Dr. Myers, President of ABCMO, responds to Review of Optometry’s February 2018 Article: How the Diploma Deluge is Reshaping Optometry.
Published in Review of Optometry, April 2018.
Although in the past decade concerns about the rapidly growing numbers of optometry graduates have been voiced at optometry web discussion boards, schools of optometry and the American Optometric Association continued to claim more graduates were needed. The AOA continued to report to the U.S. Bureau of Labor Statistics that greater numbers of future optometrists were needed…leading the popular media to portray optometry as a “hot” profession that stimulated the opening of more schools, especially at sites with osteopathic schools which were rapidly expanding.
And when the most recent (2014) and “definitive” study of future optometry and ophthalmology supply and demand (Lewin Study – supervised by the AOA) surveyed practicing optometrists and found an optometry overcapacity of 30%, the AOA interpreted this to mean “there would be an adequate supply of eyecare providers in the future”. See AOA Misinterprets Lewin Group Studies for more information.
Optometry appears traveling down the same “Yellow Brick Road” followed by law, veterinarian, pharmacy and other professional schools whose excess graduates carry large student debts and face restricted opportunities to practice their profession.
Meanwhile the ratio of “qualified optometry applicants per seat” has fallen to a record low of nearly one-to-one, the number of licensed optometrists per capita is at record highs and the almost doubled graduation rate of some 1,900 per year will eventually produce about 76,000 licensed optometrists compared to the current 42,000 which is a record number. And the U.S. birth rate has been falling each year since about 1996.
How does optometry growth compare?
Percent growth in degrees conferred 1986-2015 and male/female ratio of graduates in 2015 (Data complied from HEGIS Survey)
Dentistry +15%, 1.08 Medicine +15%, 1.09 Podiatry -6%, 1.58 Chiropractic -25%, 1.51 Veterinary +24%, 0.28 Optometry +47%, 0.50 *
* By 2020 total O.D. degrees conferred will be 85% higher than base year 1986 if enrollments remain at current level.
Click here to read AOA’s misinterpretation of the Lewin Group Studies. The Lewin Group studies are available for free only to AOA members.
For independent reviews of the Lewin Group findings please read
U.S. Dept. of Education, National Center for Education Statistics, HEGIS Survey, Division of Education Statistics, Table 324.50, May, 2017.
Review of Optometry was the first non-academic trade association to investigate the optometry surplus. Bill Kekevian, Senior Editor, takes a look at the issue while focusing on the impact on academic standards.
Until 1974 the Department of Veterans Affairs (DVA) lagged behind the Department of Defense in providing optometry care to its beneficiaries. But Congressional legislation, critical external reviews and the findings of a General Accounting Office investigation then set the stage for the development of a national DVA Optometry Service that now treats over one million unique patients per year utilizing some 700 optometry medical staff members while pioneering and now operating 81 optometry resident programs training 220 optometry residents each year in medical optometry, the only optometry specialty requiring postgraduate residency specialty training and passage of a national specialty examination that leads to national board certification in medical optometry.
The following article from the web-based textbook Optometric Care within the Public Health Community published in 2010 describes how those reforms in DVA optometry care mirrored those reforms used to achieve other signal improvements in DVA medical care.
Public Health and the Department of Veterans Affairs (This is the full article)
Development of Medical Optometry Within the VA (Pages 1-5 and 16-28 from above)
The author (Kenneth J. Myers, Ph.D., O.D.) served as founding director (emeritus) of the DVA optometry service, 1974-1989 and is founding director of the American Board of Certification in Medical Optometry.
In his most recent paper, The Future of Optometric Education – Challenges and Opportunities, Dr. Charles Mullen gives an overview of the major issues faced by optometric education along with recommended actions to address each one. The links below will take you to specific sections in the paper.
Formed in 2009, the American Board of Certification in Medical Optometry is now recognized by credentialing committees at over 100 Joint Commission accredited medical facilities across the nation that have appointed ABCMO certified optometrists as specialists in medical optometry rather than general practice.+ Specialists hold Level 2 credentials after completing an accredited specialty residency, passing a national specialty examination and certification by a recognized specialty board.
This acceptance of ABCMO certification established medical optometry as a recognized specialty and resulted from its adoption of specialty requirements analogous with those required of specialists in medicine, osteopathy, dentistry and podiatry.
