No national board certification, OD groups say

Most participants in a recent summit meeting rejected the idea of a single, national certification process. Subspecialty certification may have a chance, however.

Issue: July 1, 2001

ST. LOUIS – The House of Delegates of the American Optometric Association voted last year to table the idea of national board certification, and participants in a recent summit meeting of optometry organizations have seconded that rejection. A need for certification in subspecialty areas such as contact lens practice, however, was recognized by many of those same groups.

The American Optometric Association (AOA) developed a plan in which optometric board certification would be administered by a new organization, the American Board of Optometric Practice (ABOP). The details of the proposal were outlined in Resolution 1935, which was brought before the AOA House of Delegates at their 1999 annual meeting. Although the resolution was passed at that meeting, an outcry by various state and national optometry associations brought the issue back the following year.

At the June 2000 meeting of the House of Delegates, the plan was put on hold indefinitely. The House also charged the AOA with organizing a Summit on Board Certification and Continued Competency, with a report to be presented at the House of Delegates meeting. Representatives from the major optometric organizations, as well as the state associations, met here in April for that Summit.

Participants were not asked to debate the original board certification resolution. “As far as Resolution 1935, that will be up to the House of Delegates,” said summit project team co-chair Kevin L. Alexander, OD, PhD.

Four issues addressed

The summit project team consisted of Lee Ball, Jr., of the American Optometric Student Association; Leland W. Carr III, OD, of the Association of Schools and Colleges of Optometry; Don Crouch, OD, of the Association of Regulatory Boards of Optometry; Jack Yager, OD, of the American Academy of Optometry; Sherry Cooper and Jeffrey L. Weaver, OD, of the AOA staff; and facilitator Marilyn R. Marr. (See the accompanying sidebars describing the roles of some of these optometric organizations and their positions on this issue.)

The project team asked all interested parties to address the four points listed in the accompanying box. Twenty-four written responses were submitted to the project team in advance, and 14 groups were invited to make oral presentations, after which an open discussion took place.

Half of the written responses indicated there was clearly a need or demand for demonstrating continued competency in optometry. The responses regarding the use of board certification as a tool to demonstrate continued competency were not so clear. In fact, half took no definitive stance on board certification’s role in demonstrating competency, but the majority of the other half were opposed to it.

Responses to the questions regarding the best way to measure competency and the existing measures of competency varied widely. Voluntary programs such as fellowship in the American Academy of Optometry and continuing education were frequently cited as possible measures that already exist.

“This was an opportunity for everyone to see that we’re all considering the same issues,” Dr. Alexander said. “We may disagree on how to get there, but we’re all worried about the same kinds of challenges facing the profession.”

Jeffrey L. Weaver, OD, MBA, MS, director of the AOA’s Clinical Care Group and co-staff for the summit project team, added: “It opened the lines of communication across the majority of optometric organizations that, certainly, will be good for the profession in the future.”

Some planning

In June 1999 the AOA House of Delegates, by an overwhelming majority, voted to authorize the creation of ABOP, the first national certification body for optometrists. This national board certification program was ad vanced partly in response to the growth of managed care. Proponents of board certification said they believed that instituting a national program would assist in optometrists’ inclusion in managed care plans and enhance their status and that of the profession by exhibiting ongoing competency training.

State boards of optometry traditionally have been the only authorities that specified licensure policies and regulated optometrists within the bounds of each state’s scope-of-practice legislation. Although ABOP was not to supercede this state-level authority, it would have been the first credentialing body enforcing nationwide education and practice standards for optometrists.

