with carriers. Granted, carriers may be sending up smoke screens to see what we will do...but I am a cynic regarding their past attempts to discriminate against our profession so tend to believe this.

Should our profession look this over carefully? You bet. I can tell you though, we have colleagues out there that should have hung it up...based on my experience on our state board. They are not a large percentage but they are out there...they tell themselves they are practicing optometry "the old fashioned way" and some other excuses. A quick "health screening" (direct ophthalmoscopy and refraction) is NOT an exam nor is it standard or care. How do we make sure we have doctors maintaining their skills once they have received their license? Regular CE alone as we have been doing it? Do we want others to tell us how to do it? If we do it for ourselves...is what the JBCPT proposes the best way?

Thank you for your thoughts...I hope mine will give you a little more to think on related to some historical perspective you might not have been aware of as well as the impact this might have on a purely "local" issue.

Cordially, Xxxxx

Thank you for your thoughts on board certification -- i couldn't agree more!
- Dan Xxxxx

Excellent piece, Art. We will be having our local society meeting in Illinois next month, and I'll be sure to voice my objections to board certification.

Dr. Xxxx Xxxxx

Art,
Thank you for writing a well thought out piece on board certification. I agree with everything you've said regarding the current proposed process and its potential impact on our profession.

'I just hope that the "powers that be" within the organizations pushing this listen to their constituents. What I'm afraid of is that the JBCPT proposal will be killed and that another organization, ARBO comes to mind, may set off independently to estabish a BC process which will really splinter our profession.
Tom

Dear Art,
I could not have stated it better myself and we are in complete agreement on this subject. I just hope the few don't manage to ram it down our throats anyway. national licensure would serve the profession more by showing uniformity of education and skills among our therapeutic certified optometric physicians. Yet some states must be worried that they will be inundated with practitioners if this occurs. Since i will not be able to attend the national convention in dc this summer, please vote no for me.
sincerely,
jeff

Art,

Great editorial !

Just a thought, please name the guilty parties (and their email addresses) to ramming this down our throats. Let's all inundate these "leaders" with email voicing our strong opposition to board certification.

Thank you for everything.

Best Regards,

Doug

Gosh Art...

How do you really feel about Board Certification?

I have appreciated the time you have devoted to study and comment...it has been eye-opening for me. Up until today, I have basically been convinced that it was inevitable and good for the profession, so was willing to put in the hours of work and study necessary to achieve certification. Now that I have become better educated, I realize that much of the proposal is based upon false assumptions and emotion (hope, fear, etc.) and that even if fully enacted, the certification may have ZERO value...

Still undecided, but leaning in a way favorable to you.

Thanks again.

Dave Xxxxx

Hello Dr. Epstein,

Great editorial in this week's optometric physician! Also, it was nice seeing you at the Alcon dinner during SECO! I hope all is well!

Jerry

Xxxx Bch, Fl

Art,

You are right on. Certification serves no purpose in optometry. Medicine needs it because of all their specialties, but we as optometrists already specialize in one organ system.

I have already informed my state association of my position and my impression is that my state association executive committee is in agreement.

See you at the AAO.

Warm regards,

Michael

Hi, Art. I agree with you completely. This would be a costly process, adding another level of bureaucracy that would likely be questioned and ridiculed by other professions who already question optometry. Patients will not benefit either, since added costs of education/testing will at some point end up costing patients and/or insurance. There is nothing to gain from Board Certification, and it is just a risk to the profession and our professional organizations, especially with the high percentages of optometrists who are against it.

Ellen

I couldn't agree more. Thanks for saying so eloquently what we all are thinking.

Scotts Valley, CA

Thank you so much for your editorial. I really appreciate it.

I tried to vote on the poll but it does not load. If it ever does, please vote ”no” for me!

Diane

Hi Art,

I envy you traveling to Asia. My nephew is a foreign diplomat in Bangkok. I do not know when I will get to visit, but parts of Thailand look spectacular.

As president-elect of Rhode Island, and the one charged with presenting board certification/maintenance of competency to the optometrists of our state this coming Wednesday, I was looking forward to you sharing your insights. I know understand that if you publish something less supportive, that will not make Pete happy and could make the remainder of your trip less pleasant.

Personally, I am still on the fence. From a public health standpoint, I am in support of meeting the standard set forth by medicine. In online forums I have been characterized as an "elitist" because I am an Academy Fellow and that I consider us optometric physicians held to the same standard of care as a board certified OMD. I do not see a legal defensive team in a court of law saying to a jury, "Do not blame the optometrist. Yes, he gets paid the same as a board certified ophthalmologist from Medicare, but he is not expected to deliver the same level or quality of care."

On the flip side, it is hard to rationalize spending significant the time and money to create an entity without a defined need at this point in time. It is a risk-benefit issue. We risk creating a need when there would potentially be none. The benefit would be having the means for BC in place should the playing field change and BC becomes something that CMS and insurance companies require.

If we do nothing, would insurers carve us out and limit care to just OMDs with board certification? I my opinion many would and still are even without board certification. Rhode Island, in my opinion, has the best parity law in the country and yet here comes Tufts Health Care who says only OMDs can provide medical care to our subscribers and ODs can only provide "routine exams" through EyeMed. Our attorney informed them of the law. They said thanks for pointing it out, but we believe we are within our legal rights. In other words spend the money to take us to court, (which I think AOA should help us with) or go back to the legislature and tighten up the law so there is no room for misinterpretation. More time and money.

I would like to think that optometry is nothing but an eyelash on a financially hairy beast of CMS, yet today Rhode Island ODs are currently being audited for over utilization of the 92014 code. This, according to AOA is not happening any where else in the country. How does that decision come about? Does someone make a phone call and encourage someone to undertake a state wide audit? My point is, there are things going on that no one understands regarding decisions made by insurers, including Medicare. If there was some way to ascertain what the insurance companies will expect in the future it would make the BC decision easier. That may never happen and as many point out BC and pay for performance issues do not necessarily translate into better patient care.

http://blog.yjhm.org/2009/02/how-health-insurers-dehumanize-medical.html

If you have time and choose to respond I will not respond I will not share your comments with any one else. Just looking for your learned perspective so I can be better prepared when facing the RIOA membership this Wednesday. As always, thank you for your time and dedication to our profession.

Best Regards,
Paul

Dr. Epstein:

Thank you for making Ken Myers's paper available in your newsletter. I thoroughly enjoyed it, and feel for the first time in 10 years that someone has clearly identified and explained the exact reasons why most of us (in our gut) knew that "Board Certification for all ODs" was inappropriate and unneccessary. Finally someone willing to speak the truth, with plenty of historical references, and not drown us in the usual propaganda! I'm sure I'm not the only one who chuckled at the line about insecurity driving the push towards using the title. I guess I'm tired of being told, like a child, what is good for me and our profession, when we seem to have it pretty good right now.

thanks again-

Dr. Xxxx Xxxxx
Mason City, IA

Art,

Dr. Myers’ article is very interesting. He has done a great job in examining the system as it is today. As we look into the future however, I am wondering if the shift is toward payers identifying “specialists” (as OD’s are referred to by most insurers) as a requirement to participate in most medical insurance plans. Separating a private practitioner from a refractionist, or a refracting optician may not only be useful but necessary for future economic survival. Additionally, since we actively compete for patients with ophthalmologists, and dentists have no similar specialty competing for their patients, one might wonder in a changing political climate if it is necessary to prove additional competence (whether that be called “Board Certification” or not) beyond entry level to justify optometry competing for the same pool of patients. Since it is fair to say that more insurance panels have MDs on their advisory/board of directors this may be a significant issue to deal with as we forge into the murky future of socialized medicine. While I agree COPE approved CE has raised the level of education in recent years, I often wonder if a more rigorous form of CE should be required periodically. If some type of specific and formalized clinical training with testing standards exceeding mere attendance was established, documented, and monitored by a designated certifying body then perhaps that might be sufficient to permit recognition by the medical type of insurance panels most ODs wish to participate, making “Board Certification” for general practice ODs moot.

This debate is very interesting and I am beginning to understand both opposing view points. Thank you for this forum and continued vigilance on this very vexing question facing the future of our profession.

Sincerely,

Jeff

Dr. Epstein:
Thank you for making Optometric Physician possible. The enclosed attachment (article) was never published. I continue to practice optometry but the flame is being diminished. Some state agencies are being swayed by the term "certified" as though this means board certified.
Dr. Miller

ART:

GREAT ARTICLE BY KEN MEYERS, I HOPE YOU CAN GET IT INTO THE HANDS OF THE RANK AND FILE AOA MEMBERS. I'M BECOMING DISMAYED AT THESE RIDICULOUS ATTEMPTS TO FORCE FEED NATIONAL BOARD CERTIFICATION DOWN OUR THROATS UNDER THE GUISE AND INSINUATION THAT IT WILL BE REQUIRED BY MEDICARE AND INSURANCE COMPANIES. WHEN WILL THE ACADEMIA REALIZE THAT WE HAVE AN EXCELLENT SYSTEM IN PLACE WITH STATE BOARD OVERSIGHT, CONTINUING EDUCATION REQUIREMENTS AND OPPORTUNITIES TO SHOW SPECIALTY COMPETENCE WITHIN THE ACADEMY AND DIPLOMATE PROGRAMS. SUCH PROPOSED CERTIFICATION WOULD ALSO DEMEAN AND DILUTE THE IMPORTANCE OF CURRENT RESIDENCY AND VA PROGRAMS.

FURTHERMORE, MRS. JONES WHO CAME TO ME FOR EYECARE TODAY COULD CARE LESS IF I WAS NATIONALLY BOARD CERTIFIED AND MY CARE FOR HER AND NOT ANOTHER CERTIFICATE ON THE WALL WILL DICTATE IF SHE RETURNS TO MY OFFICE. THE POLITICAL PUSH FOR NATIONAL BOARD CERTIFICATION ONLY PERPETUATES OPTOMETRY'S INFERIORITY COMPLEX AND I FOR ONE WILL OPPOSE IT IF IT COMES TO A VOTE. IF WE DO NOT GET TO VOTE, I INTEND TO VOTE WITH A CANCELLED AOA DUES CHECK.

KEEP UP THE GOOD WORK AND KEEP SPREADING THE GOOD WORD,

TOM XXXX, OD

Art,
I adamantly oppose board certification. I see no value –simply increase costs to individual OD’s in an already difficult economic time.
Moreover, I think it is a mistake for the “profession” (i.e. bureaucrats) of optometry to separate itself from those of us in the trenches (clinicians)- the majority who fiercely oppose board certification. It is important that the profession is united –and the continuing push vs. the will of the majority borders on disrespect.
Thanks for asking us. We need to be heard.

Sincerely,
Jane Xxxxx, OD

Art, count me as one more OD who's against board certification, for the same reasons as have been stated so many times.
Mark

Dr. Epstein,

Thank you very much for addressing this important topic in your e-journal, Optometric Physician.

Although none of us wants to work more than we have to, and the idea of board certification is not popular, I think we need to ask ourselves what course of action is best for our patients and our profession. Our friends in medicine invest quite a bit of time and money to maintain board certification, knowing that without a formal mechanism to ensure knowledge and skills are maintained, they will deteriorate.

Who among us can adequately describe the visual pathway, the mechanism of action of the pharmaceuticals we use, or even discuss basic retinal anatomy and physiology? We, as a doctorate level profession, must be able to analyze complex and sometimes conflicting data to diagnose and treat appropriately. How can we do this without maintaining our knowledge base? How often do we now rely on practice patterns that are decades old, because they usually work? How are we to improve our quality of care without improving our understanding of the eye and related systems?

Leadership does not necessarily involve doing what is popular. Leadership is determining the best course of action, and then motivating others to follow. I hope that our leadership does what is best for our profession, and develops a thoughtful plan to implement board certification.

Respectfully,

Chris Xxxxx, OD
PA

Dr Epstein, first let me begin by saying how much I look forward to and enjoy your weekly email letter. I have been receiving it for a few years now and I find it very insightful and educational. I graduated from Optometry school in 1996. I was a Navy veteran and had a degree in engineering before I switched gears to become an Optometrist. I couldn’t be happier.
I am going to try to follow this saga to better educate myself in what we hope or expect to achieve with board certification. My biggest complaint and concern has always been the dismal inequalities of our profession from state to state. I have been lucky enough to practice in Connecticut. A very proactive, well organized, pro-optometry state. With all our requirements and advancements I still can not practice in RI or Florida with out going through a battery of tests or evaluations. We lack reciprocity. It is my understanding that an OMD could move to any state in the USA and practice full scope medicine. What a sad state of affairs that we have not concentrated all our efforts to resolve inequities among our own profession. We all graduated with the same requirements, we all took and had to pass the tests from the “Board of Examiners in Optometry” yet we are not equal. Will requiring each of us to be newly Board Certified help achieve reciprocity. If not than I feel our goal is again misdirected towards merely attempting to achieve a paper equality with Ophthalmology.

Art,

Thank you for your weekly discussions about board certification. I hope that your efforts will help to eliminate this proposal. I intend to email the leaders of our profession to express my sentiment. Thank you for providing these email address' for us to contact these individuals.
Keep up the great work leading us against the Board certification issue. I don't think that others could have said it any better than you.

Art,
NOW WE’RE TALKING!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
This is exactly what AOA should be working for instead of BC. This would lift all ODs in the US to the same level of what we’re able and allowed to do. The biggest obstacle to this endeavor however, in addition to our medical brethren, is the territorial nature of many of the state optometry boards. If many of them won’t recognize the need for simple reciprocity or licensure by endorsement processes, do you think they’ll really agree to give up their power and endorse a national licensure standard? If they really care about their profession, they will. If they want to continue to play their silly territorial games, as several will, they won’t like this idea and will fight it.
National licensure is the issue that should be debated at this year’s AOA Congress instead of the absurd BC proposal.
Tom

Dr Epstein,

Thank you, thank you, thank you. For speaking truth to those who would ramrod a terrible proposal down our throats. Keep it up.

See my response below which I sent to my state association and key colleagues.
Xxxx Xxxxx, OD  Lt Col, US Army Reserve (Ret)

Dear Dr Cockrell,
With all due respect, "Bollocks", as the Brits would say. If we don't have a recognized certification process, what are we doing slogging through the 3 phases of the NBEO process?

I think that a better way to approach this issue is for the AOA to work hard through the state boards, the NBEO, and the AAO to spend our efforts on the quality of eye care, not the quality of certification tests. To this end, I suggest the following:

1) develop a minimal recommended set CE requirements for every state,
2) make tested CE mandatory in every licensure cycle,
3) require some form of 10 year re-examination of skills and knowledge, to include some form of hands-on examination and diagnosis of clinical (not just optical) cases, with some emphasis on glaucoma and neuro-opthalmological cases, and
4) create a true self-regulatory system which includes "mystery patients" knowledgeable in the components of a true eye exam, as opposed to a lightning fast refraction.

I'm sure that the last 2 suggestions are the most controversial, especially the final one. I have personally done exactly this (as observer and as mystery patient) to check out the quality of eye exam in some practices, and have had some abysmal, actually malpracticing, experiences. For what it's worth, this observation has only a little to do with private vs corporate practitioners. I am in a corporate setting, and take pride in the quality of care I deliver. Quality optometry, in the current world, depends solely on the personal / professional conscience of the practitioner. There is no QC at all, as far as exams go.

I agree that our profession needs to take the lead in monitoring the quality of care we render, but the quality of post-grad tests we can compose really does little to address this. Having seen many, many "You're 20/20 now gimme your money" refractions masquerading as eye exams, I think we need to spend our efforts on the quality of care side of things, not the quality of certification.

Dear Art,

Bravo! on your leading the efforts to defeat the AOA's attempt to shove specialty certification down the profession's throat.

Best regards

Harvey

Hello Art. It added creditability and respect for your stance. Likewise your independent and thorough investigation of the subject should be emphasized that you are not the sheep like other AOA leaders. I am sure that there are AOA trustees who do not believe the sale of the AOA. Where are they? Better to get off the sinking ship than to stay on and be labeled as the AOA agenda. Thank you again on your independent stance. My respect for you. In the months before the AOA in Washington DC many trustees will be asked where to they stand on the issue.
Don

ART, I wanted to send you a note telling you that i agree and support your stance on board certification. Mostly, my argument would be that only the states have a right to credential,police and govern our profession. Aren't we already board certified by the states. I have a license in NY, certified by the NBEO AND an Arizona license certified by the state of Arizona. What would board certification get me that I don't have already, and how could that supercede NY and AZ's certification process? Unless we go to a national licensure, i am against certification as well. I saw your partner Joe Freedman at an TLC sponsored CE course 2 weeks ago and we had a nice conversation there. I look forward to seeing you soon, perhaps in AZ.
Anthony

Thanks for your excellent dialog on this issue. I don't get it either, I don't know what their (AOA) agenda is. I agree with you 100%...keep up the good work.

Xxxx Xxxx O.D.
Santa Cruz, CA

Dear Dr. Epstein,

Thank you for your BC editorial. I could not agree with you more. I tried to get email addresses from the AOA for the key people trying to revive this BC issue, but got no answer back from them. It would be so useful if you could find and print these email addresses so that we could all weigh in on the subject directly to the responsible parties.
Thank you again.
CB,OD

Art,
You could not be more correct in your assessment on Board certification.The AOA and local society's need to concentrate on the real threat to Optometry which is Ophthalmology.I do co manage with various Ophthalmologists who are very Optometry friendly.I also know of Ophthalmologists who besides their practice and very involved in the movement to strip OD"s of therapeutic privilege's.This the real threat not patient's and insurance companies worried about us being Board Certified.
Please see the attached PDF file about MD's in Pennsylvania..and it's only the tip of the iceberg.

Sincerely,
Dr. William Xxxxx

ART:

WHAT WE SHOULD DO IS REQUIRE A BOARD CERTIFICATION OF REGULATORY BOARD MEMBERS AND THE AOA, IT WOULD BE RUN BY THE RANK AND FILE AOA MEMBERS . I FIND IT INCREDIBLE THAT THEY ARE TRYING TO PUSH THIS DOWN OUR THROATS WITHOUT A VOTE BY THE RANK AND FILE AOA MEMBERS. IT IS AMAZING TO ME THAT THIS PROCESS HAS GOTTEN THIS FAR. TAXATION WITHOUT REPRESENTATION. ARE WE A DEMOCRACY. EVEN IF THEY VOTE NOT TO GO FORWARD WITH THIS, I WILL FOREVER QUESTION THEIR MOTIVES, AND THESE ARE THE PEOPLE WHO ARE SUPPOSED TO REPRESENT OUR INTERESTS? THERE NEEDS TO BE MORE OUTRAGE AND PERHAPS A CALL TO PREMPTIVELY CANCEL MEMBERSHIP UNTIL THE VOTE.

TOM

I agree with Dr Epstein, the board exams we took after our intensive specific optometric training was , I believe, enough to certify our competency. After that, the experience ODs get in practice is the school of hard knocks which may actually be more useful than any other's ideas of re-certifying us ad infinitum.

Oakland, CA

Outstanding editorial!!!!!

Please forward to every state board, as you eliquently expressed the sentiment of every OD I know.

Xxxx Xxxxx, OD
Mentor, OH

Thank so much for your editorial.

Xxxx Xxxxx OD, FAAO
Manassas, Virginia

Art-

If this ill-conceived concept and program is adopted by AOA in June, it portends DISASTER for our profession. I would encourage you to continue your efforts to end consideration of this inane idea.

Xxxx Xxxxxx, Col.(ret) US Army.

Dear Dr. Epstein,

I read your commentary on board certification for optometrist and I whole-heartedly agree with you. To me, board certification is just another way to make it costly to have an optometry license. I graduated 10 years ago and am still paying back my student loans. I graduated from an accredited optometry school, took 3 national board exams and various state board/law exams. To me that is more than enough proof that I am competent to practice optometry. Maybe the ones who feel that yet another form of certification is good for their self-esteem or ego. But, I for one have enough self-esteem to know that every day I practice to the best of my ability as an optometrist and I have never, to this day, had a patient question my competence as their optometrist. Why then would it make financial sense or any sense at all for me to go through another process of certifications, continuing educations, etc? I truly hope that most of our colleagues will stand up for our assertions that we are all very capable and competent optometrists already.

Best regards,

Teresa Xxxxx, OD

Dr. Epstein:

I am in agreement with you. While Dr. Myers work is incredibly repetitive, though much appreciated, your brief column should be published in the AOA News to counter the Academic's onslaught. I say this because, I believe the proposed BC process would help them the most and do nary a thing for optometrists in the trenches.

Bravo! Sensible optometrists do exist.

Dr. William Xxxxx

Thanks, Art! Job well done. I couldn't agree with you more.

Larry

Dr. Epstein,

Thanks for your editorial, with which I totally agree. I think that there is little evidence (and lots of conjecture) used to support the idea of BC, and the framework that was proposed was weak at best.

Like you, I support the idea of MOC – I think that there are lots of good justifications for increasing the rigor of our CE processes. Let’s continue down that path as you propose, and see where that leads us.

BTW, our local optometric society had similar to national results – 10% for ABO, 80% against, 10% undecided. Will AOA et. al. go against what appears to be the strong will of its membership? We’ll find out soon.

Xxxxx Xxxxx, OD
Bloomington, IN

Bravo Art on your direct and complete analysis of this burr in the saddle of every Optometrist. We do not need to address the "inferiority complexes" of some Optometrists who feel we are not on the level of other primary care givers, by alienating the majority of Optometric Physicians who are well respected by their patients and peers for their diagnostic and treatment skills.

Xxxx X. Xxxxx O.D.
San Diego CA

Dear Art,
THANK YOU, THANK YOU, THANK YOU for your editorial on board certification. My wife and I, both in practice for over 15 years, couldn't agree with you more. Thank you for giving a voice to the silent majority. Keep up the great work!
Many thanks,
Xxxxx and Xxxx Xxxxxx

"Amen" to your article on Board Certification.
Xxxx Xxxxx, OD
Sioux Falls, SD

Dear Art,

Thank you for your well constructed, well thought out presentation on certification. As a 65 year old practitioner, I could get excited about re-credentialing, but not pseudo board certification. When my son joined me in practice 11 years ago, it was difficult to get him on provider lists such as medicare and VSP. As a result there were about months when he was unable to see a bunch of patients who wanted to see him. This is another consideration for this proposal. Unlike residents, who practice under another umbrella, our non residents will probably be shut out of regular practice for the extended time it takes to get certified.

Maybe you could provide an email address list of AOA people we could contact in opposition. If that went out via "Optometric Physician, we could distribute it widely. My understanding is that Indiana probably will vote to say no at the April State Convention.

Thank you for all you do.

Jon

Hi Art,

I just read this from "Contact Lenses Today"

"Joint Board Certification Project Team Holds Forum at SECO
The Joint Board Certification Project Team (JBCPT), formed by six optometric organizations in 2007, continues its efforts to widely distribute their model framework for a board certification process for optometry that was released in January. On March 5, the JBCPT conducted an Open Forum on Board Certification at SECO 2009, as the latest effort to communicate the model to the profession."

I just want to know. How well it was advertised that there was a meeting at SECO for the JBCPT.

Were you at this meeting? Both David Cockrell and Johnathan Shrewsbury graduated with me in my class of 1981 from SCO. I was at SECO 2009 and heard nothing of this "Open Forum" that Cl today discusses!

Seems to me they are all trying to be hush hush about this and get it by with no one watching

Thank you for your insight
Xxxxx Xxxxx, OD

Dr. Epstein,

I have been watching your blog for info re: the latest from AOA. I am reminded of “the sky is falling.” I haven’t seen any posts the last few days. Have you received any feedback in the last three days?

Thank you,
Jim Xxxxx

dr. epstein, thanks for a get piece on the cert. debacle. i knew you were smart , but what good "horse sense" you have. thanks for telling the truth, keep up the good work. george xxxx

May 5th, 2009

Hi Art,

There are certain dangers to be found after working all day at the office then drinking 2 1/2 glasses (OK, 3 glasses) of sangria with dinner on Cinco de Mayo. The danger being that certain urge to catch up on reading optometric journals including both issues of the April AOA News. And now, on the heels of the Kentucky Derby, for the first time in my 30 year optometic career I may have witnessed another professional milestone -- an optometric trifecta of stupid articles in the April issues of the AOA News.

Win -- All the hoops you have to jump through to become board certified.

Place -- The name of the new University of the Incarnate Word Optometry School in Texas.

Show -- Jeff Foxworthy as the headliner for the AOA presidential celebration. I hated his "Are you Smarter than a Fifth Grader" TV show. It was just too stupid to watch. I can't imagine sitting through an hour with him.

Honorable mention -- The 10 step Optometric Bill of Rights which conveniently spanned both issues. #10 Eliminate Amblyopia? A better goal would be to eliminate all bratty kids that won't watch TV while wearing an eye patch.

Yes, these two AOA News issues sure pegged my "Stupid-o-meter." I can't wait until the May issue -- including the CE credit quiz -- "Are you smarter than the a**hole ophthalmologist down the street?"

Make that 3 1/2. (I need another drink)

Please help me by starting up the American Association of Optometric Physicians so I have some place to go after I quit the AOA in protest after board certification.

Xxxx Xxxxx, FAAO

Art:

Good seeing you today and hearing your lectures. Guys like you and me are beating our heads against the wall trying to wake up the idiots of optometry, but we’ll never learn; will we.

Ira

Right on!! seems to me we dont need this Board certification thing at all. uniform licensure implementation would be a vastly improved usage for such effort and would give optometry a much greater chance to become the primary eycare provider. we will never be accepted as such if we cannot bill medical plans for our services. thanks for your thoughts and keep up the good work.
c

Dr. Epstein:
You are the voice of reason that optometry so desperately needs.
Keep up the good work.

Xxxx Xxxxx OD
Altoona PA

Attached is my letter of response to my State Board (Oklahoma). Thank you for your critical and courageous leadership on this issue.
OD OK

4/29/2009

Re: AOA-JBCPT Proposal

I’ve spent the past few weeks reviewing various presentations and commentaries regarding this highly controversial issue. I’m taking this time to present critical feedback, as I believe sitting idly by while this train proceeds could have some disastrous effects.

When I say I’ve reviewed the issue, I’m referring to presentations made in publications, AOA Trustee Dr David Cockrell’s informative live presentation at the Oklahoma spring convention as well as his two written follow-ups sent by our State Association. Anyone wanting a truly informed view should read and hear both of these as they do present the surely well-intended side of the JBCPT.

In summary, the JBCPT believes that the administration, health care reform, and third-party payers are proceeding with plans that would require Optometry to have or be forced to have some form of Board Certification or continuing competence verification. They contend that failure to do so could or will leave Optometry out of future participation in government ( Medicare, Medicaid, Tricare ) and, or private insurer’s programs.

In response to this, various professional forums led by trusted industry veterans are reporting that reader response is overwhelmingly against the proposal. Further, high percentages of respondents have claimed they will resign from the AOA if this resolution is passed at the AOA Congress this summer. This fact, above all others is the reason the issue should be withdrawn. I believe the single most important factor in the success of the Optometric profession has been the existence of a strong AOA. I am a 100% supporter of the AOA and do not wish to challenge the membership by proceeding with this proposal.

Also, the entire JBCPT position is based upon opinion. Yes, it is informed opinion based upon their experience on various panels and forums and shouldn’t be taken lightly. However, it is inconceivable that the federal government or the insurance industry would summarily remove the entire profession of Optometry as providers within our health care system.

Worse, we could be creating our own nightmare by dividing our profession into two groups, those with and those without Board Certification. Once this is in place, the third party payors could indeed follow through with the threat and allow only Board Certified practitioners to serve on provider panels. Anyone who failed to seek or simply those who did not qualify could face disastrous financial consequences. If this happens, it will take considerable time for any practitioner to rectify his decision to not seek Board Certification.

In conclusion, I submit that the AOA should continue to research the issue of continued competence and work with State Boards to come up with a better solution, but that they withdraw the proposal from the agenda of the AOA Congress. Taking it that far will prove to be a very poor decision.

Respectfully,

Xxxx Xxxxx, OD

I am currently a member of the AOA, and have been for the last thirteen years. If the AOA continues to pursue the JBCPT Board Certification proposal, I will cease my membership, and so will almost everyone else.

JBCPT Board Certification proposal equals death of the AOA. Get it?

I passed Boards in 1996, and therefore I am Board Certified. Any and all changes that are necessary as our profession evolves should be pursued through The National Board of Examiners in Optometry (NBEO), and the series of tests that they give to insure doctor competency as students graduate. That this was not pursued as the obvious direction smells of corruption and a money trail.

Xxxx Xxxxx
Goshen, IN

Dr. Epstein,

It is with sincere gratitude that I am writing this note. I cannot thank you enough for taking the time and making the efforts required to inform and update those of us who are not privy to the machinations of what is fast becoming just another self-serving political organization. It is very disappointing to see the AOA continue a path that is obviously not in the best interests of and contrary to the desires of its members or the patients they serve.

Thank you,

Xxxx Xxxxx, O.D.
Fort Myers, Florida

Xxxxx
thanks for the link to Medical Homes (MH), but if your and dr. cockrell's (aoa board member who sent the 'dear aoa member' email 4-14) contention is this is why optometry needs board certification i think you are providing misinformation, unless i am completely missing something. i read hundreds of pages from the link you sent me and MH appears to apply to primary care physicians only, providing care for chronic, prolonged illnesses, requiring regular medical monitoring or treatment. I have highlighted points below from the MH fact sheet i attached in pdf form , and particularly note the exclusion of specialties and subspecialties. If this fact sheet from January 2009 is correct, dr. cockrell's email to aoa members is very misleading.
please let me know if i am missing something demonstrating how optometry could be involved in this model that excludes ophthalmology.
it is also interesting to note that according to the american college of physicians web site, only 62% of all physicians are board certified and only 50% of internists are board certified.
i look forward to hearing from you. Thanks
Xxxxx

" 3-year demonstration providing reimbursement in the form of a care management fee to physician practices for the services of a "personal physician." The legislation directs CMS to use the relative values scale update committee (RUC) process to establish the care management fee codes for care management fees.

We have shared these papers with the American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics, the American Osteopathic Association, the American Medical Association, The American Geriatrics Society, and others. Their comments indicated a general agreement with the options presented in the papers.

Excluded specialties and subspecialties include radiology, pathology, anesthesiology, dermatology, ophthalmology, emergency medicine, chiropractic, psychiatry, and surgery. "

Hi Art. Thanks for bringing this issue to the forefront. I am generally in favor continued competency, but am very leery of this "board certification" proposal. I have the email at work, but the executive director of the Xxxxx Optometric Physicians Association, Xxxx Xxxxx stated to me something to the effect that this wasn't something to be decided by popular opinion, but by a committee of individuals who had weighed the issues carefully.
I will have a telephone conversation or two tomorrow. Thanks again. -
Charlie

Dear Dr. Epstein,

I have written letters to my representatives (Academy, ASCO, Ohio OA, AOSA) in regards to my thoughts of board certification. In these letters I would like to document a poll that supports my claim that the majority of optometrists are against it. If you could point me in the right direction it would be much appreciated. I have included a copy of my letter below.

Xxxx Xxxxx
The Ohio State College of Optometry
Class of 2010

Dear ,

I am writing you because of your standing as a voting member at the AOA conference to express my opinion on the issue of Board Certification.

I along with the majority of Optometrists in this country am against Board Certification. I cannot speak for everyone, but here are my personal beliefs on why the currently proposed Board Certification legislation is not good for our profession.

1. While Board Certification is good for ME as an individual, I believe that it is bad for US as a profession in the long term. I see that it will divide the profession into two groups, creating tension within our profession limiting our ability to lobby on future issues that will arise.
2. The proposed Board Certification is far different from other professions Board Certification programs. Most professions specialize in a specific area of a profession vs. the proposed, which is across all areas of Optometry.
3. Board Certification would not increase the scope of Optometry.
4. Board Certification would require Doctors to spend less time with patients, decreasing patient access to doctors, increase health care costs which would be passed onto patients, and decrease efficiency of the already bloated health care system.
5. Board Certification would not help patients.
6. There has been a lot of talk that if Board Certification is not passed insurance panels will exclude Optometry. If insurance panels want to exclude Optometry from coverage simply having "Board Certification" will not stop them. I believe that there will always be a loophole that they can use if they choose to do so. Additionally, I believe that if our profession chooses Board Certification, it will make it easier for insurance companies to create more rules of exclusion, leverage against doctors, and decrease access for patients. I recognize that our profession will have challenges like this ahead of us, but I believe that these challenges can be better met with a large and united profession than a Board Certified one.

As a current student I understand the significance of this issue on the future of the profession. I simply want to share my opinion in order to allow you a better understanding of how students like myself feel. If you have any other questions or comments feel free to contact me at
xxxxxxx

Thank you for your time,

Class of 2010

HI,
I agree with you on the way the AOA is addressing this. It is no different than in the past. Last time it resulted in this study group. That was the easy way out for the Board. It was ready to fail that time also.
Bob

Hi Art:

We are now being asked not to prevent our association delegates from voting against board certification until the proposal is in final form. Is it just me, or does this sound as if A.O.A. leadership has taken a lesson from the federal government?
Nothing will be proposed which has not been thoroughly vetted, researched, and discussed. Everything will be out in the open, and no one will be asked to vote without a thorough opportunity to review all proposals, etc. Oops...one little thing...your delegates will have to vote during the annual convention, or else we couldn't move forward for another year, and that might be disastrous.

Now licensed O.D.'s are being referred to as having 'entry-level' skills. Really? So our national boards, and state boards are licensing minimally competent doctors? What wonderful ammunition we are giving our opponents! I have served as a clinical examiner in New Mexico for a number of years, and say without reservation I would trust my care in the hands of all those I have tested who have passed our exam. In fact, these doctors are all capable of a level of care greater than our Optometry act, (one of the broadest in the nation), presently allows. To what higher level must they aspire?

To be honest, I have not done a single diffraction grating problem in over 30 years. Will I have to know more than national board standards in all areas of Optometry to become 'board certified'? If not, which specific areas will be tested, and to what depth? Oh, I forgot; we'll just have to wait until after passage for the details.

Let's not enter hastily into a program having the potential to affect future generations of our profession in the same manner the actions of the last 6-8 months by the federal government has done to our children and grandchildren. The leadership of the A.O.A. would do well to present their proposal at the annual meeting and encourage comments on a state level, leading to a vote next year, if moving the issue seemed appropriate. If not, we should all vote 'No!'.

Thanks for your efforts to keep us all 'in the loop'.

Maurice
--

Seems pretty simple to me….The AOA can’t “force” this issue without money. We need to simply turn off the money faucet…..stop paying our dues.

So far only looks like our dues have only been used to undermine our own profession anyway. I am residency trained and let’s face it……we are JOD’s (just optometrists). If I had a nickel for every time I have been asked by a patient, “Now are you an ophthalmologist or JUST an optometrist,” I could have retired already. And I am only 42.

This is kind of like finding out the dad you thought was your dad, really isn’t. I thought the AOA was looking out for us…..guess not.

Jerry Xxxxx
Florida

Dear Art,

The AOA Letter to Affiliate Association Leaders dated April 3, 2009 is a continuation of the kind of attitude taken by the central leadership which convinced me many years ago to drop my membership. The audacity of the group of leaders to assume that the model put forth by AOA for Board Certification is a well intentioned document, and a model for the future direction of the organization and its members is totally outrageous.
The leadership has once again, taken a holier-than-thou approach in guiding the membership into believing that Board Certification is in the best interest of its members, and for the profession as a whole. The letter, in my opinion is repugnant. To even suggest that the team has come up with a “Board Eligible” status for all ODs is to suggest that the team has no clue as to what it is doing, that they are now running scared, and are attempting to throw out little appeasements to satisfy and quiet down the members and others opposed to the process. Further to that, the statement strongly implies that the Board Certification exam is already a done deal- by suggesting that the Board Eligible status puts all ODs in the position to take the exam! Pure and simple, this approach is nothing less than insulting.
The haughtiness that comes across in the AOA letter is an affront to me as an individual, and to the membership and all ODs in general. This reminds me of some of the attitudes that I experienced in the military many years ago as if to be accused of being insubordinate when one would not wish to participate in so-called ‘voluntary’ activities. I believe that the AOA has totally lost touch with its constituents- shame on them. The leadership of the AOA should be summarily thrown out of office.

