AOA House of Delegates narrowly passes board certification

WASHINGTON — After a long discussion and a close vote here at Optometry’s Meeting, the American Optometric Association House of Delegates passed a resolution to move forward with board certification for optometry, seemingly bringing closure to a contentious debate that began on the house floor 10 years ago.

The motion, which passed with a vote of 1,126 to 887 after nearly 6 hours of discussion and debate, serves as an endorsement of the concept of general board certification and maintenance of certification for optometry and authorizes the AOA’s participation in the development of the American Board of Optometry (ABO).

The board will include one public member; two members from the AOA; and one each from the American Academy of Optometry (AAO), the Association of Regulatory Boards of Optometry (ARBO) and the Association of Schools and Colleges of Optometry (ASCO). An additional member who is an optometrist licensed less than 5 years will be nominated by the American Optometric Student Association (AOSA).

The AAO had previously released a statement indicating that its board of directors supports the concept of voluntary initial certification and maintenance of certification. At a press conference following the House of Delegates vote, incoming AOA President Randolph E. Brooks, OD, said. ASCO, AOSA and ARBO also had issued supportive statements.

In a letter to AOA members posted on the organization’s Web site shortly after the House of Delegates vote, Dr. Brooks said the next step is to clarify exactly what was approved. “After the ABO is formed, it is likely it will make some additional refinements based on further input from the profession,” he said.

Three motions passed

During the debate, a number of delegates spoke against the motion proposed and in support of it, and a number proposed changes or amendments. All motions were handled methodically by speaker of the house, Kevin L. Alexander, OD, PhD, to ensure that everyone’s voice was heard. Throughout the day-long discussion and debate, three motions were passed.

Nebraska proposed removing restrictive language from the opening lines of the original motion. The verbiage was voted to be changed from: “The AOA House of Delegates recommends that the ABO adopt the following founding principles and model for board certification and maintenance of certification” to: “…adopt the following founding principles and develop a process for board certification and maintenance of certification based predominantly on the draft model proposal below.”

Alaska allied with Texas, Minnesota, Michigan and California to propose increasing the number of points granted for experience in practice. The motion, which proposed raising the maximum from 75 to 150, equal to 5 points (instead of 3) per active year of licensure, passed unanimously by voice vote.

The delegates also passed a proposal by Missouri that fellowship in the College of Optometrists in Vision Development will be worth 50 points toward initial board certification, just as fellowship in the American Academy of Optometry is.

Concerns with proposal

Throughout the day, delegates voiced a broad range of concerns with the proposal and the concept, including “grandfathering” in experienced practitioners without testing, ABO composition and possible legal ramifications.

A number of delegates, including AOA Board of Trustee member David A. Cockrell, OD, addressed these propositions. “What you’re dealing with right now is what 12 people [the Joint Board Certification Project Team] dealt with for 2 years,” he said.

Regarding grandfathering, Dr. Cockrell said, “We need credibility. We still have uneven levels of therapeutic certification that work against us. We need to level the playing field.”

Regarding changing the composition of the ABO to 50% AOA representation, several delegates cited concerns that this would diminish the credibility of the program and appear to be an AOA-dominated process.

Regarding the absence of the National Board of Examiners in Optometry on the ABO, Dr. Cockrell stated, “In our review, our desire would be for them to be the entity selected [to be involved in the examining process]. We did not want the NBEO to be part of the board if they would be bidding on the testing process; it would create the appearance of a conflict of interest.”

Regarding potential legal ramification, Dr. Cockrell commented that the AOA’s legal department found no problems with AOA involvement in this process.

One delegate asked if all issues discussed that day in the House of Delegates were vetted through the Joint Board Certification Project Team. Dr. Cockrell replied: “Every single one, and many more.”

Pre-debate presentations

Prior to the debate among the delegates, a number of formal presentations were made. Les Walls, OD, MD, was a member of the American Board of Optometric Practice (ABOP) when board certification was first proposed to optometry 10 years ago.

Dr. Walls said that board certification was introduced to family practice when he was in medical school. “Was it uncontroversial?” he said. “Not at all. The leadership was nearly impeached at their annual meeting. The vote was close, but it passed. And now it’s widely recognized. Maintenance of certification is widely promoted to keep the public informed about family practice being the gatekeepers of family medical care, which is parallel to ODs being the gatekeepers of eye care.”

Richard Schamerloh, OD, FAAO, spoke on behalf of the Indiana Optometric Association, the first entity to put forth a proposal against board certification. “The currently proposed board certification initiative is built on elements of the current health system that are broken, administratively cumbersome and not linked to value and quality of care,” he said. “There is only speculation that third party payers, including the government, are concerned about board certification as part of health care reform.”

He urged delegates to focus more on discrimination.

Dr. Schamerloh also had concerns about the availability of residencies. “To call something board certification that does not use the residency criteria used in all other areas of health care will promote skepticism and rejection,” he said.

Any requirements for residencies should first be debated and studied, he stated.

Dr. Schamerloh cited inadequate opportunity and time to reasonably review and debate the original proposal as well as a faulty mechanism for debate.

Dr. Cockrell’s formal presentation outlined the reasons why the profession needs board certification and he reviewed the model framework.

He noted that information on the proposed program was e-mailed to 20,000 optometrists. Only 8,000 opened the e-mails, and only 800+ clicked on the link, he said. “Polls say you don’t want board certification, but I know that you haven’t looked at all of the information,” he said.

Eleven negative letters were sent to the AOA, and all were printed in the AOA News, he said. Less than 50 letters in total came in. On a blog set up by the outgoing AOA president, Peter H. Kehoe, OD, half of the comments supported certification and half opposed it, Dr. Cockrell added.

John A. McCall Jr., OD, was one of three former AOA presidents who were given the opportunity to address the delegates.

As he ended his term as AOA president in June 1999, Dr. McCall had first introduced the concept of board certification to the AOA House of Delegates, and it was initially met with tremendous support. To implement the effort, the AOA formed the ABOP, which developed a board certification program. The AOA’s plan was subsequently met with significant controversy within the profession, and by June 2001 the AOA halted the initiative and dissolved ABOP.

Dr. McCall stressed that while he had no involvement in the current process, he still supports the concept of board certification.

“I have been on my hospital staff for 26 years,” he said. “I have heard board certification mentioned countless times. Board certification means continuing competence to the world.

“The easy thing to do is not bring this up,” he continued. “The hard thing to do is to bring this up and do what’s right for the profession. This is the last debate. If you table this, it is dead as a doornail, and 10 years from now optometry will be in 1986. We may be out of Medicare again.”

For more information:

• The motion that was approved and the final vote tally are available at www.aoa.org.