Options quickly expand for ODs seeking board, maintenance of certification

Board certification has been an area of contention in optometry for more than a decade. Whether optometrists believe that it has a place within the profession or not, the presence of multiple certification programs indicates that the boards are here to stay.

After choosing not to pursue board certification in the late 1990s, the profession revisited the concept in 2007 via the Joint Board Certification Project Team. Representatives from the American Optometric Association, American Academy of Optometry (AAO), American Optometric Student Association (AOSA), Association of Schools and Colleges of Optometry (ASCO), National Board of Examiners in Optometry (NBEO) and the Association of Regulatory Boards of Optometry formed the team to explore a board certification process for optometry.

As a result of their discussions, the team, currently made up of AOA, AAO, AOSA and ASCO, formed the American Board of Optometry (ABO) and defined what board certification would mean within the optometric community.

The group established the definition as: “A voluntary process that establishes standards that denotes that a doctor of optometry has exceeded the requirements necessary for licensure. It provides the assurance that a doctor of optometry maintains the appropriate knowledge skills and experience needed to deliver quality patient care in optometry.”

Since then, several additional boards have formed with various goals.

Former AOA president John A. McCall Jr., OD, introduced the idea of board certification to the AOA House of Delegates in 1999.

“Ironically, if the profession had adopted the American Board of Optometric Practice 15 years ago, we would be where we are today with ABO: testing every 10 years and ongoing competency requirements,” he told Primary Care Optometry News. “The difference is we would have more ODs involved. Any board certification process has to be compared to the American Board of Medical Specialties, which is the gold standard. This gold standard, which is accepted by hospitals, requires that after licensure you must qualify for sitting for the board, passing a board test and measure of ongoing competency, with retesting every 7 to 10 years.”

American Board of Optometry

“American Board of Optometry board certification and maintenance of certification programs represent a process that allows doctors of optometry to demonstrate that they exceed entry level requirements and are maintaining the appropriate knowledge, skills and experience needed to deliver contemporary quality eye care,” James M. Vaught, OD, chairman of the ABO board, told PCON.

The ABO, founded in 2009, provides optometrists with a certification in general practice.

To become an active candidate, optometrists are required to have graduated from an optometry school accredited by the Accreditation Council on Optometric Education (ACOE), according to Vaught. Candidates must also have therapeutic licensure and have cleared a search of the National Practitioner Data Bank (NPDB).

Then candidates must accrue 150 points via the ABO’s “residency or equivalent” process in order to become eligible for the examination. This can be done several ways, which have various point values: an ACOE-accredited residency, fellowship in AAO, fellowship in the College of Optometrists in Vision Development (COVD), becoming a diplomate of a section of the AAO or education. At the time of this article, ABO charges a $300 application fee, a $1,500 exam registration fee and a $150 annual maintenance of certification (MOC) fee.

“The American Board of Optometry is proud of its leadership in developing board certification and maintenance of certification for the profession of optometry,” Vaught said. “In 4 short years, the ABO has developed a valid, high-quality program recognized by the federal government (Centers for Medicare and Medicaid Services) and accredited by the National Commission for Certifying Agencies.”

According to a press release issued in April 2014, the ABO has 2,750 diplomates and an active candidates list of more than 2,500.

To maintain certification, diplomates must possess a valid therapeutic license, pass an exam every 10 years as well as complete continuing education hours, self-assessment modules and performance in practice modules.

“The original intent, through combining efforts of all major optometry stakeholders in the Joint Board Certification Project Team, was to have a single board with profession-wide support,” Vaught told PCON. “Despite the fact that there are other options, the ABO will continue to pattern our program after that of medicine to ensure our place in health care through processes that can withstand the scrutiny of accreditation and demonstrate competence to the public with integrity.”

As stated on the ABO website, the organization believes that passage of national board exams or the TMOD exam is not equivalent to what it considers to be board certification.

American Board of Certification in Medical Optometry

Founded in 2009, the American Board of Certification in Medical Optometry (ABCMO) provides a distinct type of certification.

