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Yes. 

We must do unto ourselves or have others do unto us.

I’ve found that as I traveled around the country meeting with colleagues, I frequently get asked three questions about ABOP. I’ll address those here.

Is There a Need?

Since then, others have challenged the health professions to demonstrate continuing competency of practitioners. The Pew Commission called for ongoing competency of all health-care providers. The Kellogg Foundation report, citing the frequency of mistakes by health-care professionals, likewise concluded that all health-care providers must demonstrate continuing competency.

Meanwhile, the medicolegal aspects of practice have become more complex. Look at how Medicare’s coding and documentary guidelines have evolved. Third-party payers are scrutinizing our medical records more closely than ever, and doing more on-site inspections. As a profession, we must demonstrate that our doctors are up to the task.

So, we’ve tried to be proactive, which is different for optometry. In the past, ours has been a reactive, not a proactive, profession. The TPA and DPA movements are examples of this. This time, your national leaders have worked diligently to address this issue. ABOP was our answer.

Why Now?

Now we have a unique opportunity to design a program without interference from ophthalmology. That’s because ophthalmology was the last medical discipline to adopt board certification (1992). Like 23 of the other 24 medical boards, the American Board of Ophthalmology requires recertification every 10 years (as ABOP would). No ophthalmologist has yet been recertified, and ophthalmology is at a weak point to take issue with our program. If we wait 5 years, ophthalmology will join the other 23 boards with mandatory recertification, and will be a more formidable opponent. By being proactive, we can control our own destiny. 

Is it Credible?

We understand that we must make board certification for optometry comparable to that for the medical professions. The medical boards have an entry-level test, then a retest. Almost all had start-up requirements similar to what ABOP has proposed. 

First, ABOP would require a colleague to have at least 2 years of hands-on patient care before sitting for the exam. This is what the medical model requires, too.

However, what does not fit in optometry is the requirement for a residency before sitting for the exam. An optometrist has entry-level practice skills when he or she graduates from optometry school. That’s not so with a medical school graduate.

This argument should scare the practicing optometrist. A "residency" in optometry is completely different from a medical school residency. In optometry, a residency is more like a fellowship in which you focus on a particular subspecialty, such as low vision or contact lenses. In medicine, a residency is a 3-year requirement in which you receive hands-on training in the discipline in which you’ll practice. A medical school graduate does not possess entry-level skills for seeing patients. For optometrists, a "residency" should not be a requirement for board certification.

If we don’t arrive at our own model and another group does this for us, it could mandate that every board-certified optometrist must have a residency. This is the position of the National Association of VA Optometrists. That would impose an incredible hardship on today’s private practitioners whose wealth of experience is as valuable as any residency.

Some contend that ABOP’s requirement for recertification every 10 years is too long. The American Board of Medical Specialists last April concurred, yet 23 of 24 practitioner boards have this requirement. To address this, ABOP would require a board-certified O.D. to get 50 hours of tested CE to be eligible for the recertification exam in 10 years.

ABOP’s standards for CE are high. It would require closed-book exams—10 referenced questions for each hour of CE. You cannot go to a lecture and sleep or read the newspaper and expect to pass. The handouts alone can be 30 pages or more. Certifying courses has been quite a task. This is why we’ve delayed ABOP for a year; the board rejected every course that was brought to it for approval. 

Compare that to what many medical boards require of its members for recertification: an open-book, take-home exam. Whose model is more rigorous?

I’ll grant opponents of ABOP that in the medical model, board certification equals continuing competency in a specialty with one exception: the American Board of Family Practice. ABOP would be modeled after ABFP. There’s the argument that optometrists are general practitioners, not specialists, and thus do not need board certification. Family practitioners are general practitioners, but they’ve defined themselves as specialists in family practice of the body.

We are general practitioners of one organ system, the eye. We can be board-certified generalists of the eye just as family practitioners are generalists of the body.

We must make board certification accessible for working doctors. It’s easy for an academic or a doctor in a VA clinic to take shots at us, but they won’t have to travel from Iowa to Illinois College of Optometry to sit for a closed-book exam for certification. In 5 years, we’ll have a psychometric, closed-book, on-site exam. To do that now would be too much of a hardship for private practitioners.

When Paul Young, ABFP’s senior executive director, looked at our model for board certification, he said, "You have developed a credible program."