Accredited medical facilities recognizing ABCMO specialty certification include:
ABCMO has now certified 418 optometrists to date, of which over half are members of the medical staff at accredited federal hospitals and clinics.
The typical ABCMO certified optometrist is an AOA member, Fellow or Section Diplomate of the American Academy of Optometry, faculty at an affiliated school of optometry and medical staff member at a Joint Commission accredited medical facility (federal and state).
Joint Commission accredited facilities conduct mandatory re-credentialing reviews of their medical staff and now require verification of ABCMO certification during credentialing reviews.+
With 24% of optometry school graduates completing specialty residencies other nascent specialties may soon seek recognition. The American Board of Optometry Specialties, sponsored by ABCMO, is prepared to assist in their development.
Note: While medical optometry residencies began at Veterans Affairs hospitals, optometrists completing accredited residency training in medical optometry at schools and non-VA facilities may apply for ABCMO certification. About 35% of ABCMO certified optometrists did not train, or practice at a federal medical facility. This percentage will continue to increase with the growth of non-VA medical optometry residencies.
In 1946 the VA was first directed by Congress to establish medical residencies but VA optometry residencies for optometrists did not begin until 1975.
Congress realized in 1945 VA hospitals were ill prepared to care for the large numbers of WWII veterans and authorized building new VA hospitals affiliated with medical-dental-nursing schools, higher pay schedules and VA student intern and residency training programs for physicians, dentists and nurses. Today the VA is the largest component for training interns and residents in the country via its teaching affiliations.*
Unfortunately the 1946 VA modernization did not include optometry staff or affiliations with schools of optometry that continued to lack access to medical facilities, even at universities with medical and optometry schools and a nearby VA hospital.
To be fair, optometry’s isolation from hospital-based training was due to both its fear of being absorbed by medicine and a now expired AMA decree barring physicians from taking part in optometry training. In 1970 the VA still employed but 9 elderly Civil Service optometrists and had no optometry school affiliations but did have backlogs of veterans seeking eye care. Studies by schools of optometry, the American Optometric Association and the U.S. General Accounting Office documented VA lacked optometry staff, equipment, teaching affiliations and adequate salaries; the same conditions that had existed in 1945 for VA medical, dental and nursing care before VA modernization.
As in 1946, Congress responded to those findings by enacting legislation in 1976 that authorized a VA Optometry Service, transferred VA optometrists from Civil Service to the VA Medical-Dental salary scales and mandated optometry teaching affiliations; actions mirroring those of 1946 for VA medical, dental and nursing programs. As a result VA optometry care rapidly increased in quality and availability.
In 1975 the Kansas City VA hospital affiliated with the U. of California at Berkeley School of Optometry to create the first hospital optometry residency in the nation, training optometrists for hospital-based practice, a new area of optometry training.
That residency proved so effective other VAs developed optometry residencies and optometry student intern rotation programs expanded with them. (The first student rotations began in 1973 at the Birmingham VA hospital in affiliation with the University of Alabama, at Birmingham, School of Optometry.)
Today 70% of optometry students complete at least one VA rotation before graduation and the VA now has over 725 full-time optometrists on its medical staffs; operates 86 optometry residency programs training 215 optometry residents per year and VA optometry clinics have over 1.4 million unique patients enrolled.
At its annual meeting in 1998 the National Association of VA Optometrists (NAVAO) decided a standardized examination to test the competency of those completing VA optometry medical optometry residencies was a high priority.
NAVAO believed this specialty examination would address concerns of the VA Office of Academic Affiliations that while VA residencies in medical optometry were popular and accredited, there was no quantitative measure to assess the competence of those completing them. And, after extensive meetings between NAVAO and the National Board of Examiners in Optometry (the profession’s independent testing body utilized by optometry schools and state licensing boards), a joint working committee developed the written specialty examination, “Advanced Competence in Medical Optometry” (ACMO), first administered in 2005 and thereafter annually.
The ACMO examination was the second step in developing medical optometry as a recognized specialty, and is a metric by which the VA, optometry schools, and ABCMO can assess medical optometry residency programs at VA and non-VA facilities.
While the majority of VA residency programs emphasize medical optometry, there are others that emphasize “low vision” and “vision rehabilitation” that can be expected to develop similar examinations and certifying boards in the future.
