AOA and state affiliates rally to decry and defeat discriminatory ‘not-a-doctor’ bills

May 4, 2023
Amid historic gains for optometry, the AOA and seven state affiliates find themselves battling a spate of legislation that potentially seeks to block, limit or discourage doctors of optometry from being referenced as doctors and physicians in their respective states and threatens to undermine the profession’s progress.
Not a Doctor Bills by State May 2023

The AOA and its affiliates remain alert and battle-ready in order to confront an outbreak of “not-a-doctor” bills and attacks from medical, ophthalmology groups.

In Connecticut, a bill there would have prohibited anyone who does not have an MD license from referring to or holding themselves out to be publicly a physician. Gary Maglio, O.D., president of the Connecticut Association of Optometrists (CAO), says the CAO appears to have successfully rebuffed the effort.

“It would appear that it is effectively dead right now,” Dr. Maglio says of the renewed attack. “But our association is monitoring for any action to amend the language or that it doesn’t get thrown into another bill. Our lobbyist is keeping an eye on this, believe me.

“We are guardedly optimistic that it won’t get thrown in anywhere. It is a reminder that affiliates be vigilant because, even though it appears it won’t come up here, we expect it will come back in some kind of form or fashion in future years. We also believe it is a national agenda. I think a lot of affiliates ought to be vigilant about seeing a bill like this. Because we don’t really think it is an isolated incident.

Not-a-doctor bills not a coincidence?

Doctors of optometry have long been recognized by federal agencies as physicians. The Centers for Medicare & Medicaid 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 challenged.

Since January, a scattering of targeted states have seen “not-a-doctor” legislation pop up:

Connecticut: SB 899 introduced Jan. 25

Florida:  SB 230 introduced Feb. 9; HB 583 introduced Feb. 1

California: AB 765 introduced Feb. 13

Massachusetts: HD 1314 (H.3606) introduced March 9

Texas: HB 2324 introduced March 9

Wisconsin: SB 143 introduced March 23

North Carolina: HB 576 filed April 5

The current status of the bills varies. Some have been stymied by the valiant efforts of doctors’ state optometric associations. Anti-optometry language has been rooted out or a bill’s’ progress stalled in committee. However, in Florida, a battle over its bill was heating up. In response, the Florida Optometric Association (FOA) has been mobilizing doctors, optometry students, staff and concerned patients and fighting back with equal intensity.

Come back and bite optometry?

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, it potentially could 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 a new round of optometry-centered scope modernization and expanded patient access proposals being considered by legislatures in a dozen states. 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 these efforts through its Future Practice Initiative, a campaign 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.

“Optometry will continue to look to the future and the needs of our patients as we advocate for our full recognition and scope modernization priorities and lock in more wins,” AOA President Ronald L. Benner, O.D., says. “It’s clear today, however, that those who desperately want to turn back the clock on our advancement need a fresh reminder that our advocacy strength and know-how is also able to defeat any bill that does not clearly recognize optometry’s status as the nation’s primary eye care doctors.”

Sunshine State fight

FOA President Mark Marciano, O.D., has denounced SB 230 as having the potential to besmirch the perceived role of doctors of optometry in providing access to quality and safe eye care to Floridians. “The FOA will continue to defend our high level of doctoral education, patient skills and training, while keeping our doctor-patient relationship unencumbered from political abuses,” Dr. Marciano said recently. “Our efforts will primarily focus on the goal of ensuring that optometrists are recognized as honorable and valuable members of the eye health care team." 

In its original form, the bill addressed health care practitioners’ titles and abbreviations used in their advertisements, communications and personal identification. It requires health care practitioners to identify themselves in a specific manner, disclosing the type of license under which an individual practitioner is authorized to provide services and the title and abbreviations specified by the bill when treating patients and further, it states the grounds for disciplinary action, which includes a felony charge punishable by a $10,000 fine per occurrence and denial of licensure by practitioners’ regulatory boards. “Only physicians may include titles and abbreviations or medical specialties in their advertisements,” it reads.

The bill does not specifically reference optometry, but there is concern that the restrictions on titles could later be used to attack the qualifications of doctors of optometry, in particular those who specialize in certain areas of optometry. In addition, the proposed ban on the use of the term “physician” in any capacity potentially conflicts with the recognition of physician status for optometrists under federal law.

On Tuesday, Dr. Marciano and members of the FOA’s legislative team were waiting for an opportunity to be heard in the waning days of the Florida legislative session. Meanwhile, FOA members were talking to anyone who could impact and prevent the passage of “the discriminatory bill”—from several state legislators to members of the governor’s staff. The FOA, which has encouraged its members to reach out to their legislators, has responded with an impressive grassroots campaign.

“The FOA board of trustees and legislative team are extremely engaged,” says Dr. Marciano, noting that doctors of optometry in Florida and around the country can’t afford to be complacent, given the relative size of optometry’s well-funded and larger opposition. “Unlike dentistry or organized medicine, optometry is a relatively small profession and only optometrists will fight for the interests of the profession of optometry. Having a well-educated and informed membership and a strong and consistent fundraising campaign is critical to defending the honor of the profession and moving it forward.

"Make no mistake—this is a blatant attempt to disparage the profession of optometry led by a few influential ophthalmologists who prefer to attack and belittle the profession of optometry instead of forging stronger relationships. This bill is being mimicked in other states. If this falls...”

Keeping a wary eye

State affiliates continue to monitor the twists and turns of the not-a-doctor bills.

The California Optometric Association (COA) recently issued a statement to its members on the legislation:

“COA is opposed to AB 765…which would make it a misdemeanor for a person who does not have an MD license to use any term implying that the person is a licensed physician, including the word ‘doctor’ or ‘physician.’ The California Medical Association claims this bill is necessary to prevent patient confusion. COA secured amendments to clarify that an optometrist could still use the term doctor. The amendments also allow ‘any truthful statement that they specialize in a service or field that is within their licensed scope of practice.’ According to the author, the amended bill would allow optometrists to advertise as ‘pediatric optometrist’ but not ‘optometric pediatrician.’ COA continues to seek amendments to this bill to ensure that optometrists can use all terms they use now. The bill will next be heard in the Assembly Appropriations Committee.”

Once SB 143 was introduced in Wisconsin, says Peter Theo, executive vice president of the Wisconsin Optometric Association (WOA), it was quickly assigned to a committee in the legislature. Not as egregious as other not-a-doctor bills, Wisconsin’s legislation does not include a prohibition on the use of the “doctor” title for health care providers, Theo says, nor does it contain provisions requiring non-MDs to disclose to patients they do not hold a medical doctor degree.

Yet, the Wisconsin affiliate remains vigilant.

“WOA continues to assess the potential impact this language could have on individual doctors of optometry and the entire profession,” says Theo, noting that the affiliate has not taken an official position on the bill. “Should it be determined or interpreted to include any of the above, WOA members would of course respond in mass and oppose the bill. Given the unique circumstances that exist, at this point WOA has not taken an official position on the bill.”

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