"Board Certification" The Profession's Perspective

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.


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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


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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.


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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

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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

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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

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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.)

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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.


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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


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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


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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


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Dear Dr. Epstein,

I agree 100% with your article.

XX (Minnesota Optometric Association Member)


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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.

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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


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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.

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"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


----
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


----


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

----


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


----


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


----


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


----


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


----


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.


----


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

----


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

----


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

----


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,

DD


----

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


----


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


----


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

----


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


----

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

----


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

----

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

----


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


----


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

----


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

----

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

----


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

----


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

Charlotte

----


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.

----

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

----


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


----


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


----

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


----


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

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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.

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

LO, O.D.

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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

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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

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The Primary Care Section of the AAO has been discussing the insanity of the issue.
Keep up the Good Fight. Al

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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

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XX, OD FAAO

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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