Center for the Future of Health Professions April 2023 digest
Posted: April 25, 2023
The Center for the Future of the Health Professions will post its fourth monthly op-ed column for 2023. Our columns represent strong, informed, focused opinions on issues affecting the health professions’ future. As mentioned, the center was developed to provide state, local, and national policymakers and health system stakeholders with accurate, reliable, and comprehensive data and research about the healthcare workforce to effectively plan for a sustainable future and make the best use of available resources.
This month we feature a discussion on the future of the optometric profession by Dr. Taylor McMullen. Dr. McMullen is an optometrist working in the private practice modality. He received his undergraduate training from the Indiana University of Pennsylvania and earned a Bachelor of Science degree in natural sciences and mathematics in 2003. While an undergraduate, he spent a semester studying abroad at the University of Valladolid in Valladolid, Spain. He continued his education and earned a Bachelor of Science in vision sciences and a Doctor of Optometry in 2007 from the Pennsylvania College of Optometry. He founded Salt River Eye Care, PLLC, in 2012 and enjoyed seeing patients there. In addition to primary eye care, Dr. McMullen has extensive training in the diagnosis and treatment of ocular disease, as well as the management of ocular complications of systemic disease. He is active in his community and a member of the Arizona Optometric Association Board of Directors.
According to the U.S. Bureau of Labor Statistics, optometrists diagnose and treat visual problems and manage diseases, injuries, and other disorders of the eyes and work in standalone optometry offices. Optometrists may also work in doctors’ offices and optical goods stores. Some are self-employed. Most work full-time, and some work evenings and weekends to accommodate patients’ needs. Optometrists typically need a Doctor of Optometry (OD) degree and a license to practice in a particular state. OD programs take four years to complete, and most students have a bachelor’s degree before entering such a program. Employment of optometrists is projected to grow 10 percent from 2021 to 2031, faster than the average for all occupations.
About 1,700 openings for optometrists are projected each year, on average, over the decade. Many of those openings are expected to result from the need to replace workers who transfer to different occupations or retire and exit the labor force.
We look forward to your comments on this month’s digest.
Randy Danielsen, PhD, DHL(h), PA-C Emeritus, DFAAPA
Professor & Director
The Center for the Future of the Health Professions
A.T. Still University
The future of optometry through the lens of its past
Though not officially recognized in the United States until 1901,1 optometry can trace its roots back to 1263 when Roger Bacon, in his study of optics, described lenses as “useful to old persons and those with weak eyes.2 “Useful” is a great way to describe optometry. Throughout the last 122 years, this profession has sought to be useful to people.
When thinking of optometry, it is natural to think of eyeglasses and perhaps maladies like conjunctivitis or glaucoma. Before optometry existed, eyeglasses and disease were the domain of two different groups: opticians and oculists. While opticians were responsible for creating and fitting eyeglasses, oculists were concerned with diseases of the eyes.3,4 When fitting eyeglasses, the first step is refraction. Refraction is the process used to determine an optical prescription and the gateway to assessing the health of an eye. A healthy eye should achieve 20/20 vision. If an eye is incapable of 20/20 vision after careful refraction, then there must be another cause for the decreased acuity.5 The person performing the refraction is first to know if something is out of the ordinary; thus, optometry combines physics and physiology.
