'Not-a-doctor' bills are back: Affiliates, AOA preparing for fresh attacks on optometry

Despite defeats in 2023 at the hands of the AOA and its affiliates, organized medicine and ophthalmology are back at it again—seeking to block, limit or discourage doctors of optometry through “Not a Doctor” bills filed in January in two states: Florida and Tennessee.

Last year, affiliates, supported by the AOA, defeated bills in seven states that sought to keep doctors of optometry from being referenced as doctors and physicians in their respective states and threatened to undermine optometry’s progress. Those states included California, Connecticut, Florida, Massachusetts, Texas, Wisconsin and North Carolina. Florida faced a particularly contentious fight for doctors of optometry there, before Florida Gov. Ron DeSantis vetoed its legislation.

In 2024, add Tennessee and Florida to the list. S.B. 1720 was introduced in the Tennessee state Senate on Jan. 11. Florida’s S.B. 1112, a retread of last year’s bill, was introduced Jan. 9. Given the history and organized ophthalmology’s unabashed commitment to halting progress and impeding patient access to care, optometry’s advocates in each state were not surprised. Especially in light of the profession’s considerable advancements.

Says Amanda Dellinger, O.D., trustee and legislative chair of the Tennessee Association of Optometric Physicians: “In my role as legislative chair, I wholeheartedly encourage every state to brace itself for the potential introduction of this concerning legislation. As a community of professionals, we can't afford to stay on the sidelines while this nationwide push against optometry gains traction. Let's stand together, be vigilant and address these challenges head-on. Our proactive engagement is not only crucial for safeguarding the integrity of our profession, but also essential to ensure the ultimate protection of our patients. Together, by taking pre-emptive measures, we can uphold the standards of our profession and prioritize the well-being of those we serve.”

“FOA [Florida Optometric Association] will always defend the title of doctor and physician for optometrists in Florida,” says Kenneth Lawson, O.D., a practitioner of 30 years who is legislative chair for the FOA. “We are going to continue to watch the progress of the bill and make sure the profession of optometry is heard.”

The AOA stands ready to assist and support state affiliates as they protect their profession from unnecessary legislation that seeks to undermine the education, training and credibility of doctors of optometry.

Optometry challenges the challengers

Whether the language in some of the bills explicitly diminishes the role of doctors of optometry or not, the AOA and its affiliates are concerned that, at a later date, the proposed legislation could potentially undermine long-standing, hard-fought progress by the profession. AOA advocacy leaders view the emergence of state “not-a-doctor” bills as an attempt to derail optometry-centered scope modernization and expanded patient access. In 2021 and 2022, Wyoming, Mississippi, Virginia and Colorado all overcame opposition to enact optometric laser procedure laws, boosting to 10 the number of states where the profession’s education, skills and training for this type of contemporary care is recognized in statute.

The AOA has been very active in many scope advancement efforts through its Future Practice Initiative, an initiative to directly support affiliate scope modernization efforts. It was established as a 10-year, $10 million mobilization to make increased access to essential eye health and vision care a priority in state capitals across the country.

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

Despite that recognition, organized medicine and ophthalmology have opposed expansion of scope to doctors of optometry. The bills being exposed in a number of states are reminiscent of the American Medical Association’s (AMA’s) years-old campaign to build support for the “Sullivan Bill,” which was rejected in successive sessions of Congress. According to the AOA’s analysis, there are indications that the AMA also is resurfacing its “truth in advertising” campaign, which the AOA successfully thwarted. In response to last year’s challenges, the AOA and affiliates mobilized to defeat the discriminatory legislation.

“It is really unfortunate that our colleagues in medicine want to downplay our degree to this extent and do it under the guise of patient protection, when it's really the patients who would suffer from this,” says Johndra McNeely, O.D., chair of the AOA State Government Relations Committee. “We will always fight for our ability to use our degree to the highest level and to the benefit of patients."

States prepare, poised to fight off attacks

In Tennessee, S.B. 1720—an amendment known as the Healthcare Provider Advertising Law—puts:

• Conditions on the contents of a doctor’s printed, electronic or oral advertisements to the general public; and
• Adds certain activities to and exempts certain activities from the definition of the practice of medicine.

“The Executive Team and Legislative Committee of the Tennessee Association of Optometric Physicians acknowledges and expresses its disappointment in the introduction of the superfluous and discriminatory bill (S.B. 1720) by Joey Hensley, M.D.,” Dr. Dellinger says. “With a full understanding of similar legislation introduced nationwide by communications and state support efforts from the AOA and State Government Relations Committee, we were poised and well-prepared for the introduction of such legislation.

“The proposed ‘Healthcare Provider Advertising Law’ bears semblance to bills introduced and decisively defeated nationwide in 2023,” she says. “In the context of Tennessee, this legislation poses a direct contradiction to existing laws, potentially creating confusion and impeding patient access to essential care. In its current form, we staunchly oppose S.B. 1720.”

The FOA does favor passage of a more optometry-friendly measure (H.B. 1295) filed in the House on health care practitioner titles and abbreviations in advertisements, Dr. Lawson says. According to the bill, a licensed optometrist would be able to use the term “doctor of optometry” and “optometric physician” authorized under the state practice act.