R.L. OD.

Dear Art,
Our local Society of about 30 voted not to support certification, as did I. While I have not studied the situation, I do read your remarks and those by AOA leadership. The past history with TPA's and VSP makes me extremely wary of more controls on who practices and who gets paid. A FINAL proposal needs to be read and digested before voting, not last minute adjustments. There is NO reason why we have to vote "today". We will not die or go away.
Jim

Hi Art:

Just a brief note to say that while I am 100% with you, it may be important not to make this issue a "my way or the highway" regarding OD's leaving the AOA if BC should somehow pass. That is because of the threat of Ophthalmology to wipe us off the map as an independent profession.

As far as I know, you have in no way suggested this. In fact, I surmise how even I who know better, or should, have thought about not remaining a member. However, in the final analysis it is not one particular issue for most members: it's the high cost of being a member vs. the perceived value of paying this cost. Sometimes it's easy to take for granted the victories the AOA has won in the past that have saved the profession because we begin to take them for granted-just like the liberals on the college campuses who won't allow ROTC recruitment on campus.

Let's hope that as a result of your hard work (I don't know where you get the time.) that the proposal is defeated. That's my opinion, and I know yours!

Best regards,
Peter

Hi Pete,
You have probably seen this from Art Epstein. To me, his is a most scholarly voice of reason in this Board Certification fiasco. I have reached the same conclusion he has - namely that the AOA is going to put on a full court press at the annual meeting to try to force Board Certification upon us.
It shocks me to realize that I have been a XOA and AOA member for over half of my life. I have come to mistrust the AOA several times, but never have I been disappointed by my state (XOA) representatives in Xxxxxx.
So if this is going to be jammed down our throats, I will greatly miss my association with the XOA, unless some provision can be made for members who wish to support their state associations, but no longer the AOA. I think you have done entirely the right thing by taking a poll of the membership. As I said on Pete's blog, I do not know the results of that poll (but am interested in finding out, of course), but I would be GREATLY disillusioned if the AOA somehow succeeds in forcing the state's delegates to NOT accurately represent their membership.
Why all the last minute changes and secrecy? The facts and issues have been out there for all to see and read for months now, but we are not to make up our minds until just before the clock strikes one??? Unfortunately, the AOA is not a true democracy; we can't ALL be there.....
This whole process is getting uglier and smellier all the time; I'm sure it is hardening positions on both sides. This issue - this time - has the very real potential to rip this profession apart with ill feelings that are NEVER going to heal. If the AOA does not listen to its membership, then it has made it's own bed.
Les

Dr. Epstein,

Your comments on the AOA letter are spot on. They are going to try to ram this down our thoats, even with a huge majority against it.

Chris

Dr Epstein – Family practice began as a specialty what about 30 years ago ? At that time medical doctors with a specified amount of experience were allowed to become certified by taking a board exam with out doing a residency. Newly licensed MD’s than had to take a residency in order to become Family Practice Certified MD’s.

Why not create a true specialty certification with maybe a one year residency for newly licensed OD’s and allow experienced OD’s to take the same test to be certified.
That way you are not creating a Pseudo Board Certification. We would be following a “road map” of another respected medical specialty. Practicing OD’s could use their experience towards the certification. OD’s who were not up to date with their knowledge would need to get further education in order to pass the exam

Creating a true residency would cost money. Some of the costs could be included in the costs for grandfathered OD’s to take the Board certification test.

I REQUEST THAT MY NAME AND ADDRESS BE WITHHELD.

Art,
I admire your fortitude and outspoken stance to protect our profession for what is going on. You are great for optometry! Keep going!

Ellen

Hey Art.

I think I had a few e-mail discussions with you 10-15 years ago on board certification but cannot find my e-mail history back that far! Anyway - I have a xxxx practice in Omaha, NE and am forming my position on current board certification and how much I want to push the politics of my position. I laud your sticking your neck out to take a definitive stand and I am again leaning towards working against the initiative.

I found a document that I wrote and circulated around a little bit back in the ABOP battle days and I can't believe how little has really changed over the last 10 years. I bet you have a copy of this buried in your hard drive somewhere. As I read what I wrote 10 years ago I really don't see much of anything that I would change in my philosophy or practice of optometry - and I really convinced myself that I again need to stand against this initiative - not because I don't believe in the profession but that I don't think this is a good way to go about it.

If you have an hour (sorry about the length - I combined quite a few issues in this thing) please take a read and let me know if it can be used somewhere in the battle - or if you can steer me to an editor who may be able to use it.

Thanks and sorry about the unsolicited tome!

Xxxx Xxxxx, OD
Omaha, NE

Dr. Epstein,

Thank you for your well thought out and researched articles. You have given a voice to all the OD's that I know regarding "Board Certification".

I work in a large, multi-OD, multi-office Optometrist owned practice. None of our 11 Doctors support "Board Certification". As an OD in Maryland, I already have to deal with the most restrictive laws regarding Optometry in the 50 States (last in DPA's, last in TPA's, last in steroids, no foreign body removal, etc). Yet, I am required to do 50 hours of CE every two years, among the most in the Country.

That is why I reluctantly gave up on the Maryland Optometric Association and the AOA years ago, when they aquiesed to Opthalmology and agreed to a watered down TPA bill. They seemed completely out of touch years ago, and this latest episode justifies my not paying for these Associations. They don't seem to take our best interests to heart, even though THAT'S SUPPOSED TO HAVE BEEN THEIR JOB!

Where is a push for expanded and consistent scope of practice laws. How about reasonable and consistent CE requirements? National licensure or reciprocity between States. Real are just a few of the real issues that affect us every day as Doctors of Optometry.

The AOA deserves to lose all its members if this is what this tiny minority arrogantly think "Board Certification" is what we want or need. I urge all OD's to peak up in a way the AOA will understand...a lack of paying members.

Thanks again,

Xxxx X Xxxxx O.D.

Dr. Cockrell,

I am dismayed and disappointed that your letter is repeating a lot of the fear-of-exclusion propaganda being generated by a small group of advocates of the current board certification scheme.
Why do I get the sense that my previous comments as well as those of many ODs participating in online discussion & polls on this issue are being ignored? The condescending tone of your letter suggests that we ordinary ODs are not aware of the high level political games being played by the policy setting organizations you mention. Attempts at exclusion like you mentioned have been going on for decades and will continue whether this certification scheme is in place or not. This foolish scheme will embarrass or alienate a lot of AOA members.
Why was Art Epstein, OD suddenly excluded from an AOA volunteer committee right after he questioned the wisdom of the current certification scheme? Internal politics? Exclusion of a non-team player? This is a bad move for AOA leaders!

Why has the California Optometric Association not polled the 3000+ California ODs so far on this issue? I wrote directly to the executive director of the COA asking her to poll the membership on this issue before the AOA June vote. I got no response from her or any of her staff. I contacted a COA trustee I know and expressed my concerns. He responded but he told me that I should just trust the
COA board to make a good decision on my behalf. This is another example of the "we know better than you what is good for Optometry" attitude that is leading folks like you into accepting a this board certification process in an attempt to mislead third party payers.
This will open us up for new ridicule from physicians involved in political battles.

Those of us in private general practice are not as ill-informed as you assume. We know that this new board certification scheme will not provide the security of full inclusion that you are promising us. It will divide and weaken optometry. The ignored masses of optometrists will eventually react and you will have to deal with the repercussions. Good Luck.

Xxxx Xxxx, OD, FAAO

Dr. Epstein,

I would like to thank you for expressing your thoughts concerning the current proposal. I couldn't agree with you more!
I hope every optometrist gets the opportunity to read your letter "clearing the air".

Thanks again.

Xxxx Xxxxxx, O.D.
KY

Dear Art

As an AOA member, I wanted to write and say that I completely agree with your editorials about board certification. Thank you for your honest, and clear, well informed statements. You are a credit to our profession. You could very well be the individual most responsible for saving the AOA, even if current officers of the AOA don't yet understand this.
Moving forward, wouldn't it be easier to define our profession to third parties, government, and insurance carriers, if we first came up with a definition that we accepted ourselves?
Early in my career I held 4 different state optometric licenses at the same time. The ambiguities and disparities for maintaining each license was absurd. Four state boards could not even agree on what a CE hour was, or which CEs would be accepted. They each had a different renewal period.
What we do need is a nationally accepted Optometric license. One definition, instead of 50.

Perhaps that concept is too far ahead of its time, but it would certainly make our legal battles easier.

Best Wishes, and Thank- you,

Xxxx Xxxxx, O.D.
Rochester, NY

Art

I am writing to let you know that I support your speaking out against this current proposal. Thank you very much for the courage and insight you provide to those who have been shut out of the information loop that was thin and veiled to begin with. I was outraged when I read the AOA News a while back to hear about the "vocal minority" and how anyone with an opposing view was basically a trouble maker who did not understand the history of optometry. And I mean these statements to be removed form my particular view on board certification for optometry. Interestingly, I could not find a place for letters to the editor.
Such tactics remind me of the late ultra-right-wing politics (and I am historically a Republican) as well as some other historical political movements that, I think most would agree, didn't work out all that well for humanity. Certainly, board certification for optometry is not on such a level. And, I do not mean to trivialize those events or involved individuals that I referrence. Hopefully my point of unhealthy politics and consequences is made.
Thanks again. Whatever one's views on this matter, what no one deserves is to be blackballed or beat down because their views may not match those of this particular committee. I think history proves that the world could have benefited from a lot more "malcontents", especially those that have politcal power and credit within the profession.

Xxxx Xxxxx, O.D.

good on you art.

i have been a devoted member to the aoa and my state association but my involvement is at an all time low due to a few things;

1) the inbred and ingrained approach to managing issues. meaning unless you are a past president from a state finding yourself on committee structure in the aoa is near impossible.

2) the board not being geographically representative means seco and the n.e. has a historical advantage in their agenda.

3) the inability of aoa to listen to the "trenches" that there is not a shortage of o.d.'s and that any university would jump at a professional school that would increase their their eft staff to increase their funding. ( i was on staff at the university of auckland, and know how that game works).

so what i am asking is you have a forum that would allow for some grassroots action on some of these issues. but the aoa/jbcpt would possibly be a starting point. is that of interest to you. meaning ducks are in a row before going to the house of delegates.
just wondering.
cheers,

mike xxxx od

Hi Art,

Keep up the good work as leader in opposition to the AOA/JBCPT. I agree with and support your efforts.

Thanks for your hard work,

Cecil

Thank you for your comments on the JBCPT. It gives me a bad aftertaste, thinking about the AOA being involved in this. What a waste of time and money! I believe this is a tool to exclude a minority, not to include the majority, a method of making sure we all "pay the price". The criteria do not distinguish optometrists in any meaningful way and are completely duplicative.

Sara Xxxx, OD

Art, You are doing the Lord’s work.
Thank you Thank you Thank you
Dave Xxxxx OD
Xxxxx Missouri

Art I want to thank you for sharing your opinions with the profession. Sticking your neck out as you have done takes courage and resolve. We as a profession are all better for it.

Shame on AOA representatives for sending you a letter ending your service to AOA because you voiced a differing opinion on such a critical issue. I for one, would like to know who signed that retaliatory letter.

I am XX years in practice, married to a past state president and now I am Xxxxxx myself. My dismay that someone who has given the profession so much in a voluntary capacity can be cast aside for sharing an opinion different from the powers at be is deeply troubling.

If the AOA no longer needs the service of Art Epstein, then everyone is expendable. As I move forward to fulfill what I see as my obligation to the profession I will do so with a new view on the organization. My regret that you have been treated this way reflects on a larger malaise at AOA.

Best Regards,
Xxxxx

Dr. Epstein,
My vote would be NO, NO, and NO again for BC. Publish my name. What can anyone do? Draft me? That happened in the 1960's in the US Army. None of them pay ANY of my bills, and until they do I will voice my opinion. Oooooo I'm scared!
Don Spindel, OD, FAAO, a little voice from the trenches of 34 3/4 years

Art,
I have read and totally agree with you sentiment about the current proposal of board certification. I applaud your efforts and am sorry to see the AOA retaliate against you. I will be one who drops my AOA membership if this proposal passes. I know my state leadership in Ohio is against the current model. Keep up your fight. Why is the AOA so determined to do this?????
Michael Xxxxx, O.D.

GO ART, GO!!
You truly are a gifted writer. I thank you for putting those words together in such an organized, well-written manner. I hope the entire profession reads your work and agrees with you. THANK YOU, for all that you do........ and say.

KEEP UP THE GOOD WORK.

Xxxx Xxxxx, OD

THANK YOU!!!! I believe it is time to hire the marching band to march through the AOA House of Delegates meeting followed by all the OD's opposed to Board Certification. I believe it is going to take a parade such as this to get the attention of the membership.

I am so opposed to this idiocy that I have on more than one occasion said if this passes I will terminate my 40+ year membership in the AOA. I am sure I am not the only one who has said this.

It was voted down 10 years ago. Let's hope it will be again.

Xxxx Xxxxx, O D
Indianapolis, IN

Thank you, thank you, thank you for expressing what the majority of optometrists out in the field need to have expressed. I am from Illinois and have served on the Board of Examiners for Illinois and as an examiner for the National Board Practical in addition to serving on a Committee in the past. In Illinois we require certified CE hours and I think that is beneficial and although there are likely significant numbers who dislike the testing procedure following a 6 hr. presentation it does keep all attendees alert and note taking during the process. I believe that if certified CE was uniformly required by all states it would make attendance more convenient and this talk about Board Certification would be put to rest. This proposal may have economic implications for the AOA and member states to provide Pre-Board preparation classes and this might be the unstated push for this idea.

A colleague forwarded Part II of your editorial on Board Certification. I was looking for the archives on Part I.

Could you please publish Parts I and II together so that those of us who may have missed Part I can read your editorial in its entirety?

I could not agree more with your points! Bravo!

Xxxx Xxxx, OD
Minot, ND

How did this nonsense get this far? Board certification is a non-issue, we as a profession would be far better off woking on license portability. Jerry Xxxxx OD

I am not an advocate of board certification---and neither are all the members of our local Xxxxx County Society --it is waste of our time and AOA money --I am thinking of not joining this year after being an AOA member for 16 years!! --it's a ridiculous waste of resources to pursue this effort and is just an exercise for a bunch of egos!!!!!!!!!!!!! There is no proof that it is necessary--I want to spend my time taking care of patients, not filling out more paperwork!! Dr Peggy Xxxxxx

I recently attended a hearing at the Maine State House for LD863 an optometry bill. Ophthalmology used the fact that we did not have a regulatory board and are not Board Certified like medicine against us.
What are you thoughts concerning the Democrats in Washington pushing government health care, and do you think they may limit participation to Board Certified physicians only?
Xxxx Xxxxx, OD
Newburgh, Maine

Editor’s Note: The AOA/JBCPT has opened a can of worms by going down this road. The best way to handle this is by telling the truth. Optometry is trained as a specialty, passes a national board and is licensed by 51 jurisdictions in the US. Medical doctors undergo 4 years of basic medical training and then receive specialty training during their residency. Their competence in that specialty area is tested at the conclusion of their training just as ours is. Optometry’s track record in learning and expansion of scope validates our educational effectiveness and clinical competence. In addition we are held to the same standards of care proving that our training and skills are equivalent.

Thank you for your views since your the only person who is giving both sides of the story. As a past president of Massachusetts Society of Optometrists you are correct that some states have made up their mind without consulting with their membership. The coming vote for board certification can potentially fragment our association even further and destroy any confidence in the AOA. My belief is more time is needed to discuss board certification. Xxxx Xxxxx

Art,

Thank you for this excellent piece and your dedication to the facts. Some of us have been out of the loop on this issue, and your dissection of the AOA's statements was most illuminating. Your efforts are appreciated.

Sincerely,
Xxxx Xxxxx, O.D.
Brattleboro, VT

After all of the to & fro regarding Board Certification, let me see if I have this in perspective. Physicians are encouraged by the insurance companies to be Board Certified for inclusion into many plans & medical facilities. Guess who is on the Board of the insurance plans & medical facilities. Yep you guessed it – Physicians. The Board Certification idea was designed to minimize those physicians who had access – not necessarily those with the most skill. Only those who took the “approved” courses, passed the “approved” tests, designed and administered by the “approved” physicians were supposed to be considered experts. Admittedly Board Certification is an acceptable idea for physicians due to the legal and practical need for specialization. For many years there was no educational requirement after medical school & internship to maintain their license. Once you received the MD degree, you were set for life. No CE. Nothing. Even moving their practice among states was easy. Reciprocity was (is) granted to physicians unless you have committed some heinous crime.

Enter Optometry. For a long time we were virtually the only profession to require CE in every state. The problem was (is) that every state has different CE requirements, and different state laws. This is mainly due to individual state fights with the MD’s as to what the OD could do or not due in THAT state, and we succumbed to trying to please the medical community so we could practice our profession in peace. The Boards also desired to limit WHO and how many OD’s could practice there. Boards limit entry into states now by requiring all applicants to pass the same tests required of fresh out of school applicants – not really a possibility for someone out of school for 25+ years. The use of pharmacological agents was achieved, but still varies state to state due in total to fights with the MD’s. It is ALWAYS a compromise between MD’s & OD’s so that we can provide the health care that the public needs and deserves, and that we are knowledgeable with the expertise in providing.

OD’s have been mandated for many years by the individual State Boards to have a predetermined number of CE hours. Once again this was determined by what that state board considered would appease the MD’s and would cause a minimal amount of argument with them. Since our State Boards set the requirements, are we now to assume that our Boards were not adequately setting the standards. If so, why not?

Insurance Plans & medical facilities did not JUST come up with Board Certification as a requirement. The Board Certification idea did not JUST appear in all of their documents. Where has our leadership been? Why have they not insisted in the Board Certification requirement for inclusion to be omitted for OD’s. In the past if memory serves, insurance plans had several questions on their forms: Are you an Ophthalmologist (Yes/No), are you Board Certified (Yes/No); Are you an Optometrist (Yes/No). And that was IT! Board Certification was NOT a requirement for insurance billing, just more info for the company. Why are we just NOW discovering a difference in billing level ability? Was this not obvious previously? Where has our “representation” been?

Why now is there the push for Board Certification for OD’s. Will it make us smarter because we have taken a written test after the CE course? Will it make us better able to communicate with our patients? Will we be required to buy more equipment? Who will administer all of these tests? Who determines who can give the courses? And what make them the expert? What makes their solution to a clinical issue better than any one else’s? Is it just because they know a few more medical terms? Who determines the test questions and the acceptable answers? Who will pay them? Where is the money coming from? Who performs the testing oversight? Who is going to pay for all of the necessary administration? Consider all of the hundreds of thousands of office clinical hours lost to going to Board Certified courses and taking tests. Since some clinicians currently specialize (contact lenses, vision therapy, glaucoma, refractive surgery), who is going to determine THEIR skill and knowledge level? These specialty private practitioners probably know more and are more current than those who will think up the courses and test questions!

Being fresh out of school, book educated and able to pass any academic test given you is fine. But as a former partner noted just after joining his 30 year practice fresh out of school, “in school you learned how to do things by the clinical book; now you will have to re-learn how to do things in order to accommodate the patient, the insurance companies, the state board, the labs, the pharmaceutical companies, personal and professional ethics, the office staff AND the bottom line.” It was a mind and eye opening 3 year training ground. School had taught the clinical aspects of Optometry; it had not prepared one for the ART of patient communication and the ART of Optometry.

It may seem skeptical but this seems like the OD’s are once again trying to appease the insurance companies & medical facilities, who are in reality “guided” by the physicians on THEIR Boards. Once again we are just trying to compromise - all under the guise of improved healthcare. Sounds like what is happening in Washington. As the politicians see it, ONLY they know what is best for the little people. So, they will control everything and tell you what you can do, and how much you can earn while doing it. These are same ones who created the laws that got us here in the first place. Plans within plans.

Xxxx Xxxxx, Atlanta, GA.

Art,
Excellent piece this week!
You are so totally right. The leadership SHOULD seek consensus of the membership. The question is really “will they?” I heard a lot of talk at SECO that this JBCPT was a “done deal.” Membership be damned. It will be interesting to see if those same “leaders” are as arrogant in light if the overwhelming number of rank-and-file ODs against this horrid proposal.
Keep the pressure on. You have generated a groundswell. You are using your platform for the good of the profession. Thanks for doing that.
Xxxxx

As one who deeply resents and opposes the push for optometric "board certification,", and which, if enacted, will serve only to alienate me from the AOA and its state affiliates (in particular NYSOA, my own), I thought the article below (which appeared in the current issue of the Journal of American Physicians and Surgeons - one of the few non-politically-motivated physician organizations in this country) would be of interest in relation to board certification:

14 Journal of American Physicians and Surgeons (Spring 2009) 17,
"AAPS Survey: Physicians Skeptical of Recertification"
Jane M. Orient, M.D.
Download article in PDF format

If the hyperlink above does not work, this was copied from the downloaded article:

http://www.jpands.org/vol14no1/orient.pdf

Regards and best wishes,

Xxxxx Xxxxxx, O.D.

Hi Art:
Your articles are making major play around the State via our listserve. The leadership has been called to task. Your name has been adding a lot of credibility to the dissenting vote.
I wanted to make reference to one of your blog responders who stated that as a Florida OD he was already BC. Interestingly I was in Florida two weeks ago; having dinner with two OD's one night, the topic came up and they also said that they are already BC. There are two types of licenses in FL; the majority have the BC license.

All the XX delegates claim to be independent and say they will vote independently; but in the next breath, leadership says they will vote as a block ! Go figure.
regards,
Xxxx Xxxxxx, OD

Dear Art,

Often you get little recognition for the many hours expended, and I for one, really appreciate your endeavors. Please allow me thank you for all of the work that you do for Optometry. The following is a variation of a letter that I have previously sent to the Ohio Optometric Association.

I do commend the work of the joint ABO task force over the past eighteen months. However, too many questions and issues remain unanswered and unresolved. The basis of the letter will apply to Ohio Optometry, but can easily be extended nationwide.

First, Ohio currently has several levels of optometric practice. There are 50 optometrists that are still practicing with only their OD license, or possibly, even just a BS if they are old enough. In 1980, the next level of Ohio practice came into existence: there are still 75 OD’s that are practicing with only a DPA license. In 1992, the TPA license became available, which now includes the remaining 1311 OD’s. This TPA license is required for all newly licensed OD’s. Twenty-nine years have passed since the implementation of the DPA, and seventeen years the implementation of the TPA, and we are still stratified.

Second, the ABO would create in Ohio at least two more levels of practice. The new graduate or resident would be able to “easily” obtain the required points to take the ABO test. Someone like myself after thirty-five years of practice could take the continuing education hours, but taking a comprehensive test at this point in my career would be significantly more difficult. Even if there were a requirement that ABO applicants be TPA certified, it would still create at least two more levels of Ohio practice: i.e. Board eligible and Board certified.

Third, these first two points concern Ohio. There are, however, 49 other states, Washington DC, Puerto Rico, military, Veteran’s Administration, etc. each with their own laws, rules and regulations. The ABO cannot possibly succeed in creating a national level playing field as licensure is State-regulated. Maybe one of the unspoken goals is license portability, but personally I do not see ABO paving the way in the foreseeable future.

Fourth, there is no acknowledgement for time in practice or expertise gleaned from being in practice. New graduates may be able to take and pass the ABO test, but this is still not equivalent to experience. As someone who has had three different new graduate associates over the last twenty years, all with the ability to pass a rigorous test, I still would not place their levels of experience or competence at the level of a doctor with thirty years of practice. Book knowledge and practice knowledge are not equivalent.

Fifth, there is no acknowledgement of Fellowship in the American Academy of Optometry unless this Fellowship was attained within the last 10 years. And this only reduces the points required from 150 to 100. Big deal. Many of us decided to attain Academy Fellowship, and went above and beyond basic licensure. We did the various required case reports. We did the examination before our peers. To me, this is the goal that should be held in the highest esteem. The Academy even goes further with the awarding of the Diplomat in many of its specialized areas. But both becoming a Fellow or a Diplomat is still optional! Ten percent of the profession are Fellows by choice. Fellows have already done the extra work. To ignore this fact is just plain ludicrous. Similarly, there no acknowledgement of Fellowship in any of the other specialty organizations that also mandate rigorous entrance requirements and testing.

Sixth, I am not anti-continuing education. I believe in CE. I have attained the level required for the Optometric Recognition Award every year since its inception by the Ohio Optometric Association. I take six hours of transcript quality CE annually to maintain my Florida license. Furthermore, I am part of only a handful of optometrists that have received an MS in Optometric Research. I have gone above and beyond. But ABO does not acknowledge these facts.

Seventh, is the cost to the doctor to obtain Board Certification. It has been estimated that the cost for taking the ABO test that was estimated to be in excess of $1000. This does not include the time that would need to be taken out of one’s practice to take in-depth review classes. Although the 150 points can be obtained by attending COPE or State Board certified continuing education, in-depth review classes will require the expertise of ASCO. This ASCO input would include course formulation, instruction, test formulation, and grading. Is there a hidden agenda?

Finally, I firmly believe that ABO will further stratify and divide Optometry both in Ohio and nationally. We have long sought unity, but ABO will just continue to divide us.

Thank you, for listening to my rambling.

Sincerely,

Xxxxx Xxxxxx, OD

One can not talk about board certification with out discussing the topic of mobility of optometrists. Making Optometrists retake National Boards in order to practice in a state of their choice makes the concept of Board Certification ridiculous. If the idea of Board Certification is is supposed to make our profession more credible then mobility from state to state should should not be restricted by making us jump thru hoops. I would be for Board Certification if it would ease up mobility requirements.
Xxxxx Xxxxx

Dr. Arthur Epstein:

Thanks so much for your thoughtful and well written editorial about board certification for optometry. I have enjoyed the discussion of this incredibly important topic for our profession and recognize that it will undoubtedly be one of the most important topics decided by the AOA. I was initially in favor of the board certification process, but upon learning the details of the process, very quickly came to the conclusion that it would not be a "true" board certification as board certification is defined by those primarily with MD and DO degrees. In short, the process would be easily identified as a joke by those who attained board certification by a much more rigorous process, usually including a three year residency. Unfortunately I have not seen a balanced presentation of this issue by the AOA to date.

Thanks again for your input to this issue.

LeRoy

--
Xxxx Xxxxx, O.D.
Colorado Springs, CO

OP: Notice the state focus and discussion regarding pediatricians and MDs. Recommendations for BC have had nothing to do with optometry. It is exceedingly unlikely that a state would demand board certification of a non-boarded state regulated and licensed profession, especially when implementation would likely raise the cost of care. The cost for BC over 10 years has been estimated at exceeding $25,000 not including time lost from practice.

Art:

I did a quick calculation of BC costs and this cost is easily higher than $25,000 over 10 years. This is an email I posted on the Optcom list today:

I finally got my wife an ABIM board certified Internist) to say something about this last night, and what I finally got out of her was the following:

You do not receive board certification for general medical knowledge, but you get it in a specialty. She said that board certification is to prove that a doctor has comprehensive knowledge of a special nature that has been attained post-graduation by completing several years of post-graduate study in a residency and passing a very rigorous exam. You can practice medicine after receiving your permanent license (usually only requiring one year of internship) and need not undergo the extra training, but you cannot get board certification by completing a few weekend courses and taking a simple test.

She also reiterated what WE have said about filling out credentialing papers: if asked if you are board certified, N/A is the answer, meaning not available or not applicable. You cannot be held accountable for something that does not apply. However, once you have a board, then you have to answer "No, I chose not to". She added (direct quote here) "Be careful what you wish for, you might actually get it." She also said that once the board exists, a so-called voluntary plan becomes de facto mandatory.

Has anyone actually looked at the economics of this seriously? I just did a few calculations in my head last night, and the figures are staggering. I registered for 16 hours of CE at the Midwest Eyecare Congress, and got a discount for my IOA membership. The cost was $322.50, or roughly $20/credit hour. I will be required to have 50 hours per year, so a rough (and low) estimate is that I will spend $1000/year just on the CE. I am lucky that it is in my backyard, so no travel or hotels or meals involved, however, for those who must travel, let's add in $160/night for the room, and $320 for transportation.
Now, for 16 hours we are looking at $320 +$320 +$320, now costing $60/hour.

So the actual expense for 50 hours is $3000/year. Missing 2 days in the office per 16 hour stint, or roughly a week out of the office for a year.
What is the difference in revenue generated in your office for a week if you are absent? That is the variable cost, but lets say that you could say that the difference is $6-9,000

OK, $3000 per year in actual outlay for the CE. How many ODs in the US?

According to the US Bureau of Labor Statistics, ~33,000 in 2006. That equates to close to $100,000,000 in direct costs to the optometrists of this country to just maintain the BC, not including the amount of lost revenue due to not being in the office for a week. I feel it safe to say that EASILY 300-400 MILLION dollars is the annual cost to optometrists for board certification that has no demonstrable necessity.

Xxxx Xxxxx, OD

Hi,
I recently read your article about Board Certification and agree with you 100%. I dont know if you have any type of petition against it, but I would be happy to add my name to it as well as send it on to any optometrists I know. Let me know if I can help.

Xxxxx Xxxxx, OD

Thank you for speaking for the majority of O.D.s. I have been trying to look at this with an open mind, maybe something that would help my self and Optometry in general. I've been in practice for 29 years and have always enjoyed continuing education. The proposal as it stands, sounds like it would put a substantial burden on the average practicing OD. I understand this is voluntary, but it may eventually become what is the norm for insurance participation.

Xxxxx Xxxxx, O.D. (California)

Art,
I again want to say that I appreciate you stepping up and voicing your opinion on BC. I am wondering if you know what happens if the AOA delegates do vote it down this summer. Can the other organizations involved still proceed without the AOA or would it be a dead issue (again)?
Xxxxx.
Louisville, KY

Dear Dr. Epstein,

I just wanted to drop a note and let you know I fully support your editorial on Board Certification. In my 20 years of practicing therapeutic optometry I have never once been asked by a patient if I am board certified. Our profession brags about its low mal-practice ratings and we still shoot ourselves in the foot. I think the AOA needs to wake up and quit ramming worthless ventures down our throats. As far as I'm concerned AOA is trying to fix a problem that doesn't exist. I've already sent a email copy to my state affiliate. (Why do I have the feeling that the state affiliate will pretend to not get the copy or ignore it...)

Dr. Xxxx Xxxx
Omaha, NE

Dr. Epstein,

I have just finished reading your e-journal from March 16 concerning the board certification process.
Everything I have been thinking, you stated in your editorial.
Perfect, "nail on the head" summary of what is going on.
I support your viewpoint in this matter, and you can quote me on that.

Thank you so very much,

James R. Davis, IV, O.D.

Art,

I did not vote in any survey, but if you are still counting opinions, I am with you.

I am not in favor of BC.

BC is a solution for a problem that doesn't exist.

This is a situation where there is almost nothing for any individual optometrist to gain and potentially something to lose.........or at least the risks/problems that could occur is not worth any potential or perceived benefit.

It is almost as if some of these opt. organizations need something to fight for or push for in order to give them a reason to exist or in order to make them feel like they are accomplishing something important...........i just hope they can find something else to do.

(Anonymous)

Art:
re:yourcolumn: hear! hear!

Nancy Xxxxx

Dear Art,
Thank you for bringing clarity to this process and thank you for your continued articles.
FRANKLIN

Art:

Amen to you for your well-timed and brave expression of a well-thought out and articulated position.

It is truly folly to allow a change that has no need and no benefit to the general optometric practitioner, and which would be very costly to the individual and to the profession.

I agree with you and Dr. Myers that this is not necessary and the plan not even understandable. I have read the certification plan several times and still don't know what it actually means or how it would work. It is an example of the "just trust us" philosophy that leads to unwarranted regulation and bureaucracy.

You are absolutely right that we need to speak out or will be led to a future that undermines the progress we have made over the last many decades as a profession. We should realize that right now we don't want to lose precious autonomy and become more beholden to insurance regulators or increased federal mandates, but cherish our independence as a profession and simplicity of licensure. Unless it is proven that we truly NEED to broaden our training to delivery efficient and effective care, or NEED to increase specialty oversight, there is no NEED to consider this pseudo-certification.

Perhaps during this time of catastrophic "change" it would be wiser to wait and observe and do nothing rather than to dig ourselves deeper into the regulatory abyss.

Best regards,

Pat Xxxx
WA

Dear Art:
thanks so much for voicing the opionion so many thousands of us share in opposing the ridiculous board certification proposal. Please keep up the great work.

Xxxx Xxxxx, O.D.
Nashville, TN

Great editorial. I printed it and will keep it for future reference. I agree - board cert. for general optometry BAD for all the reasons you and Meyer stated. One other element lurking at the edges of this topic is the fact that our generation of ODs has had to "go back to school" for TPAs. I have done it twice here in Cali and a 3rd back-to-school requirement was shadowing an OMD for 65 hours. A 4th time will occur when we get our glaucoma TPA privileges expanded. We are weary of mandated examinations. Thank you for taking on this topic and speaking up for the majority. fight on,
--
XX Xxxxx,O.D.

Art,

Thank you for being an incredible asset to our profession and a voice of reason and common sense. The idea of board certification after becoming an optometrist, taking national and state boards (at least in my day) and being required to take TQ continuing education yearly seems like a fairly complete and comprehensive display of our commitment to obtain credibility within our profession. Additional organizations (OEP,COVD, CLS, SVS, etc.) show our desire to specialize where desired. If those organizations and all we've gone through aren't enough, another "hoop to jump through" seems ridiculous and we will see a division in our profession that won't be overcome!

Mel Xxxxx, OD

Thank you, thank you, thank you for having the courage to publicly state what most of us feel. It would add another layer of bureaucracy that would then give managed care companies even more control of our practices. We’ve got enough battles to fight without having to fight our own organizations. Let’s nip it in the bud once and for all. Pete Xxxxxx, O.D, (P. S. My Florida license says I’m already board certified.)

Hey Art. That must have been a tough one to write given the circles that you run in. Glad you wrote it. Thanks. –Charlie

Dear Dr. Epstein,

I agree 100% with your article.

Xxxx Xxxxx (Minnesota Optometric Association Member)

Dear Art,

Thank you for a clear statement. I am in agreement. If we ever meet I will shake your hand and call you friend.

Sincerely,

Michael Xxxxx, O.D.

Dear Dr Epstein, Thank you so much for your well written article concerning
Board certification. I agree with you completely.

Lance Xxxxx, OD

Art:
I agree. If done properly, board certification might be a clever or needed attribute at another point in our evolution. This is not that point. Our current priorities must be:
• Making optometric residency the standard
• 50 state portability of licenses
Simply stated, our 4 year programs do not adequately prepare OD's for current practice challenges and our current lack of license portability is appauling. These are more visceral housekeeping matters that, with proper and timely management, will have far greater impact on our future place in our medical and business communities.

Best regards,

Elliot Xxxxxx, OD

Art,

You did a beautiful job outlining the reasons that the vast majority of
optometrists in the US are against this silly proposal. You're right, this
is nothing more than a glorified (i.e., complex and expensive without
results commensurate with the costs) CE program. It will be a true Board
Certification program only in the eyes of a few optometrists and those
administering the bureaucracy created by the program. It will certainly not
be considered such in the eyes of medicine, legislators, or insurance
programs.

Thank you for expressing these and other points so well. I only hope your
message reaches those intent on ramming this proposal down our throats.
I've let our state delegation know my opinion and will continue to encourage
others to do the same.

Best wishes

Xxxxx Xxxxx

I just read your perspective on Board Certification and I have to say I completely agree with you. I see it as a glorified CME effort. More important I feel is the ability for a licensed optometrist to travel to another state and be able to obtain a state license without the horrendous restrictions that apply now. Would Board Certification mean I can move to another state and practice? If not, it’s pointless. Thanks for your opinion.

Xxxxx Xxxxxx, OD

Hello Art,
Thank you for taking a stand against this Board Certification proposal. I think there are a great many of us out there (70%?) who cannot abide by this, but most of us don't have the benefit of the "bully pulpit" to make our wishes known.
I have sent a copy of my letter to the WOA and also the AOA. I have received a favorable response from the executive director of the WOA, but of course nothing from St. Louis.

