BY INVITATION ONLY
Optometry is at a crossroads, and optometric education is positioned to help guide how optometry will thrive in the coming years. It is time for a new discussion of the state of the profession, its future, and the best way for optometric educators to prepare students for that future.
TOPICS TO BE DISCUSSED:
Quality & Quantity:
Until a decade ago, there were 17 US schools and colleges of optometry, and the newest of those was 25 years old. In 2013, three new institutions graduated their first classes, and three more programs have admitted students since then. Other institutions have either made public plans to start new optometric programs or have quietly inquired about doing so. As the number of institutions has swelled from 17 to 23, the national applicant pool to optometry has remained flat for most of those years and in fact decreased by 8% in 2017-18 compared to the year before. The availability and minimum competence of faculty members in optometry is an additional important consideration.
Scope Practiced vs. Scope of Practice:
The profession of optometry has expanded its scope from its “drugless profession” history across the past four decades. As individual states found legislative opportunity, scope expanded, first into the use of diagnostic pharmaceuticals, then into the use of therapeutic pharmaceuticals at various tiers (topical vs. oral, for example). Not surprisingly, ophthalmology and medicine has fought back, especially in the area of therapeutics. Optometry finds itself at a new threshold, including laser therapy, minor surgical procedures, and primary medical care, with some states already having granted optometrists privileges within these new scopes of practice. Indeed, some would argue that the demographics and changes within ophthalmology training will ensure that there will be continuing pressure for optometry’s scope to expand.
Schools and colleges of optometry are ethically bound to educate students to the highest scope of practice licensed in any state. That presents substantial difficulties when, for example, surgical and laser experience is needed in a state where that practice is not authorized; to date, the schools and colleges have managed to educate appropriately. How do we continue to provide the highest level of education while guaranteeing state licensing boards that our graduates have adequate knowledge, skills, and experience to practice at this highest level?
In contrast to education provided at optometry schools and colleges, the Lewin Workforce Study reported that only 20-35% of optometrists practice full-scope care. In the meantime, we have seen the rise in demand for optometrists in corporate settings that limit the ability of the employed optometrist to provide higher-level care. The emerging landscape is one where these highly educated graduates seek to practice at the highest scope, yet they are finding jobs at a reduced scope, essentially as refractionists who do cursory disease detection and regularly refer patients for advanced diagnosis and treatment. In addition, ophthalmology is increasingly hiring cost-effective optometrists. In multi-disciplinary practices, a residency-trained optometrist can practice full-scope care, although frequently under the watchful administrative eye of practice managers. Are we already a two-tiered profession or, if not, are we headed inexorably in that direction?
The cost of becoming an optometrist is already being labeled a bad investment by some sources (albeit using very questionable data). In 2013, an article in the New England Journal of Medicine showed a ratio of 1.3:1 (average student debt at optometry graduation compared to the median one-year income for an optometrist), with only veterinary medicine having a higher ratio at 1.6:1. How do we keep educating our students at the highest level, giving them experiences on the latest equipment and doing advanced procedures, while keeping the debt ratio at a manageable level?
Evolution vs. Inertia:
Many disciplines and businesses, including healthcare, have been affected by disruptive technology. Optometry is no exception. The experiences of other industries illustrate that it is probably futile to attempt to hold back all such technology. The concept of the only way for good service to our patients is through a comprehensive eye examination with a single doctor is unlikely to survive the next decade. How do we harness the technology and make eye examinations more efficient, maximize optometrist-to-patient contact time for communication rather than measurement, optimize medical care within our daily routines, and incorporate technologies, such as telemedicine, to help deliver eye care to those with limited access?
Other invasive technologies include the advent of social media. Optometrists can communicate with each other—for better or worse—in real time. They use social media to help with difficult cases; they also use it to complain about patients and the profession. Social media has not been fully harnessed by either advocacy or education efforts. Prospective students may glean negative information about the profession without any peer review of the points made or any access to dissenting opinions. How can the profession and its educational institutions successfully manage information in the age of social media and wide-ranging access to information of varying accuracy?