ABCMO organized in 2009 to certify optometrists who completed an accredited postgraduate medical optometry residency at an accredited medical facility, passed the ACMO examination and met other professional requirements. Establishing ABCMO allowed medical optometry to meet all three requirements of a recognized specialty—Specialty Residency, Specialty Examination, Specialty Board certification.
This process took 34 years and required close cooperation between the VA, the nation’s schools of optometry and the profession’s residency accrediting body.
While a slow process, thirty-four years was also typically the time required to establish specialties in medicine and dentistry.
In return for its support the VA has benefited from team delivery of eye care, better relations between medicine and optometry, reduced waiting times and creation of a national pool of hospital-trained optometrists from which it can recruit. A higher percentage of VA medical optometry residents practice in the VA than any other specialty. For example, the current national Director of the VA Optometry Service completed a VA residency, served as a VA staff optometrist and a VA Optometry Section Chief prior to appointment in Central Office.
Specialty boards began to appear first in medicine as it broadened in scope to the extent a physician with an internship after graduation, could not be competent in all areas. The first specialty organized in 1930. With time, specialties formed coordinating bodies to develop uniform standards for residency training, specialty examinations and certification boards. Early boards had “grandfather clauses” to allow older practitioners to be certified without serving a residency; these usually expired within 5-years of the board’s creation. Certifications were life-long but today many certifications expire after 10 years with re-certification required via programs of Maintenance of Certification.
The system for training and certifying medical specialists developed at clinical facilities and arose sui generis, rather than by fiat from medical schools or state licensing bodies (the latter play no role in certifying specialists). The current coordinating body for allopathic physician specialists is the American Board of Medical Specialties (ABMS).
Five prescribing health professions [allopathic-osteopathic Medical Doctors, Dentists, Optometrists and Podiatrists], are classified by the Centers for Medicare and Medicaid as “Medicare Physicians”.
This is the peer group into which optometry credentialing must be compatible with as federal medical agencies use one, standardized qualification credentialing form for them.
In this credentialing system Medicare Physicians holding a state license are credentialed as general practitioners of their profession [Level 1 credentials]; Specialists, by completing a postgraduate specialty residency, passing a specialty examination and being certified by a specialty board hold Level 2 credentials. Sub-specialists, have fellowship training within a sub-specialty recognized by their specialty board and hold Level 3 credentials.
Most (90%) allopathic and osteopathic physicians hold specialty certifications but considerably fewer of the other three Medicare Physician are specialists because their state licenses already limit their scope of practice. Optometry has one specialty board.
Medical and osteopathic physicians, dentists, podiatrists and optometrists have separate, independent governing bodies for their specialties but share in common these key requirements for recognizing specialists:
At this time there are over 30 recognized specialty certifying boards for allopathic physicians, 18 for osteopathic physicians, 9 for dentistry, 1 for optometry and 6 for podiatry.
Sub-specialists are credentialed by the specialty board of which they are a certified specialist after serving a fellowship in the sub-specialty.
Optometry educators have identified 11 areas suitable for specialization but only medical optometry has accredited residency programs, a standardized specialty examination (ACMO) and a specialty board recognized at Joint Commission accredited hospitals. Approximately 8% of optometrists practice within those accredited medical facilities.
While optometry’s legal and educational scope of practice have continued to widen, its national organization has seemed reluctant to endorse specialization although over 20% of graduates pursue specialty residency training. But specialization among the other licensed health professions has taken place with Pharmacy one example.#
In 1986 a committee of the American Optometric Association proposed guidelines by which a specialty could be recognized by non-profit specialty boards external to the AOA. But its House of Delegates voted against approving this and the AOA still has no policy on optometry specialties. ABCMO choose to align with those AOA guidelines and those of recognized specialty boards in medicine, osteopathy, dentistry and podiatry.
Earlier, the American Academy of Optometry in 1984 had examined the issue of specialization and certification and its Executive Committee concluded “being a fellow in the Academy” or a “section diplomate” did not constitute certification of clinical competence as they were “knowledge based” rather than “competency” based.
ABCMO therefore has had to emerge independently (like early medical specialty boards) and establish recognition by its acceptance at Joint Commission accredited health facilities as a Level 2 credential within the “Medicare Physician” credentialing system.