I can't accept anything about this proposal, including the cautious and flowery language in which it is framed. We are to "demonstrate" our knowledge. Oh, really? To whom? Have the NBO or ARBO members "demonstrated" their superior intellect, or clinical skills to enable them to judge me? Not to my mind, they haven't.
This whole thing is a poor process, unwarranted and unnecessary. I am totally and unequivocally opposed to it.

Thanks
Xxxx Xxxxxx, O.D.
WI

Art,
Your article is insightful and extremely well written. It has triggered numerous responses on the CAO (CT Assoc of Optometrists) site and will fuel the debate at tomorrow's state meeting.

The good news is the vast majority of the responses have agreed with you, as do I.

Thanks for writing this and one other point to consider is what if the AOA and State Associations were prohibited from providing any of the education or certification. It would all be done by an outside private agency with no financial ties to the Associations. How fast would this concept evaporate???

Regards,
Mark

Well stated. I could not agree more.

Regards.
Xxxxx Xxxxx, O.D.
Massapequa Park, NY

Dear Art,

Thanks for putting many of our collective thoughts into words. And with a minority of ODs trying to push this through the best that we mortal ODs may be able to do is to leave the AOA if it passes. That may be the only way to get their attention.

As I wrote before regarding OD board certification, no matter what we do we may never be equal to an OMD in the eyes of MDs no matter what hoops we jump through. I think MD bias brainwashing begins in med school when they go on ophthalmology rounds and get a full dose of prejudice from the OMDs and their tech "refractionists". By the time MDs are done with their residencies they have had seven formative years of "OD servant, OMD master" training. Who would you trust your MD hide with a referral -- to a servant or a master? That won't be changed with board certification or anything other than having an OD and an MD 200 miles from the closest OMD in rural Montana.

One other problem with board certification: Board certification seems just one step closer to having a national optometry license. All of our TPA laws were changed first in the small states then the big states last. The best way to stagnate our growth would be to have all TPA changes changed at the national level. One more strike against it.

You have probably heard all of this before. Thanks for being the voice of reason.

Best regards always,

Xxxx

Dr. Epstein-

Thank you so much for stating your opinion so thoughtfully. All my colleagues that I have discussed this with agree: we ARE ALREADY 'board certified' by our State Licensing Board, and need to provide CE Hours every year to prove our competency.

If the issue is the need for us to be able to get on an insurance panel, then my thought is this: If the Insurance Provider does NOT want us on their panel, then they will just change the rules from "board certification" to "MD/DO only", or some other requirement, and still exclude us.

It's amazing to me that organized optometry rushes (against the will of the rank-and-file optometrist) to push board certification, yet IGNORES us in what is for most ODs a more pressing matter, which is state-to-state license reciprocity. I work in a hospital-based HMO practice with both MDs and ODs, and our MD colleagues are amazed that we can't easily obtain a license in another state! (They are ALSO amazed that we actually are clocked-in and watched so closely at our CE courses, but that is another matter).

By the way, I am a residency-trained OD working in a position where we use therapeutics frequently, so I don't oppose the issue because I feel I couldn't 'pass the tests',,,instead I oppose it because it adds yet another layer of bureaucracy (and financial obligation) to an already full load of state-license requirements.

Anyway, I would like to thank you for sticking up for what is (according to all the polls) the 'silent majority' who oppose this issue.

Sincerely- Xxxxx Xxxxxx, OD

All I can say is “I love you!” The whole BC is a bunch of BS.

Charlotte
IL

Dr. Epstein,
I appreciate your candid opinion on board certification. I completely agree with you but have felt I would be chastised as being non-progressive if not aggreeing on this proposal. Thank you for expressing your opinion that IS shared by many others.

Anonymous Just Graduated O.D.

hi art....

bravo... well put

as a 36 year member, and past state president, I will surely vote with my checkbook.

there are some really important issues that influence me, my practice and my patients, that are being ignored with this silly board certification issue taking so great a time and dollar resource

and talk about bad timing...

Thank you for speaking out
i will follow your advice and contact my state and national representatives

larry xxxxx od

Dr. Epstein – Thank you for your editorial in Optometric Physician. Your opinion is valued but I must challenge your assertion that the vast majority of optometrists are against the board certification proposal. I am a member of the Minnesota Optometric Assn. Board and when we recently held our annual conference and presented the board certification proposal we by no means had a majority of docs against it. In fact I would argue that the vast majority of docs were in agreement that this was needed and were in agreement that as a state we should support the AOA’s position. I personally did not hear a single person speak to me against this proposal and as a board in our discussions have heard of only a handful of individuals who are opposed and none to the degree that you have implied. I believe your assertion that the VAST MAJORITY of docs are opposed to this is vastly overstated. I wonder if the unscientific pole numbers you reference would change now that more information is available and people have a better understanding of the proposal. Whether we are an anomaly here in MN is to be seen at the House of Delegates as should be the process where the masses voices are heard. So, I respectfully disagree with you on this issue. I have yet to date heard a good argument against board certification with the exception of cost which you did mention but I don’t think that this alone should be the reason we are the only health care profession without a form of continued competency.

Thank you again for your time.

XXX X XXXXX, OD

EDITORS NOTE: The optcomlist poll is showing 90% against as of June 1st

I agree with you. I think that the new proposal is just a way for ODs who have never practiced to have some form of power or importance. They are out of touch.

Thanks,
Xxxx Xxxx, O.D., F.A.A.O.

Dr Epstein,
Thank you for such a well spoken position on the AOA/JBCPT. I have heard the same sentiments from my colleagues since the proposed process was unveiled. You have given a bold voice to the never listened to masses. Thank you.
Xxxx Xxxxx, OD
New Castle, IN

Art,

Spot on! Thanks for such an insightful and well thought out stance. I totally agree, but am not nearly as articulate as you. I have contacted my state association (AFOS).
Thanks for your leadership in our profession---I know your views are very well respected. I thoroughly enjoy your weekly newsletter too--great job.
Have a great day and keep up the good work!

-Xxxxx
Xxxx Xxxx, OD, FAAO USN

Hi Art,

If this is printed I do not want it attributed to me.

I read Ken Myers paper a week or two ago. Of the items that I am very familiar, I found inaccuracies and a very biased view. He states in a paragraph all by itself that:

"This is understood by optometry students. Those serving residencies are not aiming towards a private, general practice."

First of all, it is absolutely impossible to say that those serving residencies are not aiming towards private, general practice. Of the 5 in my class that did residencies, 4 are in this exact mode: private, general practice. They are not there because they failed something and got stuck in this mode! They were headed there prior to their residency. And, to go on further and say that "This is understood by optometry students" is ridiculous. How could something that is not a truth be understood by all optometry students. Did he ask them all?

I found the paper to be biased, as if the VA is trying to protect their own newly created certification process, not wanting others on board.

What about the other aspects of the paper that I am not familiar with? How do I believe the rest of the paper is honest when I find inaccuracies in these basic concepts?

Xxxx

Thanks for stepping up on this. I don't understand why the AOA keeps pushing this idea. They could much better serve the profession by doing something about reasonable licensing reciprocity than this issue.
Xxxx Xxxxx, OD
Kaiser Permanente- Colorado

very well said,
THANK YOU!!

Xxxx Xxxxx, OD

Art – I have always enjoyed attending your lectures whether in Kansas City or Vision Expo West, and reading your articles. I think your article on board certification is spot on. You’ve really thought this through and thanks for expressing the opinion of so many of us fellow OD’s.
Thanks again, Xxx Xxxxx, OD

AOA members –
BEWARE!!

Our so-called “leaders” are “railroading”* us in to
Board Certification – whether we want it or not!
Don’t let it happen…….

*(The train has left the station!)

Robert Xxxxx, O.D.

Dr. Epstein

Thanks so much for being the first nationally recognized individual to have the nerve to come out strongly against this ludicrous board certification movement. There seems to be a conspiracy by our so-called leaders to prevent anything being published against the issue. I have tried to pay for ads in the AOA journal, I have e-mailed, snail-mailed, and called everyone listed in the journals and newsletters. NOBODY will return my calls or e-mails. I have written a letter that I have read at our OHIO meetings (My sense is that 95+ % of Ohio ODs are against board certification). I would gladly pay your publication (on Tuesday) if you would publish the letter. I will sent it to you as an attachment. Also, I will send you what is probably a controversial ad I tried to get published in the AOA journal. Needless to say, they refused to publish that one.

Thanks for your support of the oppostition to the movement!

Xxxx Xxxxx, O.D.
Lorain, OH

Hi Art,
I could not agree more with your 03/16/09 editorial in the Optometric Physician. You did not see me at the Bronstein Seminar this past January for a similar reason.
The Washington State Board of Optometry was perhaps the first state to rule that all Optometrists licensed in the state must practice at the same highest level of competancy. I, and some of my collegues chose not to be certified to use injectibles. I for one, would rather fit contact lenses, do visual therapy, precribed drugs when needed, and in general, practice full scope Optometry. Using injectables has never seemed to be within the scope of the Optometric practice that I chose when I entered the profession. Having to choose a specialty after graduation, and then to be certified is indeed beyond my imagination. I am told it is because Medicare will soon demand certification for payment.

Because I chose not to be certified to use injectables, I will lose my license come January 1, 2010. My contract at the state prison expired the end of September, My practice has been sold, though not entirely paid for. So it seemed like a good time to call it a day. I will miss my many friends and collegues in the profession, and the opportunity to offer meaningful input. My biggest regret is no longer being able to improve the learning skills of children in our classrooms.

Perhaps we may meet again.
Xxxx Xxxxx

Dr. Epstein:

Thanks for the in depth analysis on the board certification matter. I talked to a M.D. who just passed his/her BC process recently, it was an eye opener.

Keep up the good work.

Michael

Art

God Bless you for your articulate rejection of pseudoboards. I am an O.D. who graduated in 1982 from ICO. I am a much better optometrist than I was then, thanks to 27 years of experience. I could be even better if I was free to take CE courses that I was interested in instead of constantly repeating the same CE over and over again, because it was mandated by the state board to get us therapeutic privileges. I admit that my functional vision skills have atrophied due to lack of use and having to take junior ophthalmology CE that applies to my license. Thankfully we have been granted a small amount of actual optometry in our CE the last few years but not much.

Thank you for sticking with the ODs in the trenches, and not the Ivory Tower.

Peace

Ron Xxxxx

Art: I couldn't agree more! Great and well written article. Xxx Xxxxx OD

THANK YOU for saying what the majority of my friends have been saying "silently" for the last few months....this proposal is so divisive that I fear it will destroy all the gains in the scope of practice that you and I have seen gained over the last 30 years. It may also limit the AOA response to any future threats to the profession.

I have no problem if an OD wants to be "board certified" in a specialty after completing an optometric residency ( ie: Low Vision, Rehabilitation Optometry, Developmental Vision) BUT DO NOT tell me that I have to be board certified to maintain my license to practice. If you meet the continuing education criteria in your state then you can maintain you license!

I find it very interesting that the strongest support for board certification has come from the schools and colleges of optometry. WOW a whole new area of CE that they can cash in on. I haven't heard what the National Board of Optometry has to say... they are the body that gave me the right to practice at the highest level in NY State, I guess the diploma they gave me is worthless because some pseudo board say I need to take another test.

Your critical analysis of the issue is right to the point....no one that I have read has made the issue clearer. I suggest that every member contact the AOA office and their state office to oppose the board certification proposal.

Thank you again for saying what needed to be said.

Ed Xxxx, OD

Dear Art,
Thank you for cogently, enthusiastically, and honestly representing my feelings about the proposed board certification. I have long found the reasoning flawed and self serving by those who propose to control the means of certification without science or fact to justify it.
Michael Xxxx, OD

Thank you for verbalizing some of my thoughts and frustrations regarding this "board certification" process. I have been nationally certified since 1982, Academy "certified" since 1985, state certified by four different state agencies, DPA certified, TPA certified (twice going through the weekend CE meetings and passing the exam since the two states I practiced in passed the laws at different times ) and I always take more than the necessary continuing ed to maintain my licensures. I have never been denied insurance because I wasn't "board certified"- only because I wasn't an M.D. My husband is a physician- he had to pass a board exam ONCE in his career. So jumping through another hoop imposed by my own colleagues is the last thing I feel I should have to do. My malpracitice is still reasonable after all these years- if the insurance companies think we're that safe, why do some in our profession think we're not?! This whole process has gotten out of hand by a group of overzealous, valedictorian, ivory tower -type folks who seem to have an insecurity problem. Let this go once and for all-please. This will tear our profession apart!

Lisa Xxxx, O.D., F.A.A.O.

Dear Art,

Kudos to you, you nailed it with your editorial.

Xxxx Xxxxx,OD

Dr. Art. Bravo. Bravo. Bravo. I find it interesting the people charged with defining board certification seem to have allowed loopholes for themselves if they teach, sit on one of the organizations, belong to the academy, etc. Also the only people involved in the process are also those who will gain financially. This issue could be the ruin of optometry if not checked. Why is it nobody thought to ask the docs in the trenches what we think? We deal with this stuff (third party, hospital priv.) every day and not from some Ivory Tower. Regards and thank you, Mike Xxxxx

Art,

Well written and I agree 100% with your position.

Xxx Xxxxx, O.D.
OH

Hello Art friend and colleague.
I echo your position. Somehow David Cockrell and Randy Brooks want to push their agenda forward. Can you honestly think that either can look you in the eye and believe they are "serving" the "Optometrist's best interest.
Without question most practioners will support "specialty certification"
WHY DO IN NEED BOARD CERTIFICATION TO PRACTICE WHAT I HAVE A LICENSE TO DO
ALREADY?
Ask the AOA why those that have a FAAO (what year and are you better than me? and what was your FAAO specialty in?) would have a 100 point advantage.
If you are going to have board certification level the playing field!!!
Will David Cockrell or Randy Brooks take credit for the greatest defection in membership from the AOA in it's history. These economic times might be the trigger for the exodus!! 28% defection would be a disaster and 10% would be the signal of the avalanche leading to the disaster. Quite playing politics
Don

This whole Board Cert thing smells of snobbery. I get the impression that a few optometrists feel that they are better than the rest and want to add 'Board Certified' after their names to make their point.

In some ways, I can appreciate their point of view. When I was graduated from Ohio State, there were those who ranked at the top of the class and a few who just squeaked through. I often wondered about the care that patients would receive from those at the bottom of the class. The thing about optometry, is that it is not a life or death profession. I am proud to say that I have never had a patient die in my chair. This isn't brain surgery.

Xxx Xxxxx
Concord, CA

Art,
THANK YOU for your insightful, objective and well thought-out editorial regarding board certification. Your words expose as false the media PR distributed by the AOA.
The JBCPT has created an answer to a problem that does not exist. As you state, no OD has ever been denied access to an insurance plan because of board certification. It was a bad idea when ABOP was first proposed and wisely dismissed by the rank and file optometrists that are the backbone of our great profession. It remains a bad idea a decade later. Once again, the working ODs in the lanes every day need to voice their displeasure with this proposal and put this terrible idea to rest once and for all.
I am disappointed in the JBCPT. First, their definition of BC is nothing more than a super MOC. If the proposition was tied to residency training, as the VA's medical optometry board has been elucidated, that would be a step forward for our profession. The existing proposal will surely be a embarrassment to optometry in the eyes of those professions who offer true board certification. I question wheither the JBCPT understands the definition of board certification.
Surely the powers-that-be have seen the surveys, message boards, etc. that show without question the overwhelming disapproval by the rank-and-file of BC. The question now becomes: will they listen?
I have read Dr. Myer's excellent white papers regarding BC. I strongly recommend every practicing OD do the same, then as you say, let your voice be heard in your state association. Or else open your wallets.

Xxxx Xxxxx, OD, MS, FAAO, Dipl.

You have stated what I have always felt very well.

In Hawaii, locals would say, "Right on the kini popo, Brah!"

Despite assertions to the contrary, the board certification process proposed by the AOA/JBCPT is not board certification. It is an overly complex and costly form of continuing education. True board certification is a well-defined process accepted by the healthcare community, regulators, providers and accreditation agencies. Board certification occurs at the culmination of post-graduate residency-based specialty training after rigorous and specific testing. By adopting a non-residency-based pseudo-board certification process, optometry would stand alone under what would undoubtedly be intense scrutiny and perhaps ridicule from the rest of the healthcare community.
Bravo, Bravo,
Aloha from Hawaii,
Xxxx Xxxxx

Art,
Congratulations for your thoughtful ideas on Board Certification for Opometric Physicians. I agree that if the proccess mixes continuing education and equates that with residency, many obvious thing happen:
1. Optometry will become a residency required proffession, with room for 20% of it's graduates.
2. The "continuing educated ones" who practice world class eyecare with the best technology available to the full extend of the law (yourself and myself included) will become second class citizens.
3. It will be a boondoggle to execute and cost us a small fortune of time away from patients.
4. The Academy will be for what????
Let's concentarte on getting paid for what we do, being recognized for what we are, and enjoying providing visual health to the world.
Mark

Xxxx Xxxxx, OD, FAAO
Coral Springs, Florida

Dear Art,

I just read your editorial on this subject matter. Yes, I too have been flooded with emails and calls from colleagues across the country that are adamately against Board Certification. Your Editorial pretty much sums up what the majority of private O.D.'s across the nation are saying: "'thumbs down on another C-E extension." We can certainly drive a wedge into modern day optometry by this unnecessary action.

Bravo for speaking out in public. Your articles are read by most O.D.'s and thus carries quite an impact as it should. I salute you for your stance and you have my vote.

Xxxxx Xxxxxx, O.D.
Ontario, CA

Dr. Epstein,

Your sentiment is felt whole-heartedly regarding OD board certification.

My questions have been, aren't we board certified if we passed the 3 parts of the NBEO?

Aren't we general practioners?

Haven't we been taking TQ tests and CE to maintain and prove competency?

My letters to the AOA and IOA have fallen on deaf ears.

Best regards............Tony

Dear Art,

Bravo on your editorial. I especially agree that this board certification is an expensive CE scheme that will have the effect of enriching the pockets of lecturers and the members assembling the process. To boot, AOA dues would be spent paying for meetings related to the organization of the certification process.

I'm all for strict standards in CE, and in fact take about 40 hours per year for which I get no credit. But the idea of paying for certification does not sit well with me. It's among other things a "Stimulus Package" for those who insist on forcing it on the membership.

So I hope your editorial helps to defeat it, and I commend you for writing it.

Peter
Harrisburg, PA

My wife is a board certified Internist, and I take umbrage at anyone who claims that this BS/BC proposal is anything like a true certification process for a specialty. This appears to me to be little more than a money grab by Optometry schools for CE dollars, and may very well precipitate the unintended consequence (or is it?) of forcing everyone to become “board certified”. Once there is a process in place, simply putting N/A on credentialing apps will no longer work, and we may be forced to obtain certification to be on any panel.

I am one of the many who will resign from the AOA if this goes through. Maybe it is stupid, but why should I remain a member of an organization that no longer has my best interest at heart.

I am in favor of specialty certification. Low vision, pediatrics, contact lenses, pathology (VA) all have a REASON for certification, as well as a legitimate training program in place to justify it. Confusing board certification with continued competency is misguided and potentially dangerous to our profession.

Xxxxx Xxxxxx, OD

Art,

Good for you! You really told it like it is. Sometimes we suffer from elitism as do the other professions. We I attend CE and hear the conversations of some OD's, I feel something must be done either relicensure or something else to differenciate us from the "which is better 1 or 2" crowd. The board certification although well intended is excessive and is heavily biased on academy membership. Count me in on your side

Xxx Xxxxx, O.D.

Art,
I really appreciated your latest opinion article on the Optometric Board certification fiasco! Per my description, there should be no doubt that I wholeheartedly agree with you!
Dr. Xxxxx Xxxxxx
state board of examiners member in Xxxxxx, of course this is my personal opinion...

WOW !!!

That article was perfect and I agree 200% with everything that you said.

Great work and THANKS !!

Art

I knew I liked you and there was a reason I'm such a follower of your weekly excerpts. Good for you on becoming enlightened against the AOA's pseudo-"Board Certification" which is nothing more than a truly questionable means to an even more questionable end. Not only will it divide our profession but membership in the AOA will become vastly decimated. I for one will revoke my 15 years of membership should it move forward. Your overt proclomation in this weeks article should send resonance throughout the Optometry community and bring attention to the importance of the AOA listening to their very members. I salute you.

Regards,

Xxxx Xxxxx OD
Boynton Beach FL

Catching up with Email

2009-05-29T22:59:00.002-07:00

This is about 1/3 of new and uposted emails I have received. I am posting everything received on the subject including opposing viewpoints. The only exceptions are a handful where the author specifically requested I not post their email or comments that I felt were derogatory to colleagues. This is indeed a contentious issue. Art

You've done a better job of discussing and expressing the feelings of the majority of the profession than the AOA. For that you have earned my respect and thanks. I agree we have more important issues to resolve. As a profession, we have done pretty good increasing our scope of practice during the past 30 years from refractionists to optometric physicians. National reciprocity would go along way to unifying the profession.
Sent from my iPhone

Dear Art,

You are so right! Keep up the good work. Your friend in Kent, WA

Sir,

I appreciated your thoughts about National Licensure recently.

I was wondering if somehow the focus on board certification could be swayed in this direction. To me this is a much better step to take at this time for the health of the profession of Optometry.

(If I had a good literary mind, I would try and point out how Board Certification is like the Emperor’s New Clothes. But….)

Thanks,

Maj Xxxxx Xxxxx

From:
Subject: Re: Protecting Optometry's Future, Part IV
To: "David A. Cockrell, O.D."
Date: Saturday, May 9, 2009, 8:27 AM

Your delineation of points awarded for certain life situations, i.e. Academy of Optometry, really irritates me. Being a long time member of the Academy does not make me an more creditable than another, especially if I do not attend the Academy courses. I did drop my long time membership years ago when the dues money was needed elsewhere.

You make it sound so rosy, but I think this is putting the wrong horse in front of the cart. In fact, I think the horse is pushing the cart in a way that many of us do not want to go.

Xxx Xxxxx

Art,

I have had times when I did not agree with you, but on this issue you are spot on. Power comes from from unity of purpose and we as a profession are not walking in lock step now with the so called "professionals" looking down on the "commercials" and the "academics" knowing better whats good for the OD in the field. We have TPA vs.non TPA. AAO vs. non AAO. AOA vs non AOA. Just what we need is another divisive group.

I can envision the conversation I will have with insurance companies when they ask what I can do now that I'm board certified that I couldn't do before and I will be at a lose to come up with an answer. I can hear the laughter now.

We have enough enemies now with ophthalmology and soon the US government telling us how to practice, we need unification not further stratification.

Keep fighting the good fight. I'm sure the rank and file are with you.

Xxx Xxxxxx OD
MD

Good day Dr. Cockrel,
I have tremendous admiration for you but I also significantly disagree with your position on certification. I am also irritated at the hard sell that is going on by the Board. I just don’t think it is appropriate. Presentation of facts, and selling are two different acts. The selling is what I particularly am unhappy about.

My state fortunately is going to let the membership determine their vote in Washington. I do hope they are able to maintain that position.
Professionally yours,

Xxxx Xxxxx, OD

s and those who agree with you...me for one, I appreciate your standing up and speaking your mind. I am the same type of individual. I am working at a Wal-Mart Vision Center in a one door state, and am dying with all of the changes. If I was in any kind of financial stability,I would be out....... I did so much for my Xxxxx State Optometric Association as a student, and they turned their back on me. Since, I won't be XOA President any time soon, maybe I'll shoot for running for representative some day.

Thanks,

Dr. Xxxx Xxxxx

Hi Dr. Epstein,

I was the CE chair for XX for the past six years and had you speak a year or two back (it was great as expected). As a hospital based OD my world revolves around certification. I was referred to as MR. Fuchs for two months last fall because we are not "certified". This was reversed and we are now "Dr." . Hospitals and insurance companies work off white sheets that recommend what is appropriate language for hospital staff. My clinic XXXX has nurses now that are "Drs." yet cannot use that language on the floor with patients because of the higher hierarchy in hospital/medical settings.

I wish the AOA, ARBO, NBEO and etc., would just use the already in place higher competency that was used by the VA and opened that up to the general OD population after three years of practice or one year of residency.

I have always enjoyed your columns and thought I'd throw my two cents.

Best Regards,

Michael

Dear Art,
I have enjoyed reading your column over the years and was surprised to see your opposition to the board certification process. Despite my 30+ years practicing optometry, I still look forward to intellectual challenges and improving my clinical acumen. I found this ad (attached) in the Sunday Philadelphia Inquirer which I believe supports the AOA position on the need for board certification. It is becoming the standard for which practitioners are being judged. We can professionally step up to the plate and develop our own process or it will probably be imposed upon us. Practicing Optometry as we have come to know it is a privilege. I believe privileges should be accompanied with expectations.

Collegially yours,
LB

Dear Art
I began practicing before use of diagnostics were legal in most states. Optometry has surely come a long way - I would hate to see it go down the tubes because of an 'ego' or 'inferiority' complex shown by a few of the AOA elite. I am against BC and will not pay AOA dues if BC passes. Why are our 'leaders' afraid to send every OD in the country a yes or no ballot. (I could live with and continue to support the AOA no matter what the outcome of a national ballot).
Art - please continue to represent us.

DM (member of the majority)

Art:

I am one of the OD’s who supports Board Certification for a number of reasons.

1. Optometry has always been a stepchild in eye care. It’s time to take the good with the bad and demonstrate to our colleagues in Medicine, the Medical Directors of the Health Care Insurance Industry, and the State and Federal Legislators that “Optometry is the Primary Eye Care Profession” and we can prove it.
2. After serving as President of my local and state Optometric Associations, AOA-PAC for six years, State Board for 8 years and as President of ARBO, I feel I have a clear understanding for the purpose of Board Certification and I am not afraid of it. It is the best eye health policy change we could put in place to ensure the America public has the finest eye care.
3. Legislatively, our Ophthalmologic Colleagues cannot use the idea “Optometry does not recertify” against us anymore when we battle them in the State Legislatures and at the Federal level.
4. The Health Insurance Industry may discriminate further against Optometry if we did not have Board Certification. I do not wish to be opted out of plans, if anything I would like to be part of more.
5. The evaluation for Board Certification will not be Part 1 or Part 2 of the National Boards. Most of us do not wish to re-study for those kinds of tests. From my early understanding it would be a test that would measure continued competence of what we do every day in our practices. This should not be a threat, but encouraging to our profession.
6. When I apply for privileges in a hospital or a managed care plan, one of the questions asked is, Are you Board Certified? When? By who? It is not comfortable to say no to any of these questions; it is humiliating to me and our profession.

There are more pieces to this than I have described. I’m ready to begin the process and I hope more OD’s will feel the same way over time.

Regards,

RM, OD
Florida

Art,

Thank you for your efforts and for providing this forum.
It bothers me that the foundations for this Board Certification action keeps changing. First, we were told to approve the process because it didn’t mean we were agreeing to Board Certification, but only authorizing discussions about the possibilities and consequences. The next thing you know we have a full-blown, detailed proposal that we are told we really must accept. Obviously, authorizing the AOA participation in the JBCPT was a not-too-thinly-veiled, political maneuver to achieve a pre-determined outcome.
The initial agreement between the parties that constitute the JBCPT stated that if any one of the parties did not agree with the product of the project team, that it would be scrapped entirely. Then in a local society meeting attendees were told that if the AOA (their representative organization) did not approve the proposal, then the other organizations would continue, but AOA members would lose their input to the process. Interestingly, I have heard little discussion about, and no convincing explanation for, why the NBEO was voted off the project team. Supposedly, this is because the NBEO would have a conflict of interests, but I see little difference between the NBEO’s vested interests and that of some of the other organizations.
Also in the beginning of all of this, when most of us did not want it to go forward, one of the objections was that this was going to become another “mandatory” requirement to practice that would be used by insurance companies and other entities to discriminate against optometrists who chose not to participate. We were assured that this was not the case and the process would always be completely voluntary. Now the argument has changed and this is now being pushed as a mandatory requirement for the profession (and individual optometrists) to continue in Medicare and other insurance programs.
Our leaders seem committed to imitating other professions and agreeing to the ill-conceived mandates of insurers and policy makers who barely know what Optometry is. Merely accepting these declarations is not leadership. The Board Certification process in medicine was designed to provide the specialty education that could not fit within the medical school curriculum. It doesn't suit Optometry. Leadership might mean figuring out how to educate these policy entities and fighting unreasonable mandates.

Please withhold my name and e-mail address.

I agree with your stand on the Board Certification issue and appreciate you standing up for the beliefs of the others without a voice. I have two points to make for our side:
1. If the third party payers really would exclude anyone not board certified, they should stand up and say it NOW but I have heard nothing.
2. If the 3rd party payers really wanted only the best on their panels, they have had access to docs like you and me who have taken the high road and become Fellows in the Academy, but again, I've never seen that done either.
I believe the AOA has a hidden agenda although I don't know what it is.
IF this passes however, I will take whatever steps it takes to attempt to become board certified because I will play NOT second fiddle to any other OD.
David

Dear Art - I've attended many of your lectures and have enjoyed your publications for years. As such I respect you as a person and an optometrist. Your ability to address issues clearly is welcome in these confusing times. As an older OD with over thirty years under my belt I have witnessed the fragmentation of the profession over pharmaceuticals, commercialization and advertising. The need for a strong AOA was apparent with the legal and interprofessional conflicts that have arisen in the last few years but to front a non-critical issue such as board certification confuses me. It has not been an issue that hinders my practice since neither insurance carriers or patients have demanded it. I think you have done the right thing by questioning the motivation of the backers and I realize that you have stepped on some toes in the process. I appreciate your efforts to bring up points that the average OD may not have considered. I have contacted the individuals that you mentioned in your last OP issue to let them know that there are items that are facing our profession that are much more critical than this issue that will benefit few. Thank you for taking a stand.
Xxxxx Xxxxxx. OD, FAAO, IA
I'm in the twilight of my profession...almost 60, and I'll be outta here at 65. Is Board Certification gonna effect me and my practice...probably no. But would I pursue board certification, probably yes.

I've listened to the cacophony of members whine and moan/groan over this issue. From the "well the State already makes me take CE" to the "it's gonna cost like, $1,200 dollars to do this". This from someone with a late model BMW outside of the MD's office where gratis CE on new IOL's was being presented.

I graduated in '84, went overseas to practice in an Army hospital. Saw my first angle closure glaucoma the second week in practice, and the nearest ophthalmologist was 120 miles away, reachable on a balky German phone line (affectionately referred to as "Hitler's revenge"). Welcome to the real world..."doctor".

I got the patient stabilized, and the chaplain was able to go home that evening without "holding his eye" because of the pain, and I felt pretty durned good about myself. And over the next 3 years, I learned a short ton about medical eyecare that I'd have never have been exposed to working in a mall setting. Upon my return to the "States", I obviously got "stupid", because it was now illegal for me to prescribe as much as Neosporin to a patient who got hit in the eye with a hot French fry. Referral city from that point on....

The old gippers from the 70's who resoundly criticized the National Communications program (before my time, but old grudges die hard) that the AOA instilled back then, griped about Eyeglass 1 and Eyeglass 2...moaned about "commercialists" (some darned good OD's practice there-ask Bob Levoy), 1-800 CHEAP LENS, and a myriad of other problems. It's the nature of this profession, or so it seems.

That all the significant medical professions have a Board Certification process, including my colleages in Podiatry, leads one to ask...why not for Optometrists. Oh, pardon me...Optometric Physicians...a title bestowed by many a legislature. Yet when it comes to the rubber hitting the road, 20 & 30 year veterans are threating to bail? Lovely.

I suppose there will always be the "takers" in any profession...you know, the guys who reap the benefits of co-management, free CE, free this and that, yet they never volunteer to help their organization. But suggest a course of study that will encumber you for a period of time where you might actually learn something useful for the 90% of what you do sends the majority scurrying for the exit.

If it'll make me a better OD, and if it'll open my eyes to new and exciting things, then it's worth it. I got stupid once flying across the Atlantic...but if it'll advance the profession, then I'm in...whether or not I choose to use it.

"And that's all I have to say about that"

Regards, CJ, OD

Art,
I was at CE meeting the last 2 Sunday's in Philadelphia and a shocking number of OD"s were not aware of the Board Certification issue?? I was absolutely blown away! The most important issue this profession has seen and some are not aware.!!!!

I did go to a meeting, a local society meeting , with Bob Bittel ,Pres. of the POA on April 8th, and I came out of there more angry then when I went in. It seems like they have their minds made up.I asked where the democratic process was and the response I got was basically they are listening and they will make up our minds!
Tom Lewis was there to give and update on the JBCPT. He was told by a member"your school has a lot to gain by Board Cert.proposal". He did not have a real good response.
I hope that the AOA comes to it senses before June when they take the vote!!
Members at this meeting said" where will the AOA get $$ when many members drop out.

What a mess for Optometry.and lets not forget that even though I do co-manage with many different Ophthalmologist's, there are many in my town and many town's across America that want our therapeutic privileges taken away.The MD's must be laughing at us now an may up their efforts at this time when we are in disarray.

Regard's , Xxxxx Xxxxx, OD, PA

Dear Art;

I meant to e-mail you when you started your editorials concerning Board Certification. I am definitely against it. It seems we have more to loose and very little to gain as a profession.

I am Board Certified as a Developmental Optometrist by COVD, but that does not count in this model. Nor would a Contact Lens Specialist or Low Vision Specialist.

This was a bad idea 9 years ago, and a worse idea today. It will little effect me since I am retiring at the end of June. I love this profession and it has been very good to me. I would hate to see it self destruct in my life time.
Xxxx Xxxx, OD, PA

Hello Art.
Thank you for your message. I could not agree more openly. However one begs the question since the AOA and the JBCPT board has conducted this shroud in secrecy how can we know that the AOA can be honest and impartial in tally of the votes on this matter. I trust the AOA as much as you can throw an elephant!! Will an outside organization be able to monitor or even audit the voting of the house of delegates. There is growing resentment that the AOA will proceed regardless of what the membership votes on. I don't like the comment that this is still an ongoing development (which means just gives us the votes to proceed without knowledge of what will happen) David Cockrell had 2+ years to develop the infrastruture and still says this is ongoing development?
Secondly is the AOA pursuing this for financial reasons? at 1000.00 a pop and how many members does the AOA have? at 200,000 that comes out to 20 millions dollars every couple of years. So what is there is mass defection of 1/3 that still leaves 15 million dollars. Get my drift? Is it about the Benjamins?
Don

It’s déjà vu all over again. See the link below:

http://findarticles.com/p/articles/mi_qa3921/is_200004/ai_n8880649/

Board Certification is not for an entire profession but for sub-specialty expertise despite the current proposal to board certify general optometric practice

Subspecialty residencies should be developed followed by board examination and awarding of sub-specialty certification

Any physician declare practice in any subspecialty..an OB GYN can get sick of midnight deliveries and declare himself an ophthalmologist ( a real example) the only promototional/advertising difference is that he cannot declare himself board certified as he did not do a fellowship or residency

To attempt to board certify an entire profession, dilutes the value of board certification and fails to follow the protocols established in other health care professions

grumpy ol doc Xxxxxx

Hi Art,

I continue to read your editorial with much emotion. Thank you for expressing thoughts that so many of us are unable to do.

I agree with you that many O.D.'s are contemplating the withdrawal of their membership in the A.O.A. Many of my colleagues have been on the edge and this topic of BC was the final piece of feather which will push them over the edge. That is indeed a shame to witness.

This reminds me so much of my recent church experience. We had grown to a nice congregation of over 500 members. I was an Elder and close to the action. A few disgruntled members who disagreed with us decided to split the church. We split off into 3 groups. Everyone today suffers as a result. Rebuilding a new following is very difficult to do in our lifetime. My new group began a few years ago with 8 members. Today we have built a new fellowship hall and now have 30 members. We appear to be happy but my heart misses the larger body that we had worked so hard to attain (40 years). As you say, this could cause untold damage to the AOA that it will never recover.

Once people lose 'trust' then it is all over. In hindsight, the leaders should have allowed more open dialogue to embrace and cuddle the discontented members. When I joined the malcontent to give them a 'voice' in the main huddle, I found myself pitted against my former friends. The Conference president in dispair sought my advice. I told him that there were now 3 different camps and that he should allow a 3 way split before more groups began to form. I wanted to salvage the 'main body' of believers. I asked my family to stay within the mother church as I left with a small group to form their own identity. My group consisted of one M.D. , myself and 6 other good people. The 2nd group left with 45 members and worship in a rented school. I am in constant touch with all groups. They are my friends and will always remain my friends. I now see the AOA becoming fractured much like my group of believers. The pain and suffering will never be recovered.

