EDITOR'S PAGE

Board Certification:
Think Outside the Box

by  Richard M. Kirkner

In all my years of sitting in the AOA House of Delegates, last month's debate on board certification was the most scintillating floor deliberation since the body tackled the ethics of treating AIDS patients at my first Congress in 1991.

The delegates finally voted to create the American Board of Optometric Practice. Before they did, they heard some cogent arguments about why ABOP should be diligent and meticulous as it sets to work over the next year on a framework for board certification.

John A. McCall Jr., O.D., outgoing AOA president who championed board certification, makes the case that ABOP would allow O.D.s to "check that box" on insurance panel and hospital applications that asks "Are you board certified?" However, board certification must be about more than a box on an application.

First, it should be about proving beyond a reasonable doubt that there is a national standard of optometric practice. That is, a board-certified O.D. should be one who dilates routinely, uses therapeutics judiciously and understands and applies the principles of optics expertly. That latter point has been pushed aside too often, though it's still the main reason most patients come to you.

With 44 states now allowing O.D.s to treat glaucoma, board certification should also be about proving that there is a national optometric standard for managing this disease. Ditto for your ability to comanage cataract surgery, and refractive surgery (for the day those LASIK fees take their nosedive). In other words, board certification should be about holistic eye care.

One AOA delegate raised the point that board certification would "create another tier of discrimination." Of course, there are already "tiers" in optometry, with TPA-certification, fellowship, diplomates, residencies, etc. ABOP would do well to keep this in mind as it builds a structure for board certification.

Above all, keep it voluntary (Dr. McCall says this is the intent). And, don't require post-graduate education (i.e. residencies). Not every doctor is worried about "checking that box" on panel applications. Indeed, you have to wonder if you wouldn't be better off not looking at those applications at all.

Optometry isn't medicine, although it has to jump through many of the same hoops. Certainly, there's a medical component to taking care of the eyes, but there's the refractive component, too. That's something the medical professions can't touch. The moniker "Board Certified Optometric Physician" should make that clear.