Board Certification Resolution for ODs adopted at 102nd AOA Congress

Issue: August 1999

SAN ANTONIO — This year’s House of Delegates meeting at the American Optometric Association (AOA) Annual Congress brought the unexpected for many attendees. On June 25, after more than 3 hours of animated discussion and debate, an overwhelming majority of delegates from all 50 states voted to adopt the Board Certification Resolution, setting in motion what House Speaker T. Joel Byars, OD, called “history in the making.”

Then-president John A. McCall Jr., OD, presented the specifics of the resolution to the AOA House of Delegates. Dr. McCall told Primary Care Optometry News that board certification raises the bar for optometry. Following the lead of other professionals helps ensure a more secure spot in the ever-changing arena of managed care, he explained.

“We don’t have to do this, but managed care and the way medicine is being changed in the marketplace right now calls for higher quality assessment and improvement in all areas,” he noted. “Optometry, as well as other medical disciplines, is having to not only raise its standards but prove that it is, in fact, a cut above average; therefore, this is a good argument for optometrists’ inclusion in managed care plans. This extra step, if optometrists choose to participate, will enable them to be certified by a national board that will have standards with ongoing competence training that nobody else has. We think that will benefit optometry in the marketplace.”

Leading the implementation is the Board Certification Project Team, consisting of: Dr. McCall, chair; John F. Amos, OD; William G. Hendrix, OD; Brooke Kirby, OD, PhD; Thomas Lewis, OD, PhD; Jeffrey Locke, OD; Lesley Walls, OD, MD; and AOA staff member Jeffrey Weaver, OD, MS, MBA.

Establishing guidelines

Dr. McCall said that an American Board of Optometric Practice (ABOP), modeled after the American Board of Family Practice, will be assembled to develop the bylaws and legislation of the board-certified continuing education courses for mid-year 2000 implementation. Beginning Jan. 1, 2000, the board will begin accepting applications for voluntary board certification.

To become board certified for a period of 10 years, practitioners will need to complete a set number of board-certified continuing education hours yet to be determined by the ABOP. Each course will be followed by an exam. To achieve recertification, a practitioner will need to complete and prove competency in 50 hours of board-certified continuing education over a 10-year period and pass an open-book, take-home, recertification exam.

To apply for board certification, optometrists must possess either a diagnostic certificate or therapeutic license. If a practitioner holds a diagnostic certificate only, board certification will expire Dec. 31, 2006, if he or she is not therapeutically certified by then. Until that time, board certification will be awarded without a therapeutic license as long as the practitioner meets the other requirements. AOA membership is not required for board certification.

For those who enroll in the first year, the fee will be $300; the second year, it will be $400; and for the third year and beyond, the cost will be $500. Dr. McCall said that the graduated fee scale was established to encourage early enrollment. He noted that the AOA will not profit from the fees, which will serve to offset such overhead costs as an office, a computer system and the employees hired specifically for that purpose.

“Budget-wise, I think it will work,” Dr. McCall said. “If there are any excess funds, the AOA will shift them into areas that either support the schools and colleges of optometry or the members.”

The struggle to adopt

Following Dr. McCall’s presentation to the House of Delegates, a lengthy debate ensued concerning whether to adopt the resolution immediately or refer the matter until next year’s Congress. Missouri delegate Jack W. Bennett, OD, made a motion to postpone the issue until the 103^rd Congress, and numerous state representatives stood up to comment or offer other alternatives. A motion to call the question and stop the debate failed, and discussion resumed. The motion to refer the issue until the year 2000 also did not pass, with a 1,121 to 461 vote.

In an effort to appeal to more delegates in favor of referring the matter until next year, a motion was made to amend the resolution, and another motion was made to amend the amendment. While the latter was withdrawn, a vote was taken on the original amendment, which did not pass. Finally, after 3 hours of debate, a voice vote was taken to adopt the original resolution and it passed overwhelmingly, prompting a spontaneous cheer from supporters.

Not enough time

The group of delegates who supported Dr. Bennett’s motion to refer the issue until the next Congress was small but vocal. Many claimed they had not received sufficient notice prior to the vote to thoroughly discuss the issue with the fellow state optometrists whom they represent. Dr. Bennett told Primary Care Optometry News that a notice outlining the details of the resolution was only mailed out to the delegates on June 4 of this year, prompting the contention that a vote at this year’s Congress would be too hasty.

“There was no time for me, as a delegate, to know what the optometrists in Missouri, whom I am representing at the meeting, were thinking,” he said. “It was a significant issue, and my comments were not directed at its substance, but at the timeliness of the notification. I just felt that we had not been given the information in a timely fashion before the meeting, and I would have preferred to have an opportunity to talk to the optometrists in our state and get their reaction before I cast a vote.”

For Dr. Bennett, unanswered questions remain. “I have questions about how the members of this certification board are appointed, how they go about making their decisions,” he said.

For Joseph Stamm, OD, president of the New York State Optometric Association, who seconded Dr. Bennett’s motion, the sticking point was not insufficient time and notification, but the lack of details provided until this year’s Congress was imminent.