“ABCMO is a specialty board that certifies competence in the specialty of ‘medical optometry’ and requires a 1-year residency in medical optometry,” Kenneth Myers, OD, PhD, president of ABCMO told PCON. “ABCMO is configured in the same way and with the same requirements as specialty boards in medicine, osteopathy and dentistry, and only those certified by ABCMO can be credentialed as ‘specialists’ by credentialing committees at joint commission-accredited medical facilities.”

The ABCMO’s website states: “Certification is achieved by successfully completing an ACOE-accredited 1-year postgraduate residency training program in medical optometry, documenting 2 years practicing medical optometry immediately prior to application and meeting other criteria of appropriate specialist practice setting as deemed appropriate.”

Applicants must also pass the Advanced Competence in Medical Optometry (ACMO) exam administered by the national board and pay an application fee of $175, Myers said.

Since 2011, 397 optometrists have been board certified by the ABCMO, according to Myers.

“Of these 397, about 85% are also fellows of the American Academy of Optometry and about 75% are AOA members,” he said.

ABCMO certification lasts for 10 years. According to the board’s website, optometrists must meet all existing state re-licensing continuing education requirements and re-pass the ACMO examination for recertification, and continuing education hours must be in medical optometry and approved by the Council on Optometric Practitioner Education (COPE).

Myers said many optometrists believe they are already board certified in general practice once they pass the NBEO exams required to be licensed to practice optometry in their state.

“Data from the Council for Affordable Quality Healthcare that acts as a broker of professional credentials shows that about 22,000 general practice optometrists have stated they are board certified by the NBEO, and several hundred have stated they are board certified by the American Academy of Optometry,” Myers told PCON. “This was before the ABO existed.”

American Board of Clinical Optometry

The American Board of Clinical Optometry (ABCO) distinguishes itself as a MOC program as opposed to a board certification program.

“The American Board of Clinical Optometry was founded in 2010 with the philosophy that optometrists are deemed competent to enter practice by virtue of having passed their licensing examinations,” Janet Carter, OD, executive director of the ABCO, told PCON. “We believe that in optometry the NBEO examinations best fulfill the necessity to assess initial competence for practice, and, therefore, we have concentrated on the ongoing maintenance of certification process… that serves as one means of participation in a lifelong program of continuing education and learning.

“Our ABCO fellows are committed to remaining knowledgeable about new developments in practice and technology and learning new techniques as they become part of the practice of optometry,” Carter continued. “We do not believe that board certification per se in general optometry is necessary.”

According to Carter, a few hundred optometrists have been certified via the ABCO. Exact numbers were not available.

In order to obtain certification, fellows must have an active therapeutic license to practice optometry in at least one state, complete an application and a background check and submit a recent self-query from the NPDB, as detailed by Carter. The fee for initial certification is $350, and the annual MOC program fee is $95.

The MOC program includes “yearly continuing education requirements beyond that required by most states, case studies, practice assessment modules and a recertification assessment every 10 years,” Carter said.

Carter noted that she has encountered some employers, specifically hospitals, who ask that employed ODs are board certified.

“My belief is that this comes from a misunderstanding about the role of MOC in optometry as opposed to medicine,” she said, “and that this requirement would probably be lifted if those asking for proof of certification fully understood the profession of optometry and how doctors of optometry are trained and assessed.

“Furthermore, we are talking about, at most, a handful of individuals who had employers asking about board certification,” Carter continued. “Certainly, the programs in existence are adequate for these individuals, and requiring certification of everyone is simply not necessary. The state licensing boards in optometry are and should continue to be the ultimate authority on what steps, if any, are necessary to ensure continuing competence of practitioners.”

Carter noted: “We feel that the new NBEO-BC program is consistent with our MOC vision and plan on encouraging our ABCO fellows to participate in that program for their ongoing maintenance of certification activities in the future. We believe that the NBEO is the premier assessment agency within our profession, and we are very pleased to see that they have initiated a MOC program.”

National Board of Examiners in Optometry-Board Certification

Launched in 2013, NBEO-BC works in conjunction with the examination activities of the NBEO.

“The philosophy of our board certification program is expressed in our mission statement: to recognize and promote professional lifelong learning among practicing optometrists through the joint board certification and maintenance of certification programs, thereby encouraging and supporting excellent optometric care for the general health, welfare and benefit of the public,” Jack E. Terry, OD, PhD, NBEO-BC president, told PCON.

