Is Optometric Board Certification for Me?

Debate regarding the need for a universal optometric board certification has been going on for nearly 2 decades. The pros and cons of developing a nationally recognized optometric board first received major attention during the Congress of the American Optometric Association in 1999. At the House of Delegates session during that meeting, the establishment of an American Board of Optometric Practice (ABOP) was proposed.

The impetus for developing such a national certification body was prompted by the growth of managed care organizations. It was argued that a national certification body would increase the recognition of the profession of optometry and reduce discrimination against it, and that certification would help optometrists gain access to participation in provider panels for insurance companies. It was proposed that, for ODs to receive ABOP certification, the committee would set credentials that would included extra continuing education and a fee structure.

The proposal was about to be adopted by overwhelming majority, but fierce minority opposition brought the process to a screeching halt. The opposition argued that the goal of the ABOP was already being met at the state level.

A decade later, in 2009, the American Board of Optometry (ABO) was established with the same objectives as originally proposed for the ABOP. For certification, this board requires passage of an entrance test and a somewhat rigorous maintenance regimen. The purpose of this certification is to distinguish an advanced level of professional prestige. The purpose and limits of board certification are described thusly: “Board Certification and Maintenance of Certification for optometry is a means of demonstrating ongoing clinical competence independent of established licensing and regulatory boards. Board Certification does not confer legal qualification, privilege or license to practice optometry.”¹

The legitimacy of the ABO was challenged shortly after its inception by a newly formed organization, the American Optometric Society (AOS), which brought a false-advertising lawsuit against the ABO. The suit was decided in favor of the ABO in US District Court of the Central District of California in August 2012.² This decision allowed the ABO to continue its efforts to unite the profession under a national umbrella. But, although it may seem that the fervor of this conversation has subsided, the debate and mixed feelings on this matter are not completely gone.

NOT ONLY OPTOMETRY

The dispute regarding the need for or validity of certifying boards is not unique to optometry. Medical doctors must also have a medical license to practice, which they obtain through a state certification process similar to optometry’s. However, there are a number of specialty and subspecialty certifying boards that operate under the umbrella of the American Board of Medical Specialties.

Physicians are not universally required to be board certified to practice, but most hospitals and surgery centers require board certification to bestow privileges. An example of a specialty certifying body is the American Board of Ophthalmology. Not all ophthalmologists are certified by the American Board of Ophthalmology. Those who are not certified remain in a stage termed qualified.

Not all ophthalmologists agree with the policies of the American Board of Ophthalmology. In 1992, ophthalmologist Rand Paul, MD, now known as a US senator from Kentucky and former presidential candidate, objecting to policy changes instituted by the American Board of Ophthalmology, created his own certification alternative, the National Board of Ophthalmology.³ He was joined in his venture by other ophthalmologists at the time.

Dr. Paul’s objection to the American Board of Ophthalmology centered on the costs of the certification and recertification processes. Many optometrists elect not to apply for ABO certification for the same reason. For instance, many faculty and staff members of colleges and schools of optometry have not joined the ABO because their schools may not reimburse them for the initial examination and maintenance fees.

WHY GET CERTIFIED?

I became board certified for a number of reasons. One was the inspiration of my friend and esteemed colleague Paul C. Ajamian, OD, who was the chairman of the board of the ABO at the time. Dr. Ajamian invited me and other optometric colleagues to participate as the first group of item writers for the ABO examination, which was an excellent learning experience. He also encouraged me to be among the first group to take the test. I received my diplomate status in August 2011.

Another motivation for me to seek certification that may appeal to others is the sense of accomplishment and professional gratification that comes with demonstrated proficiency and from a desire to ever expand and improve one’s skills. I recently took one of the ABO’s Continuous Assessment Program (CAP) examinations that is required for maintenance of certification. This CAP assessment was in an area not associated with my day-to-day niche retina practice. To be honest, I didn’t do so well, which was a reminder of how much we forget over time when we move away from mainstream practice. I believe these CAP programs and other continuing education efforts help us to maintain and improve our competence.

In addition to my ABO certification, I received certification from the American Board of Certification in Medical Optometry (ABCMO) in February 2011. At that time, ABCMO certification was granted to those who had certain credentials and who practiced in a medically oriented setting such as Veterans Administration hospitals. Interested individuals can find the information on the requirements for this certification at abcmo.org. This organization describes its value thus: “ABCMO certification provides the public, credentialing committees and fellow medical practitioners a national, uniform indicator that an optometrist possesses specialized, advanced knowledge, skills and competence in the practice of medical optometry. It is not only recognized, but also required by many employers.” A number of credentialing organizations and committees recognize ABCMO certification for optometric physician accreditation.

A PERSONAL DECISION

I realize that most of my managed care credentialing is still completed by verifying my state licenses and does not rely on my ABO or ABCMO certification. One could argue, therefore, that these certificates do not confer any benefit to me in a multidisciplinary private practice setting. However, during our lifetimes we pay for many things that we hope never to have to use, including auto, home, malpractice, and disability insurance. Some of these insurance policies are required by state laws, mortgage companies, or other lenders, and we may see them as necessary evils. Therefore, one could argue that it is better to have these policies and never have to use them, rather than one day needing them and not having them at our disposal. Using this line of reasoning, I would rather have and maintain my board certification now than ever regret not having it somewhere down the road in the future.

For now, whether to certify or not to certify is a decision every optometrist must make for himself or herself. Perhaps some day in the future board certification in optometry will become a federal or state mandate.