Bill seeks physician-level recognition, more competitive pay and advancement opportunities for VA doctors of optometry

A bill introduced in Congress would add doctors of optometry to the list of physician-level providers at the United States Department of Veterans Affairs (VA), putting them on par with medical doctors, osteopaths, dentists and podiatrists and better recognizing the value of the eye care they deliver to veterans and their families.

The bipartisan bill, called the VA Clinician Appreciation, Recruitment, Education, Expansion and Retention Support (CAREERS) Act of 2023 (S. 10), would:

• Recognize doctors of optometry as physicians and elevate them to the more competitive, market-based pay scale alongside medical doctors, osteopaths, dentists and podiatrists.
• Make doctors of optometry eligible for supervisory positions now available to a medical doctor, osteopath, dentist or podiatrist.
• Increase the salary cap for doctors of optometry, helping to retain experienced providers and make the VA a more attractive career option.
• Also, make doctors of optometry eligible for $1,000 in annual continuing education costs as other VA doctors are.

These provisions are part of a larger VA workforce bill meant to improve retention and recruitment of doctors, nurses and others, thus providing greater access for veterans seeking eye care and other essential services amid VA staffing shortages.

The AOA and the Armed Forces Optometric Society (AFOS) are working in concert in support of the bill.

“This bill will level the opportunities for optometry within the VA,” AOA President Ronald L. Benner, O.D., says. “It will bring pay parity for our frontline VA providers as well as allow them to rise to leadership roles. Both parity and opportunity have been subjected for too long to the political whims of those who still fail to acknowledge the skills, education and training of doctors of optometry within the VA.

“Physician recognition is the path we’ve been on since Medicare in the 1980s and this is yet another milestone in that many-decades fight,” Dr. Benner says. “We know we are working it at all ends, and everyone should be proud of our significant progress at the local, state and federal levels.”

The bill has the support of the AOA and AFOS, as well as leading veterans’ advocacy organizations such as American Veterans and the Disabled American Veterans—because of what it could mean for veterans’ access to care that is needed and deserved.

“Many very talented doctors of optometry have dedicated their careers to public service, education and research in the VA setting,” says Brian Williams, O.D., AFOS board member who practices in the Cleveland VA Health Care System. “They often hold faculty positions and serve as leaders in ocular disease, TBI rehabilitation and low vision specialty care. Physician recognition and more competitive compensation will help ensure that they can continue in these roles, advancing the profession of optometry and educating future generations of our nation’s primary eye care providers.”

Adds Sean Dempsey, O.D., AFOS board member at the St. Cloud VA Health Care System: “The recruitment and retention of such highly qualified individuals will bolster access to eye care for our nation’s deserving veterans. The patients of VA clinics will benefit from the passage of the CAREERS Act, since it will allow for maintaining their eye care from qualified doctors and in increasing access to that care with a more robust workforce.”

Optometry is the only group of licensed, independent, prescribing practitioners not included on the VA physicians’ pay scale. Optometry is currently excluded from the physicians’ pay table and grouped with chiropractors.

About the bill

The CAREERS Act was introduced by Sens. Jon Tester, D-Mont., and John Boozman, O.D., R-Ark. Sen. Tester has called the VA’s pay system for physicians and other high-level clinicians “antiquated.”

A week ago, the bill cleared the Veterans Affairs Committee and is moving to the full Senate for consideration.

“As chairman (of the Veterans Affairs Committee), I often hear from veterans in Montana and across the country about the lack of providers in rural communities,” Sen. Tester says in a statement by his office. “We need the VA to hire providers faster and be able to retain high-quality talent in rural areas. That’s why I’m proud to be joining my friend Senator Boozman on this bipartisan effort to ensure the VA can recruit the best and brightest clinicians to help deliver veterans—including those in rural areas—their earned health care and benefits.”

Sen. Boozman says the bill would create a “sustainable pipeline” for hiring physicians and fulfill the nation’s promise to the people who served the nation.

Says Sen. Boozman, who has heard similar concerns by veterans: “Our legislation expands the VA workforce in communities nationwide and creates a sustainable pipeline, strengthening its ability to attract expert physicians. Ensuring the VA is properly staffed is key to fulfilling our promise to the men and women who served in uniform.” 

Last July, a VA Office of Inspector General (OIG) review showed widespread workforce shortages among clinical and nonclinical positions at VA facilities. “The OIG found that all 139 VHA facilities reported at least one severe occupational staffing shortage,” the review says. “The total number of reported severe shortages was 2,622. Twenty-two occupations were identified as a severe occupational staffing shortage by at least one in five facilities.”

Also last year, nurses at VA centers in New York rallied over chronic short staffing.

As of January 2023, the VA showed 62 openings across the country at its facilities for doctors of optometry. The starting wage for a VA doctor of optometry is listed at about $66,000 for most jobs, before such factors as credentials and experience are considered. VA doctors of optometry are generally compensated $20,000 to $60,000 below that of their private-sector peers in the same communities.

Dr. Benner notes the bill’s commitment to providing access and quality eye care to veterans—advocacy for veterans shared by the AOA. Doctors of optometry provide 70% of essential primary and medical eye care each year to veterans, and eye health and vision care are the third-most requested health care services by veterans, behind only primary care and mental health care.

“Sen. Tester has always been a champion and has fought for the VA patient to have the best access and care available,” Dr. Benner says. “He has been a great friend to our profession and continues to open doors for the care we provide. As the only elected optometrist in the Senate, Sen. Boozman knows and respects the quality of care that his fellow doctors of optometry provide.”

How doctors can support the bill

At the recent AOA Leaders Summit in St. Louis, Dr. Benner laid out the “significant strides” being made in VA policy, despite aggressive opposition by ophthalmology. That progress includes:

Laser ban lifted: “Many of you know that after strategic advocacy on the part of AOA, AFOS and our veteran partners, the VA rescinded restrictive language in a 15-year-old directive that had effectively limited veteran access to therapeutic laser eye procedures at VA medical facilities provided by doctors of optometry. Aside from limiting care that our nation’s veterans need and deserve, this years-long optometric laser ban had been used repeatedly by organized medicine to raise doubt in state houses across the country whenever we were working to expand our state scope of practice. Losing this talking point and advocacy tool angered ophthalmology.”

Language dropped restricting invasive care by doctors of optometry: “Then, recently, the VA again rolled back restrictions that had limited veteran access to care provided by doctors of optometry. The VA dropped language from documents governing its Community Care program, which had prevented community doctors of optometry from providing veterans with so-called invasive care, including injections, lasers and eye surgery. Now, the VA will allow these procedures based on the provider’s state-issued license.”

Now doctors and students of optometry have the opportunity to support passage of the CAREERS Act and help advance physician recognition of doctors of optometry. They can:

• Learn more about the issue by reviewing a fact sheet on the issues.
• Go to the AOA Action Center and reach out to their senators.

“VA optometry has historically led in matters of optometric scope of practice and standard of care,” Lindsay Wright, O.D., AFOS executive director, says. “As the nation’s largest hospital network with locations in every state, VA optometry’s issues can have a great impact on the entire profession. We need everyone’s help!

“There is no doubt we need unified support from all VA optometrists for the CAREERS Act, but we also need support from the optometry community as a whole,” she adds. “We, doctors of optometry, can all benefit from a strong show of support for this bill and its proposed changes for physician recognition and advancement opportunities for optometry.”