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 <
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
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
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
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