Fortunately, the group which I nurture is doing well spiritually. We have gained a well known Cardiologist and an OB-Gyn giving us a huge boost. We just built a beautiful sanctuary that will greatly increase our growth. Yes, I am gaining many new friends but my heart is still in pain and suffering for what once used to be. My advice to the leaders of the AOA - please wake up now before you fragment our association into many pieces. "Listen to the voice of the members before you have no members to listen to" A body of believers is no different. What good does it do to have a beautiful church with no members?

Been there, done that.

Xxxx Xxxxx, OD
Ontario, CA

Dear Doctor Epstein,

I am a 62 year old practicing optometrist. I have kept up with our profession, being licensed in therapeutics/glaucoma since it was legal in Pennsylvania. As the news spread about board certification, I felt this was an elitist move to satisfy the egos of the academics and other "wannabees" in the profession. Once the steam builds up, it's hard to stop the train, but a few courageous O.D. such as yourself analyzed the movement for what it really was. In my career, I have always felt we had to jump through so many hoops that were imposed from outside our profession. To this day, in Pennsylvania, the Secretary of Health must singly approve each new drug that an optometrist may use. Why would we want to add another hoop to this long procession?
I always enjoy reading your prospective on the issues and our day to day life in optometry, but I particularly appreciate your waving the red flag to slow down this runaway train.

Cordially,

NH, O.D.

P.S. I realize you will probably not get a chance to see this note because of the huge volume of correspondence you receive, but it was therapeutic!

Art,
I feel that it is imperative that you reconsider your direction at this time. I spoke with both Randy Brooks and David Cockrell this past weekend. There are changes to be made to the proposal for board certification. These changes are being made by the AOA leadership and face certain opposition by some of the other groups involved, but they are changes that are going to be necessary for this process to continue.
That said, I feel that it is irresponsible at this time to continue to condemn a process that has yet to unfold. None of us knows allof the details of the final proposal to be brought before the house of delegates and what it will look like, none of us can effectively comment on it untill we know the full depth and breadth of it. It would truly be a travesty if the final product is a good one, but it is condemned because of the retoric before it's announcement!
Please, for the good of the profession, issue a statement accurately describing the process as we know it today. Let those who follow your column understand what is happening and when to expect to have a final product to evaluate. Give the doctors who make up your audience a chance to fully understand the final product and to make an educated and fair decision regarding its validity and viability.

Sincerely,
SMM, O.D.

Art,
Thanks again for putting this whole process in the correct perspective. I hope the "powers" realize how divisive this whole process will be to the profession. And then there is the obvious potential for ophthalmology to point their collective finger at us with ridicule.....it will undo many years of advancement.
all the best
Jeff

Hi Art:

I happened to have some extra tme and went to the blog section, and, to my surprise, found my note posted. There's a lot more of the commentary I'd like to go through, so I'll visit back there periodically.

I thought the note from the guy who asked to be "removed from your list" was telling. What an idiot!!! You're obviously reaching the right people and exposing a raw nerve.

Enjoy the weekend, and keep annoying those bastards!J

-Paul

Art-
If people stop talking to you over this then they're not really your friends...

I still talk to my misguided friends that voted for McCain/Palin!

Hang in there!

JP, CA

I totally agree with your assessment that Board Certification for Optometrists is Not needed. With the economy changing and possible relocation needed by OD's and their families, why does not the AOA turn its attention and resources to enact Universal licensure? That should be its focus, not to form a faux FAAO.
Keep up the good work

TO, O.D. NY

Right on!
PS, OD, FAAO

Art,

Count me in as a supporter.....of YOUR position! That letter from AOA is amazing and absurd.
Please stay healthy- we're going to need your LOUD voice at AOA to put them in their place.....
All the best
Jeff

Art, thanks for taking a stand and adding some sanity to this very divisive situation.I am totally opposed to BC. DL O.D.

Art,

Keep up the good work.

Dave

Dear Art,
It is hard to believe that in America, the land of freedom,
where elections and representation are valued treasures
that someone would FEAR retribution due to their opinion.
If you do not speak up with your attitudes and thoughts,
the other side automatically wins, right or wrong. Any
retribution is disgusting and should be aired in public.
If certification is that volatile, we need to step back and
gather a lot of info before making decisions etched in stone.
JT

You're right on the money here... pun intended... And, as you've commented several times in the past on this subject, I do feel that many of my colleagues are silent due to the political pressure.

Personally, on a 'grass-roots' basis I've heard the idea expressed that the proponents are just "MD-wannabe's" - which may be truthful but a nasty, emotional statement. In my school years the concept of putting on a white clinic jacket was akin to being a 'real doctor' and the current divisiveness still has the same feeling to me. I sit in CE gatherings, small and large, and listen to others speak in terms of the medical-type work (tests, diagnoses, treatments) they are performing. As far as I'm concerned, the public - the people who 'sign my paycheck' - care a lot more about their vision. Those of us who work day-in/day-out giving people clear and comfortable eyesight and have the education and common sense to know who needs medical care... we are the 'meat-n-potatoes' of our profession.

There! Now, I'll get down off my soapbox and back to the issues... :)=)

I wonder how many ODs are not even aware of this entire issue? In talking about it one-on-one, I'm thinking there may be a significant number. :( How are they going to find out what's going on? It's really sad, because you are just about the only resource of opposition that I know of. If there are any other references, people or publications, who are at least neutral, would you please share them with us. I think there are many ODs who don't really have a clue (non-AOA members as well as those who are less active in the associations) as to what this is all about.

If you're a lonely 'voice in the wilderness' - hang in there and remember all the prophets... you're in good company!!! :)

Art,
Xxxx Deleted To Protect Identity Xxxxx
It's an uphill battle for you, however, you're fortunate to have such a large forum to express your opinions. There is an "elite" cadre in all professions. It's been my experience that those who are truly knowledgeable don't go around telling everybody how great they are and how to lead their lives. They lead by quiet accomplishments and examples.
What we have here in Optometric leadership is a clique. A clique that is popular among its own members and nod agreement to whatever idea comes from any member of the clique. It's only by an uprising from the rest of the "class" that these people will be forced to change their direction. But remember, it's that "class" that put them where they are. So, in essence, we have only ourselves to blame for whatever direction is taken.

I've never found myself in disagreement with any of your opinions expressed in Optometric Physician and only read the attached articles if they sound interesting. Most are. Keep writing. You have tremendous support!

Xxxx Xxxxx

I could not agree more with OP’s accurate assessment of the Board Certification issue. Thank you for putting this important information out there!

OD UHCO

Art, thanks for writing passionately about BC which is more appropriately referred to in this case as BS.

I have been educating residents for the past 30 years. As you know, there is a big difference between advanced competence and general competence. Your comments on need are spot on and there is no evidence that BC is required for most optometrists. However there is a group of ODs who are residency trained who may benefit for a credible attempt to recognize their advanced competency.

The only credible Board Certification involves advanced competency via completion of an accredited residency program, a credible examination, and a review by a board. JBCT skirts those deliberately. We have many residency trained ODs eligible for the ACMO exam administered by NBEO. Wouldn’t completion of a residency and passing ACMO be more credible vs the sham that’s being presented to fellow AOA members? We need to kill the JBCT version and thanks for your effort in this area! Feel free to share this.

Jerry

I’ve never met you and don’t know anything about you, but I applaud you and agree with you about the board cert. True enough I may not know the issues entirely, but thank you and I hope our profession will not agree to pay a select few that organize unnecessary ways to make money.
Mitch

Hi Art,

It could neither be more complete nor clearer.

Only ONE MD asked about pulling the wool over our myopic vision?

Best,

Al

Art,

First of all, thanks for taking some much time to discuss this major issue. I see BC as something that will fracture our profession in its current proposed form.

I seem to remember that at one of the major meetings, perhaps SECO, 2 or 3 years ago that a couple of groups involved in the JBCPT called an unannounced news conference and said they were going to begin evaluating a BC process for ODs. I believe that ARBO was one of those organizations. AOA and the other organizations on JBCPT weren’t notified of this decision nor about the press conference/announcement.

Last year, I was speaking with one of the AOA VPs at a meeting. He told me that the surprise announcement of this BC project shocked AOA and it decided that it should try to take the control of this process back from these “renegade” groups by insisting that all of the organizational stakeholders participate in this process. He said that, prior to that surprise announcement, AOA did not have any active plans to revisit the BC issue.

Having seen ARBO in action as a state board of optometry member, I asked him what ARBO was doing in the JBCPT process. He said that it was his personal opinion, from what he’d heard from JBCPT members, that ARBO was attempting to scuttle the JBCPT program in hopes that its proposal would be rejected and that ARBO would then independently try to establish a BC process.

I’ve discussed this with a newer ARBO board member and she denies that this is their purpose or that they started the current BC process with their surprise announcement.

I guess we’ll just have to see how this all plays out. As you may know, Pete Kehoe sent a letter out to all of the state associations in the last couple of days saying that the BC process was being modified as the JBCPT receives feedback from sessions it’s held as well as from the state associations as they meet with their members. That’s nice to hear, but my thought would be to table the vote on the BC process until the JBCPT can present a “final” version of the BC process to our members. I wouldn’t feel comfortable with them saying “trust us, we’ll look out for your interests” because I’m not sure they have the vision to do that.

Finally, I agree with you that the states are the only entities that have the authority to determine what constitutes continued competence of their licensees. If we had a national optometry license, then I could perhaps see the need for a national continued competency process for all ODs in the US. Until we have that national licensure in hand, which won’t happen in our life time, BC is a waste of time, energy and money.
Tom

Dear Art,

If the majority of AOA membership oppose board certification and if board certification becomes a reality despite majority objection, where does that leave the AOA as a credible representative of optometry?

Vincent

Good morning Art. I applaud your comments and they reflect the general membership. As you head off to the XXXX meeting please continue your message. More importantly will ophthalmology look upon this as divide, weaken, and conquer. Will they can they introduce legislation to diminish the advances of Optometry. The leaders of AOA can face a mass defection in membership based on their current course. can they afford that? The agenda of a few can not out weigh the wants of the many. Specialty certification should be recognized and established to move the profession onward first.
Secondly as one astue member mention that this certification is aimed at practioners over 40 years old. Is this movement to bear pressure for the senior doctors to consider retirement versus continue the fight? Is this an attempt to thin the herd? The AOA's ideology is not complicated but filled with deception.
Don

Dear Art,
I am writing to ask for a more honest and factual discussion of the Board Certification issue in Optometry. The time has come for a more balanced dialogue for this pivotal topic. There has been much said regarding the concept of a providing our profession with a verifiable mechanism to demonstrate continued competence. It seems to me that many are too caught up in the lesser important details and are indeed missing the larger picture. I fear that some of our colleagues truly believe that defeating this measure at the AOA Congress in June will make this issue go away. This issue is not going away, we can not simply ignore it.

The facts are that optometry is the ONLY independently licensed prescribing Doctoral level health care profession with no mechanism for proof of continued competency. Much has been said about the mechanisms in place for other professions to demonstrate continued competency and third party carriers, state and local governments, and consumer groups have made the assumption, right or wrong, that those mechanisms help insure a higher level of quality in health care. These assumptions may or may not be valid, but the fact remains that optometry has no such mechanism and presently cannot compete with those professions that do. We need to enact a system of accountability for the public, for our patients, for third party payers, and for the governmental agencies who are demanding a demonstration of continued competence.

Most of us work in a third party payer system. Accountability measures for quality of care are becoming more commonplace. We have no idea as to what health care reform will bring. While many have stated their feeling that it is inconceivable today that any carrier would deny a physician privileges for lack of a system proving continued competence, it is happening right now in some of the Medicare Medical Home projects. As the health care delivery system evolves, it certainly could be a more widespread reality in the future. A system such as this is going to take time to develop, time to verify, time to legitimize, and time for doctors to attain. National standards need to be developed. A common language needs to be used in dealing with this evolving system. This is the very thing that the JBCPT is developing and we need to move this process ahead now.

Having a mechanism for continued competency testing and certification is simply part of the evolution of the profession of optometry. Critics say "why now" and I ask them why not now? There has yet to be a valid reason given not to continue the investigation of this topic and certainly not enough evidence given to suggest that tabling the discussion would be of any benefit to the profession as a whole! I practice in Rhode Island and am fortunate to enjoy the company of those who made the first major stride taking the profession of optometry from a drug free profession to what we know today. They too were visionaries. They foresaw the future of the profession and moved forward for optometry’s sake. They had to take on the responsibility and to make hard decisions and time has proven their decisions right. These were the leaders in optometry of the last generation, who will lead the profession into the generations to come?

Sincerely,

SMM, O.D.

I just received AOA News. From the President's column I gather that AOA intends to charge ahead like a bull, regardless of members' opinions.
Paul

What is wrong with the present AAO? Do they not provide a means of certification for those who want to prove their expertise in a subspecialty like VT etc?
Why not use the AAO for the purposes of "Board Certification"

XXxxxx
California

Art,Very well done. You have summed up the problems beautifully.I especially agree with your comments regarding the lack of necessity of BC. I don't understand why we are trying to solve a problem that MAY exist in the future instead of seriously attacking the problems that threaten optometry NOW.We all have our own list, but unless BC can be shown to definitively help interstate license mobility and equal access and parity for insurance, why are we fighting this fight? Tom

Thank-you. I have read Dr. Myers and agree with both of you.

PCO 19XX grad.

--
Craig

Thank you so much for your taking a stand on the board certification. I hope the AOA will change it direction on board certification soon. We need to use our funds for programs much more productive and popular that the current proposal.

RK, OD

Art keep up the great job. LT OD

Art:

You have indeed done the profession a tremendous service with you well thought out editorials on this subject. You have reason to be proud of your efforts.

Stu

Hi Art,

I liked your comments on the board certification in optometry. I am looking forward to reading the upcoming editorials. My impression is that board certification will just divide the profession more. Those of us with COVD Board certification in Vision Development have all ready committed to the concept and I believe that it is necessary in specialty but not in general. So much for now. This will be critical as you have said. Xxxxx

Hi Art,

I am pleased to see that you have articulated exactly how I feel about this issue, and then some. In fact, you brought even more than I had ever thought to the table in your editorial. And you'll be pleased to hear that I attended a continuing education meeting in Xxxx yesterday in which, after the "complex and costly" process was explained, a virtually unanimous vote against the plan was taken. The entire program, once explained, seemed fraught with complexity and cost, with no apparent benefit to those of us who have been practicing for many years - not even the privilege of carrying our licensure to another state (there's an issue we need to work on.)

I can see why board certification is found within the medical profession: each practitioner, after internship, will undertake a residency - whether it be in primary care, cardiology, endocrinology, or some other specialty - and then demonstrate proficiency in that area. Optometrists exit optometry schools ready to begin seeing patients, and while some choose to go on to residency programs, it is usually to gain expertise for a specific area (e.g. cornea, contact lens, low vision.) Diplomate status within the AAO is the option that they have available, if they so desire.

You have also covered well the issue of further division within our ranks, which is something we really do not need at a time when we need our strength in numbers to take on the challenges and battles of dealing with issues of participation and parity within managed care networks.

You have done an excellent job of making your case, and I will be sure to forward it to as many colleagues as I can.

With Sincere Regards,

RB, OD

Dr. Epstein,

I couldn’t have said it better myself. I follow your editorials weekly and tend to agree with most of your opinions. In my opinion, as a new optometrist out of school 3 years, Board Certification in no way, shape, or form, would benefit me in my practice. I practice in a medium sized town of about 40,000 in Kansas and our practice is thriving and growing. The medical side of our practice is taking off by leaps and bounds, even in this rough economy. We get referrals on a weekly basis from hospitals, urgent care clinics, medical clinics, etc. to my wife and I (I, too, am married to an O.D.). I am a member of every medical plan the major employers in our area offer and had no trouble being credentialed for these plans. What do I need to be board certified for? We remove foreign bodies, prescribe oral narcotics as necessary, and practice to the full scope of the great state of Kansas’ optometry law, already. My colleagues, both O.D.’s and M.D.’s, refer to our clinic because we have done well with their patients previously and we go to great lengths to communicate our care back to these offices, not because I am board certified as a full-scope optometrist, which sounds quite ridiculous, too, doesn’t it?

I am with you that the only thing this will bring (and already has), is divisiveness in a time where cohesiveness is necessary. Our time would be much better spent protecting our scope of practice in those states that are lucky enough to have a good one, and pushing for expansion in those states that don’t.

Anyway, well said, and I appreciate your willingness to come under fire for saying things that the silent majority (myself previously included) really wants to say.

MS, O.D.
KS

Dear Dr. Epstein,

I must thank you for having the courage to share your information and opinion on AOA Board Certification. I cannot swallow the AOA "coolaid" on this subject, and agree with your assessment.

Much thanks!
Respectfully,

ERB

Dr. Epstein,

Very well delineated.
After gathering 7 state licenses (sitting for 5 state boards) over 23 years, requiring passage of the complete series of national boards- TWICE- my husband and I are flummoxed . We are done proving ourselves to our own profession. Why would more "certification" be needed?Keep the pressure on to call this move down.

Xxxx and Xxxxx Xxxxxx

Art- you may blog this-or use this as you see fit:

I’m surprised that Ken Myers is on the outside looking in on this issue. Both of his pieces on Board Certification are well thought out and detailed with FACTS. He has obviously put a tremendous amount of time and effort into this and should be taken seriously; and he comes from a position of knowing the facts. You have put voice to these issues, as you have warned for months. I can’t help but think of why he has not been part of the debate within the organizations discussing this issue, and since I cannot speak for Dr. Myers, I empathize with his perspective- and support it. By default, I support your position as well.

What can only be described as potentially serious consequences for optometry may occur should Board Certification be adopted by the AOA and other organizations. I know how these ‘bandwagon’ issues take root, and people with less than a front line involvement often get caught up in the mass hysteria created by the controlling parties. However, this time, the consequences can be dire.

Let me add that Dr. Myers has not only laid out the flaws in the current movement toward Board Certification, but he provides very workable solutions at bringing about resolution to maintenance of competence (MOC) concerns for optometry, without compromising anyone’s state license(s) to practice optometry, as it was designed.

Hooray for the ongoing debate right now. Let’s hope that there is enough front line interest to make sure that both sides of this argument for or against Board Certification get a proper hearing.

Richard E. Lippman, O.D., F.A.A.O.

I agree.

MJ, OD

Art

I knew I liked you and there was a reason I'm such a follower of your weekly excerpts. Good for you on becoming enlightened against the AOA's pseudo-"Board Certification" which is nothing more than a truly questionable means to an even more questionable end. Not only will it divide our profession but membership in the AOA will become vastly decimated. I for one will revoke my 15 years of membership should it move forward. Your overt proclamation in this weeks article should send resonance throughout the Optometry community and bring attention to the importance of the AOA listening to their very members. I salute you.

Regards,

ES, OD
Florida

WOW !!!

That article was perfect and I agree 200% with everything that you said.

Great work and THANKS !!

Xxxx Xxxx, OD
NJ

Art,
I really appreciated your latest opinion article on the Optometric Board certification fiasco! Per my description, there should be no doubt that I wholeheartedly agree with you!
Dr. Xxxxx Xxxxx
CT

Art,

Good for you! You really told it like it is. Sometimes we suffer from elitism as do the other professions. We I attend CE and hear the conversations of some OD's, I feel something must be done either relicensure or something else to differenciate us from the "which is better 1 or 2" crowd. The board certification although well intended is excessive and is heavily

JC, OD

My wife is a board certified Internist, and I take umbrage at anyone who claims that this BS/BC proposal is anything like a true certification process for a specialty. This appears to me to be little more than a money grab by Optometry schools for CE dollars, and may very well precipitate the unintended consequence (or is it?) of forcing everyone to become “board certified”. Once there is a process in place, simply putting N/A on credentialing apps will no longer work, and we may be forced to obtain certification to be on any panel.

I am one of the many who will resign from the AOA if this goes through. Maybe it is stupid, but why should I remain a member of an organization that no longer has my best interest at heart.

I am in favor of specialty certification. Low vision, pediatrics, contact lenses, pathology (VA) all have a REASON for certification, as well as a legitimate training program in place to justify it. Confusing board certification with continued competency is misguided and potentially dangerous to our profession.

Xxxxx Xxxxx, OD
IL

Dear Art,

Bravo on your editorial. I especially agree that this board certification is an expensive CE scheme that will have the effect of enriching the pockets of lecturers and the members assembling the process. To boot, AOA dues would be spent paying for meetings related to the organization of the certification process.

I'm all for strict standards in CE, and in fact take about 40 hours per year for which I get no credit. But the idea of paying for certification does not sit well with me. It's among other things a "Stimulus Package" for those who insist on forcing it on the membership.

So I hope your editorial helps to defeat it, and I commend you for writing it.

Peter

Board Certification, Maintenance of Certification, & American Board of Optometry

2009-05-24T21:44:00.003-07:00

Dr. Epstein,

In recent weeks I've been reading with great interest the editorial section of "Optometric Physician" regarding your stand and reasoning about residency, board certification, maintenance of certification and the formation of the American Board of Optometry. In principle I agree with you about all the propositions as presented. I had the opportunity to visit face to face with Randy Brooks, OD and AOA President-Elect in Albuquerque, NM, at the NMOA convention last week. I've also visited face to face with Stanley Woo, OD and Texas Optometric Association President-Elect at a recent meeting in Amarillo, Texas. So, I'm fully informed on the AOA's and joint committee's propositions and reasoning.

The short version of my position is that board certification is unnecessary for a legislated profession whose scope of practice is dictated by state statutes on a state-by-state basis. Further, Optometry appears to be attempting to become something it never was and (in my opinion) doesn't need to be. If Doctors of Optometry want to become Ophthalmologists they should have gone to med school and completed the appropriate Ophthalmology residency.

The long version of my position follows...

The multiple issues swirling around Board Certification and Maintenance of Certification are going to be difficult for all concerned. As much as we'd like to think the issues are relatively clear cut and have academic and professional elements worthy of their own merits, it really seems a little more simplistic and, perhaps, sinister to me. That is, in the end it may be more about $$$ than any of us are willing to admit. And, adding insult to injury, it will most likely divide organized Optometry into the “haves” and “have nots”. Further, it may be “voluntary” in concept, but the reality is that it will become “mandatory” IF you want to be a panel provider on most (if not all) vision plans. Therefore, if enacted, it will be “voluntary” in name only... just like TPA was “voluntary”... unless you wanted to be a panel provider for VSP and others who REQUIRED it.

Back to the $$$... “Value Driven Health Care”... rephrased, the “Cheapest Health Care Possible” is the governmental model. Period. End of statement. COST CONTAINMENT is the driving force behind the “sweeping health care movement” today. It isn't nearly as much about “quality of care” as much as it is “cost of care”. Affordability and profitability is more important to all third party providers (governmental agencies included) than quality and availability.

Follow this thinking/reasoning... if Optometry can be forced, coerced or shamed into a “voluntary” board certification process... and IF a significant number of OD's opt to NOT become board certified, then they can be PAID LESS by all third party payors and/or EXCLUDED from panels to squeeze down the number of patients actually being seen.... saving untold amounts of $$$$.

Secondarily, medicine (particularly Ophthalmology) would probably LOVE for us to develop a BC and MOC process. It would finally give them ammunition to take to the negotiating table with third party payors as “proof” that we are substandard because our board certification process is not like the CURRENT medical model (regardless of how some of the medical specialties in the past have obtained their BC without a lengthy residency). They can play the “BC” issue from either point of view.... if we don't have it we “look” inferior, and if we DO have it the process by which it is obtained will be viewed as “inferior”. Either way, we stand to potentially loose.

BC and MOC does NOTHING to change, modify or enhance scope of practice. And BC will not change individual state regulations regarding scope of practice since we ARE a LEGISLATED profession. Example: I hold licenses in two adjoining states and practice in both. My education for both is identical. I hold the highest license privileges available by law in both states... yet what I can and cannot do is DIFFERENT based on individual State Legislation restrictions / privileges.

Speaking of “scope of practice”... it seems Optometry continues to have an identity crisis. In the 40 years I've been in practice the definition and scope of practice has continually changed. Perhaps for the better.... yet, I knew full well what an OD could and could not do BEFORE I went to Optometry School. I didn't want to be an Ophthalmologist then nor do I want to be one now. I'm relatively certain I'm smart enough to have gone to med school and a subsequent Ophthalmology residency. But, I didn't... on purpose. There has to be some “line in the sand” that will define what Optometry is and does and set it in granite. At some point we must cease trying to kick in the back door of Opthalmology and be content with the definition and limits of our license. If I was an Opthalmologist I'd probably be offended and irritated by Optometry's continued intrusion/encroachment into their field of expertise.

I'm far more concerned at what organized Opticianry is doing with their expanded scope of education and garnering political support than I am about BC and MOC. They can use the exact same logic for performing "refractions only" (advanced education and training) that we use to encroach farther and farther into ocular medicine (advanced education and training). If Opticians gain a legislated “license to refract” for glasses and contact lenses, then every OD can take their BC and MOC and get a cup of pencils to sell on the street corner because OMD's will hire them by the bushel full as will all the major optical chains. We can then take our BC and MOC and shove it because at that point all we can do that Opticans can't is treat a red eye, or treat and manage glaucoma (only in select states!) or remove a FB now and then!

Don't forget the law of unintended consequences. Some times we make choices and/or do things, rationally or irrationally, without considering unforeseen consequences that could have devastating effects. Who knows what unintended consequences will result from the BC and MOC initiative? For starters, at a minimum it will fracture Optometry into two camps... those with BC/MOC and those without. And there are rumblings of lifelong AOA members dropping their membership... which would have devastating effects on the profession. There are costs to be considered to become BC and maintain MOC... and it won't be cheap. Some veteran (read older) Doctors of Optometry with 40-50+ years of experience may choose to either go without BC/MOC or retire when they had actually planned to remain in practice for an indefinite period of time at a professional level considered equal with their peers. By the admission of advocates for BC/MOC, as many as 10% of OD's will FAIL the BC exam! That, in my opinion, isn't something to be taken lightly and is unacceptable.

So, what do we do? The lion is out of the cage... or is it? So far nothing has actually happened other than some words by people with potentially self serving interests claiming BC/MOC is an inevitable goal of health care reform. That is, at this point, more speculation than fact. Shame on us (collectively and individually) for not making legislators and governmental health care personnel aware that board certification simply “does not apply” to the profession of Optometry because we aren't a part of conventional/traditional medicine. We don't have a routine residency program available to all OD's as part of our formal education process, and as comprehensive Primary Eye Care providers we perform an overwhelming percentage of first contact with the ocular health care delivery system for the public.

Therefore, a plausible solution: All that is required is an exception/exemption for Doctors of Optometry in the wording of any statute or regulation pertaining to participation or continued participation in ALL third party provider entitlement at an equal level with all other health care providers. A tall order? Yes. But it is the most effective solution because it is academically, clinically and legislatively accurate, tenable, achievable and affordable.

Couldn't a Grass Roots effort be made by the AOA leadership and every State Leader and as many of the “rank and file” Optometrists as possible to contact their legislators at all levels of state and federal involvement as well as third party vision care providers to garner support of such an exception/exemption? It isn't too late and would require FAR LESS EFFORT, time, money and commitment than enacting the proposed BC/MOC project. But it probably would take the combined efforts of EVERYONE to make it happen... not just a select few. And since every OD in this country will be affected, it is in the best interest of every individual to get involved.

Respectfully submitted for your consideration.

Sincerely,

Cled Click, O.D. - Offices in Amarillo, Texas, and Clayton, NM

Therapeutic Optometrist, Optometric Glaucoma Specialist and Optometric Physician

Private practice for 38 years and 2 years of Military Optometry

Optometric Physicians of WA Board in Favor of BC Proposal

2009-05-24T13:30:00.004-07:00

Below is the position taken by the OPW Board earlier this week. To their credit, they have not committed their delegates (who are usually members of the board) to support the AOA proposal. As they request, it is critically important that OPW members share their perspective with the OPW board and delegates.

May 21, 2009

Dear OPW Members:

As an association we have actively discussed board certification (BC) and maintenance of certification (MOC) for the profession of optometry in Washington State. After four months of discussion with members, the OPW Board of Trustees (BOT) has evaluated the proposal's pros and cons, researched the justification and model for BC and MOC, participated in discussions with local and national groups, and listened to and considered diverse points of view. The OPW BOT has come to a consensus in support of the Joint Board Certification Project Team (JBCPT) model for establishing the American Board of Optometry (ABO). The ABO would be an independent, not-for-profit organization with the mission of establishing a voluntary process for board certification and maintenance of certification for optometry. Importantly, this position by the OPW BOT is not a mandate directing the OPW delegates how to vote on this issue at the AOA House of Delegates (HOD) in Washington, D.C. Delegates will base their voting decision(s) on OPW member feedback, the OPW Board position, newly emerging information and policy changes in healthcare, further modifications to the JBCPT model, and the actual motion and amendments as presented at the AOA House of Delegates.

The OPW BOT recognizes our obligation to safeguard the short- and long-term interests of our members and our profession. As your elected leaders, we have the responsibility to protect the profession, to anticipate our future challenges, and to act in the best interest of members. Optometry is stronger today because of members working together to advance our profession via legislative efforts for expanded scope of practice, inclusion in Medicare and private third party programs, and reimbursement parity. These were crucial milestones in advancing the profession, yet even these efforts had their critics within the profession at the time.

As our profession works toward national consensus, there will be continuing dialogue and ongoing discussion on this issue. OPW delegates will go to Washington, D.C. and actively participate in the AOA House of Delegates educated about the issue of BC and MOC and fully aware of the perspectives and opinions of OPW members. We continue to encourage you and other members to share their feelings and opinions with us. Whatever decisions are made in Washington, D.C., the OPW and its leaders will fully support and respect the final vote.

Sincerely yours,

Curtis A. Ono, O.D, President
David S. Hays, O.D, President-Elect
James P. DeVleming, O.D., Vice-President
Michael C. Noble, O.D., Immediate Past President
Teresa Erickson, O.D., Secretary
Kim J. Calnan-Holt, O.D., Trustee
Judy N. Chan, O.D., Trustee
Michael E. Heil, O.D., Trustee
Denis Holmes, O.D., Trustee
Lonnie O. Ness, O.D., Trustee
Jeffrey B. Sutro, O.D., Trustee
Kathy C. Williams, O.D., Trustee

Sent by: Judy A. Balzer
Executive Director
Optometric Physicians of WA
E-mail: opw@eyes.org
Web site: www.eyes.org

Eye Symposium Northwest
Great Wolf Lodge -- Centralia
July 16-18, 2009

MISSION STATEMENT: The mission of this association is to enhance the vision care and eye health of the public and to promote the continued development of the profession of optometry.

Florida Optometric Association Rejects Board Certification Proposal

2009-05-24T13:22:00.003-07:00

May 19, 2009

Open Letter to FOA Membership

RE: AOA JBCPT proposal on ‘Board Certification’

The FOA Board of Trustees has, through the dissemination of information and a survey, solicited the opinion of the FOA membership regarding the forthcoming AOA Joint Board Certification Project Team (JBCPT) proposal on ‘board certification’. Our efforts were for the purpose of affording each FOA member the opportunity to express his or her opinion and concerns regarding ‘board certification’. To that end, 55 % of our members who responded to the survey indicated that measuring continued competency in ‘some’ form is good for the profession of Optometry. However, over 77% of the members who responded do not support the proposed ‘board certification’ in the form presented by AOA JBCPT.

The FOA has reviewed national board certification models, including the 24 different board certifications offered under the jurisdiction of the American Board of Medical Specialties. FOA is also mindful of the recent announcements by CMS of the importance of advanced certification criteria. Further, recent reports from U.S. Senator Max Baucus, Chairman of Senate Finance Committee, concerning review of the issue of board certification and continued competency to participate in PQRI reimbursement models have likewise been assessed. Other professional Optometry resources [e.g., ODWire.org; OD2OD; Optometric Physician; etc] and ‘white papers’ both for and against ‘board certification’ were reviewed.

After more than 18 months of study by the JBCPT, the original JBCPT model was presented to the FOA leadership for the first time during the AOA President’s Council meeting in January, 2009 in St. Louis. This presentation described the JBCPT’s recommendation as including a ‘board certification’ model and related maintenance of continued competency. This initial presentation was shared with the FOA membership through correspondence and a posting on the FOA web site. In March, 2009, the FOA leadership received another presentation on this issue at SECO which revised the original January, 2009 JBCPT model. Subsequently, two additional conference calls and a webex presentation have disclosed additional changes to the January 2009 JBCPT model.

The AOA President and select AOA Board members have further expressed to state affiliate leaders that they wait until the AOA Congress – House of Delegates meeting in June to see the final model before making a decision on the issue.

The FOA Board of Trustees has reviewed the JBCPT recommendations and weighed the input of our membership very closely. The FOA leadership spent considerable time in discussions on this issue during the May 16th Board of Trustees’ meeting and a formal vote was taken by the Board of Trustees at that meeting. As a result of that vote, the FOA leadership and delegates will cast a vote of “No” on the JBCPT proposal at the upcoming AOA Congress – House of Delegates meeting in Washington, D.C. in June 2009. The “No” vote is not because FOA anticipates that the future of Optometry will not involve some formal program/requirement to measure advanced and/or continued competency. Rather, the “No” vote is based upon many elements of the original January 2009 JBCPT proposal which have continued to change, modified, or added without the benefit of full disclosure to, and input from, our membership.

The FOA Board of Trustees may consider supporting a Resolution to delay a vote on this issue, if a delay is proposed during the AOA House of Delegates meeting. Nevertheless, FOA leadership believes two elements will remain critical to a final decision in this matter: (a) the federal government’s involvement on this topic is not going away – rather, we expect that reimbursement and quality of care models will continue to challenge Optometry’s standing; and (b) until a final model, including an organizational formation (ABO), is resolved, it is impossible to keep the stakeholders (FOA members and AOA members) properly informed prior to implementation.

The FOA leadership applauds the JBCPT project team’s work on this issue. We further believe that future demands and outside influences will require the profession to consider enhancements to continued competency as it relates to value added services. However, in the ‘rush to succeed’ the better course of action should be to permit our members to be fully informed prior to implementation of the JBCPT model which has continued to change content and direction since its initial presentation.

Thank you for your continued FOA membership and your input and involvement in issues impacting your ability to practice Optometry.

Sincerely,

R. Andrew Wiles, O.D.
President

Massachussets Rejects AOA/JBCPT proposal

2009-05-24T12:52:00.010-07:00

The Massachusetts Society of Optometrists, MSO President Dr. Michael Cohen and the MSO leadership followed the wishes of their members by rejecting the AOA/JBCPT proposal this past week. Beyond explaining their reasoning for their decision, the MSO leadership offers valuable insight and guidance. I think you will find their reasoning constructive and intelligent.

Read the full text of the MSO position paper here

.

Ohio Optometric Association - Another Voice of Reason

2009-05-07T19:54:00.003-07:00

May 7, 2009

Dear OOA Member:

For over two years organized optometry has been reviewing implications regarding optometric board certification. The OOA Board has followed and participated in these on-going discussions by national optometric organizations. During the past three months information has been announced regarding the direction that is being considered for board certification. Although new information continues to be developed and a final model of optometric board certification has not been determined as of the date of this letter, the OOA Board in good faith to you, our members, is publishing our opinion. That statement follows this letter.

The opinion developed by the OOA Board will be carried to the House of Delegates of the American Optometric Association, June 25-27, in Washington, D.C. The Board does not anticipate that our opinion will change during the next 45 days, but we will continue to monitor modifications that are being considered by national leadership.

We recognize that these are challenging times at the local, state and national levels and anticipate significant health care reform. Accordingly, it is imperative that optometry remains united including strong support of the Ohio Optometric Association and the American Optometric Association. We appreciate your significant interest in this matter as well as your continued support of organized optometry’s efforts to maintain and advance our profession.