In summary, the three levels of staff appointments made at Joint Commission accredited health facilities for “Medicare Physicians” are:
+ The Joint Commission (formerly Joint Commission on the Accreditation of Health Care Organizations) is the recognized gold standard of health care facility accreditation.
* The Dept. of Veterans Affairs and Department of Defense (DOD) are separate Federal Agencies. VA cares for those discharged from active duty while DOD health systems care for active duty personnel and dependents. Retired military personnel are eligible for care from the VA or DOD.
# Though not considered “Medicare Physicians”, the Board of Pharmacy Specialties was organized in 1976 as an independent agency of the American Pharmacists Association and it recognizes five areas of specialty pharmacy practice: Nuclear Pharmacy, Nutrition Support Pharmacy, Oncology Pharmacotherapy and Psychiatric Pharmacy.
The factors and legal background leading to the formation of ABCMO and its credentialing standards are detailed at these links:
These links provide perspective and supplemental material explaining the ABCMO mission, why VA pioneered medical optometry residencies and the agreement of ABCMO criteria with standards and requirements of specialty certifications in medicine, dentistry and podiatry.
The majority of optometrists are in private practice for which the legal requirements are an O.D. degree from an accredited school or college of optometry and valid, current state license to practice optometry. The states, not the Federal Government issue licenses to physicians, dentists, optometrists and podiatrists as well as to non-medical practitioners (insurance agents, realtors, barbers, brokers, opticians, beauticians, etc.) State licensing boards do not regulate specialists other than requiring them to hold a state license.
Prior to WWI the majority of physicians were in private practice and had completed a one-year internship. Their training was geared to the solo practice of general medicine. With the spread of hospitals and beginning development of medical specialties, some young physicians sought specialized training by spending time with a hospital-based mentor.
One of those physicians was W.J. Mayo of Rochester, Minnesota who set aside time each year to study with an expert in a specific area. In 1894 he visited the new school of medicine at Johns Hopkins University, in Baltimore, where he met Dr. William Osler. Johns Hopkins was held as an example of how modern medical schools should be organized and had adopted the German style of medical education where permanent “chiefs” ran specialty clinics at which recent medical school graduates “resided” to study a specialty.
Dr. Mayo, impressed by this system, joined others in endorsing the Johns Hopkins model and adopted it for what is now the respected Mayo Clinic System. From this developed the “residency” training model. The Mayo Clinical System was among the first to accept ABCMO certification.
These residency “rules” were first established at Johns Hopkins:
The “voucher of specialist competence” was a letter from the residency “chief” attesting to a resident’s competence which evolved into a specialty certification process.
Medical doctors are free, once granted their medical degree and license (which requires serving an internship of 1-2 years after graduation) to establish the type of private medical practice they wish, without completing postgraduate training in a specialty. At one time most physicians did not specialize after their internship and established general practices (GP). Today 90% of medical and osteopathic physicians complete a specialty residency and general practice itself is a specialty.
Prior to about 1950 physicians who did not wish to be a GP would list their practice as “limited”. For example, “oculists” were physicians limiting their practice to the eye while others limited their practice to specific organ(s) or diseases. These physicians had not served specialty residencies but had usually stressed those areas while an intern.
After WWII large numbers of young M D.s who served in the armed forces, upon returning home took advantage of the new G.I. Bill to pursue a specialty residency (or attend medical school) and more hospitals began to be built and the country M.D. who once did surgery in the office (or patient’s home) were becoming the minority. Meanwhile early medical insurance plans were forming around larger cities and industrial concerns.
The first specialty to establish board certification after residency was ophthalmology in 1930 to distinguish its practitioners from G.P.s, oculists, EENT doctors, optometrists, opticians and “doctors” who at that time sold mail-order patent medicines that “dissolved cataracts” or “treated” eye weakness.
But until about 1980 the majority of physicians operated private, independent practices, while holding hospital privileges to admit patients for more complex conditions or procedures. In those times the primary purpose of specialty board certification was to signal to their colleagues their area of expertise to enable referrals.
