Optometric profession debates increase in number of schools

With 20 accredited schools and colleges of optometry in the US and plans for two new schools in the works, it is evident that optometry continues to be a growing profession.

However, amid concerns over a potential oversupply of optometrists and a perceived “identity crisis” within the profession, some optometrists are calling for a more careful oversight of this growth.

The first class of optometrists at Western University of Health Sciences College of Optometry (WUCO) in Pomona, Calif., will graduate in 2013. WUCO’s Health Education Center Building is pictured. Image: WUCO

“My concern is that, as far as I know, optometry as a profession has had no plan or compass on which to grow,” Agustin L. Gonzalez, OD, a private practitioner in Dallas and adjunct faculty member at InterAmerican University, told Primary Care Optometry News in an interview. “Organized optometry and accrediting agencies have no clear indications of what resources we currently have or what we will need. I’m concerned that we are moving forward blindly and by faith, without a plan or roadmap.”

Doing the math

For some optometrists, the burgeoning rate of new schools is an indicator of growth gone awry. Three of the existing schools and colleges of optometry – University of the Incarnate Word’s Rosenberg School of Optometry (RSO) in San Antonio, Texas; Western University of Health Sciences College of Optometry (WUCO) in Pomona, Calif.; and Midwestern University’s Arizona College of Optometry (AZCOPT) in Glendale, Ariz. – opened within the past 5 years.

WUCO projects 74 optometrists in its first graduating class in 2013; AZCOPT estimates a graduating class of 50 in 2013; and RSO enrolled 122 students in 2010-2011. Enrollment in the 20 professional OD programs saw an increase of 3.9% over the previous year and 12.7% since 2005-2006, although the number of graduates remained roughly the same from 2009 to 2010, according to the Association of Schools and Colleges of Optometry (ASCO).

“Our first class graduates in 2013,” Elizabeth Hoppe, MPH, DrPH, founding dean of WUCO, said in an interview. “We project 74 well qualified, service-oriented, interprofessional and enthusiastic new doctors who will help shape the future of our profession.”

Future schools

In July 2011, the Massachusetts College of Pharmacy and Health Sciences announced its plans to launch a school of optometry in the college’s Lincoln Square Living and Learning Center.

Capital improvements for the school will include an onsite optometry clinic, research space, administrative offices, faculty/staff offices and an optical dispensary, and housing for up to 200 students.

In December 2010, the Virginia Coalfield Economic Development Authority approved a $5.6 million request from the Industrial Development Authority of Buchanan County for a loan to be used in the development of the tentatively named Appalachian School of Optometry. The first class of optometry students is slated to begin in August 2013, according to a press release.

Arthur A. Medina, Jr., OD, a private practitioner in San Antonio, PCON Editorial Board member and faculty member at RSO, said new optometry schools may generate commerce for the universities, but they can also be a perceived threat to private practices in those communities.

Arthur A. Medina

”A teaching institution automatically becomes one of the largest practices in the region,” Dr. Medina told PCON. “An optometry school might have 30 to 40 licensed faculty members and 55 to 100 students per class who are seeing patients in that community.”

Dr. Medina said this threat to the livelihood of private practices is in no small part responsible for some of the opposition to new optometry schools.

“I think, right or wrong, that is why many of the private practitioners feel concerned,” he said. “The question remains: if every optometrist out there had an abundance of patients, would they still be as concerned as they currently are? Most private practices do not have an abundance of patients.”

New workforce study

To evaluate the need for more optometrists in the future, organizations such as ASCO and the American Optometric Association (AOA) have recently undertaken two new studies of the optometric profession. One of these is a nationwide workforce study designed to evaluate the adequacy of the current and future supply of optometrists.

According to Dr. Hoppe, who also serves as a team member for the workforce study, the study aims to create a system of data collection about the optometric profession and to plan for its future.

“The primary goal is to design and implement a method to collect data on all current US eye care providers, to create a system that will keep the information current and up-to-date, and create some estimates about how things might change in the future based on changes in the supply, demand and health care market forces,” Dr. Hoppe said.

The study, which was launched in February 2011, is expected to take 18 months.

The Abt study

The last extensive workforce study addressing the optometric profession was the Abt study, published in 2000. This study, led by economist Alan J. White, PhD, predicted an excess supply of optometrists through the year 2030.

