Would our profession be better served concentrating our efforts to ensure uniform national optometric practice acts throughout the states first, then assess clinical competency once we're all playing on the same level field? ABOP made note of this recommendation.

"Considering the great disparity in optometry scopes of practice among the 50 states, it's unlikely that national uniformity in state optometry board regulations could be accomplished in the foreseeable future."

Still, it would be interesting to see what could be accomplished in this area if the same fervor were applied.

While national board certification to assess continued clinical competency sounds like a good idea, the fact remains that optometry is licensed and regulated by the individual state boards of optometry. Our scope of practice is determined by the Sovereign State Board, which also sets the requirements for continuing education (CE). These CE requirements vary widely from state to state. ABOP has no licensing authority or foundation and has no intent to interfere with or restrict professional licensure. However, that hasn't kept several state boards from weighing in on the subject.

• The Virginia Board of Optometry
sent a letter to the AOA and ABOP in November 1999 stating that, "the goal of this process to 'certify a minimal level of competency' in the practice of optometry is an affront to the work done by the Schools and Colleges of Optometry, the National Boards of Examiners in Optometry and the individual State Boards of Optometry in the United States." The Virginia Board goes on to say that, "we feel it is a sham to propose that the ABOP program would certify an optometrist to a higher level of competency than the national and state tests do already."
• The North Carolina State Board of Examiners
in Optometry issued a policy statement on Feb. 20, 2000, that "declares and reaffirms that the responsibility for the continuing education, continuing competency, certification, recertification, credentialing and re-credentialing of this board's licensees resides solely with the North Carolina State Board of Examiners in Optometry."
Furthermore, this board declares that the use of the term "board certified" or any substantially equivalent term, if such term refers to ABOP certification, may be deemed by this board to be misleading and deceptive, and thereby harmful to the public, and may subject the licensee using such term to discipline by the board."

Optometry, unlike medicine, is a limited license profession. In a letter published last December in the AOA News, Sheldon Kreda, O.D., F.A.A.O., of Lauderhill, Fla., wrote, "Licensed medical doctors have the right to practice any specialty without additional certification or training. This is why board certification is so important to medicine and why managed care organizations insist upon it. By requiring board certification for M.D.s, insurance carriers protect their memberships from physicians practicing beyond the scope of their training. Additional board certification in a limited license profession is nonsensical."

Dr. Hanlen looks at this argument differently. "As an independent profession, we may choose to define board certification as it best meets the needs of our practitioners and the public."

Or, we may choose not to. The NBEO paper also points out that there's no board certification issue in general dental practice, another limited license profession. The NBEO recommends that optometry look at dentistry instead of medicine as a model in these discussions.

But, as Dr. John McCall said in a recent telephone conversation, "Dentistry has no competition for its patient base. If optometry didn't, we wouldn't need board certification either."

Dr. McCall has also been quoted saying that board certification will allow optometrists to "check the box" on insurance panels and hospital applications. He told the AOA delegates that this is a proactive response to the demands of insurance plans and hospitals. "This is a shot across the bow," he said. "Managed care companies understand board certification."

When he was asked what problems board certification might raise, Dr. McCall responded that "the real concern is that if we don't do this, our doctors won't be able to get into plans at all."

As he told me, "it became obvious that board certification is the language that managed care understands. It demonstrates continued competency to them."

This statement begs the question, "have optometrists been excluded from insurance plans or hospital privileges due to a lack of board certification?"

According to John Warren, O.D., of Racine, Wis., the answer is "yes." He said, "While I was employed by an ophthalmologist, I had access to the medical plans in my area. Once I ventured out on my own, I was locked out of several plans. Many of these plans used hospital privileges as a criteria for inclusion, and one of the hospital's criteria for privileges was board certification." I'm sure Dr. Warren isn't alone.

If optometry perceives the lack of board certification to be a barrier to insurance panel inclusion, then shouldn't we ask insurers if board certification would make a difference in O.D. acceptance?

I posed this question to Tommy Hudson, D.D.S., senior vice president for Ancillary Products for Blue Cross and Blue Shield of Georgia. His responsibility includes credentialing all optometrists in the Georgia Blue Cross network. He was very frank in his comments:

"An HMO environment seeking accreditation from the National Committee for Quality Assurance (NCQA) places importance on physicians being board certified. No organization could require a credential that isn't in existence. Even if optometric board certification were in place, it wouldn't help or hurt you from a managed care standpoint. Certification isn't necessary to be on our panel. But, if this credential is put in place, it will play into recruiting and certification."

Dr. Hudson pointed out that his organization also credentials dentists, and board certification for general dentists has never been an issue.