Positions presented at the AOA Summit

American Academy of Optometry: “Optometry has a variety of quality assurance measurements already in place. We need to use those resources already available in the profession.” – Robert D. Newcombe, OD, FAAO, president
American Optometric Student Association: “We will support an educated and well-founded decision that will unify the profession and further the mission of improving quality care optometry.” — Chad Fleming, president
Association of Regulatory Boards of Optometry: “Continued competence is the purview of state licensing boards. ARBO, the national organization, in partnership with other organizations, should be involved in the continued competence aspect.” – Frank Salimeno, OD, president
Association of Schools and Colleges of Optometry: “Continuing competence should be an ongoing concern for the profession in general and for the regulatory bodies in particular. Most of all, it is and should be the primary and utmost concern of the individual.” — John Schoessler, OD, PhD, president
College of Optometrists in Vision Development: “There is no compelling reason to adopt a program of board certification for primary care optometrists … It is time for the profession to recognize advanced competencies and specialized practice within optometry.” — Carl F. Gruning, OD, immediate past president
National Board of Examiners in Optometry: “The state boards are the proper agencies to assure continued competence. Reconsider the 1986 report of the AOA Commission on Optometric Specialties as a basis for further profession-wide discussion when the time is right.” – James Hartzell, OD, FAAO, president
Neuro Optometric Rehabilitation Association: “Certification is to demonstrate excellence within a particular specialty. No examination process will guarantee clinical competency. Board certification should not be confused with competency evaluation.” – Brenda Montecalvo, OD, executive officer
Optometric Extension Program Foundation: “A requirement for assessment of continued competency is inevitable. Alternatives for participation and assessment must be developed rather than a single method.” — Glen T. Steele, OD, president
Department of Veterans Affairs: “Look at existing federal credentialing and privileging as a mechanism to try to improve the continuing competence/certification process.” – John C. Townsend, OD, director, optometry service
California Optometric Association: “Board certification is unnecessary until the profession accepts the concept of specialty areas and clearly defines them and elevates the level of training and education in our residency programs.” — Scott Daly, OD, president
Minnesota Optometric Association: “Board certification is a useful tool in clarifying baseline education, but it is very different from assuring clinical competency.” – Marlane J. Brown, OD, FAAO
Montana Optometric Association: “The MOA voted overwhelmingly to support the AOA’s board certification program because we felt certification can be an important component of ongoing competency management.” — Michael H. Simons, MPA, OD, president
North Carolina State Optometric Society: “We simply believe there is no problem and, therefore, there need be no solution.” — William E. Dolan, OD, president
Oregon Optometric Physicians Association: “Our recommendation to the project team is to continue to push forward with discussion on how to implement a uniform competency program and to continue the discussion on the concept of specialty board certification.” – Wayne Schumacher, executive director
Other state associations who also submitted written responses: Delaware, Indiana, Maryland, Nebraska, New York, North Dakota, Virginia, Washington, West Virginia and Wisconsin.

Resolution 1935 stated that for an optometrist to become board-certified for 10 years, practitioners would have to complete 10 hours of board-certified continuing education. Each course would be followed by an exam. To achieve recertification, a practitioner would need to complete and prove competency in 50 hours of board-certified continuing education over a 10-year period, which would include successfully passing the accompanying test. A minimum of 20 hours of these continuing education courses needed to be completed within the 4 years preceding certification. Applicants for recertification would be required to obtain a passing score on an examination ad - ministered by ABOP. Board recertification would be granted for 10 years.

In order to apply for board certification, optometrists would need to possess either a diagnostic certification or a therapeutic license — credentials beyond the OD degree that authorize them to use diagnostic and therapeutic drugs in their state of licensure.

For ODs who enrolled in the first year of ABOP certification, the fee was to be $300; the second year, $400; and the third year and beyond, $500. The graduated fee scale was designed to encourage early enrollment.

Not an easy road

The Board Certification Project Team was charged with determining whether there was a need for board certification in optometry. The team decided a need existed, so the ABOP Board of Trustees was formed.

Even as the ABOP Board of Trustees formulated a board certification program, optometrists who saw no need for board certification continued their opposition. Those who opposed this effort said ABOP was unnecessary or even potentially harmful to the profession. Some critics even alleged a financial motive for the plan.

The Board of Directors of the National Board of Examiners in Optometry (NBEO) issued a position paper on the AOA’s board certification plan. The NBEO is the national body that administers the examinations used by state boards of optometry in licensing opto m etrists. The position paper stated, “Creating a new national credential with less credibility than existing credentials, or that competes with, or does not ex ceed, the standards required for obtaining and maintaining an optometric license, would be a waste of time and resources or, worse, could reflect badly on all optometric credentials in the eyes of the public and other health care professions.”

In June 2000, after months of debate, plans for a board certification program came to a standstill when the House of Delegates voted to halt the board certification process. Those opposing the creation of ABOP argued that the goals of the program were already sufficiently covered at the state level and that optometrists had not been given enough time to evaluate the program proposed by the AOA’s Board Certification Board of Trustees. The House of Delegates also called for the April open summit.

Shift to specialty certification

At the summit, some attendees noted that the emphasis on general certification a year ago seemed to have shifted to recognizing specialties. After investigating the topic in 1986, the AOA Board of Trustees issued a policy statement de claring no need for specialty certification.

“In 1986 we did not have therapeutic practice in all 50 states as we do now,” Dr. Weaver said. “Since that time we have emphasized optometry as the prim ary eye care profession. Despite the pro gress that was made at this summit, we would definitely need further discussion as to how specialties could be recognized.”

John A. McCall Jr., OD, former ABOP and AOA president, also noted the emphasis on specialty certification in the formal presentations at the summit. “Specialty certification has been voted down at least three times by the AOA,” he said. “The reason it was voted down was not because it was a bad concept and everyone disagreed with it; it was because it was exclusive to a number of optometrists in the country.