With the advent of vertical integrations of medical care, public media advertising of health care as a commodity delivered by “providers”, insurance panels, and patients being thought of as “customers” to which TV ads pitched cures, health care changed dramatically and became a fungible business commodity. Its delivery was concentrating around hospitals, HMOs and large group practices and new physicians were becoming employees of them. Growing numbers of specialty procedures became performed only at hospitals or large group practices. The public and insurers became malpractice sensitive, particularly hospitals which used credentialing and privileging for quality control.
Physicians who once had no difficulty in obtaining hospital privileges without being board certified are now often unable to receive privileges. The new specialty of “hospitalist” developed for physicians practicing only within a hospital have no private office but coordinate the care by other specialists within hospitals.
The prime drivers of board certification have become hospitals for quality control purposes while the general public is only vaguely aware of its meaning.
While board certification is almost mandatory for medical physicians, it is of lesser importance to dentists and optometrists in general practice for which state licensure is the main requirement and hospital privileges not needed.
Podiatrists are affected to the extent they increasingly need to admit patients to hospitals for surgical treatment of below-the-knee conditions and diagnostic scans and tests and have moved, beginning in the 1970s, towards requiring residency training for state licensure. Many of their residency programs also began within VA medical centers and clinics and their utilization within the VA medical system was expanded by the same legislative initiatives applied to optometry in 1976 and equally successful in improving VA care.
Dentists have continued to perform most of their surgical procedures within their private or group offices but have established specialties and board certification programs. Most dentists are in general practice however, have not served residencies and are not board certified in general dentistry.
The majority of optometrists, like dentists, remain in private general practice without need to admit patients to a hospital. The specialty of medical optometry is predominately practiced within accredited medical facilities, optometry-ophthalmology eye centers, group optometry practices and rural optometry practices.
To Err is Human: Building a Safer Health System. Institute of Medicine, National Academy Press. Washington, D.C. ISBN 0-309-06837-1.
The Doctors Mayo, Garden City Publishing Co., Inc. Copyright 1941 by the University of Minnesota.
History of the American Academy of Optometry, James R Gregg. 1987.
Organizational Issues in Health Care Management, Alan Shelton. Spectrum Publications, Inc. 1975.
History of the VA Department of Medicine and Surgery. VA Central Office Library, Washington, D.C.
Bulletin from the Commission On Optometric Specialties, #106, May 29, 1986. AOA St. Louis Office.
The American Board of Certification in Medical Optometry (ABCMO) confers a specialty board certification for optometrists who have completed an ACOE accredited residency in medical optometry, passed the advanced specialty examination “Advanced Competence in Medical Optometry” administered by the National Board of Examiners in Optometry and met additional requirements specified in the ABCMO Bylaws. It is the only optometry specialty board certification available and congruent with recognized specialty boards in medicine, osteopathy and dentistry.
The following medical facilities have utilized ABCMO to verify specialist status in medical optometry. However, this list should be viewed as a sample only because it does not include requests for verification of certification from private practice offices.
DVA Birmingham, AL
DVA Fayetteville, AR
DVA Tucson, AZ
DVA Wilmington, DE
DVA West Palm Beach, FL
DVA Chicago, IL
DVA Honolulu, HI
DVA Baltimore, MA
DVA Detroit, MI
DVA Battle Creek, MI
DVA St. Louis, MO
DVA Salisbury, NC
DVA Manchester, NH
DVA East Orange, NJ
DVA North Las Vegas, NV
DVA Montrose, NY
DVA Oklahoma City, OK
DVA Roseburg, OR
DVA Columbia, SC
DVA Fort Meade, SC
DVA Memphis, TN
DVA White River Jct., VT
DVA Puget Sound, WA
DVA Walla Walla, WA
DVA Milwaukee, WI
South East Alaska Regional Health Consortium, AK
Indian Health Service, AZ
Indian Health Svc., Chinle, AZ
Indian Health Svc., NE Tribal Health, Sys., AZ
Indian Health Svc., Tuba City, AZ
Tuba City Regional Health Care, AZ
Indian Health Care, Inc., Banning, CA
Naval Hospital, Camp Pendleton, CA
Sanford Health Care, CA
U. of Iowa Hospitals and Clinics, IA
Wheaton Franciscan Healthcare, IA
Eye Specialists of Indiana Surgery Center, IN
Indiana U School of Optometry, Indianapolis Clinic, IN
Henry Ford Hospital System, Detroit, MI
Mayo Clinic, MN
Western Physicians Providers Inc (PHO), NE, SD, WY
Stony Brook Medicine, NY
Indian Health Svc., Lawton, OK
Northeastern State U College of Optometry, OK
Conemaugh Memorial Center, Johnstown, PA
Air Force Credentials Verification Office, TX
Gundersen Health Care, WI
Gunderson Lutheran Health Svc., WI
The Joint Commission is the recognized accrediting body for federal and state-chartered medical facilities.