“Looking at this study, which is currently the only one available for optometry, I think there will be an excess of ODs,” Dr. Gonzalez said. “I believe the fundamentals of supply and demand will catch up and will balance the workforce at some time in the future (20+ years). In the short term, the next 7 to 20 years, I believe we will have more ODs than available workforce opportunities.”

ASCRS study

Dr. Medina cited a study conducted by the American Society of Cataract and Refractive Surgery (ASCRS) 2 years ago, which concluded that there would be a shortage of cataract surgeons in relation to the increasing population of senior citizens.

“According to that study, there will not be enough surgeons to perform the number of cataract procedures that will be indicated within the next 5 years,” he said. “Will that leave a void in the marketplace – treating anterior segment disease – that could be managed by qualified optometrists?”

Dr. Medina said such an opportunity could mitigate a potential oversupply situation. He added, however, that he is concerned that today’s optometry schools are not adequately preparing students for this opportunity.

“Are we training future optometrists to have those skills and abilities,” he said, “not only clinically, but administratively, to administrate the medical model?”

A ‘booming’ business?

One of the driving forces behind the development of new optometry schools is the aging baby boomer population, which is expected to increase demand for eye care providers.

“The United States is expected to experience a shortage of all health care providers,” Dr. Hoppe said. “There are expected increases in demand for health care due to improved access through health care reform, increased need for services due to the aging population and increased rates of eye disease associated with the diabetes epidemic.”

According to Mario Gutierrez, OD, FAAO, a practitioner in San Antonio, Texas, adjunct professor at the University of Houston College of Optometry and future adjunct professor at RSO, advances in technology can help lessen the demand created by the aging population.

Mario Gutierrez

“Although we are an aging population that will require more comprehensive optometric care, it’s important to remember that efficiencies in modern practice using advanced technology allows us to see more patients in a day and do a better job than ever before,” he told PCON. “I would defer to an honest, nonbiased study to determine if, taking technology into account, such a need for additional optometrists exists.”

Kenneth E. Elder, OD, a private practitioner in Wallingford, Conn., said the aging of baby boomers has already been more than accounted for in eye care’s future planning.

“Baby boomers have been presbyopic for years and, as such, have been in the optometric pipeline for years,” he said in an interview. “Even with the increased prevalence of cataracts or diabetic disease, it will have little effect on optometric demand, because optometrists don’t treat cataracts or diabetic retinopathy. Yes, we might get an extra office visit here and there to ‘monitor’ these conditions, but optometrists throughout the country are already largely under-booked.”

Reality or perception?

Dr. Hoppe maintained that in many cases, optometrists who oppose the opening of new schools are influenced by their individual situations.

“We often find that people form opinions based on their personal experiences or personal frustrations, rather than based on health policy predictions,” she said. “We always urge potential students to investigate all of the information.”

Dr. Elder said his opinions are founded on more than his own practice, which he said is doing well. He said he is convinced that with the current supply of practitioners, optometry could easily absorb any increase in demand that may occur.

“Every optometric consultant I’ve ever spoken to has said that the number one reason doctors seek out consulting services is to obtain more patents,” he said. “That sure doesn’t sound like an undersupply to me.”

Quality of applicants

As more optometry schools and colleges open their doors, thereby allowing more students to be admitted to optometry programs, some practitioners have voiced concerns about a potential decline in applicant quality.

“I would personally like to see the teaching institutions be held accountable for how many students are applying for how many spots, and let’s track where the students go after they pass and have gotten credentialed,” Dr. Medina said. “My big concern is the number of qualified applicants.”

Dr. Gonzalez agreed that too many spots could potentially compromise admission standards.

“It is more likely for the new programs to have a lowering effect on academic standards, especially during the programs’ inception years,” he said. “The lower competition for available seats will likely mean that students who statistically would have been rejected for admission would now have a better opportunity to gain acceptance to a program.”

Dr. Gutierrez said he is concerned that substandard optometry students will lead to substandard optometrists.

“Not everyone has the right to attend optometry school and become an optometrist simply because their family has the money to pay for tuition,” he said. “That being said, all optometrists who are currently enrolled in school deserve to be trained as thoroughly as possible. This is not only the right thing to do for them, but the also the right thing for our profession. We cannot allow substandard optometrists to graduate from any optometry school.”