“For example, if there were specialty certification and you didn’t practice in a specialty area, you wouldn’t be able to get board certified,” he said. “We patterned our general board certification program after family practice to be inclusive, because we have all viewed optometry as being the family practitioners of the eye. We felt that after general board certification was imple- mented, specialty certification would be the natural evolution.”

Planting the seed

Dr. McCall continued, “The AOA board felt general certification would be the least controversial route to go. I believe that the AOA’s position of why we felt general certification would benefit optometry was never articulated well enough to the masses. If the ABOP controversy has planted a seed to start board certification in any form in optometry, whether it be general or specialty, the entire process has been worth it.”

Incoming AOA President David W. Nelson, OD, also heard the presentations, and agreed that most attendees seemed willing to support specialty board certification. “The AOA would certainly be willing to explore any issue the House of Delegates feels is vital to the profession. We were pleased to see the number of organizations that took the time and effort to comment and send representatives to the summit.”

Howard J. Braverman, OD, AOA president, said he thought the summit was a good opportunity for a full and free discussion of the issues. “It’s clear that there will need to be more discussion, and I’m looking forward to seeing the final report,” Dr. Braverman said.

How is optometry organized and credentialed?

Association of Schools and Colleges of Optometry (ASCO): ASCO is a nonprofit association representing the interests of optometric education. ASCO’s membership includes the seventeen schools and colleges of optometry in the United States and Puerto Rico. A number of non-U.S. optometry schools are affiliate members. ASCO also has corporate members in its sustaining member program.
National Board of Examiners in Optometry (NBEO): The primary purposes of the NBEO are to develop, administer and score examinations that assess competence in optometry, to report candidate performance on those examinations, and to undertake related activities in the interest of improving test performances and standards. The NBEO administers the standardized testing used by the state boards of optometry.
State boards of optometry: Optometrists are licensed according to criteria established by state boards of optometry, which operate within “scope of practice” laws passed by each state legislature to define the legal practice of optometry. Although all states require applicants to possess an OD degree from an accredited school of optometry, variations in licensing criteria set by individual states represent significant hurdles to ODs who want licenses to practice in more than one state. The issue of a national-level optometric certification has been debated for many years.
American Optometric Association (AOA): The stated mission of the AOA is to improve the quality and availability of eye and vision care for all Americans. The association represents the optometric profession to the federal government and national health care organizations, and it serves as a coordinating body for state optometric associations. A House of Delegates and a Board of Trustees elected by the House of Delegates govern the AOA. The House is composed of representatives of each state association, optometrists in federal service and students of optometry. It meets at an annual AOA Congress to transact association business, establish association policy and elect officers. It was the AOA’s House of Delegates that in 1999 approved — and last year halted — the implementation of a national certification board.
American Board of Optometric Practice (ABOP): ABOP was proposed within the operations of the AOA as a body to establish and administer — for the first time outside of state control — programs for the certification and recertification of licensed practitioners in the profession of optometry. ABOP also proposed to offer educational programs designed to increase the knowledge, skills and experience of optometric practitioners — but explicitly ruled out any plan to confer any secondary, undergraduate or graduate academic degrees or any license or other right to practice optometry. ABOP is currently funded by the AOA, essentially borrowing money with the idea of eventually paying it back and supporting itself with exam fees. The ABOP was created as a freestanding organization, but its bylaws say that the AOA will have some say in its operations.
American Academy of Optometry (AAOpt): AAOpt describes itself as a scientific, educational and charitable organization, founded to promote the art, science and research of vision care. It supports research and educational programs in optometry and related sciences. It holds an annual meeting (focused on optometric education) and publishes the journal, Optometry and Vision Science. The AAOpt is an apolitical organization that plays no role in the certification of optometrists.

For Your Information:

Kevin L. Alexander, OD, PhD, can be reached at 1310 Cramer Circle, PEN 405, Big Rapids, MI 49307; (231) 591-3706; fax: (231) 591-2394.

Jeffrey L. Weaver, OD, MBA, MS, can be reached at 243 N. Lindbergh Blvd., St. Louis, MO 63141; (314) 991-4100; fax: (314) 991-4101.

John A. McCall Jr., OD, can be reached at 711 E. Goliad, Crockett, TX 75835; (936) 544-3763; fax: (936) 544-7894.

David W. Nelson, OD, can be reached at 7428 Mineral Point Rd., Madison, WI 53717; (608) 833-4242; fax: (608) 831-9249.

Howard J. Braverman, OD, can be reached at 1938 E. Hallandale Beach Blvd., Hallandale, FL 33009; (954) 458-2112; fax: (954) 458-7186.