At Joint Commission accredited medical facilities a required, standardized credentialing policy is the basis on which appointments to the medical staff, written clinical privileges and other responsibilities are individually assigned to licensed medical and osteopathic physicians, dentists, optometrists, podiatrists and chiropractors. These six professions thus undergo the same credentialing process and standards and are referred to as Medicare Physicians by the Centers for Medicare and Medicaid for billing and other purposes.
Licensed practitioners other than this group of six are credentialed and assigned clinical privileges under separate, differing standards at Joint Commission accredited medical facilities and bill Medicare and Medicaid via different code groups.
This article explains how credentialing and privileging of this “group of six” is done, their three possible levels of privileging (general, specialty and subspecialty practice) and the role of the American Board of Certification in Medical Optometry (ABCMO) in credentialing optometrists practicing at Joint Commission accredited medical facilities.(1)
U.S. Department of Veterans Affairs medical facilities are the largest single employer of optometrists and each VA medical facility is individually Joint Commission accredited. The VA credentialing document for these six prescribing health professions listed above can be found at the end of this article.
Because the great majority of optometrists practice in private, independent offices not part of medical facilities, they are not as conversant with the credentialing process at Joint Commission medical facilities as physician, dental and podiatry colleagues.(2)
Approximately 5% of optometrists practice within Joint Commission accredited federal and state-chartered HMOs, hospitals, clinics and other medical facilities where credentialing and privileging of practitioners follow uniform established policy. While accredited medical facilities require the professional degree and an active state license they, in addition, carefully review each applicant’s post-professional degree training, if any, other pertinent credentials and previous clinical experience and privileges.
At Joint Commission accredited medical facilities, applicant physicians, optometrists, dentists, podiatrists and chiropractors undergo identical scrutiny by credentialing committees and complete identical application forms. The chief purpose of this process is to best assign clinical privileges and responsibilities congruent with each applicant’s global education, training and experience.
A first step in credentialing requires each applicant physician, optometrist, podiatrist, dentist or chiropractor to state whether they are applying as a general practitioner of their licensed profession, a specialist or sub-specialist in an area of their licensed profession.
The three levels of privileges granted at JC accredited medical facilities are:
This essay explains the credentialing system at JC accredited medical facilities and the distinctions between credentialing as a general practitioner, specialist or sub-specialist, and the role ABCMO plays in this credentialing process.
This national accrediting body, organized some 80 years ago, accredits over 18,000 federal and state-chartered health care organizations that include hospitals, medical centers, HMOs, home care agencies, and health clinics. Approximately 85% of US medical facilities are accredited by the Joint Commission and its accreditation is the “gold standard” and a prerequisite for Medicare-Medicaid participation and billing.
The Joint Commission does not accredit, or hold jurisdiction over, private independent offices. For this reason, private practice optometrists are generally unaware of its credentialing policies unless they apply for privileges at a JC accredited medical facility.
The Joint Commission led in requiring hospital physicians performing more complex procedures and diagnostic tests to have postgraduate specialty residency training and specialty board certification. This phased out the once common practice of permitting general practitioners (Level 1 credentialed) to perform specialty procedures and tests within hospitals and accelerated the growth of specialty residencies and board certification in medical specialties. Later, specialties requiring residency training and certification developed in dentistry, podiatry and optometry in that chronological order.
Private, independent offices not falling under Joint Commission jurisdiction can, and do, offer any procedures falling within the licenses of their providers irrespective of whether these are specialty procedures that require a specialist to provide if done at an accredited medical facility.
At inception, Joint Commission policy limited hospital medical staff membership and awarding of written clinical privileges to physicians and dentists. Privileges for other clinicians were then set by that medical staff and varied widely. Osteopathic physicians, podiatrists and optometrists were generally refused medical staff membership and medical privileges. For this reason, osteopaths once had to maintain their own hospitals to obtain hospital privileges but, over time, identical licenses to “practice medicine” became issued to M.D. and D.O. holders and both are considered, by state laws, to be physicians and often practice together at most medical facilities.