In 1901, Minnesota became the first state to pass legislation regarding optometry. This first law established the minimum educational requirements for the practice of optometry. Other states followed, and universities soon offered optometry programs with standardized curricula.6 However, the definition would have to expand only a short time after optometry was defined. An important step forward in scope expansion came during and after World Wars I and II. There were not enough enlisted ophthalmologists to treat the needs of soldiers and veterans. Optometrists began using diagnostic and therapeutic drugs under the supervision of physicians even though this was not allowed by legislation in any state. After leaving the service, these optometrists lobbied for the ability to continue practicing at that level.7 Thanks to their successful efforts in scope expansion, optometrists are now regarded as primary eye care practitioners. Indeed, “optometry delivers more than two-thirds of the primary eye healthcare in America, with doctors practicing in more than 10,176 communities.”8 Now training includes using diagnostic drugs to dilate pupils to obtain a better view of internal ocular structures. Training also involves using therapeutic drugs to treat conditions, including the many causes of conjunctivitis, inflammation like uveitis, and diseases like glaucoma. Filling a gap in access to healthcare is the primary driving force for optometric scope expansion. Medical school enrollment has increased, but residency slots have not increased at the same rate.9
As our population grows, so does the demand for refractive and medical eye exams. As a point of reference, let’s look at the time frame of 2015 to 2025. In that period, refractive eye exams are projected to increase by 3.2%, whereas medical exams are projected to increase by 31.5%.10 A 31.5% increase equals 16.3 million annual medical exams.10 Compare these figures to the number of full-time-equivalent optometrists and ophthalmologists joining the workforce. One calculation projects that the number of eye care providers in the U.S. will increase by 34 ophthalmologists per year while the number of optometrists will increase by 1,800.10 As things are currently in eye care, we face a real shortage of medical eye care providers. The easiest and least costly way to counter this is by expanding the scope of practice for optometrists because “99% of the U.S. population has access to a doctor of optometry.”8
Optometry education is standardized in the U.S., but the scope of practice for optometry is regulated at the state level. This means that many states need to allow optometrists to practice at the level they are trained to. Some of the minor in-office procedures that optometrists can perform are laser procedures and the removal of noncancerous eyelid lesions. These few items would decrease the patient load for surgeons, but optometrists are only legislated to practice at this level in a few states.11, 12
The patient need will ultimately determine the growth of optometry. Even with pandemic-related setbacks, increased access to healthcare and improved healthcare outcomes have been made in many states.13 The future of optometry lies in the hands of the people who, working tirelessly, seek to bring high-quality eye care to the people living in all 50 states.
References
1. Kekevian B. Senior. Legalizing Optometry. https://www.reviewofoptometry.com/article/legalizing-optometry
2. James RR. THE FATHER OF BRITISH OPTICS: ROGER BACON, c. 1214-1294. Br J Ophthalmol. 1928;12(1):1-14. doi:10.1136/bjo.12.1.1
3. Prentice CF. Legalized Optometry and the Memoirs of Its Founder. Casperin Fletcher Press; 1926. Accessed January 7, 2023. https://www.google.com/books/edition/Legalized_Optometry_and_the_Memoirs_of_I/MTWsAAAAIAAJ?hl=en&gbpv=0
4. John F. Amos O.D. A Summary of the Life of “The Father of Optometry,” Charles Prentice. Hindsight: Journal of Optometry History. 2022;53(1 & 2). doi:https://doi.org/10.14434/hindsight.v53i1&2.35648
5. 20/20 Vision | Cleveland Clinic. Cleveland Clinic. Published 2020. https://my.clevelandclinic.org/health/articles/8561-2020-vision
6. Taron A. A Fight for the Right to Learn. www.reviewofoptometry.com. Accessed January 7, 2023. https://www.reviewofoptometry.com/article/a-fight-for-the-right-to-learn
7. McAlister WH, Weaver JL, Davis JD, Newsom JA. Military Optometry from World War I to the Present. Hindsight: Journal of Optometry History. 2021;52(1):4-8. doi:https://doi.org/10.14434/hindsight.v51i3.31044
8. The scope of success. www.aoa.org. Accessed March 11, 2023. https://www.aoa.org/news/advocacy/state-advocacy/the-scope-of-success?sso=y
9. Boyle P. Medical school enrollments grow, but residency slots haven’t kept pace. AAMC. Published September 3, 2020. https://www.aamc.org/news-insights/medical-school-enrollments-grow-residency-slots-haven-t-kept-pace
10. Edlow R.C. The Future of Optometry in America. Modern Optometry. https://modernod.com/articles/2019-mar/the-future-of-optometry-in-america?c4src=article:infinite-scroll
11. Cooper SL. 1971 – 2011: Forty-year history of scope expansion into medical eye care. Optometry. 2012;83(2):64-73. Published 2012 Feb 15.
12. Kekevian B. Expanding Scope of Practice: Lessons and Leverage. www.reviewofoptometry.com. Accessed March 11, 2023. https://www.reviewofoptometry.com/article/expanding-scope-of-practice-lessons-and-leverage
13. Spiegle L. Scoping Out Optometry’s Next Era. www.reviewofoptometry.com. Accessed April 12, 2023. https://www.reviewofoptometry.com/article/scoping-out-optometrys-next-era