Advocacy for the Modern Optometrist: Examining Levels of Need

When you hear the word “advocacy,” what comes to mind? For decades, optometric advocacy has led to legislative actions at federal and state levels focused on optometric scope of practice, third-party payment, and related political activism to ensure that optometry is effectively represented. Because the practice of optometry in the United States remains legislated, these activities have historically been essential to the profession’s development, which includes doctors of optometry being positioned as Centers for Medicare & Medicaid Services-recognized physicians. These ongoing advocacy efforts remain essential to many issues, such as combatting recent state-level attacks on optometry’s role as doctors and physicians in Florida, Texas, and Connecticut.¹

CHALLENGES IN OUR FIELD

Optometrists provide primary eye care across the nation, and our expanding scope of practice encompasses primary through tertiary eye and related systemic health care for people of all ages. Doctors of optometry face similar challenges to our allopathic and osteopathic primary care colleagues—challenges related to equitable reimbursement for necessary, but time-consuming primary care aimed at prevention and preservation. In addition, we are responsible for integrating the same national recommendations regarding patient safety and public health (eg, those related to COVID-19). We also share the same influencing factors on health as other primary care physicians, such as where our patients live and who they are.^2,3

Ultimately, the value of a health profession is reflected in how effectively people are cared for to maintain and improve health. Ensuring equitable access to the highest quality eye care and espousing all available evidence to show that this care improves health is essential.

DYNAMICS OF MODERN HEALTH ADVOCACY

Advocacy can be understood as public support for or recommendation of a particular cause or policy and is apparent throughout our daily practice of optometry. From daily face-to-face interactions with patients and their families; to interprofessional, state, and national networking; to building upon the evidence supporting comprehensive eye and vision care; the modern optometrist has numerous daily opportunities to advocate for the profession.

A growing number of us practice professional advocacy around key health-related issues in addition to legislative efforts to protect and expand our scope of practice. We use strategic approaches to raise awareness of relevant health care perspectives with optometric and other health care colleagues across the nation to improve optometric engagement.

We live in an unprecedented time in which political influence and opinions often supercede scientific and professional health expertise in legislative decision-making. Determining priority issues, identifying respected professional voices, and building bespoke team approaches for successful advocacy are fundamental to our profession’s evolution and relevance in this turbulent landscape.

So, what can we as modern optometrists do to advocate for ourselves, our patients, and our profession? For starters, we can examine our contemporary advocacy arena in terms of macro- and micro- influences to inform decision-making on relevant issues affecting our patients and profession.

Advocacy and Health

The primary role of health care professionals is to use their specialized training to preserve and protect the health of patients. Health is influenced by many factors, and is commonly organized into interconnected categories known as the determinants of health.⁴ These determinants include genetics, behavior, environmental and physical influences, medical care, and social factors.^2,3

Borrowing terminology from economics, we can broadly think of determinants as macro and micro. It is important to understand that associations exist between each determinant of health. That is, the likelihood of being exposed to individual material, psychosocial, and behavioral health risk factors at an individual, or micro level, is strongly influenced by determinants at the societal, or macro level. Macroeconomic characteristics, such as income distribution data, health care policy, and societal norms, are referred to as contextual effects that also influence the delivery of care by health professionals.⁵

Micro-advocacy can be understood as focus on the patient care and clinical experience, whereas macro-advocacy focuses on policies that improve the health of a large segment of society.^6,7 Many health professional organizations successfully market their value based on a macro-level approach. One macro-level example is using patient-reported outcome measures (PROM) data to inform health policies on provision and reimbursement of services; patient reported outcome-based performance measures are a high priority for CMS.⁸ A visual representation from PROM research into response shift (ie, when a person's self-evaluation of their health changes) shows how a health care system can incorporate stakeholder preferences at the macro- and micro-level when making decisions on coverage or clinical care (Figure). Some organizations work to bridge the macro and micro divide, skillfully prioritizing emerging evidence and contemporary health findings to craft a more holistic advocacy approach.^6,7 An example of this would be the use of individual encounter data between patients and doctors to alter and reproduce macro-level health-care infrastructures over time.

It is worth considering these different strategies when examining current focal issues of our existing optometric entities to support a shared professional future. The ways that stakeholders frame advocacy shapes your current and, more importantly, your future abilities and role as a doctor of optometry, which influences patients’ access to your care and, consequently, affects their health and vision outcomes.

Influence of the Economy

The economy in which we provide care is a complex system that involves regulation from institutions, markets, finance, labor, the public-private balance, and production and distribution effects.⁹ Economic factors that influence health can broadly be conceived of in seven major categories: 1) market regulation; 2) institutions; 3) supply of money; 4) finance and loans; 5) the balance between public/private/third-party sectors; 6) labor; and 7) production and consumption approaches.⁷

In health economics, both micro- and macro-level approaches are used to estimate changes in population health.^6,7,9 Recognizing the full range of determinants of health (factors that include key economic, social, and other influences) is important to our understanding of how to improve health and reduce health disparities.^4,10

An important takeaway from health economics is employing a macro and micro approach that can help clarify your day-to-day advocacy priorities and inspire you and your team into needed action.

EVERYDAY ACTIONS LEAD TO BIG CHANGES

How we advocate for optometry determines whether desired population health and professional outcomes can be achieved. The messaging we use and actions we take to support these aims go a long way in shaping local, regional, and national health policies and regulations, and terminology borrowed from economics can help us refine and prioritize engagement.