In 1986, Joint Commission policy expanded to permit optometrists and podiatrists to be elected members of the medical staff and hold clinical privileges permitted by their state license and the medical facility. Joint Commission policy guidelines now require physicians, dentists, optometrists, podiatrists and chiropractors be credentialed under identical standards. Application for Physicians, Dentists, Podiatrists, Optometrists & Chiropractors – VA Application Form 10-2850 (PDF).
There are now 74 recognized specialties in medicine, osteopathy, dentistry and optometry that require specialty residency training, passage of a specialty written examination and board certification in the specialty. The first medical optometry residency was established by the VA in 1975. By 2005 the National Board of Examiners in Optometry, in cooperation with the National Association of VA Optometrists, began administering a national, standardized specialty examination, Advanced Competence in Medical Optometry (ACM0), and in 2010 ABCMO began offering board certification in the specialty medical optometry.
After 2010, credentialing committees at Joint Commission accredited facilities began credentialing optometrists certified by ABCMO as specialists in medical optometry.
Joint Commission policy governing credentialing of allopathic and osteopathic physicians, dentists, podiatrists, optometrists and chiropractors and the levels of credentials granted them is uniform across accredited medical facilities.
These 6 providers, or “Medicare Physicians” as termed by the U.S. Centers for Medicare and Medicaid, are considered a subgroup of those providers referred to as “Licensed Independent Prescribers”.
In addition to undergoing the same credentialing and privileging process at Joint Commission facilities as physicians, an optometrist is subject to periodic record and peer reviews, professional performance reviews and ongoing (usually biannual) confirmations of licensure and advanced specialty credentials. They must also periodically furnish their self query results from the National Practitioners Data Bank of any adverse actions taken against them as well and continue to meet the licensure renewal requirements placed on private practice optometrists by the state optometry board that issued their license.
Another difference from private practice is that a medical facility optometrist can seek clinical appointment in the general practice of optometry or, if qualified, as a specialist. (Step #2 in VA Form 10-2850). Optometrists who have completed accredited residency training in medical optometry, passed the NBEO examination Advanced Competence in Medical Optometry and hold ABCMO certification become eligible for appointment as a specialist with attendant potential for increased responsibilities and advancement.
The current credentialing system, with its three levels of credentialing for physicians, dentists, optometrists, podiatrists and chiropractors* at Joint Commission accredited medical facilities is uniform across the nation and defined as follows:
When seeking appointment at a Joint Commission accredited health facility, an ABCMO certified optometrist can be credentialed and privileged as a general practitioner of optometry or a specialist board certified in medical optometry.
Joint Commission policy requires certification of specialists be affirmed on a regular basis, usually every two years, and ABCMO provides this confirmation of certification for specialists in medical optometry as described in Article 22 of its bylaws.
Joint Commission accredited medical centers limit use of “board certified” and “specialist” to describe physicians, dentists, optometrists, podiatrists and chiropractors* holding Level 2 credentials.
However, some practitioners with Level 1 credentials state they are “board certified”.
As the scope of medical care broadened after the 1920’s, hospitals (with support of medical and public health societies) began to limit hospital-based specialty procedures to physicians with residency training in them. The Mayo Clinic and John Hopkins Medical School were early leaders in developing residency training in medical specialties. Today, about 85% of physicians (allopathic, osteopathic) are board certified in recognized medical specialties. By contrast, the first hospital residency program for optometrists began much later, in 1975, at a VA hospital, although today about 20% of optometry graduates elect to enter residency training in a specialty of optometry (the Association of Schools and Colleges of Optometry lists 11 specialty residency types).
While board certification in a specialty is not required for the independent, private practice of the 6 medical professions discussed, most physicians are board certified specialists in order to hold privileges at Joint Commission accredited medical centers.
The same is not the case with dentists, optometrists, podiatrists and chiropractors because the majority of them, to varying degrees, are not affiliated with a Joint Commission medical facility and are in the general practice of their profession. As a result the use of “board certified” is chiefly associated with physicians.
