A profession of their own

Excerpted from page 32 of the September 2018 edition of AOA Focus.

Ann Waterman, O.D., was in the right place at the right time to contribute to optometric history—whether she realized it or not.

To her, the 1978 AOA Congress in New Orleans was just like any other AOA national conference that she'd attended so many times before, both as the daughter of a doctor of optometry and later as an optometric technician—and eventually as a doctor of optometry herself. But when a meeting for a new AOA section stalled on the grounds of parliamentary procedure, Dr. Waterman fatefully raised her hand.

"At a young point of time in my life, I had the nerve of making a few suggestions about how to proceed, and then I got elected to something," Dr. Waterman recalls with a laugh. That something was the council for the AOA's new Paraoptometric Section. Together, Waterman, Patricia O'Brien, Barbara Jablonski, Catherine Muhr, Rita Pierce and Council Chair Carol Schartner would usher in a paradigm shi­ft for paraoptometry with the rap of a walnut gavel. Even the gavel itself—handcra­fted by Waterman's grandfather, H. Hovey Manring—was momentous as it symbolized not only the care and determination, but also the newfound governance and legitimacy that went into the first-ever section of "front-desk girls."

Tasked with changing that derisive perception, the AOA Paraoptometric Section devoted itself to developing optometric staff into essential members of the health care delivery team through quality education and skill building. Forty years later, that mission still rings true as the preeminent source of paraoptometric education.

"It was always about improving skills to help serve patients and individual practices, and helping the individual paraoptometric be happier in his or her working life, because if you're happy with what you're doing, you're better at it," Dr. Waterman says. "That's how it has evolved continually."

From humble beginnings

The first Paraoptometric Section Council chair Carol Schartner

Well before that first Paraoptometric Section Council meeting came to order, paraoptometrics, doctors and educators alike devoted countless hours into laying its groundwork. In optometry, the '70s were a decade of scope of practice expansion that saw the profession grow by leaps and bounds. Except for vocational training programs for optometric technicians nationwide, paraoptometrics were by and large trained on the job by their employing doctor of optometry. Scope expansion necessitated a formalized paraoptometric education that doctors could implement in their practice as the standard of care elevated.

"Paraoptometrics were very eager for that education, and so were the doctors at that time, because they were beginning to get busier and not able to train sta­ff, and staff­ were not able to leave their practices to attend a formal 1- or 2-year program," recalls Schartner. "They were getting folks with no optometric training at all and found they didn't have time to do that on-the-job training."

So, in May 1972, AOA launched the AOA Registry, which assigned the responsibility of education and staff evaluation to the employing AOA-member doctor. The AOA Registry required doctors to check off­ staff­ proficiency among at least four areas, ranging from reception work to dispensing and visual field testing.

Those skills would make staff­ eligible to be listed with the National Registry for Paraoptometric Personnel of the AOA, according to a 2011 "Paraoptometric View" article written by Jill Luebbert, CPOT, in Optometry—The Journal of AOA. Then, in 1975, Schartner and Muhr were appointed to the Committee on Paraoptometric Personnel, where they worked on a more formal registry that included examinations as well as the feasibility of a section.

	Al Levin, O.D., AOA past president

It became increasingly necessary to add a new category to AOA's membership structure that administratively permitted paraoptometrics to become associate members of AOA at minimal cost. They found a willing champion for their e­fforts in Al Levin, O.D., AOA secretary-treasurer at the time. It was a fateful connection that would benefit paraoptometrics for years to come, Schartner says.

"Dr. Levin would take me under his wing," she recalls. "He taught me the importance of becoming a leader and to share my knowledge with our officers; that it is so important that we represent our section, the AOA, the doctors of optometry with whom we work and our patients to the very best of our ability."

Three years of hard work collecting data and registry results would culminate with a proposal before AOA Congress in 1978 to form the first Paraoptometric Section. Approved in New Orleans by the AOA House of Delegates, the Paraoptometric Section was given a $5,000 startup fund and a charter board was installed with Schartner as chair and Waterman as a council member. But celebration was short-lived; the real work was just starting.

A commitment to education

In subsequent years, the Paraoptometric Section Council worked tirelessly on a career ladder and home study guides for assistants and technicians to progress in their education. This would lead to the Paraoptometric Advancement through Continuing Education (PACE) program, a collaboration of educators, doctors of optometry, graduates of optometric technician programs and on-the-job-trained paraoptometrics that generated continuing education for regional, state and national meetings. Ultimately, the education would orient paraoptometrics toward examination.

"This was the first opportunity for an on-the-job trained and educated optometric sta­ff to qualify for the title of Optometric Technician based on a standardized written test, and gave new credibility to a position that previously relied solely on the input of the employing optometrist," writes Luebbert in Optometry.