One thing is certain. If ABOP becomes a reality, then the concerns voiced by the State University of New York's (SUNY) optometry school President, Alden Haffner, about "commercial houses" embracing board certification would be only one of our potential problems.

You can bet managed care organizations, private insurers, credentialing organizations, employers, the government, the military, academia and everyone else will flock to this new credential like ticks to a dog. So the "voluntary" participation ABOP has envisioned will quickly fall by the wayside.

We'll all be forced to participate for economic survival. Or, as Tom Cheezum, O.D., of Chesapeake, Va., and a member of the Virginia Board of Optometry wrote in a recent letter:

"I'll probably take this sham certification test . . . only to protect myself. The insurance companies will likely think we need board certification to be provi-ders, and some O.D.s will advertise themselves as 'superior' if they're certified."

Or, as the NBEO stated, 'the original potential problem of not being able to check the box will then be a real problem -- a self-fulfilling prophecy.'"

The proposed mechanism for initial ABOP certification calls for 10 hours of "board certified continuing education" with certification attained after successful completion of a monitored 100-question exam. According to Kevin Alexander, O.D., Ph.D., and current AOA trustee, the initial certification process was "done in this way to be credible, yet doable for everyone."

Dr. McCall added, "What ABOP is doing to initiate board certification is the same as every board certification program has done in its respective beginnings. There has to be some way to bring existing practitioners into the program."

Yet the certification process is not without its detractors. The NBEO maintains that "the ABOP standards for initial certification will be quite different and considerably lower than those of any other healthcare profession."

Dr. Haffner is also concerned about this. "I fear the public ridicule, and I also fear the mischief-making by other disciplines that will seize the opportunity for public criticism."

Remember when you were trying to expand your respective scope-of-practice acts in your state legislatures? Think about what our opposition can do with this ammunition.

A colleague of mine, who asked that I not use his name, put it more bluntly.

"The real problem in my mind is that ABOP board certification in its current form is nothing more than glorified transcript-quality continuing education, which isn't close to being comparable to board certification in the medical professions.

"It's set up so that we can get a nice title without getting our hands too callused. Medical board certification by all accounts is a very arduous process that often must be repeated by even the brightest docs.

"If ABOP really wanted board certification to be comparable to internal medicine or ophthalmology, it would set up something like the diplomate program in the Academy. But of course, this wouldn't be palatable for most O.D.s, and so it's politically untenable."

On whatever side of the ABOP fence you're sitting, one thing is certain: It's a divisive issue. That the ABOP proposal was perceived as "rushed" through the AOA Congress doesn't help win support. While this charge has been denied, the perception remains. And perception is reality to many optometrists.

We need to reach a consensus among us. Proceeding without a consensus risks alienating members of the profession.

One state optometric association president, who asked not to be identified, fears "attrition among the rank and file." Our leaders should remember that participation in the AOA is also voluntary. Or, as Dana Rohleder, O.D., of Oneida, N.Y., noted in a recent letter:

"Although well meaning, I don't feel the AOA acted on my behalf on this [ABOP] issue. I will have to think long and hard about writing that check to renew my membership."

Dr. Kevin Alexander, AOA trustee, expressed that "there is a value to our profession with this issue that speaks to our ongoing commitment to continued clinical competence. However, there needs to be a consensus. Everyone's thumbprint needs to be on this."

To address this concern, the NBEO has called for a "national meeting in 2000 to discuss the issue of board certification in its entirety with all stakeholders present and represented."

This June, during the 103rd AOA Congress, board certification for optometry will be revisited. Delegates will be asked to reaffirm the 1999 resolution creating ABOP.

According to Dr. McCall, "Three hours have been set aside for debate. Every organization will be invited and given an opportunity to present its views."

If we could look through a crystal ball and peer into the future, where will optometry be if board certification becomes a reality? In Dr. McCall's opinion, optometry will grow and expand. Optometrists will be equals to other healthcare professionals and will benefit in the marketplace.

Yet others say the profession will be further divided -- another hoop will have been added to jump through, another layer of bureaucracy upon an already unwieldy and expensive credentialing and licensing process.

Brian Kahn, president of the Georgia Optometric Association, shared his summary of the matter: "If board certification is a way for us to improve ourselves, then we should. We have the opportunity to establish our own standards, rather than have another set imposed upon us by others."

According to Jan Donnan, executive director of the New York Optometric Association, this is "the most significant core issue that optometry has faced in the last quarter century." And its outcome will affect how each and every one of us does what we do for a long time to come.

Your opinion is important. Have a voice in deciding where the ABOP train is going. Read all you can on the issue. Talk with your colleagues. Form your own opinion. Then, above all, contact your state leadership. Everyone's thumbprint does indeed need to be on this. Including yours.