A few physicians with Level 1 credentials refer to themselves as “board certified” but have not served an accredited specialty residency nor is their “specialty” recognized by the medical or osteopathic professions. Their postgraduate training may consist of training and seminar sessions in their “specialty” instead of residency training in them. One example is the recognized specialty of plastic surgery vs. the non-recognized specialty of cosmetic surgery.
For some years a number of general practice optometrists have portrayed themselves as “board certified in optometry” which, they may claim, is from having been issued a license to practice optometry or from having passed the examinations required for graduation from optometry school. But a license and passage of those examinations are required of all optometrists to enter practice and they are not equivalent to specialty residency training and passage of a written specialty examination. They, like all other practicing optometrists who have not specialized, hold Level 1 and not Level 2 credentials and credential as general practitioners of optometry.
More recently the American Board of Optometry and the National Board of Examiners in Optometry established board certifications for general practice optometrists that, while, differing in requirements, do not require serving a residency in general practice nor passing a specialty examination and do not claim to be specialty boards. Thus these credentials are voluntary, additional continuing education for general practitioners and are of merit, but are not specialty board certifications as understood by credentialing committees at Joint Commission accredited medical facilities.
Other Level 1 general practice optometry education programs of merit are the annual Optometric Recognition Program of the American Optometric Association (begun in 1986) recognizing completion of annual CME in excess of that required for license renewal and election as a Fellow of the American Academy of Optometry (founded in the 1920’s). About 10% of practicing optometrists are Fellows of the Academy and are entitled to place FAAO after their name.
The American Board of Certification in Medical Optometry, a nonprofit, is the only recognized specialty board in optometry at this time although additional specialty boards will be established since 20% of optometry graduates enter specialty residencies.
Organized in 2009, ABCMO provides a Level 2 credential that requires completion of an accredited residency emphasizing medical optometry, passage of the national examination Advanced Competence in Medical Optometry administered by the National Board of Examiners in Optometry, practice of the specialty for a minimum of 2-years in an appropriate setting and meeting other specifics listed in ABCMO Bylaws. It has taken 40 years to establish a process equivalent to those used to train and certify specialists in medicine, dentistry and podiatry. A prime supporter continues to be the U.S. Department of Veterans Affairs, Office of Academic Affiliations which first offered these residencies in order to prepare optometrists for hospital practices.
Since 2010, 412 ABCMO certified optometrists have been credentialed as specialists in medical optometry at federal, Joint Commission accredited medical facilities (VA, DOD, US Public Health and Indian Health Service) and at Joint Commission accredited state-charted medical facilities, among them the Mayo Clinical Health System and Henry Ford Hospital System, or utilized as specialists in medical optometry at private optometry and medical group practices.(3) The majority of them hold faculty status at an affiliated school of optometry or school of medicine, are Fellows of the American Academy of Optometry and members of the American Optometric Association.
Verification of ABCMO certification can be obtained by visiting the ABCMO website and following the procedures specified in bylaw Article 22. Click here for ABCMO certification verification.
(1) At this time chiropractors are credentialed at only Level 1.
(2) Formerly the Joint Commission on the Accreditation of Health Care Organizations.
(3) This represents 1% of licensed optometrists in 2015.
* A physician is defined as one holding a state license to practice medicine and includes allopathic and osteopathic medical providers.
The great majority of medical optometry residencies are funded and operated within U.S. Veterans Administration medical facilities which are accredited by the Joint Commission with their optometry residency programs accredited by the Accreditation Council on Optometric Education via their academic affiliations.
The standard joint agreements between VA medical facilities and their affiliated schools of optometry specify VA medical facilities retain responsibility for the administration and supervision of its residency programs and the patient care rendered by optometry residents.
All Joint Commission accredited medical facilities with residency training programs in medicine, dentistry, optometry and/or podiatry, whether at VA or other sites, are required to meet Joint Commission regulations on residency supervision. In addition, medical facilities billing Medicare must meet Medicare requirements on the supervision of residents and the type of care they may independently provide.
These regulations, as they apply to VA residents, are ably summarized by the Veterans Health Administration Office of Academic Affiliations in the “Pocket Card” linked below.
ABCMO requires medical optometry residents based at Joint Commission accredited medical facilities be supervised per these regulations as they represent current “best practices”.