Dear Dr. Tulenko,
I am writing as President of the Association of Schools and Colleges of Optometry (ASCO), the academic leadership organization representing the twenty-one accredited schools and colleges of optometry in the 50 states and Puerto Rico. Our member institutions educate and train the nation’s Doctors of Optometry. This letter is to take issue with several comments pertaining to optometry and health professions education made in your September 13, 2012, New York Times Op-Ed, “America’s Health Worker Mismatch.”
You refer to Doctors of Optometry as “therapists” and the profession as guilty of “credential creep.” The educational requirements for the Doctor of Optometry (O.D.) degree involve the completion of an accredited four-year post-baccalaureate professional doctoral program and have for more than 50 years. Indeed, doctors of optometry provide roughly two thirds of all eye care delivered in the United States. The construct of “credential creep” was inappropriately applied.
Erroneous facts notwithstanding, the effort to stimulate discussion of the challenge of meeting the country’s health care needs and developing a strong and properly deployed workforce is laudable. The Op-Ed’s emphasis upon caring for underserved populations both here and abroad is equally so. However, I believe that you confuse symptoms (credential creep) with solutions and mistakenly focus blame upon schools of the health professions.
While the central theme of the Op-Ed is the negative impact of migration by health professionals out of developing countries, you appear to sweep many non-MD providers in the United States along with your logic. You seem to infer that it is undesirable for non-MD providers (credential creep) to acquire the skills to render higher level care and that the solution is simply to expand enrollment in US Medical Schools. Doctors of Optometry, as well as other doctoral health care professionals including dentists, podiatrists, pharmacists, and others, have been rendering care for many years and yes, in many cases help to compensate for a shortage of primary care physicians. The quality of patient care outcomes by these providers has historically been high and I would suggest that rather than being a symptom of the problem, they are a part of the solution for meeting an increasing demand for health care in this country. The same may be said for the enhanced use and expanded privileging of ancillary personnel.
The effort to place the blame on health professions education programs for not simply expanding enrollment disregards a decades-long trend of decreasing public support for higher education in general and health care provider education in particular. Indeed, the reduction in public support has shifted escalating costs in health care and education onto the backs of students in the form of tuition. The high cost and high debt frequently dissuades well-qualified candidates from applying. It is often not a question of whether programs want to expand, but rather whether they can afford to. Notably, in spite of reduced public support, there has in fact been an expansion in the number of health professions programs in the United States over the past decade.
Finally, I would also share that Doctors of Optometry must be licensed by the state board of the state in which they wish to practice. All states either accept or require passage of the National Board of Examiners in Optometry examination or a combination of the national exam and a state-administered examination for licensure. Only graduates of the 21 schools and colleges of optometry in the U.S. and the two in Canada meet the accreditation criteria to be licensed in the United States. By lumping together health professions schools from a multitude of disciplines together and stating that “The same licensing system actually favors foreign-trained workers, who for various reasons, do not meet these degree requirements”, is untrue and misleading to your readers.
ASCO appreciates the opportunity to set the record straight regarding the applicability of the conclusions reached in your Op-Ed piece in the New York Times.
David. A. Heath, O.D., ED.M.
cc: Thomas Feyer, Letters Editor
New York Times