Scope Of Practice Expansion: Explain It To Me Again

How should consumers — and optometrists — view optometry's expansion of scope of practice?

BY WALTER D. WEST, O.D., F.A.A.O.
Chief Optometric Editor

When I was a kid, I thought about visiting a tourist attraction called "Ghost Town." You've probably been to a similar spot at one time or another. Or, perhaps you've attended an "old timers day" celebration where docents or "re-enactors" demonstrate how things used to be done — you know, like how early settlers made soap, spun yarn, pulled taffy and wove baskets. A little farther down the road, you could see how the pharmacist used to compound prescriptions, and my personal favorite: how the livery stable was managed. I particularly enjoyed watching the blacksmith, hot, sweaty, blackened with soot, whaling away with a five-pound hammer shaping a piece of iron into a horseshoe or whatever.

We're intrigued with these things because we see how much easier we have it now, and just how primitively some things were done — even those things that functioned very well. We marvel at how far we've come and how we've adapted to better ways to do just about everything.

Not so long ago…

Then I think about optometry and how far we've come in the 35 years that I've been in the profession. We've broadened the scope of practice to include levels of care that weren't available even as late as the early 1970s, and weren't even a concern before that time, such as therapeutic pharmaceutical agent rights. Unfortunately, too many O.D.s didn't recognize the "expansion of scope" as a change in direction. Instead of providing vision care and medical care, many O.D.s left one for the other. Next, vision care, which was always our primary focus — and something no one did as well — began to take the backseat to medical care.

Fighting for additions

Like others, I fought for and invested in the privilege to provide medical care to patients, and it was a great addition. That's "addition," not "replacement." I'm afraid that if you showed the Optometry College Aptitude Test to someone who was completely unfamiliar with optometry, he would never realize that the exam had anything to do with a profession whose roots are in vision care.

In addition, I'm afraid that, that same person could look at the current curriculum for an optometry school and never see where vision care was a major component of the syllabus or where the national boards test one's command of all the skills needed to deliver total vision care. It seems as though we're drifting farther and farther away from the definition of what the consumer thinks we are, in an effort become more of what we think we are, or want to become. Yet in the end, isn't it the consumer (or patient) who shapes our businesses (practices)? Or, at least, shouldn't it be? Simply put, shouldn't we deliver on the patient's expectations for total vision care?

Back to the future

I hope that when future generations visit tourist attractions or watch demonstrations about how things used to be way back when, that optometry isn't included in the professions that have fallen by the wayside. I hope that the demonstration doesn't include an optometrist surrounded by patients who demand vision care, while she explains the medical model of optometry. OM

Optometric Management, Issue: June 2010