“The first time we had anything resembling details was at the mid-year planning meeting in January in La Jolla, Calif.,” he stated. “The written plan was not sent out to the society presidents until about 2 weeks before the June meeting. Some people felt that, because they had heard about it in January, they’d had adequate notice, and some of us felt that because we didn’t see the details until just before the meeting we didn’t have adequate time. We had enough time to discuss the concept — not the details, but the concept.”

Dr. Stamm said that the only issue preventing New York ODs from getting on managed care panels or hospital staffs is “just plain old politics with the MDs — it’s not necessarily the board certification. We’re very concerned that this is just going to set another level of discrimination for getting onto plans. Board certification isn’t going to allow us to practice any differently than we do day-to-day, where TPA certification obviously does. It’s not going to change our practice; it’s just another hoop that we have to jump through.”

However, now that the resolution has passed, Dr. Stamm said he is looking forward to seeing it develop in the coming months. “It will be interesting to see how it becomes implemented, to see what kind of feedback the AOA gets from the varying states and state boards,” he said. “We’ll make the best of it. It was a democratic process in action.”

Time is of the essence

After 15 months in the making, with the project team developing guidelines and Dr. McCall and other AOA board members spreading the word at various meetings, Dr. McCall said that the time to vote on the board certification program had definitely arrived.

“We brought this before a legislature conference with members of all 50 states in September of 1998,” Dr. McCall said. “Then, I took this to every regional meeting, and my trustees and I took this to every state meeting. We were getting the word out as much as we could without putting it in print because it was still an ongoing process. In January, I went to the president’s council and said that I would come back and present it again at Congress, at which time it would be voted on. Every state president knew about it in January.”

Incoming Colorado Optometric Association president Randolph E. Fincher, OD, said that not recognizing the importance of the issue of managed care was not sufficient reason to delay the adoption of board certification. “The majority of optometrists are not listening to what’s going on,” he said. “If they’d listen and see what’s going on in the marketplace with managed care, they would have paid more attention to what was being said. I don’t feel bad for any of these people who said they didn’t get enough notice. In managed care, you’d better pay attention to what’s going on or you’re going to get passed by.”

Scott Walters, OD, president of the Oregon Optometric Association, said that managed care and hospital access were the primary factors that prompted the state’s vote to pass the resolution. “Oregon is heavily penetrated by managed care,” he said. “The state has allowed us to say that we are board-certified just by license, but in my opinion, that doesn’t lend any credibility. We felt the idea the task force came up with is more credible and more defendable as a true certification process. Also, more and more of the same managed care organizations are asking for hospital privileges. To be on a hospital board and get privileges you almost have to be board certified.”

Anthony J. Adams, OD, PhD, president of the American Academy of Optometry (AAO) and dean of the School of Optometry, University of California at Berkeley, said that the AAO supports the project and hopes to play an active role in its development.

“The AAO has always been interested in quality of practice, its measurement and its advancement,” Dr. Adams said in an interview with Primary Care Optometry News. “The academy will work with the newly formed board to assure that the quality will be there, and the academy expects, as things evolve, to play a leadership role in any development of subsequent specialty certifications through its sections and resources of its diplomate programs. We certainly think it’s an appropriate step for the profession as a whole to take. There’s no hesitancy in that at all.”

The future of board certification

While the project has a basic foundation from which to build, Dr. McCall said that more of the specific details will be hammered out over the next several months. “If you are therapeutically certified, you will be issued a certificate once you meet the guidelines,” he stated. “We don’t know yet exactly what they will be; those guidelines are still to be tweaked. These criteria will be developed by the ABOP.”

Dr. Walters said that while the endeavor is still in the developmental stages, he feels positive about its impact on the profession. “It’s an evolutionary process,” he said. “It takes some further thought, but we wanted to give directive to continue the process, not delay it. They’ve selected a very able task force; it’s a broad mix of ideas and people, some of the best minds in the profession. I have confidence that task force members are going to do the right thing.”

For Your Information:

John A. McCall Jr., OD, is the immediate 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.

Jack W. Bennett, OD, is dean of the School of Optometry at the University of Missouri. He may be reached at University of Missouri-St. Louis, School of Optometry, 8001 Natural Bridge Rd., St. Louis, MO 63121; (314) 516-5606; fax: (314) 516-6708.

Joseph Stamm, OD, is the president of the New York State Optometric Association. He may be reached at 1815 South Clinton Ave., Ste. 435, Rochester, NY 14618; (716) 271-2210; fax: (716) 271-7274.

Randolph E. Fincher, OD, is the incoming president of the Colorado Optometric Association. He may be reached at 1399 South Havana St., Aurora, CO 80012-4041; (303) 750-7621; fax: (303) 755-1259.

Scott Walters, OD, is the president of the Oregon Optometric Association. He may be reached at 1022 NW 6^th St., Grants Pass, OR 97526; (541) 476-4545; fax: (541) 479-5985.

Anthony J. Adams, OD, PhD, is the president of the American Academy of Optometry and dean of the School of Optometry, University of California at Berkeley, Berkeley, CA 94720-2020; (510) 642-3414; fax: (510) 642-7806.