AOA and AFOS: ‘Cut through the noise’ and empower licensed doctors of optometry to provide greater access to care to veterans

Call it a tour de force for AOA and the Association of Armed Forces and Federal Optometric Services (AFOS) advocates. Between a congressional hearing Sept. 19, a meeting with lawmakers and staff from both the House and Senate Veterans Affairs Committees Wednesday, and a recent VA listening session, they are unapologetically taking their fight to every corner—to supporters and naysayers alike over the VA’s creation of new national standards of practice.

The VA’s action could transform the scope of care doctors of optometry provide there.

The standard-bearer for optometry on Sept. 19 was Paul M. Barney, O.D., who appeared at the congressional hearing in Washington D.C., by the House Veterans’ Affairs Committee Subcommittee on Health.

Dr. Barney, a member of the AOA Board of Trustees and center director for the Pacific Cataract and Laser Institute in Alaska for nearly 25 years, didn’t come alone to the hearing, called “VA’s Federal Supremacy Initiative: Putting Veterans First?”

A contingent of 20 doctors of optometry from across the country showed up, on short notice, to support Dr. Barney and the AOA’s position that the new national standards of practice should confer greater authority to optometrists to provide care based on their education, training and licensure, a win-win proposition for veterans now facing wait times and delays in VA care and doctors who would be able to practice at their highest levels.

Among the supporters in person were doctors of optometry in private practice, AFOS members, AOA Advocacy Chair William Reynolds, O.D., and three members of AOA’s Board of Trustees.

The new standards for optometry have not yet been released by the VA. But anticipated changes have drawn fire from ophthalmologists—the very first witness at the subcommittee hearing was the president of the American Medical Association Jesse Ehrenfeld, M.D. The hearing was called by U.S.  Rep. Mariannette Miller-Meeks, R-Iowa, whose online profile states that she practiced ophthalmology prior to her election to the House.

During the hearing, Dr. Ehrenfeld called physician-led, team-based care “the gold standard of health care.” That triggered a prolonged discussion on the topic of the VA’s model of care and who should lead the team.

“The AMA strongly supports physician-led, team-based care,” Dr. Ehrenfeld said. “Nobody should be practicing in a silo.”

The physician leaders of the American Academy of Ophthalmology and the American Society of Anesthesiologists quickly agreed.

Responded the AOA’s Dr. Barney: “Yes, we support physician-led care. But, keep in mind, optometrists are physicians.”

Rep. Miller-Meeks later remarked in the hearing, apparently in response to Dr. Barney’s comment: “Doctor, be clear, I do not consider an optometrist a physician.”

Doctors of optometry have long been recognized by federal agencies as physicians. The Centers for Medicare & Medicaid did so in 1986. Optometrists also are referred to as physicians under the Federal Employees’ Compensation Act, as they are at rural health clinics and federally qualified health centers.

Optometry and the VA’s new national standards of practice

The VA’s national standards of practice would specify what services can be performed by various professionals in the VA, such as optometrists, nurses and physical therapists. The standards would be used by the VA to modernize its electronic health record.

Further, the VA is motivated by its status as a national health system. Under the VA, as long as doctors were licensed in one state, they were able to practice in any VA facility no matter the location in the country, according to the VA. It operated this way so its professionals would not be “unduly burdened” by state requirements as they moved between VA facilities, it has said.

The VA is currently collecting comments from stakeholders on the new standards. While in Washington, AOA and AFOS met with staffers for senators who authored a bipartisan bill seeking physician-level recognition, more competitive pay and advancement opportunities for VA doctors of optometry.

“I am so proud to be a part of an organization that can come together to fight for VA optometry and help ensure our veterans get the eye care they deserve,” said Lindsay Wright, O.D., AFOS executive director.

The AOA won’t settle for less.

“We’d hope the new standards would recognize the important work that optometry provides within the VA system,” AOA President Ronald L. Benner, O.D., says. “Our doctors should be able to practice at the highest level of their education and licensure.  

“Ideally the standards will say just that—VA optometrists will be allowed to treat their patients at the level granted to them by their state licensure,” Dr. Benner adds. “For those trained and licensed to do surgical procedures such as YAG, SLT and incisional procedures on the lids. Anything less than this would shortchange the VA and VA patients of necessary care and cause undue wait times and unnecessary visits for veterans.”   

Optometry puts veterans first

Dr. Barney masterfully presented optometry’s argument for increasing care for services they are licensed to provide, certain office-based surgical procedures and to help relieve VA staffing shortages and reduce long waits for care for veterans.

“America’s doctors of optometry are stepping up to fill that gap,” Dr. Barney testified. “Optometry’s training and abilities have continued to advance alongside the evolution of technology. Today’s rigorous four-year optometry school curricula focuses exclusively on the study of ocular health and vision care.

“At a time when VA is struggling to meet veteran demand for eye care, it is important that VA cut through the noise and do what is right for veterans by advancing an optometry (national standards of practice) that recognizes and ensures veteran access to the full range of care, including laser eye care and other contemporary procedures, that doctors of optometry are trained, licensed and fully able to provide,” he said.

In those 10 states where doctors of optometry are authorized to use lasers to treat ocular conditions, he said, there have been “little or no patient complaints.” (A few of the speakers at the hearings inferred that veterans would be harmed by allowing optometrists to provide laser care.) Dr. Barney noted that optometrists are licensed by states, each of which sets the laws and regulations for their licensure.

Doctors of optometry provide roughly three-quarters of all eye and vision care at the VA, with optometrists often being the only eye care provider at many VA medical sites.

“… What the department decides to include or exclude from the optometry National Standards of Practice will have an outsized impact on access and timeliness of care, which will affect patient outcomes, and veteran quality of life for years to come,” Dr. Barney said, noting that the AOA’s position had the support of AMVETS, a leading veterans service organization, which it voiced at the recent VA listening session.

AMA position

Dr. Ehrenfeld, noting that “no other health care professionals come close to the education and training that physicians receive,” said the AMA opposes the VA initiative.

After attacking optometry and asserting that the AMA is an authority on health care policy issues, Dr. Ehrenfeld faced withering questions from Rep. Derrick Van Orden, R-Wisconsin, a retired Navy SEAL and a leading advocate for veterans’ health care. Rep. Van Orden said he did not view the AMA as an unbiased authority and accused Dr. Ehrenfeld and the AMA of “playing politics with medicine. That’s not just dangerous. It’s terrifying.”

Rep. Jack Bergman, R-Michigan, a retired Marine Corps general, warned organized medicine not to focus solely on protecting their own “rice bowl,” a term he said was used in the Pentagon to denote prioritizing a specific narrow interest over the greater good.  

A third lawmaker, Rep. Jen Kiggans, R-Virginia, who is a former Navy helicopter pilot and nurse practitioner, added that the AMA comments regarding the care of non-medical doctor practitioners, such as nurse practitioners, being more costly and of less quality, were wrong and "offensive to me, personally.”

Added Rep. Kiggans: “We practice differently. We just do.”

What optometry’s advocates can do

The AOA will continue working on this issue, rallying optometry’s advocates until the updated care standards are finalized and issued to health facilities, clinics and physician offices across the country.   

The AOA is urging members to contact their U.S. Senator and House members regarding expanded access for America’s veterans.

For more information about the immediate outlook on Capitol Hill, please contact Matt Willette mwillette@aoa.org or Ruth Hazdovac at rhazdovac@aoa.org.

View the AOA Fact Sheet on National Standards of Practice.