Off the Cuff: Students, Debt and the Future of Optometry was written by Arthur B. Epstein, OD, FAAO and Chief Medical Editor of Optometric Physician.
Part 1 – Off the Cuff: Students, Debt and the Future of Optometry
Student debt is a steadily escalating problem for health care professionals. It has gotten so bad that this past week, the NYU School of Medicine announced that it is waving tuition for all new and existing medical school students. Their action is in response to growing debt among young doctors and the trend away from lower-paying, but much-needed, primary care practice. The school reportedly views this as a public health issue. The hope is that other medical schools will follow suit.
Unfortunately, optometry doesn’t appear that fortunate or farsighted. To my knowledge, no optometric program is planning to wave tuition or even reduce it to more affordable levels. In sad fact, optometry school graduates have a higher debt-to-income ratio than any other health care professionals with an earning capability far lower than most. With even more new schools on the already crowded horizon, it’s difficult to not view additional optometry programs as predatory, preying on increasingly less-qualified students who have dreams of becoming a doctor.
For many of these young ODs, I fear that their dreams may quickly turn into a nightmare. The glut of new graduates will eventually exceed demand, if it hasn’t already. With continuing advances in technology and too many practices still mired in traditional refractive care, OD salaries are likely to tank while competition for a shrinking number of positions grows exponentially. More and more of these young ODs will be working just to pay off their student loans, and some may not be able to pay them off at all. If reimbursements drop to fuel Medicare for all, it won’t be pretty for any of us, but especially painful for young and in-debt grads.
Unfortunately, there is no simple answer. By the time the law of supply and demand kicks in, it will be too late. Some have suggested that we actively discourage prospective new ODs from pursuing optometry as a career. The only thing that will accomplish is to deprive the profession of a greater number of quality candidates rather than dissuade the poor ones.
Eventually, some existing schools will have to close and new ones not open, but that will never happen as long as there are students willing to pay, and schools are making money from minting new ODs. The one solution that would work and might actually save the profession is the hardest. Raise entry and training standards to almost painful levels. That would ensure qualified candidates and well-prepared ODs, and force the worst schools to close. Ultimately, the future of optometry lies in the hands of the AOA and its Accreditation Council on Optometric Education.
Off the Cuff: The Big Bang was written by Arthur B. Epstein, OD, FAAO and Chief Medical Editor of Optometric Physician.
Part 2 – Off the Cuff: The Big Bang
Over the past few months I’ve written extensively about my concerns for the future of our profession. This is an emotional issue and, as you might expect, has generated a good deal of comment. In fact, no topic has ever generated more email with the exception of the very divisive topic of board certification—or what we call board certification.
From colleagues across the country, the general consensus—with virtually no dissent—has been that we have too many schools, too many graduates and a profession that, if it doesn’t right itself will soon, be in serious trouble. Rarely have I seen so many on the same page on a single issue. Unsurprisingly, some in academia don’t see these concerns in the same way and have taken my comments as personal attacks on their institutions or have convinced themselves that I have declared a holy war on optometric education. Nothing could be further from the truth.
Here is the truth as I see it. Every academic institution has an inviolable duty to serve the public good by producing qualified, knowledgeable and skilled graduates. This starts with the admission process where entering students must be selected that can be molded into capable clinicians and successful practitioners. Our institutions have an obligation to the profession at large to responsibly plan for the needs of the public and ensure that its graduates can achieve professional success and financial independence. Ideally, this process should be self-regulating, as it has historically been in other professions. Organizations such as ASCO, the AOA and the ACOE should approach with balance and transparency and discourage new and existing programs that fail to meet the needs of the public and the profession. The most recent ASCO/AOA optometric manpower study and its subsequent spin was neither balanced nor transparent.
Let me make it clear that I don’t think the problem is our new schools. The problem is too many schools. I recently visited Midwestern University Arizona College of Optometry, and I was honestly blown away by how the program has evolved and grown since its inception. Likewise, I have visited older programs that are excellent. Truth be told, some newer and some older programs have not kept up, and their continued existence should be in question. Common sense planning suggests that we clearly don’t need more than one program serving a single city or state unless there are truly extenuating circumstances.
Our organizations must take strong charge of controlling our profession’s future. That control starts with the number and quality of our educational programs. However, we all must have a voice in this. I am asking you to complete this simple open questionnaire about your perceptions regarding optometric education, the number of programs we have and need and of the quality of current optometric education. Let your voice be heard.