Dr. Hoppe acknowledged that for those who are concerned about the ratio of applicants to available seats, increasing the applicant pool would be a positive step.

“If people are basing their concerns on this issue, rather than on a perceived lack of need for more doctors of optometry, then an increase in the applicant pool might alleviate their concerns,” she said.

However, Dr. Hoppe said she and other administrators at WUCO do not share these concerns.

“Our college has felt very comfortable with the quality of student applicants in regard to academic potential, personal potential and professional potential,” she said. “We have not lowered or altered our high standards due to numbers in our applicant pool.”

Dr. Gutierrez added that although more schools might mean less competition among students, it would also mean more competition among schools.

“Now there will be more competition among schools to produce a good product,” he said. “Five to 10 years from now, some of these new schools or even some marginal quality existing schools may not be around,” he said. “The reality is, if your school does not produce a marketable, quality optometrist, your enrollment will deservedly decline.”

Where to go from here?

According to the conclusions of the Abt study, future optometrists will respond to oversupply in the following ways: reducing patient volume or work hours, or accepting less attractive work conditions; relocating to geographic areas where there is no excess supply (specifically, to underserved areas of the West); and taking on alternate careers.

Dr. Medina said the geographical distribution of optometrists is definitely an issue.

“I’ve always said, I don’t think the number of providers is in excess, I think it’s the distribution of providers,” he said “In my area, for instance, everyone wants to live in downtown Houston or Dallas. Very few people want to live in the border towns or smaller cities that don’t have ophthalmic care.”

He said a shift in the optometric population toward more rural areas would be beneficial not only to the communities they serve, but to the optometrists.

“Some of the most successful optometrists in recent years are those ODs in the small, rural areas,” he said. “Their income has been substantially better than those in major metropolitan areas.”

A changing profession

Another significant challenge for future optometrists, Dr. Medina said, will be trying to find a niche in a profession that is currently in flux.

“Vision plans have reduced the reimbursement for vision care and essentially have taken away the retail component of our profession,” he said. “The typical optometrist practice receives only 18% of its total professional services from medical reimbursement. It’s pushed optometry into a predicament where it is very difficult to compete with Wal-Mart, Costco and other ‘big box’ stores.”

Although he said that opportunities are likely to open up in treating anterior segment disease, he is concerned that many schools do not train optometrists for the clinical and administrative requirements of this work. He said he is impressed with the program at RSO, which was developed by founding Dean Hani Ghazi-Birri, MS, MD, OD, PhD, OCS.

“This is a person with unique credentials, and the one he is most proud of is being a bona fide third-party billing and coding expert,” he said. “His vision was to create an optometric program that was really focused on the medical model. What they have achieved in 2 years has been remarkable.”

However, Dr. Medina said he fears that RSO’s model is the exception rather than the rule.

“My biggest fear is that the profession of optometry will be relegated to pharmacy status,” Dr. Medina said. “We need to move the profession forward, toward providing true medical treatment as opposed to vision exams. Otherwise, the private practice of optometry is in jeopardy.”

Dr. Gutierrez echoed this sentiment.

“I don’t believe many optometry students dream of working next to riding lawnmowers in the garden center of a big box store,” he said. “If our graduates can only find jobs at such stores or commercial chains, then the end of optometry as an independent, vibrant profession will be in sight.” – by Jennifer Byrne

• Kenneth H. Elder, OD, can be reached at 821 N. Main Street, Ext. Ste. 1, Wallingford, CT 06492; (203) 265-5152; nipidoc@earthlink.net.
• Agustin L. Gonzalez, OD, can be reached at AG@txeyedr.com.
• Mario Gutierrez, OD, FAAO, can be reached at Vision Source San Antonio, 5212 Broadway, San Antonio, TX 78209; (210) 829-8083; mariogut@flash.net.
• Elizabeth Hoppe, OD, MPH, DrPH, can be reached at Western University of Health Sciences College of Optometry, 309 E. Second St., Pomona, CA 91766; (909) 706-3497; ehoppe@westernu.edu.
• Arthur A. Medina Jr., OD, can be reached at 1100 McCullough, San Antonio, TX 78212; (210) 225-4141; medinaa@airmail.net.