Ohio Optometric Association Board

Thomas Bobst, OD, President
Gilbert Pierce, OD, PhD, President-Elect
Heath Gilbert, OD, Secretary-Treasurer
Todd Clark, OD, Trustee
Donald Faimon, OD, Trustee
Leon M. Favede, OD, Trustee
Teresa Gossard, OD, MS, Trustee
Jason Miller, OD, MBA, Trustee
Brenda Montecalvo, OD, Trustee

----------------------------

Ohio Statement Regarding Board Certification
May 7, 2009

The Ohio Optometric Association acknowledges the work that has been done by the Joint Board Certification Project Team and thanks them for their efforts.

In the interest of providing quality and competent care to our patients and with the knowledge that participation in value-driven health care reform will require a means for all health care providers to demonstrate competence throughout their career to the public, government and third party payers, the Ohio Optometric Association Board concurs with the AOA Board of Trustees that a credible and defensible mechanism of demonstrating continued competence needs to be made available to our profession.

However,

Board Certification as defined in the medical model demonstrates expertise in a particular specialty of medical practice and represents advanced competency requiring residency based specialty training.

Completion of the Doctor of Optometry degree, National Boards and appropriate state licensure requirements should be recognized as the only necessary documentation for competence to practice optometry.

Therefore we find board certification in optometry to be unnecessary to demonstrate continued competence and divisive to the profession.

Recognizing that demonstrating continued competence and the value of optometric care to the public, government and third party payers would allow optometrists to fully participate in any future healthcare models, efforts should be redirected to develop the following:
• Effective measures to show the cost/value benefits of optometric services in healthcare.
• A coordinated debate on the need for a national measure of continued competence that does not include board certification.
• Level licensure

----------------------------

Appendix
Discussion/Rationale for the position paper

We believe it is a critical mistake to equate board certification with continued competence. They are not the same. We feel that the optometric profession does not require board certification to be able to demonstrate a high degree of competence and public accountability. A method should be found that is a less onerous and divisive process to demonstrate proof of continued competence and the high value for the health care dollar that optometrists can provide.

Following the path that is currently being proposed would set optometry on a road that is fraught with many unintended consequences and implications. These include the assumption of a future optometric education model that will require residency training, a future requirement which could subdivide optometry into specialties such as primary eye care, pediatric care, etc. and a divisive method by which outside agencies could discriminate against optometrists who do not choose to be board certified.

We agree optometry should discuss and define its own process of demonstrating requirements such as public accountability, proof of initial competence and proof of our continued dedication to life-long learning, evidence based care and continued competence. We disagree that this requires us to accept board certification as the only path to attain this.

Board Certification represents advanced competency in a particular specialty.

As we have stated, Board Certification as defined in the medical model demonstrates expertise in a particular specialty of medical practice and represents advanced competency requiring residency based specialty training.

It cannot be overstated that optometry is not a specialty within a discipline such as family practice, pediatrics, or any other example in medicine. Medicine has evolved to the point that the general practice M.D. does not effectively exist. Areas of specialty are required to practice. The American Board of Medical Specialties Member Boards currently offers 145 specialties and subspecialties for certification. The M.D. must complete a residency and then the board certification process is used to “certify” that the practitioner has obtained the necessary training to provide quality healthcare within that given specialty. This is not advanced competency but rather the necessary competency to be able to work in their selected specialty of medicine. An ophthalmologist is not an eye doctor upon completion of the M.D. or D.O. degree. Optometrists are eye doctors when they finish school and are licensed. This is an important distinction that should not be forgotten.

It is often stated that optometry is “like Family Practice” and should use their model as a basis to build our system of measuring competence. The flaw in this argument is that Family Practice is a specialty within medicine that requires a medical degree followed by a three-year residency program and qualifying examinations. While their model of demonstrating continued competence might be useful in defining how we will prove our continued competence, it is not appropriate to demonstrate initial competence. Once again, we are faced with comparing apples and oranges. Optometry is not a specialty within a discipline but rather a professional degree that provides the necessary training to all O.D.s who complete the education process and pass National Boards and state license requirements.

Podiatry may predict the future of optometry’s current foray into the arena of board certification. One of the consequences of their program was a push toward a significant advanced post-graduate training before being able to practice. In podiatry to be Board Qualified post-graduate candidates must complete two years of Council of Podiatric Medical Education, which must include one of several specified residency programs. To be Board Certified, candidates must complete the Board Qualification process and then document 42 months of clinical experience and/or education inclusive of residency, pass a case documentation process and oral and written exams. Podiatry’s process had an unintended consequence of creating a profession that required residencies and/or post-graduate training to be licensed.

Dentistry most closely resembles optometry in that it deals with a specific component of the human health system and has the training and licensure that allows its practitioners to fully provide primary services without post-graduate specialty training or board certification. Less than 1% of general dentists are board certified. Most dentists do not become board certified because it is not necessary or required to practice and does not necessarily enhance their ability to provide high quality and competent care to their patients. For those who choose to be certified it is a long and difficult process that is obviously of little real value to the general dentist or their patients. To be certified a dentist must complete a two-year general dentistry residency, or a one-year general dentistry residency plus 600 hours of continuing education, or earn a Mastership with the Academy of General Dentistry, which requires 1100 hours of continuing education or two years of advanced education plus 300 hours of training. Acceptance of this process by the practicing dentist has been underwhelming.

It is interesting to note that according to the American Board of General Dentistry, “The [board] certificate shall not be held out to the public as evidence of superior skill and/or knowledge. The Board does not intend in any way to interfere with or limit the professional activities of any duly licensed general dentist who is not certified by this Board.” If optometry chooses to make a truly voluntary system, it may be important to include such wording to insure that those who would use board certification as a sorting tool do not discriminate against optometrists who are duly licensed to practice but not board certified.

Who is competent to practice today and in the future?

Completion of the Doctor of Optometry degree, National Boards and appropriate state licensure requirements should be recognized as the necessary documentation for competence to practice optometry.

Optometric training is specifically designed to allow the optometrist to be the primary health care professional for the eye and to examine, diagnose, treat and manage diseases, injuries and disorders of the visual system, associated structures and ocular manifestations of systemic disease. All optometrists are trained and competent to perform these services upon completion of their Doctor of Optometry degree, passing National Boards as administered by ARBO and obtaining appropriate state license as required by law. No further training or certification is required to be an optometrist and therefore advanced competency is not required to be a successful and skilled practitioner.

Does the AOA no longer feel that optometrists, as primary eye care providers, are fully capable of providing full-scope eye care based on state licensure? If entry-level competence is no longer adequate to provide good optometric care, then we must argue for residency based advanced competence in a specialty of primary eye care. Do we really need or want to have a specialty in general practice (like family practice)? If the answer is “yes,” then that position needs to be fully examined and vetted to insure that the grass roots optometrist is “on board” with this new process and that our educational system can be modified to undertake such a major restructuring. It appears that the board certification debate is moving us towards requiring advanced competency. Before we climb this ladder we should be sure we are leaning it against the right wall. It would cause significant harm to our profession if we invest valuable time, effort and political capital only to find that board certification was the “wrong” wall upon which to climb.

A required residency and subsequent specialty designation in optometry should not become a reality because it is a consequence of a program that did not evaluate all of the potential ramifications of a board certification process. If the profession wishes to pursue residency requirements in the future, we should have a study and debate about that specific issue. The leaders of our educational system should direct this study and bring to the front all relevant issues such as the total restructuring of the educational programs and clinic features in today’s colleges of optometry, the increased costs students would incur by adding 1 to 3 years of training and the potential challenges to recruit the number of new residency programs to handle the volume that will be required. This is not a path to be taken lightly or by accident.

Controlling our own future

It is important that optometry define its own criteria for measuring continued competence and not bow to a board certification definition that does not fit our current education process. To call something board certification that does not meet the “specialty and residency” criteria used in all other fields of health care will promote skepticism and rejection from the very parties we are trying to persuade. If our goal is to demonstrate continued competency, then we should create our own system of evaluating that competence. Many of the ideas and programs suggested by the Joint Board Certification Project Team could provide a useful starting point for discussion. Ohio optometry would look forward to being an active participant in any future discussion of continued competence.

--------------------------------

Key Page from Senate Finance Policy Paper

2009-05-07T19:37:00.003-07:00

P a g e | 6
As directed in MIPPA, CMS is currently developing a plan for transitioning PQRI to a value-based purchasing program that will financially reward physicians based on their performance, rather than for simply reporting quality data. CMS is required to submit the plan to Congress by May 2010.

Proposed Option

A new PQRI participation option would be added to the existing options described above. Eligible professionals could also receive PQRI incentive payments for two successive years if, on a biennial (every two year) basis, the physician (1) participates in a qualified American Board of Medical Specialties certification, known as the Maintenance of Certification or MOC, or equivalent programs, and (2) completes a qualified MOC practice assessment.

For purposes of this proposal, the following definitions would apply.

1. Qualified American Board of Medical Specialties Maintenance of Certification (MOC) or equivalent program would mean a continuous assessment program to advance quality care and the lifelong learning and self-assessment of board-certified specialty physicians by focusing on the competencies of patient care, medical knowledge, practice-based learning, interpersonal and communication skills, professionalism and systems-based practice;

2. MOC programs or equivalent other programs must include the following assessment components: (a) Professional standing – Programs must require physicians to maintain a valid, unrestricted medical license in at least one state or jurisdiction in the United States, its territories, or Canada. A qualified MOC program must also include a survey of patient experience with care; (b) Lifelong learning and self-assessment – Programs must require physicians to participate in educational and self-assessment programs that require an assessment of what was learned; (c) Demonstration of cognitive expertise – Programs must require physicians to demonstrate, hrough a formalized, secure examination, that they have the fundamental diagnostic skills, edical knowledge, and clinical judgment to provide quality care in their respective specialty; (d) practice performance assessment - A practice assessment must include an initial assessment of physician clinical quality compared to peers and national benchmarks. It also needs to include implementation of a quality improvement intervention to address an identified practice weakness, and a reassessment of performance in the area focused on for improvement; and (e) An audit process that meets standards defined by the Secretary.

3. Qualified MOC practice assessment would mean an initial assessment of a participant’s practice, designed to demonstrate the physician’s ability to use best evidence and practices in comparison to peers and national benchmarks, and apply best evidence and consensus recommendations to improve quality care using follow-up assessments. Such assessment tools must: (a) Use National Quality Forum (NQF) national endorsed measures, where appropriate, to derive a set of clinical metrics that are at least equivalent in both the methods and measures used to those of the PQRI program; and (b) Require the physician to implement a quality improvement intervention to address a practice weakness identified in the performance assessment report, and then to remeasure to assess performance after this intervention.

Proposals to improve the PQRI program would require CMS to make three additional improvements to the program. First, they would be required to establish an appeals process for providers who participated in the PQRI program but did not qualify for incentive payments during their performance period. Second, CMS would be required to provide more timely feedback to providers during the course of the performance period. Third, CMS would be required to calculate incentive payments in the PQRI program without regard to the existing geographic adjustments in the physician fee schedule since PQRI incentive

A letter to State EDs from the AOA ED

2009-05-07T19:18:00.002-07:00

From: Barresi, Barry J, OD, PhD
To: State Executive Directors
Sent: Mon, 4 May 2009 10:42 am
Subject: Reflection on April Information Efforts

Dear Colleagues,

This has been an intense month of activity and the challenges that we as executive directors have been facing regarding Board Certification. One of those challenges is to simply manage the volume of communications. Attached is a single PDF that includes all the email blasts released by AOA in April. The document opens and closes with President Kehoe’s letters to state leaders at the beginning and end of the month. Included in the document are copies of both of Dr. Cockrell’s letters to the membership, Dr. Ellis’s letter, two policy papers and a Washington Advocacy Report. I hope this is helpful to you as a composite reference document for the months activities.

Yes this is a lot of information to process. But herein lies the dilemma for us. Release substantive, factual information on the fast pace developments in health care reform to keep our members well informed or hold back critical information because we are concerned about information overload. The AOA Board and I decided to err on the side getting information out the door as quickly as possible. In Dr. Kehoe’s letters he makes clear that the landscape of health care reform and even the very details of the certification model was in flux. While these developments were changing the very context of the debate about the why and how of Board Certification we were also faced with an onslaught of disinformation from outside of AOA. In the end, the choice was clear – get out the facts and urge all to keep an open mind in careful study of the issues.

Of course we as executive directors face the high wire balancing act of following the policy lead of our boards, listening to our membership and considering our own best judgment of how the organization should act. Our job is easy when all these forces are in alignment. However, that is rarely the case when organizations confront a controversial issue at the crossroads of history. In my view, we are at one of those crossroads.

For me there is no dilemma regarding Board Certification. My support of a national system of optometric board certification came well before the smoking gun this week from the Senate Finance Committee. While we released much information this month, this single event is a bolt of lightning that should shock even the most ardent opponents to optometry board certification. We now have both political parties committed to use national systems of board certification and maintenance of certification as key elements of a restructured Medicare payment system. The private pay system will soon follow.

Editor's note: the only problem with this statement is that there is no "smoking gun" nor any "bolt of lightening". What Dr. Baresi is referring to is a proposal that would tie the PQRI (Physician Quality Reporting Initiative) to MOC (Maintenance of Certification). See "Key Page from Senate Finance Policy Paper" for more information.

Our commitment to keep the membership well informed and to help you in any way continues. This week we have the special briefing WebEx for state leaders this Tuesday ( we have increased the limit to 9 attendees per affiliate) and an email blast to the membership this Wednesday on significant changes in the model that will be the basis for action at the HoD. Also in preparation this week will be a special letter detailing why a residency based BC system may evolve decades from now but is not viable and sufficiently timely when fewer than 5 percent of practicing optometrists have completed accredited residency programs. As the month proceeds we will focus on more targeted, concise messages all in the spirit of keeping the membership informed and able to distinguish fact from fiction in the non-AOA communication circulating within the profession. Thus while we expect the model to be finalized this week, updates on the health care reform context of board certification are still possible right up to the opening of the HoD.

For me this is all about our status as the primary eye care providers on the frontline. Inspired by my dad’s example of pride in his 50 years in practice and my personal clinical and advocacy experience I have never felt second class to medicine. This debate about board certification is to find the best way to assert our unique strength while still fitting into the mainstream of physician payment and health care delivery. In my first year as AOA executive director, I have been inspired by a courageous Board fully committed to these values and the ultimate goal of protecting Optometry’s future. <>

Please let me know if I can help in your member information efforts,

Barry

Barry J. Barresi OD, PhD

Indiana Opposes JBCPT's BC Framework

2009-04-28T21:04:00.002-07:00

Editor's Note: I salute the rational and courageous action taken by our colleagues in Indiana. This is among the best summaries of the issue yet. Please read.

Indiana Optometric Association

April 22, 2009

Dear Colleagues,

On April 17, 2009, the Indiana Optometric Association (IOA) House of Delegates passed a resolution opposing the Joint Board Certification Project Team’s (JBCPT’s) framework for general board certification (BC) in optometry. What follows is a summary of the major events and factors that formed opinions and ultimately led to the IOA’s decision. A copy of the resolution is also attached for your review.

Let me first begin by saying that Indiana has a long history of providing progressive leadership in our profession. Years ago, Indiana was the leader in obtaining the ability to prescribe therapeutic drugs, and today, the vast majority of Indiana delegates support the principle of maintenance of competency (MOC) for optometrists. Yet regrettably, we feel we have no choice but to voice our opposition for the current JBCPT model for the reasons delineated below.

Going back in time, the topic of BC re-emerged at the end of the “Optometry 2020 Conference” in 2006. Shortly thereafter, the JBCPT was formed and began extensive research and dialogue to develop a model of BC. Through most of the development phase, there was very little communication with the stakeholders regarding the developing paradigm. In January 2009, for the first time, details were revealed by the AOA to the profession at large. The IOA immediately launched an extensive campaign to provide unbiased education to its constituents, as well as opportuniti es for open dialogue and exchange. JBCPT presentations were posted on the IOA website, sent directly to members and website links were widely advertised in newsletters. Additionally, each of the 12 local IOA societies met between February and April 16, 2009, for the primary purpose of viewing the JBCPT presentations and discussing the proposal.

After careful consideration the IOA members have identified two primary issues. First of all, BC as defined by the JBCPT is not on par with the accredited and accepted models used by medicine. While there are some similarities, it is critically different from BC as understood by other members of the medical community, third party payers and informed members of the general public. Hence the view by some that the JBCPT model represents pseudo board certification, or “board pseudofication”. This fundamental flaw prevents the AOA leadership and JBCPT from realizing their stated goal of creating “an attainable, credible and defensible model for board certification in optometry and maintenance of certification,” and is the primary basis on which the IOA voices its opposition.

Secondly, the IOA feels that proposals of this magnitude demand responsible deliberation, beginning with the rank and file members. The paucity of information distributed by the JBCPT prior to January 2009, and the continually evolving nature of the proposal, has created a difficult situation. Thanks, however, to intensive efforts by the IOA board of directors, trustees, local society officers and members, I feel confident that the JBCPT proposal, in its initially published format, has been properly vetted by our constituents. While we appreciate the efforts of the AOA and JBCPT to elicit feedback and further refine the proposal, we must reject the AOA’s request to empower our delegates to make a final decision pending forthcoming information that may be introduced as late as the House of Delegates in June 2009. Such changes will not allow us or our members to fully study the proposals in a responsible manner. As a matter of principle, our delegates in Washington should not be asked to consider last minute changes that have not been adequately vetted by our members.

It is regrettable that we have been forced into opposition due to the serious flaw in the framework itself and the last minute maneuvering to pass something out of the AOA House of Delegates. However, as leaders of Indiana Optometry, we feel that it is a matter of principle that we represent the interests of our membership and ensure that any proposal is developed in a responsible and transparent manner.

Sincerely,

Richard J. Schamerloh, O.D., F.A.A.O.
President
INDIANA OPTOMETRIC ASSOCIATION
HOUSE OF DELEGATES
April 17, 2009

RESOLUTION OPPOSING OPTOMETRIC BOARD CERTIFICATION AS PROPOSED BY THE JOINT BOARD CERTIFICATION PROJECT TEAM

Whereas, the American Optometric Association (AOA) has endeavored with the American Academy of Optometry (AAO), the Association of Regulatory Boards of Optometry (ARBO), the National Board of Examiners in Optometry (NBEO), the Association of Schools and Colleges of Optometry (ASCO), and the Optometric Student Association (AOSA) to develop a prototype board certification process for general optometry “to demonstrate continued clinical competence” to the public, third party payers and government agencies;

Whereas, the above-named organizations established the Joint Board Certification Project Team (JBCPT), composed of two representatives of each organization, for the sole purpose of developing for board certification framework for general optometry;

Whereas, the JBCPT unveiled its proposed framework for board certification for general optometry on January 23, 2009 at the AOA Presidents Council in St. Louis, Missouri, and attendees were told that “an up or down vote” would be taken on the proposed framework at Optometry’s Meeting ® in June 2009;

Whereas, JBCPT-produced PowerPoint ® presentations that set forth the JBCPT’s rationale for the need for board certification in optometry and the framework for the proposed board certification process for general optometry were posted on the AOA’s website and were distributed via email to the membership of the Indiana Optometric Association (IOA);

Whereas, the IOA encouraged its membership to view the JBCPT PowerPoint ® presentations and make their views on the proposed framework known to their local societies from which the delegates to the IOA House of Delegates are drawn:

Whereas, each of the twelve local societies of the IOA presented and discussed the JBCPT information during at least one meeting between the dates of January 29, 2009, and April 17, 2009;

Whereas, after hearing from the members of the IOA and after much discussion and careful consideration of the JBCPT’s proposed framework for establishing a board certification process for general optometry, the IOA House of Delegates hereby resolves the following:

BE IT RESOLVED that the Indiana Optometric Association opposes the establishment of the board certification framework for general optometry as proposed by the Joint Board Certification Team.

BE IT FURTHER RESOLVED that the Indiana Optometric Association urges the House of Delegates of the American Optometric Association to reject the establishment of the board certification framework for general optometry as outlined by the Joint Board Certification Team.

BE IT FURTHER RESOLVED that the Indiana Optometric Association urges the House of Delegates of the American Optometric Association to reject any effort in 2009 to approve an alternative to the Joint Board Certification Team’s board certification framework and that any alternative plan be considered at a subsequent House of Delegates meeting after members and affiliates of the American Optometric Association have had sufficient time to fully consider and vet the alternative proposed framework.

Perspective From Craig Steinberg, OD, JD - Important Read

2009-04-28T21:00:00.003-07:00

Roy & others,

I thought I’d share a couple of emails I have recently written that discuss what I view as some of the key considerations against BC. Except as noted below, I’m not including what I was replying to, because those were private emails. The “David” referred to below is David Cockrell, who as you know is advocating strongly on behalf of the AOA for BC. One of my email responses below is responding to an email David wrote in support of BC. For context, here is part of what Dr. Cockrell stated in that email, which I include because it explains my last email below and which I think is rather critical in the full story – so this is what Dr. Cockrell wrote:
XXXX, when your friend went with through his process, CMS (Medicare) requirements for the new Medicare Home Model had not been issued. As you know from reading about that model, it for the first time in history established a requirement that an MD or DO that is the Medical Home primary doc must be board certified. I believe we will be remiss, if we refuse to look at that and wonder why? My concern is that in the future they (Medicare) might require it for all providers in that class; by class I meant the “physician” class that we are listed in along with MD’s, and DO’s. If they do, we have a problem. What I don’t understand is the desire to not prepare, and the many emails that I have received that have said let’s don’t do anything until we are discriminated against. At that point, we are climbing uphill. I know that sentiment is prevalent in the blogs, please tell me why we should not do all we can to prepare.
Please keep this email in mind when you read my response/comments below, especially the last email that starts with my saying I’ll try to call him (David Cockrell) next week.

Thanks for the comments. It’s states like Oklahoma that underscore one of the problems with the concept of BC – unlike medicine, our scope of practice varies widely. You’re doing lasers, and I have only limited access to Pred Forte! So, do I have to prove competence at your level, or will you be dumbed down to mine? If we both jump through the hoops to be BC’d, what will that say about you and me? Are we equally competent? Heck no.

But addressing the worry that if we don’t become board certified we could get cut out of plans, that’s the scare tactic, sky-is-falling approach the AOA is using to “justify” this fiasco. Where’s the meat though? Where is any evidence whatsoever that an entire profession which provides a HUGE amount of the eye care in this Country will be cut out with a single pen stroke because we don’t have a non-governmental third party that certifies us as being competent to do that which every state has determined as a matter of law we are competent to do! Quite the opposite is what will happen. Put BC in, and a large segment of the profession WILL be cut out. Here is what the AOA must do if BC passes. To justify everything they have said and done, they MUST then go out and lobby third party payers to require BC for participation. They must argue that BC’d doctors have demonstrated a higher level of competence than non-BC’d doctors, thereby sending every non-BC’d doctor out of the AOA and potentially out of business.

You can’t accept both Dr. Cockrell’s view and Dr. Epstein’s. They are diametric. If Art is right, the AOA must be wrong. You must look with a dose of “prove it to me” skepticism at Dr. Cockrell’s seemingly valid points, because they are rhetoric when you go to that depth of analysis. I’d say, hey, if there’s no major downside, what the heck, lets create a measure of forward-thinking protection. But the downside here is massive. If the AOA is wrong and those of us that are against BC are right, it could truly destroy, or at least profoundly alter, the profession. And take the AOA down with it.

As one poster said, BC will be a self-fulfilling prophecy. If there is no BC in “general optometry” then NO third party can or will require it for participation – just as none do for general dentistry. Create it, and some might require it – and optometry will become, in the stroke of a pen, profoundly weakened as thousands become ineligible for third party participation, thousands drop their AOA membership, and medicine ridicules our self-proclaimed expertise by putting up charts to legislators showing what and OMD does to be BC versus what an OD does. It’s embarrassing, quite frankly.

Thanks for the info. I have a few thoughts below, and you can (and should if you want) pass them on to the two gentlemen that responded to you.

According to David’s response below, the purpose of BC is to put a non-governmental (i.e. no licensing involved) program for demonstrating continuing competence in place. He does not in any of his email suggest “advanced competence” is a part of the need or a purpose of BC. So, my first question to him would be, is this solely a “continuing competence” program? It’s important to know what it is before its merits and alternatives can be evaluated. Of course, it’s also important because, in medicine and in the mind of the public, BC is a measure of advanced competence.

Next It appears that the entire BC move for continuing competence is to prepare for or respond to Medicare and their desire for something more than CE as a way of assuring its providers are remaining competent over time. So, my next question would be, is that a correct statement? Again, we need to know the landscape within upon this proposal is based. Are we dealing with Medicare and their (alleged) desire for demonstrated continued competence? (As a corollary, if that’s true, then Medicare is not asking for more than entry level competence, just for proof that that level of competence is being maintained over time, correct?)

To me, it appears few if any know whether this is about continuing or advanced competence, and those are two very different things. Which is it?

Since David doesn’t advocate for BC as anything more than addressing continuing competence, let’s take advanced off the table unless he says otherwise.

And that’s my first objection. Calling something BC when it is not designed as a certification of advanced knowledge or competence is misleading and will subject optometry to public and political ridicule, seriously harming our hard earned credibility as a profession. Our BC label will be compared with medicine’s, and easily shown to be more akin to mail order than to proof of advanced training. (And in response to the comment below that we’re the only health care without a BC, I think BC for optometric specialties would be overwhelmingly accepted and supported, it’s BC for “general” optometry that is not; and show me where medicine has BC that does not require at least one year of advanced training in a single discipline within general medicine after medical school to be earned.)

My next question then is, competence of what? What’s being measured, and how is a single national standard of competence to be determined against a landscape of wildly varying scopes of practice? That’s my second objection. “Competence” varies from state to state. It must until we have, like medicine and dentistry do, a national standard scope of practice. I’m certainly not competent to use lasers or treat glaucoma, because I’m in California where I can just barely sometimes use steroids! And, similarly, are we to be deemed not suitable for BC because, 20 years out of school, my knowledge of low vision or vision therapy has dissipated since I don’t practice in those areas – I refer to OD’s that do? Or the OD that does only CL now, and is damn good at it. Not competent?

Next I ask, do we have any idea whatsoever that what the AOA is indeed trying to cram down our throats against our will is what Medicare will accept as being akin to medical BC and therefore adequate?

Wait, let me back up for a moment. Do we have ANY EVIDENCE AT ALL that after, what, 30+ years of being providers, Medicare will cut the entire profession of optometry out of the program with a single rule change, notwithstanding that we provide a huge amount of the eye care in this country and for a fraction of the cost of our BC OMD brethren, if we do not have a national BC program to demonstrate continuing competence? Pragmatically, could they do that? Do we not yield, as a whole body of some 30,000 OD’s, sufficient leverage that if we stick together, they’ll have to work with us instead of the other way around? I think we’re letting the tail wag the dog here.

Now let me mention a few other concerns and problems, the downside if you will. First, the AOA will necessarily cease to represent all of optometry and will instead be an organization for BC doctors. Once they implement BC they will have to then take it to Medicare (and others) and argue that their BC should be the standard for optometric participation in the programs, thus also arguing implicitly that non-BC OD’s should be cut out. Those non-BC docs will in large numbers drop the AOA (and their state organizations) because who’s going to support an organization that is working against them? Within a few years the AOA will have a membership of almost entirely BC doc’s, which will be only a portion of all ODs. Has the AOA and its member state organizations made meaningful study of the anticipated impact on their membership and their ability to continue to function economically? What can they afford to lose and still remain viable? If that has not been measured, why move forward on a program that could destroy them? They need to have a realistic assessment of this before they go forward.

Second, if it is not a measure of advanced competence, why call it BC and subject our profession to the onslaught of indefensible comparison with medicine we will surely face? Are they ready and how does the AOA expect to respond to the arguments organized medicine will use to show our BC is a joke as it requires NO advanced training.

While I appreciate their concern about Medicare possibly requiring evidence of continuing competence in the future, and the argument that its better for us to do it ourselves outside of licensing, this program is seriously flawed and myopic. There is no such thing as “general medicine.” The AOA must surely realize that when Medicare floats new ideas, we are, in comparison to the entirety of medicine, such a small dot on the radar that they don’t yet consider how their proposals will have to be modified for the “outlying” professions. To take their broad early language as the basis for a major upheaval in the profession of optometry is a serious mistake. It would be FAR FAR FAR more effective for the AOA to represent optometry as a whole, as it’s done for years, and go to Medicare and say, “hey, BC isn’t an appropriate measure for optometry, so let’s discuss what if anything is needed to meet your goals against the landscape of our profession.” Wow – the AOA, instead of disenfranchising a large segment of the profession, would potentially draw in new members for having represented them again like they did when they got optometry into Medicare decades ago.

These are a few of my thoughts. I could write more, but I’ve got other fires to deal with…

Craig

On the marketing issue, two things come to mind. First, to all of us that have plaques on the wall that say our Board of Optometry “certify” us…, what would stop us from declaring ourselves “Board Certified?” Second, in California at least, it is almost certainly under current law ILLEGAL to hold ourselves out as Board Certified. We have two statutes that might implicate that:

3099. No optometrist shall advertise or otherwise hold himself or
herself out to be a specialist in eye disease and the treatment
thereof.

3100. The holding out as having a special knowledge of optometry,
as defined in this chapter, by the holder of a license, constitutes a
cause to revoke or suspend his or her license.

And it would easily be argued that calling oneself “Board Certified” is misleading because that’s a term generally reserved and understood by the public to mean advanced post-graduate training in a specialty, and anything that misleads the public (even if not false) is cause of revocation of one’s license.

I’ll try to call him next week. But, as I’m sure you’ve surmised, the costs below are well understated if you factor in the cost of the additional time out of the office (unproductive office hours) as well as the costs of travel (air/hotel, etc.). He’s just adding up the cost of CE hours. Moreover, it is front end heavy, so using 10 years is an accounting trick, but doesn’t reflect the thousands of dollars you have to spend in the first year or two.

However, even more profound in his message is that he has COMPLETELY changed his story as to the basis for BC. Now he’s acknowledging that Medicare has NOT actually suggested or even intimated that BC might be required for ODs. In fact, quite the opposite, they specifically said just MDs an DOs. Why? Well, perhaps because BC is a well established fact throughout medicine. Why would they not list ODs also? Well, perhaps because they know there is no such thing in our profession and it makes no sense for general optometry (note again, there is no parallel of “general medicine”).

So, this entire thing is all about that Medicare “might” require BC of providers other than MD and DO. But, really, can they if the other providers don’t have BC? That’s exactly what I said in my email – they will NOT cut out optometry because we don’t have a certification that doesn’t exist. However, create it, and they’ll then have a reason to cut out half of optometry! Oh would the OMD’s love that!

What I don’t understand is the desire to CREATE A PROBLEM WHERE NONE EXISTS.

If you’ve refracted for as long and as much as I have, like me you’ve probably learned not to fix things that aren’t broken. If the patient is happy as can be and is reading 20/15 with their habitual Rx, and you refract and find 10 degrees difference in their -0.50 cyl, do you change it? Not me. I tell them there’s a small change, but they’re doing great with what they have so I’m going to keep it the same. I learned that after then 5th or 6th remake in my first year or two in practice when they’d come back and say how the new Rx made them dizzy or whatever.

Optometry can NOT be cut out of Medicare for failure to be board certified if there is no board certification in optometry. Medicare apparently understands that, hence they did not include ODs (whom they know to be “physicians” under Medicare) in their proposal. Stupid organized optometry, on the other hand, are reading something into it that doesn’t exist (its half empty), and creating the very thing they are worried about.

Instead of creating BC, the AOA should be making sure the policy makers for Medicare know that optometry doesn’t have BC because we come out of school already knowing our profession, so our licensing is certification that we are optometrists, whereas most physicians come out of medical school unprepared to practice any field of medicine, are licensed as physicians, but then have to be trained in a field of medicine, and BC is the form of licensing them when they complete the program. THAT is what the AOA should be doing instead of dividing optometry into two classes, weakening us politically, costing us thousands of dollars, etc!

Craig

And yes, you can forward this to David. I don’t doubt he’s a good guy, successful, intelligent, etc. But some very bright people sometimes do some remarkably stupid things (trust me, as a business litigator, I know) – especially when they rush and don’t open the “great idea” to broad debate to flush out just how great an idea it is, or isn’t.

From: Roy Baker [mailto:rbaker@asis.com]
Sent: Friday, April 17, 2009 5:25 PM
To: weissman@jsei.ucla.edu
Cc: Dr. Art Epstein; Tim Hart; Hilary L.Hawthorne
Subject: COA poll on board certification

Barry,

I just got an email from Tim Hart claiming that the COA has been planning for three months to poll their members in California regarding BC proposal that will be presented at the AOA meeting in June. It is strange that my March 6th e-mail to Dr Brutvan regarding polling the membership on this issue did not elicit any reply. Another COA trustee, Paul Yarwood, OD, whom I communicated with also did not mention any plans by the COA to poll the membership. I have concerns that the majority of California ODs who may not have participated in any local society or on-line debates on BC will only be exposed to the AOA "party line" from Dr. Cockrell, which strongly advocates the present BC scheme.

I suppose internal AOA politics has led to the ignoring and purging dissenters such as Art Epstein, OD and Kenneth Myers, OD who openly questioned the current BC scheme. This is shameful group-think behavior on the part of AOA leaders.

I hope you will speak up for full and open debate and the polling of all ODs. The AOA leaders should listen to it's general membership rather than to a tiny group of BC advocates in order to make a wise decision regarding this latest BC scheme.

Roy

Roy Baker, OD, MS, FAAO

UCB '76

HDNOS past president

Dr. Baker:

Dr. Page Yarwood, a member of our Board of Trustees, shared with me a copy of your response to AOA Trustee Dr. David Cockrell’s April 14 letter on the joint board certification project.

In your response, you state:

Why has the California Optometric Association not polled the 3000+ California ODs so far on this issue? I wrote directly to the executive director of the COA asking her to poll the membership on this issue before the AOA June vote. I got no response from her or any of her staff. I contacted a COA trustee I know and expressed my concerns. He responded but he told me that I should just trust the COA board to make a good decision on my behalf. This is another example of the "we know better than you what is good for Optometry" attitude that is leading folks like you into accepting a this board certification process in an attempt to mislead third party payers.

I wanted to let you know that three months ago the COA Board of Trustees directed my Division to employ our political sampling and communications resources to design and finalize a survey to which all COA members could respond on this subject. We are currently at work on a survey instrument and expect to begin notifying members shortly after May 1 that it will be taken before the end of May and directing them to available resources for study before responding.

My staff and I have been in close collaboration with our President, Dr. Hilary Hawthorne, on this project, and I do know that our Trustees have been spending time attending meetings of their liaison local societies and listening to their concerns.

Let me know if you have additional questions or need more information.

Tim Hart
Director, Government & External Affairs
California Optometric Association

Board Certification - More Perspective

2009-04-12T18:50:00.002-07:00

Art,Very well done. You have summed up the problems beautifully.I especially agree with your comments regarding the lack of necessity of BC. I don't understand why we are trying to solve a problem that MAY exist in the future instead of seriously attacking the problems that threaten optometry NOW.We all have our own list, but unless BC can be shown to definitively help interstate license mobility and equal access and parity for insurance, why are we fighting this fight? Tom Xxxxxx

Dear Art,
Thank you for bringing clarity to this process and thank you for your continued articles.
FRANKLIN

I have more than one office. I am going to run one not accepting ANY

Insurance. My new philosophy... If you aren't going to pay, why should I play?

Health care providers are giving their services and products away.

You want filet mignon, then pay for it.

If one pays for low grade hamburger, one gets a low grade of hamburger.

Beyond Fed Up.

David

Art:
re:yourcolumn: hear! hear!

Nancy

What is wrong with the present AAO? Do they not provide a means of certification for those who want to prove their expertise in a subspecialty like VT etc?
Why not use the AAO for the purposes of "Board Certification"

SXxxx
California

Art,

I did not vote in any survey, but if you are still counting opinions, I am with you.

I am not in favor of BC.

BC is a solution for a problem that doesn't exist.

This is a situation where there is almost nothing for any individual optometrist to gain and potentially something to lose.........or at least the risks/problems that could occur is not worth any potential or perceived benefit.

It is almost as if some of these opt. organizations need something to fight for or push for in order to give them a reason to exist or in order to make them feel like they are accomplishing something important...........i just hope they can find something else to do.

