Educators, regulators: Set practice parity consistent with optometry’s evolution

Issue: September 2006

ByJennifer Byrne

The issue of optometric practice scope parity across the states has long been a priority of organized optometry as well as optometric educators and regulators. While few would argue that parity is a worthy goal, opinions may differ as to how to achieve this objective.

At the heart of this issue is determining the level to which all states should aspire. While optometrists in some states, such as Oklahoma, are currently able to use lasers, other states have only recently acquired injection or glaucoma privileges. At what level, then, should the bar be set?

“Although a decision on whether to seek expansion of scope of practice is left up to each state, the American Optometric Association (AOA) encourages all states to take the necessary measures to ensure that they are able to treat patients to the fullest extent of their education and training and to expand, as they feel necessary, to ensure access to quality care,” AOA President C. Thomas Crooks III, OD said.

The AOA’s perspective

While Dr. Crooks did not specifically address the desired level of practice scope parity in optometry, he applauded the ongoing initiative to move forward in seeking privileges.

“Doctors of optometry in every state intend to continue leading the profession with new training, technology and techniques,” he told Primary Care Optometry News. “Optometrists, just as other health care professionals, will continue to evolve as necessary to provide the best possible care to patients, consistent with optometrists’ advancing levels of training and education.”

He said all states should have access to a high level of professional resources. “The AOA would certainly like to see more equality across the board,” he said. “All states should have access to the appropriate resources and capabilities to treat patients, consistent with the education and training of the health care professional providing care.”

Dr. Crooks said the AOA supports any state association seeking to expand privileges. “When an affiliate seeks to expand optometrists’ scope of practice in its state, we support the affiliate to the level its leadership requests,” he said.

Parity and curricula

Linda Casser, OD, FAAO [photo]
Linda Casser

According to Linda Casser, OD, FAAO, director of clinical examinations for the National Board of Examiners in Optometry (NBEO) and a member of the Primary Care Optometry News Editorial Board, the disparate scope of practice among states needs to be taken into account by optometric educators.

“We have 17 schools and colleges in the United States, and each is located in a state with a specific scope of practice,” she said in an interview. “I would say that, over the years, the schools have done a good job of making the curriculum consistent with the scope of practice. The challenge is, because scopes of practice are different among states, the schools need to prepare their graduates to practice in any state.”

She said the schools work closely with the state associations and regulatory boards, the AOA and the Association of Schools and Colleges of Optometry (ASCO) to design the curricula with the goal of enabling students to practice in any state. “States with broader scopes of practice may require additional or complementary certifications or credentialing,” Dr. Casser said.

“In addition, some state boards, such as North Carolina, have been very good about contacting schools and colleges to let them know about scope changes within the state so that the schools can address that issue as they deem appropriate,” she said.

Hector C. Santiago, OD, PhD [photo]
Hector C. Santiago

According to ASCO President Hector C. Santiago, OD, PhD, schools and colleges of optometry respond to the standards set by the Accreditation Council on Optometric Education (ACOE) and the curricular requirements reflected in the NBEO examinations allowing them to meet the needs of the profession. “We undergo a scrupulous review system of our academic and clinical curriculum, ensuring that all institutions meet common standards,” he told PCON in an interview. “In addition, all graduates must complete the National Board of Examiners in Optometry exams, ensuring that they meet common entry-level requirements for the practice of the profession.”

Dr. Santiago added that the schools continuously re-examine their curricula to reflect the licensure requirements of all 50 states, Puerto Rico, the District of Columbia and Canadian provinces.

“In short, our educational system is designed to prepare graduates to meet state requirements,” he said.

Dr. Casser said her preference would be to have “as taught” legislation in all states. “That is, the institution or faculty, looking broadly at the profession, teaches to the highest level,” she said. “The faculty sets the curriculum, and the legislation follows suit, rather than having the legislature determine the scope. Ideally, every state would have a consistently broad scope.”

The NBEO keeps a close eye on the issue of parity, Dr. Casser said, and keeps in communication with the schools and colleges. She said the NBEO currently has between 600 and 700 volunteers who provide feedback in this area. The group also works closely with the Association of Regulatory Boards of Optometry (ARBO) in keeping track of parity among states.

She said the goal of parity will continue to be important in optometry for some time to come. “The key is to not be too prescriptive in scope legislation without knowing what lies ahead,” Dr. Casser said. “In the future, it will be important for us to provide the broadest level of care consistent with optometric education.”

CELMO: highest level of CE

While the Council on Endorsed Licensure Mobility for Optometrists (CELMO) is not a national licensure of any kind, it is designed to promote licensure mobility by establishing a high standard of continuing education, with the goal of assisting state boards with the process of considering ODs for licensure by endorsement.

“If an optometrist obtains a CELMO Certificate, it shows that he or she has met the highest standard of COPE (Council on Optometric Practitioner Education) approved continuing education, “ said Steven H. Eyler, OD, FAAO, a member of the ARBO Board of Directors and board liaison to CELMO. CELMO, through ARBO, collects and stores relevant data on the practitioner for the state boards, thus reducing some of the administrative burden state boards have in relationship to granting a license by endorsement. Data such as school or college of graduation, passage of national boards, active practice status, therapeutic pharmaceutical agent prescribing authority and disciplinary actions taken by any state board will be stored by ARBO. After about 18 months in existence, eight state boards recognize the CELMO Certificate as a significant credential in regard to licensure by endorsement.

Dr. Eyler said, while licensure by endorsement has long been a goal of AOA (a resolution was passed in 1995), as well as ARBO, only 12 states currently are posted on the AOA endorsement map.

“My interest for some time has been to try to make mobility of licensure more of a reality,” he said in an interview. “The ARBO Board of Directors are very much behind this issue, as is the ARBO House of Delegates, which overwhelmingly passed resolutions to support, develop and implement the CELMO program in 2004 and 2005. The vast majority of the profession is in agreement with the AOA and ARBO; we need to level the playing field when it comes to optometric licensure.”

In terms of deciding which level should be the standard for optometric practice scope, Dr. Eyler said he envisions a level of parity that keeps up with optometry’s ongoing evolution.

“The leadership of this profession will not want to go backwards,” he said. “We want to bring everyone up to a relatively consistent high standard.”

For more information:

C. Thomas Crooks III, OD, is president of the American Optometric Association. He can be reached at 243 North Lindbergh Blvd., St. Louis, MO 63141; (314) 991-4100; fax: (314) 991-4101; e-mail: AmOptBdCTC@aol.com.

Linda Casser, OD, FAAO, is director of clinical examinations for the National Board of Examiners in Optometry and a member of the Primary Care Optometry News Editorial Board. She can be reached at 200 South College St., Suite 1920, Charlotte, NC 28202; (704) 332-9565; fax: (704) 332-9568; e-mail: casser@optometry.org.

Hector C. Santiago, OD, PhD, is president of the Association of Schools and Colleges of Optometry. He can be reached at 307 Winston Churchill Ave., San Juan, PR 00926; (787) 765-1915, ext. 2500; fax: (787) 767-3920; e-mail: hsantiago10@msn.com.

Steven H. Eyler, OD, FAAO, is a member of the Board of Directors of the Association of Regulatory Boards of Optometry (ARBO) and is the board liaison to the Council on Endorsed Licensure Mobility for Optometrists. He can be reached at 6604-E East Harris Blvd., Charlotte, NC 28215; (704) 536-6042; e-mail: seylerod@ix.netcom.com.