Ophthalmologists urged to fight efforts to expand scope of optometric practice

In the wake of the rapid passage of a law in Kentucky, a robust defense is needed to thwart future initiatives in other states.

Ophthalmologists should form a united front to resist powerful efforts being mounted by optometric groups to expand scope of practice privileges, a speaker said.

At the American Society of Retina Specialists meeting in Boston, David W. Parke II, MD, CEO and executive vice president of the American Academy of Ophthalmology, urged colleagues to participate in ongoing efforts to block the passage of state legislation designed to expand the scope of practice for optometry.

Since 1999, the AAO and various ophthalmic subspecialty societies have defeated scope of practice bills in 28 states. Two states, Kentucky and Oklahoma, have laws that expand scope of practice, Dr. Parke said.

“In the end, this is all really about principles,” Dr. Parke said. “We’ve got enough patients … but this is really about principles and it’s about quality of care and it’s about patient safety. It is a battle that is supported by your professional organizations.”

Ophthalmologists should be vigilant, Dr. Parke said.

“Recognize that your state may be next,” he said. “Recognize that this has direct implications for retina. Recognize that the legislative privileges that the American Optometric Association is requesting basically de-value your training and your expertise in the eyes of individuals and in the eyes of the public.”

Impetus for expanded privileges

Currently, there are about 16,500 practicing ophthalmologists and about 36,000 practicing optometrists in the United States. Optometrists provide about two-thirds of primary eye care. About 50% of optometrists are employed in practices that also employ ophthalmologists.

Approximately half of optometrists’ incomes derive from the sale of glasses and contact lenses. However, optometrists face stiff competition from various websites that sell contact lenses and glasses, Dr. Parke said.

The pool of practicing optometrists is expected to swell by about 25% in the next 10 years by virtue of five new optometry schools scheduled to open in the next few years.

Medical optometry, centered on expanded surgical privileges, is expected to account for a growing percentage of revenues in optometry in the next few years. This stems in part from the Harkin Amendment, which forbids discrimination based on licensure, Dr. Parke said.

“This opens up the potential for optometry to do surgery and get reimbursed for it,” he said.

Rapid passage of Kentucky law

The Oklahoma law was enacted in 1999. The Kentucky law was enacted in February. Proposed laws to expand optometrists’ privileges have failed in other states.

The Kentucky law allows optometrists to perform injections and some laser procedures. In addition, it gives the state optometric board of examiners free reign to further expand scope of practice without input from the State Board of Medicine, the American Medical Association or any other medical entity, Dr. Parke said.

The Kentucky law was signed into law only 13 days after being introduced in the state legislature, Dr. Parke said.

“It basically broke all records in Kentucky,” he said. “It was lubricated, as all things are, by money. The state optometrists contributed over $500,000, according to state records, within a matter of months preceding the introduction of this bill.”

Dr. Parke described the Kentucky bill’s passage as a “stealth operation” that was undertaken too quickly for ophthalmology to stage a timely resistance.

“It was not lost, as some people have said, because there was a lack of a coalition,” Dr. Parke said. “There just wasn’t time. There wasn’t money.”

Public opinion polls showed that about 78% of Kentucky residents opposed the bill, Dr. Parke said.

“The public is confused about training and professional labels in health care,” he said.

An American Medical Association poll showed that while 94% of respondents voiced a preference for a medical doctor to perform ocular surgical procedures requiring a scalpel, 71% knew that ophthalmologists were medical doctors and 54% believed that optometrists were medical doctors, Dr. Parke said.

“There’s tremendous confusion in the minds of the public,” he said.

Organization and funding

Organized ophthalmology needs substantial funding, organization and support to mount a robust counter-offensive against future scope of practice initiatives introduced into state legislatures, Dr. Parke said.

“Unfortunately, money is the mother’s milk of politics, and the [AAO’s] Surgical Scope Fund is our weapon,” he said.

Dr. Parke encouraged ophthalmologists to forge relationships with state legislators. Organized ophthalmology is also establishing relationships with the American College of Surgeons, AARP and several national consumer groups.

In addition, the AAO and subspecialty societies are sponsoring legislation to block potential scope of practice efforts in many states, Dr. Parke said.

“We have a number of such initiatives in different states. They’ve been effective. As they say, ‘A good offense is sometimes the best defense,’” Dr. Parke said. – by Matt Hasson and Michelle Pagnani

• David W. Parke II, MD, can be reached at American Academy of Ophthalmology, 655 Beach Street, San Francisco, CA 94109; 415-561-8510; fax: 415-561-8526; email: dparke@aao.org.
• Disclosure: Dr. Parke has no relevant financial disclosures.