I’m well aware that we’re going to be the laughingstock of the health professions if our system is not right. That’s why we’ve been very careful about how we set up ABOP. And what we’ve proposed is a more credible model than what ophthalmology has.

We need to fit into a model for demonstrating continued competency of ourselves that the purchasers of health care understand. That’s not only third-party payers but also the public. The public understands the concept of "board-certified doctor."

There are two groups in this argument. The AOA and ABOP say we should look at board certification now because we can control the process. If we’re wrong, what’s the worse that can happen? This program is voluntary, inexpensive ($300 per doctor initially), and it gives us a way of measuring competency. 

If the critics of ABOP are wrong and we don’t do it, we could be locked out of plans and lose our share of the market to ophthalmology. Why put ourselves in this position? If I’m wrong, we haven’t hurt anything. If the opponents are wrong, we could hurt ourselves more than we can imagine.

Dr. McCall, a private practitioner, is immediate past president of the AOA and president of ABOP.

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No.

Credibility of credentials is hard to earn, easy to destroy.

The legitimacy of any profession is closely tied to the credibility of its credentials. This is especially true for a relatively small, independent health profession such as optometry. 

Consequently, our profession has worked diligently for more than 100 years to establish an educational program that culminates in a legitimate doctor’s degree, following undergraduate study and then 4 years of accredited and intensive didactic and clinical professional education. 

In addition, we have established a single pathway to licensure through "National Boards" and we have legally broadened our scope of practice for the benefit of the public through changes in state statutes. We also have created accredited post-doctoral residency training experiences for about 12% of our graduates. All of this effort has allowed optometry to be accepted as a true primary health profession by the public and, somewhat grudgingly, by other health professions. 

This acceptance is due to the credibility of our academic and professional credentials—credibility that was hard to earn. It took many years, but it can be destroyed very easily and quickly. As one small but significant sign of how our credentials have been recognized, I was elected to the Board of Directors of the National Board of Medical Examiners 5 years ago, and then re-elected for another term last year. I am the only health professional on the board that is neither a physician nor a medical educator. 

This unique opportunity and recognition is not due to my personal abilities; it was driven by the respect that medicine’s own national board has for optometric education and our professional credentials. It is also likely that the acceptance of optometry as a full service within the Veterans Administration—the national system of health-care delivery and training that is an important underpinning to all medical education—has influenced academic medicine and other professions to accept us as true health professionals.

ABOP Model Doesn’t Measure Up

The AOA’s program is not even remotely comparable to the requirements of a 1-year VA residency, for which there is no "board certification." This action is an affront to the credibility of this year’s graduates’ O.D. degree, their National Board certificate, their license, and, for some, their residency certificate. 

While true board certification in optometric specialties will likely evolve during the early years of this century based on advanced education and clinical training, the AOA’s plan for "board certification" in general optometry has no parallel in any other health profession. Certainly not in medicine and also not in any of those professions with educational and licensure models similar to optometry, such as dentistry. Eighty percent of dentists practice general dentistry without board certification. The 20% who are board-certified underwent legitimate multi-year residency training before being extensively examined by specialty boards. 

The contrast between what the AOA is proposing and the post-doctoral credentialing system common to medicine, dentistry, podiatry and all other health professions is stark. 

I am appalled to be told by my national association that the graduates of 2000, after having met the challenges of a rigorous 4-year professional education and having passed a multi-part national assessment of fitness to practice optometry at the highest level of therapeutic privileges, still need another 2 years of "maturation," along with 10 hours of continuing education thrown in, before they are worthy of being considered fully capable of practicing general optometry. There is something terribly wrong with this situation. 

Cooperation Needed

But by the misuse of two key words—"board certification," which together have a specific meaning to other health professions and the public—and attaching them to this CE program, a new and questionable credential is being forced upon the profession. This will lower the prestige of optometry in the eyes of all other health professions and the public, and undo much of the work of the last century. 

The profession has shown that when it is in the public interest and when it is properly executed, licensed optometrists are prepared and willing to be educated to new levels of general optometry, as was accomplished with the state-by-state expansion into the treatment and management of ocular disease over the past 25 years. 

However, there is no room in a legitimate profession for "questionable" diplomas. Optometry got rid of those at the turn of the 20^th Century. Please let’s not reintroduce one at the turn of the 21^st Century.

Dr. Wallis is executive director of the National Board of Examiners in Optometry. His e-mail is wallis@optometry.org.

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