Q&A: Florida OD association defeats bill that would limit health care provider designation
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The Florida Optometric Association recently defeated a reintroduced state Senate bill that would have limited health care provider designations, including prohibiting optometrists from calling themselves doctors.
This is the latest installment of what has been dubbed the “Eyeball Wars,” as several states have faced similar legislation targeting the profession.
“The Eyeball Wars are likely to continue into the 2025 legislative session. I would tell you that’s true nationwide,” Kenneth W. Lawson, OD, who practices at Bayshore Eye Care and serves as the legislative chair for the Florida Optometric Association, told Healio. “I guarantee you, next year other states will face this bill.”
Healio spoke with Lawson to discuss the bill and its potential impact on the profession in Florida.
Healio: Why do you think SB 1112 failed to pass?
Lawson: Florida optometry communicated effectively and worked hard to make sure legislators and Gov. Ron DeSantis understood the true purpose of the bill, which was to discriminate against the profession.
Senate Bill 1112 stated that there was misrepresentation, fraud and improper communication that deceived patients in Florida as to who is a doctor, who is a physician and who has credentials to provide them with service. When we queried, we couldn’t find any consumer or patient complaint to support that. The bill proceeded to allow other mid-level providers — podiatrists, chiropractors and dentists — to expand their titles but minimized ours. We made these points very salient and clear to the legislators and, ultimately, that led to the bill failing twice — once by governor veto and once by the House.
The bill was a resurrection of the Sullivan Bill, a federal bill introduced years ago that tried to impugn optometry’s place at the table. That legislation failed as well. What I’m seeing now in multiple states is a resurrection of that bill at the state level. Tennessee faced it along with us this year. It appears that certain groups of physicians are trying to use this at the state level the way the Sullivan Bill tried to change our title at the federal level.
Furthermore, the American Optometric Association was very helpful with resources and adjunct support through both years of our fighting and fending off this bill. They have remained vigilant in other states that have faced the same type of legislation.
Healio: How do the bill’s proponents claim it will help?
Lawson: When the bill in Florida was introduced, it was addressing an issue in hospitals, which was that if everybody is wearing a white coat with a nametag that says, “Dr. Smith,” patients wouldn’t know what type of doctor “Dr. Smith” is. The wearing of a name tag and the prohibition of certain titles had some proposed application there, and as time went on, PAs and APRNs were working in minute clinics, which featured kiosks saying “the doctor” or “the physician” was in. There were a couple of instances of patient confusion.
The bill started out 8 years ago simply addressing the APRN and PA issue. Then along the way, the Florida Society of Ophthalmology came along and shanghaied the bill and decided it was a great way to also tell everybody that optometry is not a doctor- or physician-level service. So if optometrists tried to expand the scope of their work, it becomes easy to say you don’t want a non-doctor or non-physician to provide more scope to patients without the oversight of law.
Healio: What would a bill like this have meant for practicing optometrists?
Lawson: The original form of the bill 2 years ago would have taken away your ability to use the title “doctor.” It proposed that you can place a lowercase “d” in front of your name, but you could not use “physician” even if you appended it with “optometric.” Optometrists would have lost any title with “physician” or “doctor.” That bill was vetoed by the governor.
Then it became a bill that said you can use “doctor” because that’s in your practice act, but you can’t use “physician,” although podiatrists, dentists and chiropractors can.
You also couldn’t use any other terms that weren’t in your practice act. For example, if it didn’t say “ABO certified” or “specialist,” then you couldn’t say “Dr. Smith, optometric physician, ABO-certified contact lens specialist.” You couldn’t use those titles. You would be accused of practicing medicine without a license, and you would face felony prosecution by the department of health’s special investigative unit. You wouldn’t face your own board; you would have faced the same board that an imposter practicing medicine would face for a criminal charge.
Healio: What would a bill like this have meant for patients?
Lawson: I think it would have created a ton of confusion, because patients that come to see me clearly understand that I’m an optometrist. If now I have to change every advertisement and every sign and every business card, they would wonder why. I don’t see how it would help them.
Healio: How can optometrists fight future bills like this?
Lawson: They need to stay on guard with their respective legislatures because it’s pretty clear that this type of bill is not going to go away. Florida probably fought the worst battle because we had a Senate president who was willing to trade this bill as her No. 1 health care priority for whatever the rest of the legislature wanted to look at. My advice is simple: Because optometry is a legislated profession, optometrists in each state should work hard to engage and educate their respective legislators and state leadership as to the value and meaning of who we serve and what we do. Educate your legislators and remain vigilant, as this will serve to defeat attempts to demean or discredit our noble profession.
Healio: Is there anything else you would like to add?
Lawson: There are two tactics involved with this type of legislation: First, they want to take away your use of “doctor” or “physician” or “specialist,” because they feel that will embolden the ophthalmologist. Taking it away also allows them to go back to Medicare and say, “You have paid optometrists equal to physicians since 1990, but it is now clear — because their titles have been corrected — that they’re not physicians and they should be paid more like a PA or a nurse practitioner.” That means 85% of the Medicare allowable.
In the bill that ran this year, there was actually a subsection that talked about titles for Medicare, which said “podiatric physician, a chiropractic physician, a dental physician or an optometrist.” It was clear to me that if you could get enough states to come out and say, “Optometry does not equal physician,” then you could probably go back to the payers and say, “Don’t pay them as physicians.”
There were some folks who said they were not passionate about the term “optometric physicians,” but whether you’re passionate about it or not, your value is measured by what you’re reimbursed for. If you want to keep the physician-level reimbursement, my advice is to fight to keep the term “physician” incorporated into your title. If you allow it to be stripped away, you’re opening yourself up to also be stripped of some of your reimbursement.
Reference:
- SB 1112. https://www.flsenate.gov/Session/Bill/2024/1112/BillText/Filed/HTML. Published 2024. Accessed April 1, 2024.
For more information:
Kenneth W. Lawson, OD, is the legislative chair for the Florida Optometric Association and practices at Bayshore Eye Care in Bradenton, Florida. He can be reached at docjsl@aol.com.
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