Pxxxx

I just received AOA News. From the President's column I gather that
AOA intends to charge ahead like a bull, regardless of members'
opinions.
Paul

Dear Dr. Epstein,

I just wanted to drop a note and let you know I fully support your editorial on Board Certification. In my 20 years of practicing therapeutic optometry I have never once been asked by a patient if I am board certified. Our profession brags about its low mal-practice ratings and we still shoot ourselves in the foot. I think the AOA needs to wake up and quit ramming worthless ventures down our throats. As far as I'm concerned AOA is trying to fix a problem that doesn't exist. I've already sent a email copy to my state affiliate. (Why do I have the feeling that the state affiliate will pretend to not get the copy or ignore it...)

Dr. Xxxx Xxxx
Omaha, NE

Art,
I again want to say that I appreciate you stepping up and voicing your
opinion on BC. I am wondering if you know what happens if the AOA
delegates do vote it down this summer. Can the other organizations
involved still proceed without the AOA or would it be a dead issue
(again)?

Damon

Dr. Epstein,

I have just finished reading your e-journal from March 16 concerning the board certification process.
Everything I have been thinking, you stated in your editorial.
Perfect, "nail on the head" summary of what is going on.
I support your viewpoint in this matter, and you can quote me on that.

Thank you so very much,

James Xxxxx, OD

Hi, Art...
I agree with you that board certification is not needed in optometry. With the of optometrists being against this initiative I don't see why our "leaders" don't drop the issue and move on to other, more critical ones. I believe it is because they have a hidden agenda of separating our colleagues into two camps. This cannot benefit optometry long term.

X. Xxxx Xxxx
Indiana

Thank you for speaking for the majority of O.D.s. I have been trying
to look at this with an open mind, maybe something that would help my
self and Optometry in general. I've been in practice for 29 years and
have always enjoyed continuing education. The proposal as it stands,
sounds like it would put a substantial burden on the average
practicing OD. I understand this is voluntary, but it may eventually
become what is the norm for insurance participation. Cindy

Hi,
I recently read your article about Board Certification and agree with you 100%. I dont know if you have any type of petition against it, but I would be happy to add my name to it as well as send it on to any optometrists I know. Let me know if I can help.

ER, OD

Dr. Epstein,

As a state president I have been traveling the state providing a forum on "Board Certification". Remember that the moniker "board certified" is an understood descriptor for continued competence. The public doesn't know how much work is involved, but given the choice to go to a "board certified" practitioner or a "continued competent" practitioner I think they would have heard the former more often. Continued competence will cost as much as board certification so trying to sell the requirement for continued competence as part of licensure is no savings. ARBO using COPE will increase the cost if it is required. ARBO is looking at increased fees for COPE approval, required monitors and processing. If we make it a requirement we will be giving them cart blanc to impose any design for CE including limiting the sponsorship of CE.
First let me straighten out one fact. AARP did have talks with the president of the state association in Virginia and decided to forgo further pursuit of the requirement of board certification to insure continued competence after an understanding that optometry was already looking into the process.
I don't speculate on what that means, but it indicates that the process of continued competence is being looked at by as you put it a powerful voice.
I don't feel that optometry is ready to expend the time or investment financially to maintain continued competence without a stick.
So we can just wait, but realize that the same thing happened when our economy was heading down a slippery slope and voices were out there describing the problems associated with keeping the blinders on.
Finally, realize that it will be 4+ years optimistically before the first OD is certified and that includes a great deal of input and development.
We certainly can wait, but at least this debate has been taken to the grassroots by the leadership and no one can say later that they didn't have their opportunity to be involved.
Thank you for your forum.

Dear Dr. Epstein,

Thank you for your BC editorial. I could not agree with you more. I
tried to get email addresses from the AOA for the key people trying to
revive this BC issue, but got no answer back from them. It would be so
useful if you could find and print these email addresses so that we
could all weigh in on the subject directly to the responsible parties.
Thank you again.

CB,OD

Art,
Do your opinions represent in any way the opinions of your editorial board? You might want to clarify that in your final commentary. If so, that's considerable Optometric clout. I applaud your diligence and the courage to speak up. I agree with your assessment. BTW, I work with Dave Xxxxx MD. With nearly thirty years in practice, he has never had Board Certification in Ophthalmology. He has never believed that any test can certify competence. Of course, he is admittedly NOT interested in Medical Ophthalmology, but as a Cataract and Refractive surgeon, he doesn't need it. The only limitation I know of is that as owner of the practice his optical cannot participate in VSP, big loss.

James Xxxx, OD

Dr. Arthur Epstein:

Thanks so much for your thoughtful and well written editorial about board certification for optometry. I have enjoyed the discussion of this incredibly important topic for our profession and recognize that it will undoubtedly be one of the most important topics decided by the AOA. I was initially in favor of the board certification process, but upon learning the details of the process, very quickly came to the conclusion that it would not be a "true" board certification as board certification is defined by those primarily with MD and DO degrees. In short, the process would be easily identified as a joke by those who attained board certification by a much more rigorous process, usually including a three year residency. Unfortunately I have not seen a balanced presentation of this issue by the AOA to date.

Thanks again for your input to this issue.

LeRoy

One can not talk about board certification with out discussing the topic of mobility of optometrists. Making Optometrists retake National Boards in order to practice in a state of their choice makes the concept of Board Certification ridiculous. If the idea of Board Certification is is supposed to make our profession more credible then mobility from state to state should should not be restricted by making us jump thru hoops. I would be for Board Certification if it would ease up mobility requirements.

Lew

Art,
As President Elect I was at the presentation given in St. Louis, we have presented to our membership and we will be going over it again at a future meeting. Our membership is not for this proposal, at least those that have voiced an opinion. Our membership has in fact bound our delegates to vote according to membership wishes on this topic. So in Xxxxx we will follow the wishes of our membership and not our own personal opinions. Personally I would never vote against the will of the membership anyways, but now we are bound.

Personally I am not against some kind of concept of continued competence, but I think this proposal is flawed and does not meet the needs of the Optometric Profession. I would think this will have a hard time passing but you never know.

Xxxxx

Art,

Very well said in the latest issue of OP. You also must be aware that those of us who have mistrusted organized Optometry for many years also want a say in this. I am sure 100% of OD's who are not members of the AOA feel this is just another way to alienate them from these organizations.

Where do these docs voice their opinions or is it ONLY a decision by the AOA membership?

Please remove me from your email list.

I have grown tired of your rantings and self-serving agenda.

Mark
ND

Dear Art,

It's just unbelievable how some "Johnny come lately's" think they have invented something to verify the base curve of RGP contact lenses as you've reported. These 45 degree mirror assemblies have been around for as long as Keratometers. I still have two of them in my drawer of ancient inventions, and they probably date back to 1950 or before. It pains me to think that some people are so easly fooled by the re-introduction of an old thing, that these charlatains describe as new.

Since those old days, we've had a Humphrey auto-refractor in our office for about 8 years that was originally equipped with an attachment for RGP contact lenses to measure the back and front radius. How these guys missed this, and conjured up an attachment that they wrongly imagine is a brand new modern state of the art invention is not just incredible, it's outrageous and downright dishonest. I hope you tell them what I think (and I'm sure I'm not the only old fart in this business who has one or two of the original models that fit the keratometer). Unbelievable hypocrisy on their part.

Sincerely,

Your very good friend
RR

Dear Dr. Epstein,

Thank you so much for writing this editorial. I whole heartedly agree with your opinion. We don't even have the state laws equal in scope of practice... How can we be board certified if the state boards aren't equal in scope?... I can't treat glaucoma in Texas but I can in the other states I'm licensed in. In order to treat glaucoma in Texas I have to take another 30 hr. course at $1600.00 , take a written exam and follow an Opthamolgist around for a month. Does anybody realize how difficult this is when you have a practice and it's BUSY??? I finally feel like someone in my profession is representing me.( Dr. Epstein) I sure as heck don't feel any representation from the Optomerty beaurocrats who have hijacked the profession. This fiasco is why AOA will not get a dime out of me... -Make my optometric life easier?, yah, right...

Dr. Epstein,

Concerning board cert, have they considered mandating residencies for all new grads first? That seems the only logical way to go about this. Those grads could take the test and thus begins a legit board cert process. They could even grandfather in all current optometrists.

Todd

Dear Art,

Often you get little recognition for the many hours expended, and I for one, really appreciate your endeavors. Please allow me thank you for all of the work that you do for Optometry. The following is a variation of a letter that I have previously sent to the Xxxxx Optometric Association.

I do commend the work of the joint ABO task force over the past eighteen months. However, too many questions and issues remain unanswered and unresolved. The basis of the letter will apply to Xxxxx Optometry, but can easily be extended nationwide.

First, Xxxxx currently has several levels of optometric practice. There are 50 optometrists that are still practicing with only their OD license, or possibly, even just a BS if they are old enough. In 198x, the next level of Xxxx practice came into existence: there are still xx OD’s that are practicing with only a DPA license. In 199x, the TPA license became available, which now includes the remaining 1xxx OD’s. This TPA license is required for all newly licensed OD’s. Twenty-nine years have passed since the implementation of the DPA, and seventeen years the implementation of the TPA, and we are still stratified.

Second, the ABO would create in Xxxxxx at least two more levels of practice. The new graduate or resident would be able to “easily” obtain the required points to take the ABO test. Someone like myself after thirty-five years of practice could take the continuing education hours, but taking a comprehensive test at this point in my career would be significantly more difficult. Even if there were a requirement that ABO applicants be TPA certified, it would still create at least two more levels of Xxxxxx practice: i.e. Board eligible and Board certified.

Third, these first two points concern Xxxxxx. There are, however, 49 other states, Washington DC, Puerto Rico, military, Veteran’s Administration, etc. each with their own laws, rules and regulations. The ABO cannot possibly succeed in creating a national level playing field as licensure is State-regulated. Maybe one of the unspoken goals is license portability, but personally I do not see ABO paving the way in the foreseeable future.

Fourth, there is no acknowledgement for time in practice or expertise gleaned from being in practice. New graduates may be able to take and pass the ABO test, but this is still not equivalent to experience. As someone who has had three different new graduate associates over the last twenty years, all with the ability to pass a rigorous test, I still would not place their levels of experience or competence at the level of a doctor with thirty years of practice. Book knowledge and practice knowledge are not equivalent.

Fifth, there is no acknowledgement of Fellowship in the American Academy of Optometry unless this Fellowship was attained within the last 10 years. And this only reduces the points required from 150 to 100. Big deal. Many of us decided to attain Academy Fellowship, and went above and beyond basic licensure. We did the various required case reports. We did the examination before our peers. To me, this is the goal that should be held in the highest esteem. The Academy even goes further with the awarding of the Diplomat in many of its specialized areas. But both becoming a Fellow or a Diplomat is still optional! Ten percent of the profession are Fellows by choice. Fellows have already done the extra work. To ignore this fact is just plain ludicrous. Similarly, there no acknowledgement of Fellowship in any of the other specialty organizations that also mandate rigorous entrance requirements and testing.

Sixth, I am not anti-continuing education. I believe in CE. I have attained the level required for the Optometric Recognition Award every year since its inception by the Xxxxxx Optometric Association. I take six hours of transcript quality CE annually to maintain my Florida license. Furthermore, I am part of only a handful of optometrists that have received an Xxxx in Optometric Research. I have gone above and beyond. But ABO does not acknowledge these facts.

Seventh, is the cost to the doctor to obtain Board Certification. It has been estimated that the cost for taking the ABO test that was estimated to be in excess of $1000. This does not include the time that would need to be taken out of one’s practice to take in-depth review classes. Although the 150 points can be obtained by attending COPE or State Board certified continuing education, in-depth review classes will require the expertise of ASCO. This ASCO input would include course formulation, instruction, test formulation, and grading. Is there a hidden agenda?

Finally, I firmly believe that ABO will further stratify and divide Optometry both in Ohio and nationally. We have long sought unity, but ABO will just continue to divide us.

Thank you, for listening to my rambling.

Sincerely,

Jeffrey, OD

As one who deeply resents and opposes the push for optometric "board certification,", and which, if enacted, will serve only to alienate me from the AOA and its state affiliates (in particular NYSOA, my own), I thought the article below (which appeared in the current issue of the Journal of American Physicians and Surgeons - one of the few non-politically-motivated physician organizations in this country) would be of interest in relation to board certification:

14 Journal of American Physicians and Surgeons (Spring 2009) 17,
"AAPS Survey: Physicians Skeptical of Recertification"
Jane M. Orient, M.D.
Download article in PDF format

If the hyperlink above does not work, this was copied from the downloaded article:

http://www.jpands.org/vol14no1/orient.pdf

Regards and best wishes,

Paul

Good morning Art. I applaud your comments and they reflect the general
membership. As you head off to the NAP meeting please continue your
message. More importantly will ophthalmology look upon this as divide,
weaken, and conquer. Will they can they introduce legislation to diminish
the advances of Optometry. The leaders of AOA can face a mass defection in
membership based on their current course. can they afford that? The agenda
of a few can not out weigh the wants of the many. Specialty certification
should be recognized and established to move the profession onward first.
Secondly as one astue member mention that this certification is aimed at
practioners over 40 years old. Is this movement to bear pressure for the
senior doctors to consider retirement versus continue the fight? Is this an
attempt to thin the herd? The AOA's ideology is not complicated but filled
with deception.
Don

Art,

Thank God you are speaking out. If this thing passes I will be completely opposed to organized optometry. I spoke to my county optometric association president and forwarded your views telling him I felt the same. He said that you may have ulterior motives because you are a paid speaker and would have to become certified to keep your speaking engagements, which would cost you more money. Although I know that's not your reasoning for speaking out, maybe you want to address this in your next letter for those who may feel that's your rational for opposing.

Keep your message strongly opposed, as I'm sure you will.

Thanks,
Eric

Thanks for your stand on so-called board certification for optometrists. I see nothing from the AOA which indicates anything other than an advanced tier of CE. It may be many things, but is not board certification in the sense that any other health care provider or health care consumer would expect. This will divide optometry and should, in my opinion, be opposed. Shamefully, this new effort has stopped a legitimate board certification for those with VA residencies.

Sincerely,
Richard
TX

Art,
Excellent piece this week!
You are so totally right. The leadership SHOULD seek consensus of the membership. The question is really “will they?” I heard a lot of talk at SECO that this JBCPT was a “done deal.” Membership be damned. It will be interesting to see if those same “leaders” are as arrogant in light if the overwhelming number of rank-and-file ODs against this horrid proposal.
Keep the pressure on. You have generated a groundswell. You are using your platform for the good of the profession. Thanks for doing that.
E

Hi bravo i enjoyed reading your comments on the lack of need for board certification please send an email to the NYSOA and OSCONY as the leadership in NY has been brainwashed into voting for it in June. I haven't met one OD who is favor of this and more of us need to speak out against it, Robert

NYC

Dr. Epstein,

I sincerely appreciate your views regarding board certification and I support them. Our group has discussed this briefly and we have come to the following conclusion. If this passes we will "jump through the hoops" to become certified, regardless how meaningless it is, to avoid any pitfalls of being "left behind". However, the AOA can forget about our membership and membership dues from that point on and I fear that may apply to the majority of members. What will be left is a skeleton organization that will have no power and no purpose to go forward.

Craig

Dear Art, 03/30/2009

Your “Off the Cuff” Dated 03/20/2009 was perfectly constructed. I have visualized the same letter in my mind over the past few weeks, but never wrote it. Now I do not have to write that letter because you did it for me. Thanks so much.

Since I do not have a vote on any of the people involved within the AOA or the joint board I am not sure to whom I should extend my outrage towards their misguided energy. I will at least send my opinion to the AOA president and the president and president elect of The Texas Optometric Association.

Becoming more skeptical or cynical with age I did think about the rule of “Follow the Money”. Since colleges of optometry and optometric bureaucrats seem to have potential financial gain, would they doom us all to hundreds of study hours and thousands of dollars for their own gain? The first time that happened in Texas it was favorable and I became a Therapeutic Optometrist. The second time I became an Optometric Glaucoma Specialist, so I could treat Glaucoma. This next board certification does not allow me to do anything I cannot do now, except maybe be taken off of medical panels if I do not choose to subject myself to be re-educated on general optometry. Follow the money? Maybe so. Perhaps the committee’s time and the AOA’s money should be focused on lobby efforts. That will be necessary if I receive another board certification or not.

Thanks for what you do.

George Xxxxx, OD
TX

Optometry has always been its worse enemy and it is doing it again. I have been in practice since 1967 and have seen this over and over again. A good example is VSP a plan by optometrist For optometrist can they still say that with a straight face. They keep crating more hoops for us to jump through. When we received legislation for Diagnostic and Treatment of disease we told our members that this was for those people who wanted to do it. Now we are saying if you don't have it they are going to forfeit the license of those who did not do it. I don't think those doctors practice worse optometry in fact most are better because they have not bought into the medical model. Yes I have all my certification but I still don't think it is right for those that do not. So keep up the fight obviously this will no affect me as I am about retirement age but I just hate to see us tie our hands again over something that is not necessary. I am a past president of the Xxxxxx Optometry Association so I know the battles we have fought. I still say we are Doctors of Optometry first and we have the right to use medicine and I for one am not a frustrated non MD I am proud of my profession. Yes I have heard I could have been a real doctor and my reply is a real doctor that would be a RD which is a register dietitian the last time I look. Wake up optometry. Thanks for taking up the fight.

By the way, I thought you article was great on the 3/26 edition of the Optometric Physician. I think it was great for a distinguished leader in our profession to address leaders of our profession to be very careful with their decisions and about their obligations to responsibly improve our profession. Your poll is great to show that many Optometrists are against this Board Certification process and I hope our leaders take note.
Just check to see if there is a problem placing votes b/c in my previous email I stated that when I went to place my vote for "no", it was not being submitted to the poll. I had a web page pop up stating the "web page could not be displayed."

Ken

no to board certification.......................except perhaps in specific specialties...........eg...COVD already awards board cert.in Vision therapy/vision development............no reason for any other body to do so...........and NORA.........offers Clinical Skills Crt in Neuro-optometric rehab............no reason for any other body to do so.............what a crappy idea this generic board certification is..............I have no problem with specialty cert. .........but for general optometry............the optometric leaders are clueless.
ER

After all of the to & fro regarding Board Certification, let me see if I have this in perspective. Physicians are encouraged by the insurance companies to be Board Certified for inclusion into many plans & medical facilities. Guess who is on the Board of the insurance plans & medical facilities. Yep you guessed it – Physicians. The Board Certification idea was designed to minimize those physicians who had access – not necessarily those with the most skill. Only those who took the “approved” courses, passed the “approved” tests, designed and administered by the “approved” physicians were supposed to be considered experts. Admittedly Board Certification is an acceptable idea for physicians due to the legal and practical need for specialization. For many years there was no educational requirement after medical school & internship to maintain their license. Once you received the MD degree, you were set for life. No CE. Nothing. Even moving their practice among states was easy. Reciprocity was (is) granted to physicians unless you have committed some heinous crime.

Enter Optometry. For a long time we were virtually the only profession to require CE in every state. The problem was (is) that every state has different CE requirements, and different state laws. This is mainly due to individual state fights with the MD’s as to what the OD could do or not due in THAT state, and we succumbed to trying to please the medical community so we could practice our profession in peace. The Boards also desired to limit WHO and how many OD’s could practice there. Boards limit entry into states now by requiring all applicants to pass the same tests required of fresh out of school applicants – not really a possibility for someone out of school for 25+ years. The use of pharmacological agents was achieved, but still varies state to state due in total to fights with the MD’s. It is ALWAYS a compromise between MD’s & OD’s so that we can provide the health care that the public needs and deserves, and that we are knowledgeable with the expertise in providing.

OD’s have been mandated for many years by the individual State Boards to have a predetermined number of CE hours. Once again this was determined by what that state board considered would appease the MD’s and would cause a minimal amount of argument with them. Since our State Boards set the requirements, are we now to assume that our Boards were not adequately setting the standards. If so, why not?

Insurance Plans & medical facilities did not JUST come up with Board Certification as a requirement. The Board Certification idea did not JUST appear in all of their documents. Where has our leadership been? Why have they not insisted in the Board Certification requirement for inclusion to be omitted for OD’s. In the past if memory serves, insurance plans had several questions on their forms: Are you an Ophthalmologist (Yes/No), are you Board Certified (Yes/No); Are you an Optometrist (Yes/No). And that was IT! Board Certification was NOT a requirement for insurance billing, just more info for the company. Why are we just NOW discovering a difference in billing level ability? Was this not obvious previously? Where has our “representation” been?

Why now is there the push for Board Certification for OD’s. Will it make us smarter because we have taken a written test after the CE course? Will it make us better able to communicate with our patients? Will we be required to buy more equipment? Who will administer all of these tests? Who determines who can give the courses? And what make them the expert? What makes their solution to a clinical issue better than any one else’s? Is it just because they know a few more medical terms? Who determines the test questions and the acceptable answers? Who will pay them? Where is the money coming from? Who performs the testing oversight? Who is going to pay for all of the necessary administration? Consider all of the hundreds of thousands of office clinical hours lost to going to Board Certified courses and taking tests. Since some clinicians currently specialize (contact lenses, vision therapy, glaucoma, refractive surgery), who is going to determine THEIR skill and knowledge level? These specialty private practitioners probably know more and are more current than those who will think up the courses and test questions!

Being fresh out of school, book educated and able to pass any academic test given you is fine. But as a former partner noted just after joining his 30 year practice fresh out of school, “in school you learned how to do things by the clinical book; now you will have to re-learn how to do things in order to accommodate the patient, the insurance companies, the state board, the labs, the pharmaceutical companies, personal and professional ethics, the office staff AND the bottom line.” It was a mind and eye opening 3 year training ground. School had taught the clinical aspects of Optometry; it had not prepared one for the ART of patient communication and the ART of Optometry.

It may seem skeptical but this seems like the OD’s are once again trying to appease the insurance companies & medical facilities, who are in reality “guided” by the physicians on THEIR Boards. Once again we are just trying to compromise - all under the guise of improved healthcare. Sounds like what is happening in Washington. As the politicians see it, ONLY they know what is best for the little people. So, they will control everything and tell you what you can do, and how much you can earn while doing it. These are same ones who created the laws that got us here in the first place. Plans within plans.

Don

Art,
I assume you don't ever plan on being an AOA trustee?

Jim

Art,

Thank you for this excellent piece and your dedication to the facts. Some of us have been out of the loop on this issue, and your dissection of the AOA's statements was most illuminating. Your efforts are appreciated.

Sincerely,
XX Xxxxx, O.D.
VT

Thank you for your views since your the only person who is giving both sides of the story. As past president of Massachusetts Society of Optometrists you are correct that some states have made up their mind without consulting with their membership. The coming vote for board certification can potentially fragment our association even further and destroy any confidence in the AOA. My belief is more time is needed to discuss board certification. Alan Xxxxxx

As "mere optometrists" we suffer, collectively, from a bit of penis envy and no BC will make us PC with the big weenies in medicine. Please continue to expose the fraud of BC before it is too late! The only benefit of this nonsense will accrue to members of the Academy, most of whom, I suspect, could not make it in the world of private practice. Wally-world maybe, but not in the classical independent practice of optometry.

Dr. William Xxxxxx

I recently attended a hearing at the Xxxxx State House for Xxxxx an optometry bill. Ophthalmology used the fact that we did not have a regulatory board and are not Board Certified like medicine against us.

What are you thoughts concerning the Democrats in Washington pushing government health care, and do you think they may limit participation to Board Certified physicians only?

John Xxxx

Dear Art,

If the majority of AOA membership oppose board certification and if board certification becomes a reality despite majority objection, where does that leave the AOA as a credible representative of optometry?

Vincent J. Crispino, O.D.
River Falls, WI

Art,

First of all, thanks for taking some much time to discuss this major issue. I see BC as something that will fracture our profession in its current proposed form.

I seem to remember that at one of the major meetings, perhaps SECO, 2 or 3 years ago that a couple of groups involved in the JBCPT called an unannounced news conference and said they were going to begin evaluating a BC process for ODs. I believe that ARBO was one of those organizations. AOA and the other organizations on JBCPT weren’t notified of this decision nor about the press conference/announcement.

Last year, I was speaking with one of the AOA VPs at a meeting. He told me that the surprise announcement of this BC project shocked AOA and it decided that it should try to take the control of this process back from these “renegade” groups by insisting that all of the organizational stakeholders participate in this process. He said that, prior to that surprise announcement, AOA did not have any active plans to revisit the BC issue.

Having seen ARBO in action as a state board of optometry member, I asked him what ARBO was doing in the JBCPT process. He said that it was his personal opinion, from what he’d heard from JBCPT members, that ARBO was attempting to scuttle the JBCPT program in hopes that its proposal would be rejected and that ARBO would then independently try to establish a BC process.

I’ve discussed this with a newer ARBO board member and she denies that this is their purpose or that they started the current BC process with their surprise announcement.

I guess we’ll just have to see how this all plays out. As you may know, Pete Kehoe sent a letter out to all of the state associations in the last couple of days saying that the BC process was being modified as the JBCPT receives feedback from sessions it’s held as well as from the state associations as they meet with their members. That’s nice to hear, but my thought would be to table the vote on the BC process until the JBCPT can present a “final” version of the BC process to our members. I wouldn’t feel comfortable with them saying “trust us, we’ll look out for your interests” because I’m not sure they have the vision to do that.

Finally, I agree with you that the states are the only entities that have the authority to determine what constitutes continued competence of their licensees. If we had a national optometry license, then I could perhaps see the need for a national continued competency process for all ODs in the US. Until we have that national licensure in hand, which won’t happen in our life time, BC is a waste of time, energy and money.
Tom

I am not an advocate of board certification---and neither are all the members of our local Xxxx County Society --it is waste of our time and AOA money --I am thinking of not joining this year after being an AOA member for 16 years!! --it's a ridiculous waste of resources to pursue this effort and is just an exercise for a bunch of egos!!!!!!!!!!!!! There is no proof that it is necessary--I want to spend my time taking care of patients, not filling out more paperwork!! Dr D

Hi Art,

It could neither be more complete nor clearer.

Only ONE MD asked about pulling the wool over our myopic vision?

Best,

Al

Dear Dr A,

Hope you are well down under. Have you seen any of the effects of the
fires there?

This question and answer is G-R-E-A-T!

We are having a local Society meeting at the end of the month. Can I
copy and distribute this Q&A discussion to those present?

From sunny (and dry) California,

DrX

I’ve never met you and don’t know anything about you, but I applaud you and agree with you about the board cert. True enough I may not know the issues entirely, but thank you and I hope our profession will not agree to pay a select few that organize unnecessary ways to make money.

Xxxx Xxxxx, OD

How did this nonsense get this far? Board certification is a non-issue, we as a profession would be far better off woking on license portability. Jerry

Art, thanks for writing passionately about BC which is more appropriately referred to in this case as BS.

I have been educating residents for the past 30 years. As you know, there is a big difference between advanced competence and general competence. Your comments on need are spot on and there is no evidence that BC is required for most optometrists. However there is a group of ODs who are residency trained who may benefit for a credible attempt to recognize their advanced competency.

The only credible Board Certification involves advanced competency via completion of an accredited residency program, a credible examination, and a review by a board. JBCT skirts those deliberately. We have many residency trained ODs eligible for the ACMO exam administered by NBEO. Wouldn’t completion of a residency and passing ACMO be more credible vs the sham that’s being presented to fellow AOA members? We need to kill the JBCT version and thanks for your effort in this area! Feel free to share this.

Jerry

Gerald J. Selvin, O.D.

Chief, Optometry Section

VA Boston Healthcare System

150 South Huntington Avenue

Boston, MA 02130

A colleague forwarded Part II of your editorial on Board Certification. I was looking for the archives on Part I.

Could you please publish Parts I and II together so that those of us who may have missed Part I can read your editorial in its entirety?

I could not agree more with your points! Bravo!

Jill

Art,

I have no idea if you will actually be able to read this but I want to say thanks for your counterpoints to BC. I’ve attached an essay written by Russ Beach, O.D. of Virginia. He posted this on ODWire.org and I think his points are valid and may speak contrary to a couple of the points you presented in, Off the Cuff, Part 2.

Let me say that I am in complete agreement with you and Russ that the current BC proposal is a joke and will not be good for the profession in the end. The big problem I see is with MOC. I haven’t heard a solid stand from you on the idea of MOC but I think the optometrists I’ve heard from and have spoken to with the IOA think that MOC and BC are all one and the same. I would love to see someone in an optometric relations position stand up for MOC and stand up with conviction. More often than not the initial arguments I hear against BC are more against MOC and the idea that we should have to prove ourselves beyond graduation.

In my opinion we are in a time of soon to be necessary MOC. We don’t have it. Anytime you have a profession that has individuals calling themselves “Board Certified” because their license is renewed by a State Board of Optometry; we have a problem. A decent number of these guys are the same ones who simply sit in the back of lectures and read newspapers and play solitaire on their Blackberry’s. (Occasionally missing RDs; from my personal experience.)

Elderly patients don’t like it when we tell them it might not be best for them to drive any longer and it seems most ODs don’t like anyone telling them that maybe they need some new/updated education to continue practicing at the highest level the public/government is now starting to expect.

I think we need a major education effort on what MOC is and try to rally optometry around the idea of MOC. If you really sit and listen to people, even those die hard BC haters believe on some level that MOC makes some sense.

Are you willing to step out in support of MOC? Do you believe it should be on a national level with an end goal idea of reciprocity nationwide? Or, should individual states step up to the idea to force higher standards on their own.

Thanks for reading from my soapbox!

Sincerely,
Nick

Thank you, thank you, thank you for expressing what the majority of optometrists out in the field need to have expressed. I am from Xxxxxx and have served on the Board of Examiners for Xxxxx and as an examiner for the National Board Practical in addition to serving on a 5 member National Board Oversight Committee in the past. In Xxxxxx we require certified CE hours and I think that is beneficial and although there are likely significant numbers who dislike the testing procedure following a 6 hr. presentation it does keep all attendees alert and note taking during the process. I believe that if certified CE was uniformly required by all states it would make attendance more convenient and this talk about Board Certification would be put to rest. This proposal may have economic implications for the AOA and member states to provide Pre-Board preparation classes and this might be the unstated push for this idea. Pete Kehoe, from Illinois was also instrumental for the idea of InfantSee and although this program has merit I felt it would best be done in an arena setting throughout the country as a giant screening involving multidisciplinary volunteers with support from the child/baby care industry underwriting the endeavor. Just my thoughts on that one. Bringing a baby into offices for a staff stressed session with the potential of incomplete looks at the eye interior while the scream decibels exceeds hearing safety standards .....at no cost may be noble but costly to offices and potentially presenting opportunities for legal nightmares for the O.D. that missed a sight/life threatening situation.

Thanks for your excellent dialog on this issue. I don't get it either, I don't know what their (AOA) agenda is. I agree with you 100%...keep up the good work.

Tony

I could not agree more with OP’s accurate assessment of the Board Certification issue. Thank you for putting this important information out there!

Xxxxx

Art:

I am one of the OD’s who supports Board Certification for a number of reasons.

Optometry has always been a stepchild in eye care. It’s time to take the good with the bad and demonstrate to our colleagues in Medicine, the Medical Directors of the Health Care Insurance Industry, and the State and Federal Legislators that “Optometry is the Primary Eye Care Profession” and we can prove it.
After serving as President of my local and state Optometric Associations, AOA-PAC for six years, State Board for 8 years and as President of ARBO, I feel I have a clear understanding for the purpose of Board Certification and I am not afraid of it. It is the best eye health policy change we could put in place to ensure the America public has the finest eye care.
Legislatively, our Ophthalmologic Colleagues cannot use the idea “Optometry does not recertify” against us anymore when we battle them in the State Legislatures and at the Federal level.
The Health Insurance Industry may discriminate further against Optometry if we did not have Board Certification. I do not wish to be opted out of plans, if anything I would like to be part of more.
The evaluation for Board Certification will not be Part 1 or Part 2 of the National Boards. Most of us do not wish to re-study for those kinds of tests. From my early understanding it would be a test that would measure continued competence of what we do every day in our practices. This should not be a threat, but encouraging to our profession.
When I apply for privileges in a hospital or a managed care plan, one of the questions asked is, Are you Board Certified? When? By who? It is not comfortable to say no to any of these questions; it is humiliating to me and our profession.

There are more pieces to this than I have described. I’m ready to begin the process and I hope more OD’s will feel the same way over time.

Regards,

Robert M Easton Jr OD FAAO
1587 NE 39th Street
Oakland Park, FL 33334-4629

Dr Epstein, first let me begin by saying how much I look forward to and enjoy your weekly email letter. I have been receiving it for a few years now and I find it very insightful and educational. I graduated from Optometry school in 1996. I was a Navy veteran and had a degree in engineering before I switched gears to become an Optometrist. I couldn’t be happier.
I am going to try to follow this saga to better educate myself in what we hope or expect to achieve with board certification. My biggest complaint and concern has always been the dismal inequalities of our profession from state to state. I have been lucky enough to practice in Connecticut. A very proactive, well organized, pro-optometry state. With all our requirements and advancements I still can not practice in RI or Florida with out going through a battery of tests or evaluations. We lack reciprocity. It is my understanding that an OMD could move to any state in the USA and practice full scope medicine. What a sad state of affairs that we have not concentrated all our efforts to resolve inequities among our own profession. We all graduated with the same requirements, we all took and had to pass the tests from the “Board of Examiners in Optometry” yet we are not equal. Will requiring each of us to be newly Board Certified help achieve reciprocity. If not than I feel our goal is again misdirected towards merely attempting to achieve a paper equality with Ophthalmology.

Art, count me as one more OD who's against board certification, for
the same reasons as have been stated so many times.
Mark

Art,
I adamantly oppose board certification. I see no value –simply increase costs to individual OD’s in an already difficult economic time.
Moreover, I think it is a mistake for the “profession” (i.e. bureaucrats) of optometry to separate itself from those of us in the trenches (clinicians)- the majority who fiercely oppose board certification. It is important that the profession is united –and the continuing push vs. the will of the majority borders on disrespect.
Thanks for asking us. We need to be heard.
Sincerely,
Jane

Hi Art,

Congrats and best wishes, just a little late. I liked your comments on the board certification in optometry. I am looking forward to reading the upcoming editorials. My impression is that board certification will just divide the profession more. Those of us with COVD Board certification in Vision Development have all ready committed to the concept and I believe that it is necessary in specialty but not in general. So much for now. This will be critical as you have said.

Xxxxx

MORE TO COME....

"Board Certification" The Profession's Perspective

2009-03-18T12:33:00.014-07:00

Editor's Note:

Due to the sheer volume of response, I was unable to contact each of you to make sure you were comfortable with having your words attributed. Rather than exposing a colleage who wished to remain anonymous, I masked all names except for those who specifically requested attribution. If you would like your email attributed to you, please email me at artepstein@optometricphysician.com, and I will do so.

Thank all of you for your emails, kind words and your passion for our profession. I urge you to share my editorial on the AOA/JBCPT proposed "board certification" with your friends and colleagues and ask that they contact their local optometric society and state optometric associations to share their concerns.

It seems that some societies and associations are not seeking input in an attempt to thwart the membership's wishes and democratic process. Let them know how you feel. If this passes, we will have only ourselves to blame.

Art Epstein, OD

Addendum: The following contains every email that I have received over the past week with the exception of a small handful where confidentiality had been requested. The emails have been edited only to remove identifying characteristics. Only two emails were at all favorable to the proposal. In both cases, they were state board members and to their credit, both agreed to seek and accept the perspective of their constituents before formulating a final voting decision.

I will be traveling over the next few weeks and may not be able to update this blog as frequently. Don't let that stop you from sharing your perspective.

--------

Art:

Amen to you for your well-timed and brave expression of a well-thought out and articulated position.

It is truly folly to allow a change that has no need and no benefit to the general optometric practitioner, and which would be very costly to the individual and to the profession.

I agree with you and Dr. Myers that this is not necessary and the plan not even understandable. I have read the certification plan several times and still don't know what it actually means or how it would work. It is an example of the "just trust us" philosophy that leads to unwarranted regulation and bureaucracy.

