AOA delegates put board certification on hold, call for national summit

Issue: August 2000

LAS VEGAS — After a year of nationwide debate, the issue of board certification came to a standstill at the American Optometric Association (AOA) 103rd Congress here when the House of Delegates passed a resolution to cease implementation of the board certification process, effective immediately. The resolution also specified that all affiliated organizations are invited to participate in a national summit, after which a report will be made at the 104th Congress in Boston.

Last year’s House of Delegates meeting in San Antonio introduced Resolution 1935, the proposal to develop a board certification process, which an overwhelming majority of the house voted to adopt. Also that year, a motion to refer the issue until this year’s Congress failed. Opponents of the issue have been vocal during the past 12 months, prompting the AOA to schedule a discussion at this year’s Congress.

This year in a 971-674 vote, the House passed Motion 6, an amendment to the original Resolution 1935. The motion, which was presented to the house by the AOA Board of Trustees, states: “1) That all implementation of the board certification process shall cease immediately, and that there be no new expenditures of AOA funds for the activities of the American Board of Optometric Practice (ABOP) unless approved by the House of Delegates; and 2) That the AOA shall convene a summit on board certification and continued competency; and that such a summit shall be facilitated by an outside party, and include, but not be limited to, representatives — of their own choosing — of the following national optometric organizations: the American Academy of Optometry (AAO), Association of Regulatory Boards of Optometry (ARBO), Association of Schools and Colleges of Optometry (ASCO), National Board of Examiners in Optometry (NBEO), American Optometric Student Association (AOSA), Neuro-optometric Rehabilitation Association (NORA), College of Vision Development (COVD) and the Optometric Extension Program Foundation (OEPF), as well as representatives from affiliated associations at a time and location to be selected by the AOA, which shall make a report on the conference to the House of Delegates in Boston at the 104th annual Congress in June 2001.”

Speaking out on board certification

After John A. McCall Jr., OD, reviewed for the House of Delegates members the rationale behind board certification and the creation of ABOP, representatives of organized optometry read formal statements. ASCO said it would not appoint members to serve on the Board of Trustees of ABOP until the ABOP proposal was formally adopted by ASCO. NBEO called for a national summit and “a clean slate” before any additional certification is imposed on optometrists. ARBO said only that it declined to be represented on the ABOP Board of Trustees. AOSA said flatly that it does not support board certification due to the apparent divisiveness to the profession.

The floor was then opened for general comment, after which the vote was taken to approve Motion 6. During the general comment session, Charles B. Brownlow, OD, FAAO, executive director of the Wisconsin Optometric Association, urged the House to vote in favor of the motion to halt board certification, allowing ABOP to stand as an inactive corporation with the work that has already been completed. “The profession is constantly being threatened from without,” he said. “We can withstand threats from without. We cannot withstand threats from within.”

W. David Sullins Jr., OD, FAAO, of Athens, Tenn., a former president of the AOA, said that while evaluating continued competency is necessary, this program has divided the profession. “I have no doubt that the ABOP Board of Trustees did what they were charged to do in San Antonio and that they did it well,” he said. “However, I have never seen anything be as divisive to this profession as this issue.”

While A. Norman Haffner, OD, FAAO, president of the State University of New York College of Optometry, agreed about the divisiveness of the issue, he also questioned the credibility and competency of the program. “The closeness of ABOP to the AOA has not yet been raised, and it should,” he said. “Isn’t it strange that ophthalmology hasn’t uttered a word about this? I urge the house to get rid of it. It is not appropriate. It is flawed, and we can do, and have done, much better.”

Following the 103rd Congress, the American Academy of Optometry issued a statement regarding the House of Delegates session and its anticipated participation in a national summit. “The Academy would enthusiastically participate in an appropriately constituted forum,” said President Anthony J. Adams, OD, PhD, FAAO, in a statement. “We look forward to participating in a meaningful dialogue with profession-wide stakeholders and leaders. However, such a forum must involve an open and thoughtful dialogue of all the issues related to continuing competence and education, as well as issues related to advancing the clinical competence of optometrists.”

A fair discussion of board certification

Many who attended this year’s Congress felt that the discussion that took place prior to the final vote on Motion 6 provided both sides with a relatively open forum in which to present their views. “My overall impression was that it was handled much better than it had been the year before,” said Marjorie Knotts, OD, president of the Indiana Optometric Association, whose state’s House of Delegates had approved a resolution to vote against board certification. “There was a real effort by [immediate past president of the AOA] Dr. [Harvey] Hanlen, I felt, to make it an inclusive and fair discussion in general. I was very pleased by that. The only comment I would make in the negative is that when we got down to actually voting, the question was called very quickly and there wasn’t time to really pull things together. But I thought he gave a very fair shake to most of the discussion.”

Linda Casser, OD, FAAO, a member of the board of directors of the NBEO who spoke to the House of Delegates about the lack of credibility and defensibility of the ABOP board certification process, agreed that the meeting proceeded relatively fairly. “Given how processes of this nature tend to unfold, I would say that the process was a reasonably fair one,” she said. “I think the preference would have been for the plan to proceed as it had been originally proposed, and that was to have a vote solely on the motion to continue Resolution 1935 rather than amend it; a dimension was added to the process that wasn’t projected initially. It wasn’t a surprising approach, and I feel reasonably comfortable with the process as it was conducted on-site.”

