Optometry’s scope wins draw new attacks from medical, ophthalmology groups

As state after state, Congress and an array of federal agencies have updated laws, regulations and policies to recognize optometry’s essential and expanding role in health care, opposition is continuing to push its own narrow agenda.

In recent days, legislation potentially seeking to block, limit or discourage doctors of optometry from being referenced as doctors and physicians has been introduced in the legislatures of a handful of targeted states, including Florida, Connecticut and Texas. So far, any anti-optometry language has been rooted out and is being actively opposed by affected state associations and the AOA.

A decade ago, an American Medical Association (AMA)-backed national effort to pass “Not a Doctor” legislation—known in Washington, D.C., as the “Sullivan Bill”—was exposed and defeated by the AOA and affiliates in spectacular fashion, as reported by the national media at the time.

Facing this renewed attack at the state level, the Florida Optometric Association (FOA) has been mobilizing doctors, optometry students, staff and concerned patients in fighting back with that same intensity.

"Senate Bill 230 is particularly concerning because it has the potential to directly impact the perceived role optometrists play in providing access to quality eye care for Floridians throughout the state,” FOA President Mark Marciano, O.D., says. “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. 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." 

The bill filed Feb. 9 in the Florida Senate relates to 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 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.

As optometry gains, opposition doubles down

The bills being exposed in a number of states reveal the linkage to the 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 public-facing “truth in advertising” campaign, which the AOA successfully challenged. As this threat has emerged, AOA legal, legislative and communications teams have been providing information and counsel with state associations.

In Texas, H.B.2324 was introduced Feb. 14 and relates to “regulation of certain health professionals and health facilities.”

"Legislative proposals attempting to prevent doctors of optometry from using the term ‘doctor’ are harmful to patients and petty from organized medicine,” says Tommy Lucas, O.D., director of advocacy for the Texas Optometric Association. “In Texas, we are currently monitoring this type of legislation that would affect the nursing profession but does not affect optometry in the bill's current form. States should remain vigilant in protecting patients from confusing public policy that would potentially delay and hinder their important eye care.”

Similarly, doctors of optometry are omitted from a bill in Connecticut, called “An Act Concerning Truth in Advertising by Health Care Providers.”

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 (FPI), 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.”

Game-changing successes at federal level

The AOA continues to build momentum at the federal level, demonstrating the growing role of doctors of optometry in providing access to needed primary eye health and vision care.

In 2022, the U.S. Department of Veterans Affairs (VA) took a pro-patient access and pro-provider stance, revising its long-standing guidelines to open up greater access to veterans seeking the care of doctors of optometry whose state scope laws allow them to perform invasive eye procedures.

This opens access to doctors of optometry who are eligible to participate in the VA’s Community Care Program and whose state law allows. The program provides health care to eligible veterans through local, in-network providers outside of VA medical centers, making the care of doctors of optometry more accessible to veterans.

This change came amid opposition from ophthalmology and as a result of persistent advocacy over nearly 20 years by the AOA, the Armed Forces Optometric Society, the Mississippi Optometric Association and members of Congress who urged the VA to recognize current scope of practice, which allows doctors to provide a wide range of comprehensive, medical eye care services, including injections, foreign body removals and therapeutic laser eye care.

Beyond the big advance in care for veterans, optometry leaders are cautiously optimistic that it bodes well for future advocacy, specifically when it comes to the anticipated release of the VA’s National Standards of Practice. Currently, the VA is developing new national standards of practice (NSP) for doctors of optometry and other health care practitioners within the VA system. Triggered by a coordinated effort by the VA and Department of Defense to implement a unified electronic health record platform, such NSP will outline the list of services that veterans may seek from VA doctors of optometry and could have a significant impact on veterans’ access to care. These NSP for optometry are expected to be released in the coming months.

Most recently, a bi-partisan bill, the VA Clinician Appreciation, Recruitment, Education, Expansion and Retention Support (CAREERS) Act, was recently introduced in Congress and would add doctors of optometry to the list of physician-level providers at the VA, putting them on par with medical doctors, osteopaths, dentists and podiatrists.

Since Medicare reform in the 1980s, the AOA and doctors of optometry have relentlessly pursued physician recognition and these milestones are clear indications of progress in this many-decades fight.