You are absolutely right that we need to speak out or will be led to a future that undermines the progress we have made over the last many decades as a profession. We should realize that right now we don't want to lose precious autonomy and become more beholden to insurance regulators or increased federal mandates, but cherish our independence as a profession and simplicity of licensure. Unless it is proven that we truly NEED to broaden our training to delivery efficient and effective care, or NEED to increase specialty oversight, there is no NEED to consider this pseudo-certification.

Perhaps during this time of catastrophic "change" it would be wiser to wait and observe and do nothing rather than to dig ourselves deeper into the regulatory abyss.

Best regards,

Xxx Xxxxx, OD, FAAO
WA

--------

Great editorial. I printed it and will keep it for future reference. I agree - board cert. for general optometry BAD for all the reasons you and Meyer stated. One other element lurking at the edges of this topic is the fact that our generation of ODs has had to "go back to school" for TPAs. I have done it twice here in Cali and a 3rd back-to-school requirement was shadowing an OMD for 65 hours. A 4th time will occur when we get our glaucoma TPA privileges expanded. We are weary of mandated examinations. Thankyou for taking on this topic and speaking up for the majority. fight on,
--
XX Xxxxx,O.D.

-------

Dear Art:
thanks so much for voicing the opionion so many thousands of us share in opposing the ridiculous board certification proposal. Please keep up the great work.

Xxxx Xxxxxx, O.D.
Nashville, TN

-------

Just read your BC letter....

I'm glad you wrote it. I'd like to see you go out on a limb and tell the
AOA they are playing games with their members.

Jamie

-------

Hi Art:

I want to compliment you on the finest editorial you have ever written--no kidding. I hope it gets some response that will have an impact on the AOA--which as you know is on a "full steam ahead" mode and to hell with public opinion from their colleagues.

WELL DONE, my friend.

John

-----

Thank you, thank you, thank you for having the courage to publicly state what most of us feel. It would add another layer of bureaucracy that would then give managed care companies even more control of our practices. We’ve got enough battles to fight without having to fight our own organizations. Let’s nip it in the bud once and for all.

Xxxx Xxxxx, O.D, (P. S. My Florida license says I’m already board certified.)

-----

Dear Art,

Thank you for a clear statement. I am in agreement. If we ever meet I will shake your hand and call you friend.

Sincerely,

ML, O.D.

----

Art,

Thank you for being an incredible asset to our profession and a voice of reason and common sense. The idea of board certification after becoming an optometrist, taking national and state boards (at least in my day) and being required to take TQ continuing education yearly seems like a fairly complete and comprehensive display of our commitment to obtain credibility within our profession. Additional organizations (OEP,COVD, CLS, SVS, etc.) show our desire to specialize where desired. If those organizations and all we've gone through aren't enough, another "hoop to jump through" seems ridiculous and we will see a division in our profession that won't be overcome!

Mel, OD

-----

Art,
You could not be more correct in your assessment on Board certification.The AOA and local society's need to concentrate on the real threat to Optometry which is Ophthalmology.I do
co manage with various Ophthalmologists who are very Optometry friendly.I also know of Ophthalmologists who besides their practice and very involved in the movement to strip OD"s
of therapeutic privilege's.This the real threat not patient's and insurance companies worried about us being Board Certified.
Please see the attached PDF file about MD's in Pennsylvania..and it's only the tip of the iceberg.

Sincerely, Xxxxxx Xxxxx

-----------

Hey Art. That must have been a tough one to write given the circles
that you run in. Glad you wrote it. Thanks. --Xxxxxx

Xxxxx Xxxxx, O.D.
Beaverton, OR

-----------

Dear Dr. Epstein,

I agree 100% with your article.

XX (Minnesota Optometric Association Member)

----

Thank you Art !
for a very well thought response to this nonsense called BC. As a local society official I have tried to bring attention to this potentially divisive exercise and of course this has not been received well by State (XX) leadership. Hopefully this is not a done deal and the majority will be heard.
regards,
Xxxx Xxxx, O.D.

---------

Art,

I just finished reading your article (as well as Ken Myers' earlier pieces) on Board Certification. Thank you to both you and Dr. Myers for your candor and your courage. I completely agree with all of your thoughts on this subject. No doubt, all of us want the very best for our profession and our patients with regard to optometric competency. But the Board Certification issue is ten miles of very bad road upon which we have already traveled!

The time has now come for professional optometry to move on (just as dentistry has) past this contentious issue and start focusing on practical, meaningful ways to solidify membership and, ultimately, advocacy support. In an era of highly dynamic health care policymaking, that is the type of professional horsepower that will continue to be needed for optometry in the decades ahead.

All the best,

Joe Xxxxxx, OD, FAAO
Clinical Assistant Professor
XXXX College of Optometry

----

Hi Art,

I am pleased to see that you have articulated exactly how I feel about this issue, and then some. In fact, you brought even more than I had ever thought to the table in your editorial. And you'll be pleased to hear that I attended a continuing education meeting in Massachusetts yesterday in which, after the "complex and costly" process was explained, a virtually unanimous vote against the plan was taken. The entire program, once explained, seemed fraught with complexity and cost, with no apparent benefit to those of us who have been practicing for many years - not even the privilege of carrying our licensure to another state (there's an issue we need to work on.)

I can see why board certification is found within the medical profession: each practitioner, after internship, will undertake a residency - whether it be in primary care, cardiology, endocrinology, or some other specialty - and then demonstrate proficiency in that area. Optometrists exit optometry schools ready to begin seeing patients, and while some choose to go on to residency programs, it is usually to gain expertise for a specific area (e.g. cornea, contact lens, low vision.) Diplomate status within the AAO is the option that they have available, if they so desire.

You have also covered well the issue of further division within our ranks, which is something we really do not need at a time when we need our strength in numbers to take on the challenges and battles of dealing with issues of participation and parity within managed care networks.

You have done an excellent job of making your case, and I will be sure to forward it to as many colleagues as I can.

With Sincere Regards,

RB, OD

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I really liked the editorial. Some of my colleagues here in the very “optometrically” delayed state of Xxxxxx were discussing this. We were thinking that perhaps we were old “fogies.” I also thank you for linking to Ken Myers article in an earlier OP. I hope that the AOA board will listen to us.

DD, O.D., FCOVD
Behavioral Optometrist

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Art,
Great job!
LK, O.D.

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Thank you so much for your editorial. I really appreciate it.

I tried to vote on the poll but it does not load. If it ever does, please vote ”no” for me!

Diane

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I couldn't agree more. Thanks for saying so eloquently what we all are thinking.

TG, O.D.
CA

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Art:

DELETED BY REQUEST

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Hi, Art. I agree with you completely. This would be a costly process, adding another level of bureaucracy that would likely be questioned and ridiculed by other professions who already question optometry. Patients will not benefit either, since added costs of education/testing will at some point end up costing patients and/or insurance. There is nothing to gain from Board Certification, and it is just a risk to the profession and our professional organizations, especially with the high percentages of optometrists who are against it.

EE

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Dr. Epstein,

I couldn’t have said it better myself. I follow your editorials weekly and tend to agree with most of your opinions. In my opinion, as a new optometrist out of school 3 years, Board Certification in no way, shape, or form, would benefit me in my practice. I practice in a medium sized town of about 40,000 in Kansas and our practice is thriving and growing. The medical side of our practice is taking off by leaps and bounds, even in this rough economy. We get referrals on a weekly basis from hospitals, urgent care clinics, medical clinics, etc. to my wife and I (I, too, am married to an O.D.). I am a member of every medical plan the major employers in our area offer and had no trouble being credentialed for these plans. What do I need to be board certified for? We remove foreign bodies, prescribe oral narcotics as necessary, and practice to the full scope of the great state of Kansas’ optometry law, already. My colleagues, both O.D.’s and M.D.’s, refer to our clinic because we have done well with their patients previously and we go to great lengths to communicate our care back to these offices, not because I am board certified as a full-scope optometrist, which sounds quite ridiculous, too, doesn’t it?

I am with you that the only thing this will bring (and already has), is divisiveness in a time where cohesiveness is necessary. Our time would be much better spent protecting our scope of practice in those states that are lucky enough to have a good one, and pushing for expansion in those states that don’t.

Anyway, well said, and I appreciate your willingness to come under fire for saying things that the silent majority (myself previously included) really wants to say.

MS, O.D.
Eye Care Associates of Xxxxx, P.A.
KS

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Art,

You are right on. Certification serves no purpose in optometry. Medicine needs it because of all their specialties, but we as optometrists already specialize in one organ system.

I have already informed my state association of my position and my impression is that my state association executive committee is in agreement.

See you at the AAO.

Warm regards,

MHG, OD, MS, FAAO

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Hello Dr. Epstein,

Great editorial in this week's optometric physician! Also, it was nice seeing you at the Xxxxx dinner during SECO! I hope all is well!

Jerry
FL

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Gosh Art...

How do you really feel about Board Certification?

I have appreciated the time you have devoted to study and comment...it has been eye-opening for me. Up until today, I have basically been convinced that it was inevitable and good for the profession, so was willing to put in the hours of work and study necessary to achieve certification. Now that I have become better educated, I realize that much of the proposal is based upon false assumptions and emotion (hope, fear, etc.) and that even if fully enacted, the certification may have ZERO value...

Still undecided, but leaning in a way favorable to you.

Thanks again.

DH

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Dear Art,

Thank you for your well constructed, well thought out presentation on certification. As a 65 year old practitioner, I could get excited about re-credentialing, but not pseudo board certification. When my son joined me in practice 11 years ago, it was difficult to get him on provider lists such as medicare and VSP. As a result there were about months when he was unable to see a bunch of patients who wanted to see him. This is another consideration for this proposal. Unlike residents, who practice under another umbrella, our non residents will probably be shut out of regular practice for the extended time it takes to get certified.

Maybe you could provide an email address list of AOA people we could contact in opposition. If that went out via "Optometric Physician, we could distribute it widely. My understanding is that Indiana probably will vote to say no at the April State Convention.

Thank you for all you do.

Jon

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Art,

Great editorial !

Just a thought, please name the guilty parties (and their email addresses) to ramming this down our throats. Let's all inundate these "leaders" with email voicing our strong opposition to board certification.

Thank you for everything.

Best Regards,

Doug

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Dear Art,
I could not have stated it better myself and we are in complete agreement on this subject. I just hope the few don't manage to ram it down our throats anyway. national licensure would serve the profession more by showing uniformity of education and skills among our therapeutic certified optometric physicians. Yet some states must be worried that they will be inundated with practitioners if this occurs. Since i will not be able to attend the national convention in dc this summer, please vote no for me.
sincerely,

JH,o.d.

-------

"Amen" to your article on Board Certification.
TB, OD
SD

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Dear Art,
THANK YOU, THANK YOU, THANK YOU for your editorial on board certification. My wife and I, both in practice for over 15 years, couldn't agree with you more. Thank you for giving a voice to the silent majority. Keep up the great work!
Many thanks,

MB & LB

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Dear Dr. Epstein,

I must thank you for having the courage to share your information and opinion on AOA Board Certification. I cannot swallow the AOA "coolaid" on this subject, and agree with your assessment.

Much thanks!
Respectfully
ERB

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Art,
Thank you for writing a well thought out piece on board certification. I agree with everything you've said regarding the current proposed process and its potential impact on our profession.

'I just hope that the "powers that be" within the organizations pushing this listen to their constituents. What I'm afraid of is that the JBCPT proposal will be killed and that another organization, ARBO comes to mind, may set off independently to estabish a BC process which will really splinter our profession.

TC

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I’m surprised that Ken Myers is on the outside looking in on this issue. Both of his pieces on Board Certification are well thought out and detailed with FACTS. He has obviously put a tremendous amount of time and effort into this and should be taken seriously; and he comes from a position of knowing the facts. You have put voice to these issues, as you have warned for months. I can’t help but think of why he has not been part of the debate within the organizations discussing this issue, and since I cannot speak for Dr. Myers, I empathize with his perspective- and support it. By default, I support your position as well.

What can only be described as potentially serious consequences for optometry may occur should Board Certification be adopted by the AOA and other organizations. I know how these ‘bandwagon’ issues take root, and people with less than a front line involvement often get caught up in the mass hysteria created by the controlling parties. However, this time, the consequences can be dire.

Let me add that Dr. Myers has not only laid out the flaws in the current movement toward Board Certification, but he provides very workable solutions at bringing about resolution to maintenance of competence (MOC) concerns for optometry, without compromising anyone’s state license(s) to practice optometry, as it was designed.

Hooray for the ongoing debate right now. Let’s hope that there is enough front line interest to make sure that both sides of this argument for or against Board Certification get a proper hearing.

Richard E. Lippman, O.D., F.A.A.O.
V.P. for Ophthalmic Product Regulatory Affairs
R.P. Chiacchierini & Associates LLC

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Dr. Epstein,

Thanks for your editorial, with which I totally agree. I think that there is little evidence (and lots of conjecture) used to support the idea of BC, and the framework that was proposed was weak at best.

Like you, I support the idea of MOC – I think that there are lots of good justifications for increasing the rigor of our CE processes. Let’s continue down that path as you propose, and see where that leads us.

BTW, our local optometric society had similar to national results – 10% for ABO, 80% against, 10% undecided. Will AOA et. al. go against what appears to be the strong will of its membership? We’ll find out soon.

Jeff

JP, O.D., M.S.
Clinical Assistant Professor

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Bravo Art on your direct and complete analysis of this burr in the saddle of every Optometrist. We do not need to address the "inferiority complexes" of some Optometrists who feel we are not on the level of other primary care givers, by alienating the majority of Optometric Physicians who are well respected by their patients and peers for their diagnostic and treatment skills.

CB, OD
San Diego, CA

Dr. Epstein,

Very well delineated.
After gathering 7 state licenses (sitting for 5 state boards) over 23 years, requiring passage of the complete series of national boards-
TWICE- my husband and I are flummoxed. We are done proving ourselves to our own profession. Why would more "certification" be needed?
Keep the pressure on to call this move down.

SB & NB

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Excellent piece, Art. We will be having our local society meeting in Illinois next month, and I'll be sure to voice my objections to board certification.

Jay
IL

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Thank you for your thoughts on board certification -- i couldn't agree more!

DH

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Thanks, Art! Job well done. I couldn't agree with you more.

XX, OD
Member, XXX State Board of Optometry

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Dr. Epstein,

As a new residency trained graduate I appreciate your compassion and perspective. Before a conference this weekend, I had little foundation into this certification process but thought it might be a good thing for the profession. I felt it was another way to better ourselves like a residency or by becoming a fellow. It is great to see a leader in the field expressing their view. I appreciate it immensely and I just wanted to let you know.

Sincerely,

RG O.D.

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Dr. Epstein:

I am in agreement with you. While Dr. Myers work is incredibly repetitive, though much appreciated, your brief column should be published in the AOA News to counter the Academic's onslaught. I say this because, I believe the proposed BC process would help them the most and do nary a thing for optometrists in the trenches.

Bravo! Sensible optometrists do exist.

WE, OD

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Dear Dr. Epstein,

I read your commentary on board certification for optometrist and I whole-heartedly agree with you. To me, board certification is just another way to make it costly to have an optometry license. I graduated 10 years ago and am still paying back my student loans. I graduated from an accredited optometry school, took 3 national board exams and various state board/law exams. To me that is more than enough proof that I am competent to practice optometry. Maybe the ones who feel that yet another form of certification is good for their self-esteem or ego. But, I for one have enough self-esteem to know that every day I practice to the best of my ability as an optometrist and I have never, to this day, had a patient question my competence as their optometrist. Why then would it make financial sense or any sense at all for me to go through another process of certifications, continuing educations, etc? I truly hope that most of our colleagues will stand up for our assertions that we are all very capable and competent optometrists already.

Best regards,

TC, OD

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WOW !!!

That article was perfect and I agree 200% with everything that you said.

Great work and THANKS !!

IK, OD

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Art-

If this ill-conceived concept and program is adopted by AOA in June, it portends DISASTER for our profession. I would encourage you to continue your efforts to end consideration of this inane idea.

XX OD, M.Ed., FAAO, FCOVD, Col.(ret) US Army.

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Art

I knew I liked you and there was a reason I'm such a follower of your weekly excerpts. Good for you on becoming enlightened against the AOA's pseudo-"Board Certification" which is nothing more than a truly questionable means to an even more questionable end. Not only will it divide our profession but membership in the AOA will become vastly decimated. I for one will revoke my 15 years of membership should it move forward. Your overt proclomation in this weeks article should send resonance throughout the Optometry community and bring attention to the importance of the AOA listening to their very members. I salute you.

Regards,

ES OD
FL

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Thank so much for your editorial, Robert

RB, OD, FAAO
Virginia

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Outstanding editorial!!!!!

Please forward to every state board, as you eliquently expressed the sentiment of every OD I know.

KS, OD
OH

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I agree.
MJ, OD

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Dear Dr. Epstein,

The issue of how to demonstrate continuing (vs. intitial) competency will no doubt prove an interesting debate for our profession in the coming months. I would like to offer a few thoughts from the perspective a practitioner in the state of Washington who has read your editiorial but also has been plugged into this issue since ABOP failed (and for good reason). My intention is not to debate you...but to offer what may be some additional information.

I sat on our state board for six years...starting just after ABOP failed. At that time, I represented our state at an ARBO meeting where the issue of ABOP's failure was commented on by some of ARBO's leadership as a positive thing because, in my opinion, it appeared to allow an opening for that organization to take the cause forward with their ownership. There were several presentations made (by a couple of consumer and professional organizations) about how necessary continuing competency was to the profession, state licensing and assuring state's consumers that their doctors were maintaining high practice standards driven by the profession vs. the legal profession continuing to do so with tort (malpractice) suits. The bottom line was that there seemed to be some behind the scenes movement withing ARBO's leadership (my interpretation although I admit I could have been wrong) that this presented them an opportunity to push this themselves. A few years later, I again attended an ARBO meeting (our state only funds one person to go and we send members on a rotating basis) where this was still being discussed.

I have since had some conversations with some of AOA's leadership who have been involved with this. I felt they were being genuine with me at the time when asked as I brought up why they elected to once again be involved with with such a potentially divisive issue. My belief from that conversation was that they felt it was going to be pushed by ARBO/COPE and that it was better that, based on their experience with ABOP coupled with the newer political realities (that you have said you disagree with), they act as facilitator vs. have this be driven more by a group that has less membership representation. Whether one agrees with their motivation or not...I do feel that having AOA "driving" this, who represents a broader membership group, vs. ARBO in a different coalition of consumer groups with state boards...is healthier for our profession.

Related to the perspective of state legislation...a few years ago their was legislation that was proposed (Washington State) to require MD in all modes of practice to demonstrate continuing competency. Competency standards, where they didn't already exist for a type of practice such as "general" medicine, would be established by the state's department of health. In short, by the government bureaucracy. This legislation did not pass...but it did cause a governor's study group to be formed to continue to look at this issue. It is thought that eventually there very likely will be legislation that comes of this. The cabal of legislators that originally proposed this still exists and if a report recommend this comes out (quite possible) then our state will see mandated continuing competency for MD's...and it is thought that a "trickle down" effect will happen within a few years (if it is not included with the original legislation) for the other professions that don't have it including optometry, nurse practioners, and dentistry (dentistry's is so restrictive that it really only works right out of school somewhat like a residency program which is hardly continuing competency). My thinking is that it would be much better to have a program designed and driven by optometry than one from our state department of health...even in consultation with our optometry board. From what I have seen of the joint project proposals the program suggested, while I think it may need tweaking, appears to be sufficient to our state's needs...and this looks to be voluntary so individuals from other areas can choose but at least it will be available.

Are we the only state where this type thing has been considered? At this point, I believe so. Would we be the last...I doubt it...this appears to be driven in part by some consumer groups (per the one that spoke at ARBO) and should they win in our state...no doubt they will go to others.

There does appear to be another "soft" issue...with third party carriers. In out state, we have a retired OD who we have hired as a consultant to interface with the many third party carriers here. He has many private conversations with carrier representatives. He has shared that it is his understanding that carriers are looking at this issue with optometry...perhaps as a way to have different levels of payment, to limit panels, or to use as an excuse to keep ODs off panels altogether. There is no reason, considering the fact that he is no longer in practice, for him to make these statements unless they are coming up in his conversations with carriers. Granted, carriers may be sending up smoke screens to see what we will do...but I am a cynic regarding their past attempts to discriminate against our profession so tend to believe this.

Should our profession look this over carefully? You bet. I can tell you though, we have colleagues out there that should have hung it up...based on my experience on our state board. They are not a large percentage but they are out there...they tell themselves they are practicing optometry "the old fashioned way" and some other excuses. A quick "health screening" (direct ophthalmoscopy and refraction) is NOT an exam nor is it standard or care. How do we make sure we have doctors maintaining their skills once they have received their license? Regular CE alone as we have been doing it? Do we want others to tell us how to do it? If we do it for ourselves...is what the JBCPT proposes the best way?

Thank you for your thoughts...I hope mine will give you a little more to think on related to some historical perspective you might not have been aware of as well as the impact this might have on a purely "local" issue.

Cordially, Rich

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Art,
I really appreciated your latest opinion article on the Optometric
Board certification fiasco! Per my description, there should be no doubt that I wholeheartedly agree with you!
JP, O.D.
state board of examiners member in Xxxx

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Thank you, sir. To affix to your comment the majority of the appropriate clichés, you touched the bases, covered the terrain, and left no major stone unturned…does that mean most OD’s might even take the time to read your column? I sincerely hope so. Will they speak out? That, of course, remains to be seen, but you have done your part in masterful fashion.
Again, thank you.

Xxxxx

Xxxx, od, faao, mph
MT

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I agree with Dr Epstein, the board exams we took after our intensive specific optometric training
was , I believe, enough to certify our competency. After that, the experience ODs get in practice is the school of hard knocks which may actually be more useful than any other's ideas of re-certifying us ad infinitum.

Xxxx

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Oakland, CA
Dear Art-
Thanks for making your voice heard on this subject and pesenting evidence in a clear and unbiased manner. Organized Optometry has always made it's strides by presenting a unified front. The current issue at hand stands to fracture our profession and potentially put a process in place that does more harm than good. Rather than polarizing itself over this issue, the profession needs to come together in a frank discussion of how a certification process could best be implemented for the ultimate benefit of the profession as a whole.
It is repected leaders such as yourself that can help motivate and inspire involvement of local groups to come together in a meaniful manner and facilitate action that will continue to advance our profession in a manner that has gotten us to where we are today. Keep up the good work!

Warmest regards,

SH, OD
CO

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Art,

Good for you! You really told it like it is. Sometimes we suffer from elitism as do the other professions. We I attend CE and hear the conversations of some OD's, I feel something must be done either relicensure or something else to differentiate us from the "which is better 1 or 2" crowd. The board certification although well intended is excessive and is heavily biased on academy membership. Count me in on your side

JC, O.D.

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My wife is a board certified Internist, and I take umbrage at anyone who claims that this BS/BC proposal is anything like a true certification process for a specialty. This appears to me to be little more than a money grab by Optometry schools for CE dollars, and may very well precipitate the unintended consequence (or is it?) of forcing everyone to become “board certified”. Once there is a process in place, simply putting N/A on credentialing apps will no longer work, and we may be forced to obtain certification to be on any panel.

I am one of the many who will resign from the AOA if this goes through. Maybe it is stupid, but why should I remain a member of an organization that no longer has my best interest at heart.

I am in favor of specialty certification. Low vision, pediatrics, contact lenses, pathology (VA) all have a REASON for certification, as well as a legitimate training program in place to justify it. Confusing board certification with continued competency is misguided and potentially dangerous to our profession.

MM, OD

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Dr. Epstein,

Thank you for your editorial regarding board certification for optometry. I completely agree with your comments. I was opposed to this already, but reading your comments confirms my belief that this board certification process is wrong for our profession. Thanks for standing up for optometry.

JJ, O.D.
Ga.

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Art,
Congratulations for your thoughtful ideas on Board Certification for Opometric Physicians. I agree that if the process mixes continuing education and equates that with residency, many obvious thing happen:

1. Optometry will become a residency required proffession, with room for 20% of it's graduates.
2. The "continuing educated ones" who practice world class eyecare with the best technology available to the full extend of the law (yourself and myself included) will become second class citizens.
3. It will be a boondoggle to execute and cost us a small fortune of time away from patients.
4. The Academy will be for what????

Let's concentrate on getting paid for what we do, being recognized for what we are, and enjoying providing visual health to the world.

Mark
FL

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Dear Art,

I just read your editorial on this subject matter. Yes, I too have been flooded with emails and calls from colleagues across the country that are adamately against Board Certification. Your Editorial pretty much sums up what the majority of private O.D.'s across the nation are saying: "'thumbs down on another C-E extension." We can certainly drive a wedge into modern day optometry by this unnecessary action.

Bravo for speaking out in public. Your articles are read by most O.D.'s and thus carries quite an impact as it should. I salute you for your stance and you have my vote.

XX, O.D.
Ontario, CA

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Dear Art,

Bravo on your editorial. I especially agree that this board certification is an expensive CE scheme that will have the effect of enriching the pockets of lecturers and the members assembling the process. To boot, AOA dues would be spent paying for meetings related to the organization of the certification process.

I'm all for strict standards in CE, and in fact take about 40 hours per year for which I get no credit. But the idea of paying for certification does not sit well with me. It's among other things a "Stimulus Package" for those who insist on forcing it on the membership.

So I hope your editorial helps to defeat it, and I commend you for writing it.

Peter
PA

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Dear Art

What Optometry needs is not Board Certification but parity between states. What other profession is crippled by the lack of ability to move 10 miles to NJ from NY and vice versa. MD's seem to be able to move very easily. If the AOA wants to work on something let them work on that.

DM OD

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Dr. Epstein,

Your sentiment is felt whole-heartedly regarding OD board certification.

My questions have been, aren't we board certified if we passed the 3 parts of the NBEO?

Aren't we general practioners?

Haven't we been taking TQ tests and CE to maintain and prove competency?

My letters to the AOA and IOA have fallen on deaf ears.

Best regards............Tony
IN

----
You have stated what I have always felt very well.

In Hawaii, locals would say, "Right on the kini popo, Brah!"

Despite assertions to the contrary, the board certification process
proposed by the AOA/JBCPT is not board certification. It is an overly
complex and costly form of continuing education. True board
certification is a well-defined process accepted by the healthcare
community, regulators, providers and accreditation agencies. Board
certification occurs at the culmination of post-graduate residency-based
specialty training after rigorous and specific testing. By adopting a
non-residency-based pseudo-board certification process, optometry would
stand alone under what would undoubtedly be intense scrutiny and perhaps
ridicule from the rest of the healthcare community.

Bravo, Bravo,

Aloha from Hawaii,
XX

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Why do we need it?

1. We all have the opportunity to be board certified by the American Academy of Optometry.

2. We all have to take CE to renew our licenses.

3. My Florida License requires 4 hours of transcript quality(TQ)plus 12 to 14 non-TQ
CE every year.

4. We all have to take and pass a state board exam to practice optometry in any state we which we wish to practice.(At the most recent SECO the AOA/JBCPT stated this was only entry level)

It seems to me that the major push for board certification is that we don't keep up with what is new or changing in our chosen profession. Just taking the required CE regular and/or TQ to keep our licenses current would appear to me to be enough to keep us current with all the changes and both therapeutic and technological.

I am a 1966 Optometry School Graduate(SCO),took and passed the Florida Board, received my Fellowship in the Academy in 1977 (which was not entry level certificatiion), took the Tennessee Board and passed in 1990, and took the Arkansas Board and passed in 1999.
In addition I had to take the IAB therapeutic board in early 1990 to receive my therapeutic certification and also had to take the Florida Therapeutics Board in 1990 in order to receive Therapeutic Certification for my Florida License. I think having graduated in 1966 and taking the Tennessee State Board, the IAB, and the therapeutics portion of the Florida board, and passing all three, 24yrs after graduation, and taking and passing the Arkansas Board 33yrs after graduation is a testimony to keeping up with the changes in the profession.
I don't think I am unusual I think most O.D's keep up with the changes in our profession.
Further for those who are concerned with the fact that our certification is not comparable to other professions they state board certification for Optometry is necessary because board certification is the 'common currency' of continued and advanced competence in health care. The Military(i.e. the Federal Government) recognizes Academy Fellowship as the source for allowing Military O.D.'s to receive Board Certification Pay and to annotate their MOS(Military Occupation Specialty){Army&Navy} and AFSC(Air Force Specialty Code){Air Force} that they are board certified. This is the same as for Physicians that have Board Certification such as American Academy of Pediatrics, American Academy of Family Practice or Internal Medicine, etc, etc.
Since some of these other Academies have periodic retesting of there fellows maybe we need periodic retesting by our academy or maybe the Florida requirement to take transcript quality CE or some combination of these might be required, but I don't feel creating a whole new Board Certification Process is necessary for our profession.

Cordially,

BOB

Xxx Xxxxx, O.D., F.A.A.O.
Retired USAF Optometrist

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Art,
I appreciate your stand on this important topic.
And I again 100% with you.
May the majority win this battle again the AOA.
--
XX, OD
Mt. Airy, NC

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Art,
THANK YOU for your insightful, objective and well thought-out editorial regarding board certification. Your words expose as false the media PR distributed by the AOA.
The JBCPT has created an answer to a problem that does not exist. As you state, no OD has ever been denied access to an insurance plan because of board certification. It was a bad idea when ABOP was first proposed and wisely dismissed by the rank and file optometrists that are the backbone of our great profession. It remains a bad idea a decade later. Once again, the working ODs in the lanes every day need to voice their displeasure with this proposal and put this terrible idea to rest once and for all.
I am disappointed in the JBCPT. First, their definition of BC is nothing more than a super MOC. If the proposition was tied to residency training, as the VA's medical optometry board has been elucidated, that would be a step forward for our profession. The existing proposal will surely be a embarrassment to optometry in the eyes of those professions who offer true board certification. I question wheither the JBCPT understands the definition of board certification.
Surely the powers-that-be have seen the surveys, message boards, etc. that show without question the overwhelming disapproval by the rank-and-file of BC. The question now becomes: will they listen?
I have read Dr. Myer's excellent white papers regarding BC. I strongly recommend every practicing OD do the same, then as you say, let your voice be heard in your state association. Or else open your wallets.

EB, OD, MS, FAAO, Dipl.
AL

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So, Art, if I understand you (and Dr. Myers) correctly, you claim among that board certification for optometry is not necessary unless some sort of specialty training is involved, typically obtained through a residency and/or fellowship. We are generalists, by and large, but within the special field of eye care.

To those who would point out that Family Practice is very general—perhaps the most general in medicine—it seems you would say even that mode of practice requires residency training because it is more advanced than what is obtained in four years of medical school. In that sense, we optometrists specialized when we elected to go to optometry school, choosing then a specific organ system in which to specialize. In contrast, a med school education is much more general, and is always followed by some sort of residency that provides more specific training in the area selected by the recent med school graduate.

It seems to me that optometry is already specialized to eye care; within that field, we have sub-specialists in various areas. It seems that we have no gap between our entry-level training and that required to practice with competence and confidence. In medicine, that gap is quite large, and thus the requirement for certifying boards.

Do I understand you correctly?

Slowly getting a grip on the rationale for this,

CDR XX, OD

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This whole Board Cert thing smells of snobbery. I get the impression that a few optometrists feel that they are better than the rest and want to add 'Board Certified' after their names to make their point.

In some ways, I can appreciate their point of view. When I was graduated from Ohio State, there were those who ranked at the top of the class and a few who just squeaked through. I often wondered about the care that patients would receive from those at the bottom of the class. The thing about optometry, is that it is not a life or death profession. I am proud to say that I have never had a patient die in my chair. This isn't brain surgery.

XX
Concord, CA

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ART:

WHAT WE SHOULD DO IS REQUIRE A BOARD CERTIFICATION OF REGULATORY BOARD MEMBERS AND THE AOA, IT WOULD BE RUN BY THE RANK AND FILE AOA MEMBERS . I FIND IT INCREDIBLE THAT THEY ARE TRYING TO PUSH THIS DOWN OUR THROATS WITHOUT A VOTE BY THE RANK AND FILE AOA MEMBERS. IT IS AMAZING TO ME THAT THIS PROCESS HAS GOTTEN THIS FAR. TAXATION WITHOUT REPRESENTATION. ARE WE A DEMOCRACY. EVEN IF THEY VOTE NOT TO GO FORWARD WITH THIS, I WILL FOREVER QUESTION THEIR MOTIVES, AND THESE ARE THE PEOPLE WHO ARE SUPPOSED TO REPRESENT OUR INTERESTS? THERE NEEDS TO BE MORE OUTRAGE AND PERHAPS A CALL TO PREMPTIVELY CANCEL �MEMBERSHIP UNTIL THE VOTE.

TB, O.D.

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Hello Art friend and colleauge.
I echo your position. Somehow David Cockrell and Randy Brooks want to push their agenda forward. Can you honestly think that either can look you in the eye and believe they are "serving" the "Optometrist's best interest.
Without question most practioners will support "specialty certification"
WHY DO IN NEED BOARD CERTIFICATION TO PRACTICE WHAT I HAVE A LICENSE TO DO ALREADY?
Ask the AOA why those that have a FAAO (what year and are you better than me? and what was your FAAO specialty in?) would have a 100 point advantage. If you are going to have board certification level the playing field!!!
Will David Cockrell or Randy Brooks take credit for the greatest defection in membership from the AOA in it's history. These economic times might be the trigger for the exodus!! 28% defection would be a disaster and 10% would be the signal of the avanlache leading to the disaster. Quite playing politics
Don

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Art,

Well written and I agree 100% with your position.

BD, O.D.
OH

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Dear Art,

Kudos to you, you nailed it with your editorial.

Doug

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Dr. Art. Bravo. Bravo. Bravo. I find it interesting the people charged with defining board certification seem to have allowed loopholes for themselves if they teach, sit on one of the organizations, belong to the academy, etc. Also the only people involved in the process are also those who will gain financially. This issue could be the ruin of optometry if not checked. Why is it nobody thought to ask the docs in the trenches what we think? We deal with this stuff (third party, hospital priv.) every day and not from some Ivory Tower. Regards and thank you, Mike

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Dear Art,
I wholeheartedly agree with your position on optometric board certification. It may be helpful for us who are not active in the state politics and only give monetary support when asked to let us know what exactly we can do to find out who our delegates to the AOA from each state may be.
Thanks for expressing a position that the majority of us have but have not expressed it.

XX, OD
Phoenix, Arizona

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Dr Epstein,
Well said. I hope the AOA does listen.
I wasn’t part of that survey you mentioned…but I too would consider dropping out of the AOA if it passes.
SG

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Hi Art,

You are to be applauded for your courage to write such a clear opinion piece in opposition to the board certification proposal. I’m sure it is difficult for you both politically and emotionally to express your opposition so openly. I found your comments to be well written, well focused and obviously well thought out. Your voice is heard loud and clear and because of your global influence, this re-invented and still ill conceived concept should be voted down when it comes up for a vote this summer.

Bravo. Keep up the good work.

Sincerely,

DD

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Dear Dr Art,
I'm not up on all the details, but this whole Board Certification thing sounds like either a) a way for us to be forced to take more CE and get a paper certificate, such like we in California had to do for glaucoma, or even worse, b) a way to exclude people from practicing certain aspects of optometry (i.e., contact lenses, low vision, etc.) much as what VSP did when it required therapeutic certification among its member doctors.
Could you invite someone on the other side to write an opposition statement and publish it in the Opt Physician e-letter?
Also, wouldn't it be nice to have a debate set up that could be broadcast to us via the internet? Sorta like what happened with Jim Cramer vs Jon Stewart.

DrG

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Art

God Bless you for your articulate rejection of pseudoboards. I am an O.D. who graduated in 1982 from ICO. I am a much better optometrist than I was then, thanks to 27 years of experience. I could be even better if I was free to take CE courses that I was interested in instead of constantly repeating the same CE over and over again, because it was mandated by the state board to get us therapeutic privileges. I admit that my functional vision skills have atrophied due to lack of use and having to take junior ophthalmology CE that applies to my license. Thankfully we have been granted a small amount of actual optometry in our CE the last few years but not much.

Thank you for sticking with the ODs in the trenches, and not the Ivory Tower.