The NBEO published a position paper earlier this year requesting that the program be reviewed and calling for a national summit. Dr. Casser said that the NBEO is waiting for word on the upcoming summit, which comes close to what it had suggested. “It certainly speaks in good measure to the concerns that we had, and bringing everyone together is going to be an important process,” she said. “It doesn’t meet the issue 100%, but it certainly is a solid step in that direction.”

While the discussion served its purpose in allowing representatives of both schools of thought to say their piece, opinions were most likely cemented prior to the debate, said Laurie L. Sorrenson, OD, immediate past president of the Texas Optometric Association. “I’m not sure if the debate changed anybody’s minds – I think most people had their minds made up before they ever got there,” she said. “But I felt that the debate was open, there was plenty of opportunity to speak, and that the final verdict of calling for a summit was a good thing, because obviously there are enough issues and controversy associated with this that we need more people on the same page. I still think we will end up with board certification for optometry at some point. But everybody dealt with each other with respect and professionalism, and I felt that when we left there the profession was stronger, as a whole, from going through this.”

Dr. McCall, former president of the AOA and driving force behind the board certification process, said that he was glad to see the work that has been accomplished in the formulation of the program be retained. “I was proud of the House of Delegates rejecting the call from ASCO and the NBEO to dissolve the process and start over with a clean slate,” he said. “To start over would mean to dissolve ABOP and throw away the document that has already been produced. That document has 34 months of work put into it, and it is a very credible and defensible document. That suggestion, alone, would not be a prudent one. I was glad to see the House reject it.”

ABOP president resigns

The meeting also witnessed Dr. McCall resigning from his post as president of ABOP, a measure taken to protect the future of board certification, he told Primary Care Optometry News. “By pushing this, and meeting with individuals, states, regions and national organizations and explaining very passionately the position of the AOA and ABOP, if some group happened to have an opposing view, my passion tended to polarize them,” he said. “I realized after a while that some of the opposition was directed at the concept, which is OK, because a differing of opinion is healthy for a profession, especially when it’s trying to advance. But some of that was directed at me — it became personal for a lot of people and some organizations. I finally came to the conclusion that if we’re going to move toward a national summit and try to get national groups together on this with more input, then my polarization effect needed to go away. I think the process is too important to let me be a factor in it not going forward.”

Dr. McCall said that while ABOP currently is not being funded by the AOA, the organization still remains an entity. His resignation, however, is permanent. “We have excellent leaders and educators involved in ABOP right now who have done a huge amount of the work,” he said. “Those people need to rise up and be seen and heard right now, because they are a tremendously talented group, and too much focus has been on me.”

Is board certification divisive?

Dr. McCall responded to the statement that the issue of board certification has split the profession like nothing has before, saying it was an extreme statement. “I do believe it has been divisive,” he said. “So were diagnostics and, especially, so were therapeutics. If we’d had a national summit on therapeutics in 1976, the majority of the states wouldn’t have bought in. Looking back, as a therapeutic profession throughout all 50 states and the District of Columbia, obviously, that was the natural maturation of the profession; we needed to go in that direction. This is going to be the same way. The key difference here is that this profession is not accustomed to being led from the national level.”

Recognizing the urgent need for board certification, said Dr. McCall, is what prompted the AOA to start the process at the national level. “We don’t have 25 or 30 years to wait for board certification to be integrated into optometry,” he said. “We think that within the next 3 to 5 years, this will happen, and this must happen, because of the way the health care system is maturing in the United States today.”

For Your Information:

John A. McCall Jr., OD, is past president of the American Optometric Association. He may be reached at 711 E. Goliad, Crockett, TX 75835; (409) 544-3763; fax: (409) 544-7894.

Charles B. Brownlow, OD, FAAO, is executive director of the Wisconsin Optometric Association. He may be reached at 5721 Odana Rd., Ste. 102, Madison, WI 53719; (800) 827-1945; (608) 274-5044/4322; fax: (800) 308-7189; (608) 274-2674/8646; e-mail: Brownlowod@aol.com.

W. David Sullins Jr., OD, FAAO, can be reached at 417 N. Jackson St., Athens, TN 37303; (423) 745-4910; fax: (423) 745-2230.

A. Norman Haffner, OD, PhD, FAAO, is president of the State University of New York College of Optometry. He may be reached at 100 E. 24th St., New York, NY 10010; (212) 780-5050; fax: (212) 780-4949; e-mail: anhaffner@sunyopt.edu.

Anthony J. Adams, OD, PhD, FAAO, is president of the American Academy of Optometry. He may be reached at 6110 Executive Blvd., Suite 506, Rockville, MD 20852; (301) 984-1441; fax: (301) 984-4737; e-mail: AAOptom@aol.com.

Marjorie Knotts, OD, is president of the Indiana Optometric Association. She can be reached at 6326 Rucker Rd., Ste. C, Indianapolis, IN 46220; (317) 259-4234; fax: (317) 259-1538.

Linda Casser, OD, FAAO, is a member of the board of directors of the National Board of Examiners of Optometry. She may be reached at Pacific University College of Optometry, 2043 College Way, Forest Grove, OR 97116; (503) 359-2766; fax: (503) 359-2929; e-mail: casserl@pacificu.edu.

Laurie L. Sorrenson, OD, is immediate past president of the Texas Optometric Association. She may be reached at Lakeline Vision PC, 12233 620N, Suite 103, Austin, TX 78750; (512) 918-3937; fax: (512) 918-3260.