Similar to the ABO, the NBEO-BC provides optometrists with a certification in general practice.

To become certified, optometrists must submit an application, graduate from an ACOE-accredited school, attain a license to practice optometry and maintain it, be in good standing, provide documentation of therapeutic pharmaceutical agent certification and pass several board exams which, beginning in 2015, will include NBEO Parts I, II, III, TMOD, injections and the CPDO within 7 years of the initial application for board certification, Terry said.

Optometrists must also fulfill experience-related requirements to include 3 years of active practice or “attain a score of 450 or above on NBEO parts I, II (IIa or IIb) and III, plus 2 years of active practice or successful completion of a 1-year ACOE-accredited residency,” according to Terry.

“NBEO-Board Certification does not require an additional initial assessment to become board certified if an optometrist fulfills the other preliminary requirements,” he said

Associated fees include $150 for the application, $150 due every 2 years for MOC, which covers all administrative aspects of the program to include documentation of the MOC requirements, and $500 for the periodic CPDO examination, which is intended to document professional currency, Terry said.

Several hundred practitioners already have enrolled in the new board certification program, he told PCON.

Optometrists maintain their certification by retaining a license in good standing and completing 50 COPE-accredited or state-approved hours of continuing education every 2 years, including 10 self-assessment modules and two performance-in-practice modules, Terry detailed.

He said NBEO-BC believes more optometrists will “engage in board certification as the merits of encouraging quality continuing education and lifelong learning through maintenance of certification are emphasized.”

College of Optometrists in Vision Development

Formed in 1971, well before the board certification debate even existed in optometry, the COVD, similar to the ABCMO, has been certifying optometrists in a specialty.

“The International Examination and Certification Board (IECB) of the College of Optometrists in Vision Development (COVD) confers the status of a board certified fellow,” Ida Chung, OD, FCOVD, president of the COVD told PCON.

“The mission of the IECB is to evaluate and certify the advanced competency of optometrists in providing care in the areas of vision development, binocular vision, visual information processing and vision therapy,” she said. “This mission is accomplished by encouraging continuous learning and providing an evaluation process culminating in the identification of those professionals with demonstrated knowledge and clinical skills in vision care as related to development and behavior. The certification process is designed to encourage professional growth in a collegial environment.”

In addition to graduating from an ACOE-accredited school or an international equivalent, optometrists must have 3 years postgraduate clinical experience, have been involved in direct clinical diagnosis and treatment of vision therapy for at least 2 years and have evidence of at least 100 hours of continuing education in various areas of vision development. Certification involves three phases, including submission of case reports and open-book questions, taking a multiple-choice exam and sitting for an oral interview, Chung explained.

She also confirmed that 538 optometrists have earned the title of FCOVD as of December 2013.

COVD certification is valid for 5 years; to maintain certification, 75 hours of continuing education are needed per 5-year period, Chung detailed. Fees exist for the certification process and for maintenance of certification.

Multiple boards: Detriment or benefit?

Our sources had differing opinions on whether the existence of multiple certification programs is beneficial or detrimental to the profession.

“There are multiple boards in other medical specialties also,” McCall said. “The difference is that hospitals see through this and will not accept them all. I have been active staff at my hospital for 28 years and have seen this firsthand. This is where I heard the term pseudo-board. The medical staff uses this term to deny any board that does not meet the requirements set forth by the American Board of Medical Specialties. The ABO meets these standards.”

“Board certification in optometry is a voluntary program that encourages participation in the maintenance of certification aspects of the program,” Terry said. “The existence of multiple board certification programs in optometry allows each optometrist to choose a program that best fits his or her needs throughout the lifespan of the optometric career.”

“Multiple boards in optometry is no surprise to me,” McCall told PCON. “When I discussed this in the late 1990s with the former executive director of the American Board of Family Practice, he said: ‘You are in for the fight of your life. This will divide your profession, just as it did family practice in 1969.’

“History will decide whether or not this was the correct move for optometry,” McCall concluded. – by Chelsea Frajerman