Peace

Ron

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THANK YOU for saying what the majority of my friend have been saying "silently" for the last few months....this proposal is so divisive that I fear it will destroy all the gains in the scope of practice that you and I have seen gained over the last 30 years. It may also limit the AOA response to any future threats to the profession.

I have no problem if an OD wants to be "board certified" in a specialty after completing an optometric residency ( ie: Low Vision, Rehabilitation Optometry, Developmental Vision) BUT DO NOT tell me that I have to be board certified to maintain my license to practice. If you meet the continuing education criteria in your state then you can maintain you license!

I find it very interesting that the strongest support for board certification has come from the schools and colleges of optometry. WOW a whole new area of CE that they can cash in on. I haven't heard what the National Board of Optometry has to say... they are the body that gave me the right to practice at the highest level in NY State, I guess the diploma they gave me is worthless because some pseudo board say I need to take another test.

Your critical analysis of the issue is right to the point....no one that I have read has made the issue clearer. I suggest that every member contact the AOA office and their state office to oppose the board certification proposal.

Thank you again for saying what needed to be said.

ER, OD

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Dr. Epstein:

Thanks for the in depth analysis on the board certification matter. I talked to a M.D. who just passed his/her BC process recently, it was an eye opener.

Keep up the good work.

Michael

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Thank you for verbalizing some of my thoughts and frustrations regarding this "board certification" process. I have been nationally certified since 1982, Academy "certified" since 1985, state certified by four different state agencies, DPA certified, TPA certified (twice going through the weekend CE meetings and passing the exam since the two states I practiced in passed the laws at different times ) and I always take more than the necessary continuing ed to maintain my licensures. I have never been denied insurance because I wasn't "board certified"- only because I wasn't an M.D. My husband is a physician- he had to pass a board exam ONCE in his career. So jumping through another hoop imposed by my own colleagues is the last thing I feel I should have to do. My malpracitice is still reasonable after all these years- if the insurance companies think we're that safe, why do some in our profession think we're not?! This whole process has gotten out of hand by a group of overzealous, valedictorian, ivory tower -type folks who seem to have an insecurity problem. Let this go once and for all-please. This will tear our profession apart!

XX, O.D., F.A.A.O.
Clinical Attending
The Xxxx University College of Optometry

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Dear Art,
Thank you for cogently, enthusiastically, and honestly representing my feelings about the proposed board certification. I have long found the reasoning flawed and self serving by those who propose to control the means of certification without science or fact to justify it.
MR, OD

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Dear Art,

Beautifully written, and well thought out. I totally concur. Don't change one word!

RR, O.D. in Kent, WA

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I appreciate your editorial. Well written and right on target. We are about to find out if the AOA leadership is for us or for themselves.

TM

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Art: I couldn't agree more! Great and well written article. Jim

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Hi Art,
I could not agree more with your 03/16/09 editorial in the Optometric Physician. You did not see me at the Bronstein Seminar this past January for a similar reason.
The Washington State Board of Optometry was perhaps the first state to rule that all Optometrists licensed in the state must practice at the same highest level of competency. I, and some of my colleagues chose not to be certified to use injectibles. I for one, would rather fit contact lenses, do visual therapy, prescribed drugs when needed, and in general, practice full scope Optometry. Using injectables has never seemed to be within the scope of the Optometric practice that I chose when I entered the profession. Having to choose a specialty after graduation, and then to be certified is indeed beyond my imagination. I am told it is because Medicare will soon demand certification for payment.

Because I chose not to be certified to use injectables, I will lose my license come January 1, 2010. My contract at the state prison expired the end of September, My practice has been sold, though not entirely paid for. So it seemed like a good time to call it a day. I will miss my many friends and collegues in the profession, and the opportunity to offer meaningful input. My biggest regret is no longer being able to improve the learning skills of children in our classrooms.

Perhaps we may meet again.
DB

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Dr. Epstein

Thanks so much for being the first nationally recognized individual to have the nerve to come out strongly against this ludicrous board certification movement. There seems to be a conspiracy by our so-called leaders to prevent anything being published against the issue. I have tried to pay for ads in the AOA journal, I have e-mailed, snail-mailed, and called everyone listed in the journals and newsletters. NOBODY will return my calls or e-mails. I have written a letter that I have read at our OHIO meetings (My sense is that 95+ % of Ohio ODs are against board certification). I would gladly pay your publication (on Tuesday) if you would publish the letter. I will sent it to you as an attachment. Also, I will send you what is probably a controversial ad I tried to get published in the AOA journal. Needless to say, they refused to publish that one.

Thanks for your support of the oppostition to the movement!

BG, O.D.
OH

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This issue reminds me of our attempts for therapeutic
drug use. The program was supported by the majority,
and part of that majority were our older OD's. Once in
place, VSP required any member to be therapeutically
certified. Therefore, many old timers were out because
they did not want it for themselves, just for the profession.
They did not have a choice to stay with VSP, and who
will corral us into the "proper" group who will survive
board certification..

very well said,
THANK YOU!!

Rod OD

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Art – I have always enjoyed attending your lectures whether in Kansas City or Vision Expo West, and reading your articles. I think your article on board certification is spot on. You’ve really thought this through and thanks for expressing the opinion of so many of us fellow OD’s. Thanks again, KS, OD

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Art,

Spot on! Thanks for such an insightful and well thought out stance. I
totally agree, but am not nearly as articulate as you. I have contacted
my state association (AFOS).

Thanks for your leadership in our profession---I know your views are
very well respected. I thoroughly enjoy your weekly newsletter
too--great job.

Have a great day and keep up the good work!

-Kyle
FL

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Thanks for stepping up on this. I don't understand why the AOA keeps pushing this idea. They could much better serve the profession by doing something about reasonable licensing reciprocity than this issue.
XX, OD
Kaiser Permanente- Colorado

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Dr. Epstein – Thank you for your editorial in Optometric Physician. Your opinion is valued but I must challenge your assertion that the vast majority of optometrists are against the board certification proposal. I am a member of the Minnesota Optometric Assn. Board and when we recently held our annual conference and presented the board certification proposal we by no means had a majority of docs against it. In fact I would argue that the vast majority of docs were in agreement that this was needed and were in agreement that as a state we should support the AOA’s position. I personally did not hear a single person speak to me against this proposal and as a board in our discussions have heard of only a handful of individuals who are opposed and none to the degree that you have implied. I believe your assertion that the VAST MAJORITY of docs are opposed to this is vastly overstated. I wonder if the unscientific pole numbers you reference would change now that more information is available and people have a better understanding of the proposal. Whether we are an anomaly here in MN is to be seen at the House of Delegates as should be the process where the masses voices are heard. So, I respectfully disagree with you on this issue. I have yet to date heard a good argument against board certification with the exception of cost which you did mention but I don’t think that this alone should be the reason we are the only health care profession without a form of continued competency.

Thank you again for your time.

JS, O.D.

----

Thank you for your editorial. I'm glad there are at least some voices out there that represent the majority of general practice OD's. I was disturbed to find out recently from a leader of the AOSA at the XXXX Optometry school that at a recent meeting the AOA leadership told this student that there is no real debate over Board Certification. Let me give you a clip from an email received by this XXXX student

"I’m a member of the 3rd year class of 2010 at XXXX Optometry. I am originally rom Xxxxx and eventually plan on returning to the area to practice. I’m the student trustee-elect for the XXXXX, so Dr. Xxxxx has been willing to put me on the Email list and watch the board certification debate unfold.

I was curious about a couple things. Does anyone know what the attitude is among the other areas of the state, and the other states in general? The reason I ask is that the AOA sponsored a happy hour for our class, to which the president of the AOA attended. I had the opportunity to speak to him in a small group setting and was quite interested with what I heard. He made it sound like the bulk of the various states was absolutely for BC and that there was hardly a debate. In fact, if I remember correctly, he mentioned that Texas was going to bypass some part of the deciding process because they are almost completely in agreement. He also used words like “inevitable” and “it’s here now.” When I mentioned some of the points of debate, he listened, but I almost got the feeling that he thought they were out of left field. He seemed to have a good answer for all of my questions; except for the seeming disparity of the different tones I’ve heard, locally of careful onsideration/debate and nationally of an overwhelming push. "

My concern here is that the AOA seems to be ignoring it's members and trying to push through it's own agenda in an almost deceptive fashion. At least if we are going to debate it let's tell the truth .... that most OD's are against it.

Keep on being a voice for the profession.

Sincerely,

Wade

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I agree with you. I think that the new proposal is just a way for ODs who have never practiced to have some form of power or importance. They are out of touch.

Thanks,
Paul

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Dr Epstein,
Thank you for such a well spoken position on the AOA/JBCPT. I have heard the same sentiments from my colleagues since the proposed process was unveiled. You have given a bold voice to the never listened to masses. Thank you.
XX, OD
New Castle, IN

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hi art....

bravo... well put as a 36 year member, and past state president, I will surely vote with my checkbook.

there are some really important issues that influence me, my practice and my patients, that are being ignored with this silly board certification issue taking so great a time and dollar resource and talk about bad timing...

Thank you for speaking out i will follow your advice and contact my state and national representatives

larry, OD

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Somber greeting from Tucson, Art.

It has come to my attention that members of the state associations will not be allowed to vote for or against BC, which will in theory direct each states delegates how to vote at the AOA meeting this summer.

How can this be? In order to vote, one would have to join the state association and pay. Can you say Poll Tax?

I don't have to pay to vote for President of the US, but to vote for BC or against BC, I would?

*THIS IS NOT RIGHT.* The only place I can vote I have to pay to join? How is this morally defensible?

FWIW, I am a member but I know many who are not. You all think this is going to make them think MORE highly of organized Optometry? This will cost the AOA in potential members, and I dare say some current ones could go as well. This makes the process look more corrupt than anything else I've seen.

I also just had it confirmed by my State's Executive Direcotr that non members will not be allowed to vote on this process, which will affect every OD.

She's very professional, and I get the feeling she finds that decision distasteful, but she's just the messenger.

Please shine your very bright light on this, Art. I consider all ODs to be my colleagues and I think they should all be able to vote on the future of Optometric Board Certification.

XX, OD, FAAO

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All I can say is “I love you!” The whole BC is a bunch of BS.

Charlotte

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Dr. Epstein,
I appreciate your candid opinion on board certification. I completely agree with you but have felt I would be chastized as being non-progressive if not aggreeing on this proposal. Thank you for expressing your opinion that IS shared by many others.

Anonymous Just Graduated O.D.

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Dr. Epstein-

Thank you so much for stating your opinion so thoughtfully. All my colleagues that I have discussed this with agree: we ARE ALREADY 'board certified' by our State Licensing Board, and need to provide CE Hours every year to prove our competency.

If the issue is the need for us to be able to get on an insurance panel, then my thought is this: If the Insurance Provider does NOT want us on their panel, then they will just change the rules from "board certification" to "MD/DO only", or some other requirement, and still exclude us.

It's amazing to me that organized optometry rushes (against the will of the rank-and-file optometrist) to push board certification, yet IGNORES us in what is for most ODs a more pressing matter, which is state-to-state license reciprocity. I work in a hospital-based HMO practice with both MDs and ODs, and our MD colleagues are amazed that we can't easily obtain a license in another state! (They are ALSO amazed that we actually are clocked-in and watched so closely at our CE courses, but that is another matter).

By the way, I am a residency-trained OD working in a position where we use therapeutics frequently, so I don't oppose the issue because I feel I couldn't 'pass the tests',,,instead I oppose it because it adds yet another layer of bureaucracy (and financial obligation) to an already full load of state-license requirements.

Anyway, I would like to thank you for sticking up for what is (according to all the polls) the 'silent majority' who oppose this issue.

Sincerely- BN, OD

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Well written!

I whole heartedly agree.

Richard

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Having just read the AOA News reasoning for "Board Certification" and your editorial, I continue to be against this idea. Just to give an idea of who I am . . . I own a private practice, serve as a trustee for the Utah Optometric Association, am the Utah clinical director for Special Olympics Lions Club International Opening Eyes, and am also a clinical examiner for NBEO. This is really not a board certification in the sense that medicine understands and does it. COVD is a specialty and has a certification process that more closely mirrors board certification. What the AOA is talking about is continued competency education and examinations. Although I have always been in favor of continuing education, this is overkill of the worst kind. I also believe that at best it is unnecessary extra work and at its worst will be something that will make it harder to attract people to to our profession and will lead to more problems and exclusions.
Dale, OD

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Dear Art,

Thanks for putting many of our collective thoughts into words. And with a minority of ODs trying to push this through the best that we mortal ODs may be able to do is to leave the AOA if it passes. That may be the only way to get their attention.

As I wrote before regarding OD board certification, no matter what we do we may never be equal to an OMD in the eyes of MDs no matter what hoops we jump through. I think MD bias brainwashing begins in med school when they go on ophthalmology rounds and get a full dose of prejudice from the OMDs and their tech "refractionists". By the time MDs are done with their residencies they have had seven formative years of "OD servant, OMD master" training. Who would you trust your MD hide with a referral -- to a servant or a master? That won't be changed with board certification or anything other than having an OD and an MD 200 miles from the closest OMD in rural Montana.

One other problem with board certification: Board certification seems just one step closer to having a national optometry license. All of our TPA laws were changed first in the small states then the big states last. The best way to stagnate our growth would be to have all TPA changes changed at the national level. One more strike against it.

You have probably heard all of this before. Thanks for being the voice of reason.

Best regards always,

Xxxx

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Well stated. I could not agree more.

Regards.
David
NY

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Dr. Epstein,

Thank you your latest editorial posting in OP. Your clear and concise argument against BC is a breath of fresh air in this tiresome debate. I only hope that the sentiment that you expressed will be lifted up by the quiet majority so that the "higher-ups" in Optometry will actually begin to listen.

Sincerely,

DC, OD

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Hello Art,
Thank you for taking a stand against this Board Certification proposal. I think there are a great many of us out there (70%?) who cannot abide by this, but most of us don't have the benefit of the "bully pulpit" to make our wishes known.
I have sent a copy of my letter to the WOA and also the AOA. I have received a favorable response from the executive director of the WOA, but of course nothing from St. Louis.
I can't accept anything about this proposal, including the cautious and flowery language in which it is framed. We are to "demonstrate" our knowledge. Oh, really? To whom? Have the NBO or ARBO members "demonstrated" their superior intellect, or clinical skills to enable them to judge me? Not to my mind, they haven't.
This whole thing is a poor process, unwarranted and unnecessary. I am totally and unequivocally opposed to it.
Thanks
LT, O.D.
WI

----

Art,
Your article is insightful and extremely well written. It has triggered numerous responses on the CAO (CT Assoc of Optometrists) site and will fuel the debate at tomorrow's state meeting.

The good news is the vast majority of the responses have agreed with you, as do I.

Thanks for writing this and one other point to consider is what if the AOA and State Associations were prohibited from providing any of the education or certification. It would all be done by an outside private agency with no financial ties to the Associations. How fast would this concept evaporate???

Regards,
Xxxx

----

Art,

You did a beautiful job outlining the reasons that the vast majority of
optometrists in the US are against this silly proposal. You're right, this
is nothing more than a glorified (i.e., complex and expensive without
results commensurate with the costs) CE program. It will be a true Board
Certification program only in the eyes of a few optometrists and those
administering the bureaucracy created by the program. It will certainly not
be considered such in the eyes of medicine, legislators, or insurance
programs.

Thank you for expressing these and other points so well. I only hope your message reaches those intent on ramming this proposal down our throats. I've let our state delegation know my opinion and will continue to encourage others to do the same.

Best wishes

----

Dave

I just read your perspective on Board Certification and I have to say I completely agree with you. I see it as a glorified CME effort. More important I feel is the ability for a licensed optometrist to travel to another state and be able to obtain a state license without the horrendous restrictions that apply now. Would Board Certification mean I can move to another state and practice? If not, it’s pointless. Thanks for your opinion.

Richard

----

Art:
I agree. If done properly, board certification might be a clever or needed attribute at another point in our evolution. This is not that point. Our current priorities must be:
• Making optometric residency the standard
• 50 state portability of licenses
Simply stated, our 4 year programs do not adequately prepare OD's for current practice challenges and our current lack of license portability is appauling. These are more visceral housekeeping matters that, with proper and timely management, will have far greater impact on our future place in our medical and business communities.

Best regards,

EK

----

Dr. Epstein

Please keep "beating the drum" against the AOA/JBCPT proposed "board certification" for those of us that need a respected, well informed voice! Optometry should get past trying to enhance its image with "mirrors and marsh gas."

SP O.D.

----

Dear Dr Epstein, Thank you so much for your well written article concerning
Board certification. I agree with you completely.

LO, O.D.

----

Thanks for the information. Hopefully everyone will read it.

DS

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Dear Art,

Thanks for the well constructed, although lengthy presentation of the state of the state. Reinforcement why I stopped paying AOA dues 20 years ago. They do not have the best interests of the profession in their objectives. If they want to act this way, perhaps the AOA should be disbanded and we go back to paying only local dues. BTY, the idea that the national organization does not give money back but offers to loan it to the state societies for defense or even approval to bring all states to a common level (see Massachusetts Glaucoma Legislation) is appalling.
Bill

----

Hi Art,

I just read this from "Contact Lenses Today"

"Joint Board Certification Project Team Holds Forum at SECO
The Joint Board Certification Project Team (JBCPT), formed by six optometric organizations in 2007, continues its efforts to widely distribute their model framework for a board certification process for optometry that was released in January. On March 5, the JBCPT conducted an Open Forum on Board Certification at SECO 2009, as the latest effort to communicate the model to the profession."

I just want to know. How well it was advertised that there was a meeting at SECO for the JBCPT.

Were you at this meeting? Both XXX XXXX and XXX XXXX graduated with me in my class of 19XX from SCO. I was at SECO 2009 and heard nothing of this "Open Forum" that Cl today discusses!

Seems to me they are all trying to be hush hush about this and get it by with no one watching

Thank you for your insight
AG

----

The Primary Care Section of the AAO has been discussing the insanity of the issue.
Keep up the Good Fight. Al

----

Hi Art,

As president-elect of XXXXX, and the one charged with presenting board certification/maintenance of competency to the optometrists of our state this coming Wednesday, I was looking forward to you sharing your insights. I know understand that if you publish something less supportive, that will not make Pete happy and could make the remainder of your trip less pleasant.

Personally, I am still on the fence. From a public health standpoint, I am in support of meeting the standard set forth by medicine. In online forums I have been characterized as an "elitist" because I am an Academy Fellow and that I consider us optometric physicians held to the same standard of care as a board certified OMD. I do not see a legal defensive team in a court of law saying to a jury, "Do not blame the optometrist. Yes, he gets paid the same as a board certified ophthalmologist from Medicare, but he is not expected to deliver the same level or quality of care."

On the flip side, it is hard to rationalize spending significant the time and money to create an entity without a defined need at this point in time. It is a risk-benefit issue. We risk creating a need when there would potentially be none. The benefit would be having the means for BC in place should the playing field change and BC becomes something that CMS and insurance companies require.

If we do nothing, would insurers carve us out and limit care to just OMDs with board certification? I my opinion many would and still are even without board certification. Rhode Island, in my opinion, has the best parity law in the country and yet here comes Tufts Health Care who says only OMDs can provide medical care to our subscribers and ODs can only provide "routine exams" through EyeMed. Our attorney informed them of the law. They said thanks for pointing it out, but we believe we are within our legal rights. In other words spend the money to take us to court, (which I think AOA should help us with) or go back to the legislature and tighten up the law so there is no room for misinterpretation. More time and money.

I would like to think that optometry is nothing but an eyelash on a financially hairy beast of CMS, yet today Xxxxx ODs are currently being audited for over utilization of the 92014 code. This, according to AOA is not happening any where else in the country. How does that decision come about? Does someone make a phone call and encourage someone to undertake a state wide audit? My point is, there are things going on that no one understands regarding decisions made by insurers, including Medicare. If there was some way to ascertain what the insurance companies will expect in the future it would make the BC decision easier. That may never happen and as many point out BC and pay for performance issues do not necessarily translate into better patient care.

http://blog.yjhm.org/2009/02/how-health-insurers-dehumanize-medical.html

If you have time and choose to respond I will not respond I will not share your comments with any one else. Just looking for your learned perspective so I can be better prepared when facing the Xxxxxx membership this Wednesday. As always, thank you for your time and dedication to our profession.

Best Regards,
Paul

--
XX, OD FAAO

----

Dr. Epstein,

Thank you for posting the link to the "Board Certification" issue written by one of our colleagues. I had only heard about this issue and could not find info. about this to read.
I am not happy with some of the leadership in our profession. The Optometrist that wrote the article to discuss why not to make "Board Certification" mandatory for all Optometrists hit the nail on the head.
My name is XX, Jr. O.D. I practice in New York and graduated in 1997. I do not see how this "Board Certification" will change anything about how I practice day to day. I provide general Optometric care along with disease management at the Practices I work for. I don't feel we have anything to prove to other professions by creating a piece of paper that gives us a sense of validation to others that we are qualified to manage eye disease.
In Optometry school, we have to take 3 parts of a "Board" exam and pass them in order to be certified to practice Optometry. We had to take the TMOD's to show we were competent enough to manage disease with proper medical care. After I passed these exams and had earned my license, was I not "Board Certified" already? If I took 3 sections of an Examination administered by the Board of Optometry and the Board "Certified" that I passed them, doesn't that technically make me a "Board Certified Optometrist"? If not, then why I am I taking Board exams through Optometry school and after passing "Board" examinations that I am not "Board Certified?"
After reading the link to the letter written by our colleague for not creating "Board Certification" for all Optometrists, I agree with his point of view and I bet most Optometrists would.
I believe that this so called "Board Certification" that is being tossed around should be limited to people interested in working at hospitals and VA centers. Optometrists practicing primary care are already competent to provide eye care. We should not invest our time completing a residency and spending extra money to obtain this meaningless "Board Certification" title that will not make a difference in our day to day practice.
I like the model that Dentistry follows. Once you graduate and pass your exams, you can go out and practice general dentistry.

What are your thoughts about this issue?

Sincerely,

KS. O.D.
New York Optometrist

2009-03-18T12:33:00.001-07:00

Correction CA ODs retain autonomy

2008-08-23T12:15:00.004-07:00

Subject: DISREGARD THURSDAY'S AOA "FIRST LOOK"
Date: Thursday, August 21, 2008, 11:09 PM

AOA'S "FIRST LOOK" WAS WRONG
Friday, August 22, 2008

Dear Dr.

If you're an AOA member like me, you may receive AOA's e-news brief, First Look. Yesterday morning's edition quoted from of an article published by Sacramento's Capitol Weekly on its web site on Wednesday about our sponsored scope expansion bill, Senate Bill 1406. That article contained this statement about the glaucoma certification advisory committee created by the bill:
Still, "many of the final specifics of what optometrists can and cannot do will be determined by a six-member panel made up of three ophthalmologists and three optometrists. Once finalized, their recommendations would be handed of the California Board of Optometry to implement." THAT STATEMENT WAS COMPLETELY WRONG.

When our staff read the first story, they contacted Capitol Weekly immediately and set the record straight. The reporter corrected it immediately for the Thursday online and in-print versions; click here to read the accurate version, with our side of the story.
I'm disappointed that AOA decided to publish this error without consulting us here in California first. Let me emphasize to all of you again that the best sources for accurate informaton on our legislative program are volunteer members of our Legislation and Regulation Committee, our Trustees, and GEAD staff. If it doesn't originate with us, its veracity must be questioned.

If you have any questions about SB 1406, avoid rumormongering; come to the source.

Sincerely,

David Redman, O.D.
COA President

More on the Florida Situation

2008-08-22T23:17:00.007-07:00

Art,
Thank you very much for your insightful article regarding Florida’s struggle. Your eloquent description of the situation was spot on. You also adroitly described the frustration of being presumed guilty until proven innocent and the disappointment in the willingness on the part of many of our ophthalmology colleagues to believe such ridiculous accusations blindly without taking time for verification.

During the 8 years I have had the honor of serving on the Florida Optometric Association board, our legislative agenda has never mentioned injectable procedure privileges and it would have remained so had our opposition not fabricated the concept out of thin air. From a practical, open and truthful standpoint, the Florida legislative agenda, now and for the past several years, is simply to match the standard of care now practiced in 47 other states in our country with regard to oral ocular medication privileges. Privileges which, as you know, the medical community has no issue delegating to physician assistants and other staff.

Given the current situation, publicly responding to letters like yours has unforeseen potential pitfalls in that one can never be sure where or how his/her words may be interpreted, distributed or distorted. But as a very wise man once said, “All that is necessary for evil to prosper if for good men to do nothing.”

In that light and for all you have contributed to our profession over the years you have my most sincere gratitude and appreciation.

Best regards,
Bill

William D. Tanke, O.D.

Chairman of the Board

Florida Optometric Association

Dear Dr. Epstein,

It was a very timely editorial you wrote in this week's Optometric Physician; more than you might ever know. It made me decide that based on the integrity I've witnessed in our several meetings over the years over various dinner functions and cocktails that I should respond and set the record exactly straight for you on what is transpiring here in Florida in regard to organized Optometry/Ophthalmology relations. It has to start somewhere, you say? Well here it is: the truth, nothing but the truth, and some truth that no one wants to say or hear.

I became the local (Central Florida) society President last year. I didn't accept the job because I wanted it. I accepted it because I believe in taking my turn, doing my part, and giving back to my profession. Immediately it became clear that the biggest part of my job was cheerleading to those who tend not to get involved and not be a part of the solution. Over the past year and a half I have written 9 or 10 newsletters; each in some place encourages members to contribute with their time or their finances to our legislative advocacy efforts or thanks them for stepping up and doing so. Are we involved in the advocacy of our profession to our state representatives? OF COURSE we are. Frankly, in Florida it hasn't been an option for many years now because of the lies and deception mostly by the individual you've mentioned in your column and his efforts to not only stop our efforts at gaining parity with our colleagues in the rest of the country but also in trying to take away privileges we've had and admirably performed for several decades. This individual has actually lost credibility with many legislators because of the aforementioned lies and deception.

Fortunately, despite our tremendous disadvantage in fundraising ability when compared to Ophthalmology, our commitment to presenting the truth has helped us stave off these attacks despite the large sums of money medicine has used to try and buy their way to passing their agendas. Unfortunately, some in organized Ophthalmology circles have gained access to my newsletters and in a recent letter (see attached) to its membership, leaders of the AAO, ASCRS, and ASRS have pieced together quotes from my various newsletters and added their own inaccurate commentary to them but attributed them to me in an effort to support the prior assertions that we somehow seek surgical privileges and injectables. For the record, the words 'surgery' and 'injectables' are words that have never been uttered at any meeting or in any newsletter that I've ever seen associated with Optometry. Needless to say, my reputation and standi ng in organized Optometry are quite damaged. My personal relationships with local MD's (not to mention OD's) that I consider friends will need some repair as well. Let there be no doubt, however, that I will explore all legal avenues available in resolving this libel. I don't know if you've ever had the experience of having your words twisted, or as in this case having words you never spoke attributed to you in an effort to damage you, but I can tell you that your blood would boil in a way you'd never known.

I noted that you've given your Ophthalmologist friends permission to post your editorial as they see fit. That's great, however if we're ever going to have an honest and open dialogue and make any progress, letting them off the hook that easily will not suffice. If they truly care about resolving the differences between us, and I have my own doubts that they do, they are the ones who have to be proactive with their less informed colleagues. The problem we have with organized Ophthalmology is quite simple and really comes down to one thing, arrogance. Take the quote from the AAO/ASCRS/ASRS letter I attached, "one of the penalties of refusing to participate in politics is that you end up being governed by those who acquire medical and surgical privileges not through years of medical education, internship, residency, and fellowship training but by those who gain these privileges through political action. The future of Florida patient eye care lies i n your hands". These are the same people who've produced commercials here contrasting themselves with Optometrists with graphics that show stacks of books by the word Ophthalmologists and NO books by the word Optometrists. Did I really accumulate nearly $150,000 in student loan debt while studying NO books? Were the biochemistry, microbiology, anatomy, physiology, and pharmacology classes I took alongside medical students just a figment of my imagination? Did the extra two years I spent in residency and doing research mean nothing because they weren't accredited by some medicine-sanctioned review board? What these people have chosen not to understand is what exactly we are capable of and how we might best be utilized in conjunction with their services to provide the best comprehensive care for the patients of our state. Instead, they have chosen to attack anything and anyone who has not gone through the same channels as they; assuming there is no rigor or oversight or struc ture comparable to their own but not actually checking the facts in order to verify their conclusions. I experienced this attitude at the ground level of Ophthalmology while externing at Bascom Palmer. The first year residents, who barely knew where the eye was located walked around with the very same attitude that just because you didn't have an M.D., you certainly weren't worthy of looking at an eyeball. So it is ingrained in them from day one that there is this superiority that has been bestowed upon them when they get their diploma that makes them the only true eye doctors.

Art, it is a noble cause you seek in trying to 'bridge our ever-narrowing divide' with Ophthalmology. I certainly practice these principles in my day to day professional life by practicing to the highest level of my training on behalf of my patients, knowing the limits of my training and making appropriate referrals, and cultivating relationships with those to whom I do refer in order that patients might have a smooth and efficient transition and ultimately a positive outcome. However, when there continue to be individuals at the highest levels of organized Ophthalmology (ie. those whose signatures are affixed to the bottom of attached letter) who are willing to allow the twisting of other's words and the blatant fabrication of lies in order to further their own cause, I cannot say I share the same optimism as you for any real reconciliation anytime soon.

I would close by saying that I agree that a dialogue between our professions must occur, at all levels. I also believe that it will probably need to get worse before it gets better due to the many years of ill-will and animosity. I believe the time for sugar-coating things is over and for that reason I challenge you to put my words in play in your forum, without editing out the controversy. You want the truth? Here it is. Can you or the medical community handle the truth? That remains to be seen. I would add that for those out there in the medical community who've taken my good name and damaged it with your blatant lies, I can only hope that you are far more ethical when caring for your patients than you've proven to be when representing yourselves to your professional organizations and their members. Again, however, I have my doubts.

Brad Giedd OD, MS, FAAO
Optometric Physician

Dean admits student without backing

By JACK STRIPLING
Sun staff writer

Published: Friday, April 4, 2008 at 6:01 a.m.
Last Modified: Friday, April 4, 2008 at 12:15 a.m.

In a move that breaks with the norms established by medical school accreditors, the dean of the University of Florida's College of Medicine has opted to admit a student from a politically connected family, even though the student didn't have the backing of the Medical Selection Committee.

University of Florida students move about the UF campus near Turlington Plaza on the first day of school in this August 23, 2006, file photo. At back is Century Tower.

click to enlarge

Kone

Dr. Bruce Kone, dean of UF's College of Medicine, says he felt justified in breaking with the committee because the candidate was "exceptional."

"I certainly respected all of the decisions of the admissions committee, up until one," Kone said.

Kone wouldn't name the student, but sources close to the situation identified him as Benjamin Mendelsohn, the son of Dr. Alan Mendelsohn, a Hollywood ophthalmologist and a Republican fundraiser who was a grassroots organizer for Gov. Charlie Crist during his 2006 campaign.

"I can't even comment that there were any political connections that this person had, but I certainly wasn't influenced by any outside forces," Kone said Thursday.

"There was no political influence related to this thing," Kone added in a second interview Thursday night. "There never will be. There never has been. This was an exceptional student, and I wish to God I could even tell you about (the student's) credentials."

Before Kone took over as dean in May 2007, Gov. Crist sent a letter to UF in February 2007 on Mendelsohn's behalf. The letter, addressed to UF's admissions officer and copied to UF President Bernie Machen, urged UF to admit Mendelsohn to the Junior Honors Medical Program, an accelerated seven-year program that combines bachelor's and medical degrees.

"I have known Benjamin and his family for several years and know that Benjamin's affiliation with the University of Florida will mutually enhance the reputation of both Benjamin and the Medical Program," Crist's letter states.

According to Kone, he never saw the letter, which he said was not included in Mendelsohn's file for his current application.

In 2006, the Mendelsohn family gave at least $33,257 to political candidates, 94 percent of which went directly to Republicans, according to the Florida Department of State's Division of Elections. Of that money, $1,682 went to Crist, including a $500 donation from Benjamin Mendelsohn himself.

Alan Mendelsohn is a known fundraiser in the medical community. In 2005, he held a fundraiser in his own home where more than 150 physicians raised more than $100,000 for Crist, according to a news release from the Florida Medical Political Action Committee.

Benjamin Mendelsohn, who attended Northwestern University as an undergraduate, declined to comment for this story, and efforts to reach his father were unsuccessful Thursday.

Kone said he thought he was within his rights to admit a student absent committee support, but the move breaks with procedures described by the Liaison Committee on Medical Education, which provides accreditation to UF and medical schools throughout the U.S. and Canada.

"The final responsibility for selecting students to be admitted for medical study must reside with a duly constituted faculty committee," according to the accrediting body's standards.

Furthermore, the accreditation standards say "the selection of individual students must not be influenced by any political or financial factors."

Barbara Barzansky, co-secretary of the Liaison Committee on Medical Education at the American Medical Association in Chicago, said the central role of faculty in admissions is well-established in the medical community.

"I think the standard speaks for itself. It expects that there be a faculty decision around admission," she said.

"Deans may be under pressure from groups, alums, sometimes the Legislature, depending on the type of school and the location," she added.

Dr. Craig Tisher, former dean of UF's College of Medicine, said he never broke with Ira Gessner, chairman of the Medical Selection Committee.

"During the five years that I was dean, I did not go against the wishes of the admissions committee," Tisher said. "I let them make the selections, and I relied upon the judgment of the people who were interviewing the students and the chairman of the admissions committee, Dr. Gessner. All I can tell you is I didn't exercise that prerogative (to overrule the committee), if in fact that prerogative exists."

Members of the 53-person Selection Committee who spoke to The Sun describe the process of screening applicants as similar to that of a jury deliberation. After the candidate is interviewed by a small number of committee members, those committee members then give a presentation to a larger committee group about the applicant.

Committee members are then asked to rank the candidate, based on a scale of one to 10 - 10 being the highest - on their assessment of the applicant.

The chairman of the committee uses this feedback to determine admissions.

Kone would not disclose the score Mendelsohn received, and the committee's chairman declined to comment for this story.

UF received 2,783 medical school applications this year, according to the university's admissions office. The class is limited to 135 seats.

Jack Stripling can be reached at 352-374-5064 or Jack.Stripling@gvillesun.com.

Hi Art,

This incident has a precedent in the South. A while back the Academy of Ophthalmology hired a sociologist to do a research project the result of which was detrimental to the profession of optometry. The State Society sued the Academy and the sociologist and won. The Sociologist had to pay over $100,000 and the academy several times that. It the FOA is to be believed (if there's smoke, there's fire) it should pursue legal address from Dr. Mendelson. They say he has no actual sources for his defamations and slander. If so, it's a slam dunk. If I were and OMD, I would be somewhat dubious if the OD's didn't back up their claims in court. Besides, They could always use the settlement to fund their legislative campaign for orals at Mendelsons cost.

Jim

Dr. Epstein,

The constant bickering we see between ophthalmologists and optometrists is a waste of time. There are certainly enough patients that need all of our care. I am one ophthalmologist who has enough to do without worrying about these artificial turf wars. Magically, if you treat patients well they show up on your doorstep again and again. I have been fortunate to have shared patients with many optometrists. These patients need the care that we all have to offer. We all need to learn how to play in the sand box better. All the best,

Mark Fromer MD
Medical director of Fromer Eye Centers, NYC

Art:

So glad you are addressing the AAO Optometric Bashing Issue. As one of the last states to pass a bill to expand our practice act for oral medications to treat eye disease, I am glad to hear the AOA is developing alternate funding for states in our position. Florida has not passed a bill in 22 years to expand our scope. Much of our inability to pass legislation is related to scare tactics used by belligerent ophthalmologists. They lie to the legislature, they lie to the public, and they lie to their own profession to gain money and power. I have asked my state legislator to pass a bill to make it mandatory that anytime you testify in front of the legislature and/or the governor you must take an oath just like we do in court or at our state board meetings. This may curb some of the misinformation, lies, and scare tactics used by organized ophthalmology. The possibility of this kind of legislative initiative has merit, but unfortunately, knowing the lobbyists in this state, it would never pass.

Robert M Easton Jr OD FAAO