"To give extra guidance to paraoptometric assistants, in 1988 the AOA Paraoptometric Section developed a 'Home-Study Course for Optometric Assisting' ... (and) almost 10 years later in 1997, the second edition, now titled 'Self-Study Course for Optometric Assisting,' was released."

This was a welcomed development for both paraoptometrics and their employing doctors. As educational development became more standardized, it created a further need for skills recognition that would lead to creation of the Commission on Paraoptometric Certification (CPC). Accredited by the National Commission for Certifying Agencies, the CPC would ­fill that void—albeit a purely voluntary process, but one that lent credibility and weight to paraoptometric credentials.

And interest continued to grow: In 1997, the AOA Registry listed 400 optometric assistants and 200 optometric technicians; as of August 2018, there were 4,808 certi­fied paraoptometrics (CPOs), 1,433 certi­fied paraoptometric assistants (CPOAs), 533 certi­fied paraoptometric technicians (CPOTs) and 199 certi­fied paraoptometric coders (CPOCs). In total, 6,911 paraoptometrics are certi­fied, with 62 of them holding dual certi­fications.

Certification, the yardstick by which the Paraoptometric Section could be measured, was now precipitating a change to the section itself.

"The profession itself is changing," Schartner says. "But patients will always come ­first."

Continuing a legacy

In 2013, the AOA House of Delegates approved a bylaws change that allowed AOA-member doctors' staff inclusion as an AOA associate member at no additional membership cost. At the same time, the Paraoptometric Section transitioned into the current Paraoptometric Resource Center (PRC). Although the section itself disbanded, the PRC would continue to deliver the resources and education that paraoptometrics had grown accustomed to. Since 2014, more than 11,500 AOA associate members have enrolled thanks to more than 3,000 AOA-member doctors. Of those, more than 6,600 are currently certified.

Erlinda Rodriguez, CPO, AOA PRC chair, says the resource center continues the Paraoptometric Section's original vision of recognizing paraoptometry within the optometric family, as well as delivering professional continuing education (CE).

"The AOA PRC has further enhanced the quality of education, training, resources and tools to all its associate-member paraoptometrics and member optometrists to meet the current demands in health care," Rodriguez says. "We're committed to promoting awareness of paraoptometry nationwide, providing the highest level of quality education and training to all paraoptometrics, and supporting professional development and certi­fication."

Jeremy Durham, O.D., CPC, member at large, encourages every staff member in his office to attain certification not only because it leads to increased productivity, but also because it's an extra layer of patient reassurance.

"It helps our patients knowing that the staff are well-educated and certi­fied," Dr. Durham says. "As a doctor, my greatest asset is my staff, and that's why we really encourage staff to become certi­fied."

Paraoptometric certi­fication, he says, isn't all that different from the continuing education that doctors must routinely acquire. More to the point, Dr. Durham takes seriously his office's commitment to a learning environment, whether it's education for doctors, staff, bookkeepers or interns. "I would encourage anyone who is a business owner or one of its doctors to have your staff certi­fied.

Recognizing staff contributions

As demand for eye care services continues to grow, paraoptometrics continue to be a vital part of the eye care team, Rodriguez says. Recognizing the part paraoptometric staff play in delivering quality, effective and efficient practice support is more than a polite gesture; it's a meaningful sign that influences and increases paraoptometrics' level of commitment, loyalty and enthusiasm for the work they do each day.

"A well-trained optometric staff is of utmost importance and plays a role in every successful optometric practice," Rodriguez says. "Doctors of optometry who recognize their paraoptometric staff for their dedication, knowledge and professionalism are rewarded with satisfied patients and practice growth."

That's why the AOA designates every third week of September as Paraoptometric Recognition Week. Now in its 16th year, the recognition week is the only formal observance in the nation speci­fically intended to honor optometric practice staff for their dedication to the patients they serve and to the profession of optometry.

Recognize. Reward. Retain.

It's a driving philosophy behind Paraoptometric Recognition Week and, ultimately, the tools, resources and opportunities that PRC delivers its AOA associate members. Give paraoptometric staff the ability and support to meet expectations, and practices will find that staff excel.

Exceptional staff drive excellent care, thereby elevating a patient experience that leads to retention. Simply, a patient's journey through the practice begins and ends with paraoptometric staff.

Says Rodriguez: "Since its beginning, the stakeholders—with dedication and enthusiasm—paved the way to bring paraoptometry to what it is today: a valuable professional who assists the doctor of optometry in the delivery of care and contributes to the success of an optometric practice."

After all, success is a team effort.