If optometrists are going to need to pony up more money for the promotion of the profession, why not put the efforts and resources into making optometry licenses portable from state to state?


Shoot the Messenger

Not a day goes by over the past 16 months that Im not presented with someones insight on the recession. Writing how were all doomed in optometry really wasnt necessary (Can Optometry Ride Out the Recession? March 2009). We all realize at this point that there are problems with the economy. We have more last-minute cancellations and no-shows at the office, and glasses sales are down a bit. I was especially taken by your comment if you make it through 2009 Are you so horribly depressed about your situation that you need to project your fears onto the readers?

Why couldnt you comment on how optometry is relatively recession proof in that we can still make a living, albeit with a little less income? Our office has held up OK, and were able to keep all of our employees without cutting back too much for ourselves. Shouldnt that be something that we can be proud of in these economic times? The media has been irresponsible by driving fear into the public because that kind of news sells. But that kind of fear mongering should not have a place in a professional journal.

Michael Billig, O.D.

Towson, Md.


Wal-Mart: Love It or Hate It

In response to Dr. Laura Taylor and Dr. David Anderson, my previous letter was not about working at Wal-Mart (January 2009). It was about the oversupply of optometrists. My point was that most optometrists do not go to professional school with the intention of working at Wal-Mart. Those who do so are generally making the best career choice based upon available options.

The issue against working at Wal-Mart is not about the quality of exams you deliver to your patients, it is about how the presence of optometrists in Wal-Mart cheapens the prestige, credibility and perceived worth of the profession in the eyes of the public and other health disciplines.

The biggest problem with commercial optometry is that there are way too many optometrists in this practice modality. The profession should establish a benchmark goal of no more than 10% of optometrists practicing in commercial establishments. Production of new graduates should then be reduced till this benchmark is achieved. If optometry schools will not reduce the production of new optometrists, then individual states should consider tightening requirements for licensure to reduce the number of optometrists entering their states to practice. One way to do this would be to require residency training for all new licensees.

Barry M. Lebowitz, O.D., M.P.H.

Gaithersburg, Md.


I recently read Why I Love Wal-Mart (March 2009). Kudos to Dr. Langford! He unapologetically describes why his chosen mode of practicea practice within Wal-Martworks for him. I agree with his perspective that private practice seems to be the focus of many articles and reports in optometric publications.

Private practice isnt for everyone, though, and its great to see an article in a major publication that illustrates that so well. New graduates should know that there are many options out there, and that choosing a mode of practice is a personal decision based on many factors.

Ive been an HMO doctor for many years, and it suits me very well. I know that I would not be happy in private practice and made the conscious choice not to take that path. I love where and how I practice and would not change a thing about it! Despite my high level of career satisfaction, I know that there are some who would assume that working for an HMO is somehow second-best to a private practice. For me, that couldnt be further from the truth!

There are enough divisive issues in optometry; lets not add choice of practice modality to the list. We should all respect each others choice of where and how we practice the best optometry that we can.

Donna M. Ellinger, O.D.

Westminster, Colo.


Speak Up on Board Certification

There has been much discussion concerning the Joint Board Certification Project Team (JBCPT) and the proposed Board Certification (BC) for optometry. This proposal has the potential to change our profession, and should be discussed calmly, rationally and in depth.

I do not believe that someone who is against this proposal is against change or does not want to move optometry forward. This issue needs to be evaluated on its merit alone. Does our profession truly need board certification? That is the basic question that needs to be answered. Is the current proposal the best vehicle to attain that goal? What are the long-term ramifications to our profession, both positive and negative, if this proposal carries? Will this process move optometry forward, as some suggest, or will it further fragment our profession and lower our standing in the eyes of the medical community, as others warn? Practicing optometrists owe it to themselves to become well versed on the issue. And that is not enough. It then becomes vitally important to communicate your thoughts and opinions to your state leaders who will be casting votes on your behalf at the AOA Congress.

Whatever your opinion, make it known to your state officers. They are elected to represent your interests at the state and national level. I, like all of you, believe in the democratic process. I believe our elected leaders will listen to the voice of the rank-and-file and vote the will of the electorate. If not, our profession has bigger problems than board certification.

Ernest L. Bowling, O.D., M.S.

Leesburg, Ala.


A few years ago, when the president of the AOA announced that he would make board certification one of his priorities, I had great hopes that the AOA would finally get it right.

Instead, the AOA has established a contorted, bureaucratic and expensive continuing education process that only certifies general optometry while acknowledging areas of interest. I believe that the proposal should be opposed vigorously by all optometrists because it is wasteful, redundant and illegitimate. Also, it undermines the hard legislative work by organized optometry over the last 20 years.

First, the proposal undermines the advances that optometry has made in state legislatures all over the country. Optometry has been able to expand its scope of practice by convincing state legislatures that optometrists are well-trained, competent eye care specialists. This competency is shown by the optometric curriculum, the assurance of competency by the NBEO and state licensing boards, and by the commitment to competency via continuing education. The proposal appears to admit that the basic O.D. degree is not enough to assure competence of care. 

The proposal is wasteful and redundant. The AOA states that insurance regulators, the government, and other regulatory agencies will eventually force board certification on the profession. This is just not true. What these entities are looking for is proof of competence. This could easily be accomplished by amending state regulations regarding continued education. Each state could accommodate the insurance regulatory agencies of their state with a program designed to alleviate their specific concerns. One change could include certification of knowledge by post-continuing education exams. Another proposal could require some wet lab to obtain or prove competence in new exam techniques, or understanding in new exam technologies. This updating of continuing education laws would not require the bureaucracy created by the proposal. Also, this would avoid the polarizing effect of having super-competent board-certified O.D.s vs. regularly-licensed competent O.D.s.

The proposal is illegitimate in a couple ways. First, it doesnt follow the normal form of board certification. In the medical field, board certification has always been a residency-based specialization of skill sets and knowledge sets. In ophthalmology, as time and knowledge have marched on, new subspecialties have arisen: corneal specialist, retinal specialist, glaucoma specialist, refractive surgery specialist. Again, all of these are based on acquiring special skill and knowledge sets in fellowship-based programs. The proposal does not follow this form at all. It is not based on specialization of knowledge, it is not residency based, and it does not acknowledge expertise in clinical areas.

The proposal is also illegitimate in that the organization has no legitimate power to implement or regulate the contorted system they are proposing. There is no federal body that would or could implement and regulate board certification. This would lead to an even more confused situation as some states might implement different parts of the plan or implement modified versions of the plan. This would increase the chaos that currently exists with optometrists having differing privileges and different practices state by state.

The AOA has the cart in front of the horse. There needs to be uniformity of state optometry laws and transportability of optometry licenses before its version of board certification could be possible. I would heartily support efforts in this endeavor. If optometrists are going to need to pony up more money for the promotion of the profession, why not put the efforts and resources into making optometry licenses portable from state to state?

For all these reasons, I urgently request that you let your opposition to board certification be known to your local optometric society, your state optometric organization, and the AOA itself.

J. Jay Pass, O.D.
Lafayette, Ind.

Vol. No: 146:05Issue: 5/15/2009