Board certificaiton: Is it tearing optometry apart?

Optometric Management, Apr 2000 by Bowling, Ernest L

OPTOMETRISTS across the country have been hearing a train coming. Recently at the AOA convention, the sound grew louder. And now, at the train's arrival among the rankand-file, it has escalated into a deafening roar. The ABOP train is at the station, and the optometric profession has not faced such an issue since the DPA/TPA challenges of a quarter century ago.

When the AOA House of Delegates approved the formation of ABOP at the June 1999 congress, the move was hailed by many as "history in the making." Others haven't been so sure. The formation of ABOP has been called a "wrong turn" for our profession, and it has been said that we have "opened a can of worms that will create a hardship for many."

The subject of optometric board certification will impact every optometrist, no matter what your mode of practice. For that reason, it deserves our utmost attention. We need to know if the ABOP train will take us where we want to go. Do we need to get on board (is board certification necessary) and where is the train taking us (is this the best mechanism to achieve the goal)?

This article will present both sides of the issue as completely and fairly as possible in the allocated space.

What is ABOP?

The mission statement of ABOP notes in part, "the purpose of ABOP is to increase the availability of high-quality optometric care to the public by establishing and administering programs for the certification and re-certification of licensed practitioners in the profession of optometry and by offering educational programs designed to increase the knowledge, skills and experience of optometric practitioners."

Certification is voluntary, available to all optometrists who've been in practice for 2 years, or who've completed a residency or are fellows in the American Academy of Optometry (AAO).

Initial certification is accomplished by completing 10 hours of ABOP certified continuing education; 2 hours each in five "core competency areas" - refractive and binocular vision disorders, ocular disease and trauma, glaucoma, neuro eye disease and ocular manifestations of systemic disease - and successful completion of a 100-question exam based on the courses.

Is board certification necessary?

Harvey P Hanlen, O.D., current AOA president, said in a recent letter to AOA members, "The basic purpose of the certification program is to enhance the quality of optometric care available to the public by fostering continued competence for practitioners through administering high-quality education and examinations for certification and re-certification."

Dr. John A. McCall, former AOA president and current president of ABOP, stated that ABOP has been formed to meet the country's demands for "fostering ongoing clinical competency." The National Board of Examiners in Optometry (NBEO) also stressed the need for documenting continued clinical competency in the position paper, "The AOA's Board Certification Program: A Call for Review," released February 15, 2000. (The paper is available from the NBEO at www.optometry.org.)

Both Dr. McCall and the NBEO cite the findings of the Pew Health Professions Commission reports. Recommendation 10 of the 1998 report reads, "States should require that their regulated healthcare practitioners demonstrate their competence in the knowledge, judgment, technical skills and interpersonal skills relevant to their jobs throughout their careers." The same report also had another recommendation: "States should enact and implement scopes of practice that are nationally uniform for each profession."

Would our profession be better served concentrating our efforts to ensure uniform national optometric practice acts throughout the states first, then assess clinical competency once we're all playing on the same level field? ABOP made note of this recommendation.

"Considering the great disparity in optometry scopes of practice among the SO states, it's unlikely that national uniformity in state optometry board regulations could be accomplished in the foreseeable future."

Still, it would be interesting to see what could be accomplished in this area if the same fervor were applied.

We're already licensed and regulated

While national board certification to assess continued clinical competency sounds like a good idea, the fact remains that optometry is licensed and regulated by the individual state boards of optometry. Our scope of practice is determined by the Sovereign State Board, which also sets the requirements for continuing education (CE). These CE requirements vary widely from state to state. ABOP has no licensing authority or foundation and has no intent to interfere with or restrict professional licensure. However, that hasn't kept several state boards from weighing in on the subject.

1 The Virginia Board of Optometry sent a letter to the AOA and ABOP in November 1999 stating that, "the goal of this process to `certify a minimal level of competency' in the practice of optometry is an affront to the work done by the Schools and Colleges of Optometry, the National Boards of Examiners in Optometry and the individual State Boards of Optometry in the United States." The Virginia Board goes on to say that, "we feel it is a sham to propose that the ABOP program would certify an optometrist to a higher level of competency than the national and state tests do already."