More Scope, more problems!

As an optometrist that has practiced in three different states over the past 30 years, I have lived through the many changes in our profession. I fully support the expanded scope of practice that OD's enjoy in many states these days, but with expanded scope comes expanded challenges for optometry schools.

1. Optometry school curriculums are packed already! Did you know that almost every school in the country has year-round school now for all students? Why? Because it became impossible to deliver the content that was needed in 3 years and still allow a full year for external rotations. The easy solution was to take away summer breaks and fill them with more content. I think you would be shocked to see the NBEO Content Matrix for the Applied Basic Science exam. I have often argued that this content exceeds the topic areas presented in any other medical profession. We expect our 3rd year students to be physicians, optical engineers, pharmacists, vision scientists and now surgeons! When do we squeeze this additional training into our programs?

2. There aren't enough patients to train students! Did you know that each optometry graduate sees about 1200-2000 patients prior to graduation? That's great, but what a challenge for optometry schools. How do they attract high volumes of patients and patients with the right eye conditions? The reality is that many schools don't have the patient load to support student experiences, so they send the students out to external sites early and more often to drive up the patient encounter numbers. This is a reasonable solution, but now how do the schools control the quality of the teaching experiences for their students at unpaid externship sites? It is very hard to expect a busy practitioner to teach and still run their practice.

3. There aren't enough surgical patients to train students! Now, as more and more states earn the right to perform surgical procedures, how do the schools meet the various legislated requirements. For example, if an OD must complete 5 SLT procedures under the supervision of a qualified physician, how would a school obtain 300 patients that need SLT's in one year for their class of 60 students? What if a student needs to perform 5 chalazion incision and drainage procedures? Do you have 300 patients waiting for the class? Do you see the challenge here? There isn't an easy answer here, but my opinion is that optometry school has to change. I think that optometry school may in the near future continue to be 4 years in length, but then there may be a required 1 year residency at the end. This would free up more time during the 4 years for delivery of more content and allow for more clinical experiences during a full year of residency. But, would this hurt optometry's already dwindling applicant pool? It might! The other option might be to go to two levels of licensure for OD's such as a refractive optometrist and a medical optometrist. Do you think anyone would be interested in separating into these two categories? I suspect they would not. So, when you see your optometric colleagues looking tired and stressed, please understand that they are facing some serious challenges each day. Was it Biggie Smalls that said, "More money, more problems"? Well, we have something similar, "More scope, more problems"!