Q: Why consider board certification now?
A: Health care is evolving. The expectations of consumers, insurers, the government and other third parties are changing. Optometry must address the changes, or risk being left behind.
Currently, the general practice of optometry is the only prescribing doctoral-level health care profession that does not have a board certification process for the practitioner in general practice. While the College of Optometrists in Vision Development (COVD) administers a program that leads to board certification, there is currently no program for initial and ongoing measurement of competence beyond entry level for the OD ingeneral practice.
There is growing interest by managed care organizations and federal programs to address employer and patient inquiries regarding the quality of care offered. One option available to them is to consider requiring board certification for participation on a panel.
The health care community also is seeing new legislative initiatives. Legislation was introduced in Virginia was not introduced by the profession or by the legislature. It was introduced by a local AARP affiliate. These initiatives seek to ensure thathealth professionals have demonstrated ongoing competence.
Also, states have started to propose laws for study commissions to look at requiring board certification as a condition of license renewal. In 2006, as a result of proposed legislation, the governor of Washington created a work group thatis looking at requiring continuing competence for MDs. In Oklahoma, discussions were held in the 2008 legislature to require board certification ofpediatricians, though no action was taken.
Additionally, many organizations at the recent Optometry 2020 Summits chose preferred futures that were related to advanced competence and/or board certification.
So at this point, you have managed care organizations, federal regulatory agencies, state governments and the public all at various stages of working to ensure that health care is of high quality and that the costs are controlled. They all are recognizing that being able to demonstrate continued competence may serve as an important component of addressing these quality and cost challenges.
Q: Who is asking for board certification and why?
A: Consumers, managed care organizations, federal regulatory agencies, state legislatures, insurers, the government and other third parties are the driving forces behind this change.
Research and experience indicate that consumers want assurance that their doctor has maintained the knowledge, skills and experience necessary to deliver quality patient care. The Federal government believes a process like board certification can better ensure quality of outcomes (better quality of care) and thereby control health care costs. Third-party payers believe they can provide better care to their enrollees, control costs and capture more of the market with a program like board certification. Additionally, managed care organizations, state and federal regulatory agencies and patients are all working to find a way to control the cost and improve the quality of health care. They recognize that board certification may serve as an important component to address these issues.
Q: Is the AOA driving the Board Certification process?
A: No. This is a profession-wide effort with input and direction from representatives of six optometric organizations comprising the Joint Board Certification Project Team (JBCPT). This team is comprised of the American Academy of Optometry (AAO), the American Optometric Association (AOA), the American Optometric Student Association (AOSA), the Association of Regulatory Boards of Optometry (ARBO) the Association of Schools and Colleges of Optometry (ASCO) and the National Board of Examiners in Optometry (NBEO).
Representatives were appointed by these organizations to propose a model process for board certification for the profession to discuss and evaluate. None of the organizations involved has voted to adopt board certification. They have only voted to form a joint team to study the issue and propose a format that can be considered by the various stakeholders and then the profession. Although the AOA will likely have representation on any certifying board, just as the other organizations, the AOA will not be the certifying entity and will not control the process.
Q: What is the role of the Joint Board Certification Project Team (JBCPT)?
A: This is not a decision-making body. It is a project team charged with developing and proposing an attainable, credible and defensible model for board certification in optometry and maintenance of certification. The model will establish standards for voluntary board certification and maintenance of certification in the practice of optometry and will communicate information about these standards to support the public’s quest for high quality health care. The model process for board certification proposed by the project team will be evaluated by each of the professional organizations that will then decide whether to approve or reject it.
Q: What sort of background work and research has been done to help the JBCPT begin to look at developing a framework?
A: The JBCPT studied over 3,000 pages of background materials including other health care board certification models, industry standards and pre-qualification requirements for third-party payers and managed care providers and various legislative initiatives related to continued competence. We also conducted a series of focus groups to provide additional insight and feedback to the project team during the development process.
Q: We have all sorts of levels of licensure and scope of practice now. Won’t this just make a bad situation worse?
A: Any board certification process that is adopted by the profession would be national in scope so that the federal government, managed care organizations, consumer advocacy groups and other concerned parties would have a single set of criteria for evaluating continued competence and quality of care optometrists deliver. It is important to note that board certification is not tied to licensure or scope of practice. Becoming board certified would not change state regulations or laws that are regulated by your state board and your legislature.
Q: Why use the term “board certification?” Why don’t we use “advanced competence” or some other term?
A: We learned early on that the term “board certification” is the commonly accepted nomenclature used to denote continued competence in health care. It’s a term that the public knows and understands. It is also the common currency in the health care lexicon used to evaluate and demonstrate continued competence of a practitioner.
Q: Is the proposed model for continued competence similar to that of medicine, where there are requirements to be completed over a period of time?
A: We believe that it will be important for optometrists to have initial board certification and then maintenance of certification over the subsequent 10-year periods. We want optometry’s board certification process to be just as verifiable and just as credible as any in medicine. At the initiation of a process of board certification for optometry we would not have a residency requirement, but there is precedence for this in other professions. Moreover, since it is the maintenance of certification that is the real thrust of board certification, we can meet any other profession’s rigor, step for step.
Q: How many ODs do you expect would go through this process?
A: The process would be voluntary. Given that this is a profession-wide effort being undertaken by six optometric organizations with significant input from the profession, the expectation is that eventually the majority of practicing optometrists would become board certified.