Entry Requirements

[wmcdonald]

If you have read this board for any length of time, you realize I am one of the voices espousing more stringent requirements for entry into Opticianry. Education is at the forefront of my argument. I strongly believe we must, if we are to survive, mandate a formal education requirement and licensure in every state. This would allow us to have more relevance in the eye care community, and to outside parties as well.

Another issue that is important is the national certification process. We allow almost anyone with little to no training to ake the ABO/NCLE and they have approximately a 60% pass rate. I feel this is inadequate, and should be more stringent. The ABO/NCLE is a cash cow, and increasing requirements may limit their income, but I for one would like to see this accomplished for the benefit of the profession in the long run, and to the patients/customers/clients (or whatever you feel we need to call those we serve). I have had some difficulty expressing that appropriately, but ran across a post from another discussion board I felt was right up this alley. It relates to CPAs and their fudiciary duty to clients. Do we have a similar professional responsibility?

I'm a CPA. From the AICPA perspective, they'd make more $$ if more people were allowed to take the exam. So why make it stringent? Why make the requirements tough? Why not open it up to anyone and everyone and enjoy the short-term benefit? The reason? We believe CPAs have a duty to protect the public and states license CPAs as a result. Some things go beyond the bottom line, my friend. Our government is built on the notion that there are aspects of our society that commerce cannot and will not support.

We need to educate and train our folks better, and reqire some level of significant testing prior to entry into the profession. It is difficult when the main requirement in 27 states currently is a pulse, but only when we improve ourselves continually can we really say we have met our duty to the public. I would love to hear your comments.

Warren

[Roy R. Ferguson]

Hi Warren:

You and I have been playing this one note drum for more years than I would like to remember. To my knowledge no one has ever provided an adequate answer. It’s frustrating to realize that we are the only health related field that can be entered with NO education. To add insult to injury, most licensed states do not even require a formal apprenticeship. Training consists of show up, hang out for three or four years, sell the second pair, and take the ABO/NCLE until a passing score is achieved. Then, BINGO, you are a licensed optician. In unlicensed states you only have show up; all else is optional.

In my humble opinion, the reason this field has never embraced education is because most of the leadership lacks such a background and views an educated professional optician as a threat. Over the years I’ve hoped for positive change, but now believe that opticianry has embraced ignorance so tightly that the two can never be separated.

Roy

[Barry Santini]

Hi Warren:

You and I have been playing this one note drum for more years than I would like to remember. To my knowledge no one has ever provided an adequate answer. It’s frustrating to realize that we are the only health related field that can be entered with NO education. To add insult to injury, most licensed states do not even require a formal apprenticeship. Training consists of show up, hang out for three or four years, sell the second pair, and take the ABO/NCLE until a passing score is achieved. Then, BINGO, you are a licensed optician. In unlicensed states you only have show up; all else is optional.

In my humble opinion, the reason this field has never embraced education is because most of the leadership lacks such a background and views an educated professional optician as a threat. Over the years I’ve hoped for positive change, but now believe that opticianry has embraced ignorance so tightly that the two can never be separated.

Roy

And the reason I believe that no education has been the norm for us is that, even though we're medically-related, the risk of "harm" with improperly made eyewear is very low. The FDA has said the eyewear is in the lowest category of risk of any medical device.

Of course, I believe that secondary consequential risks of harm, i.e., auto accidents from indequate acuity or fusion, has not been properly, statisticcally and scientificaly quantified.

And further, I think what the three of us desire is better than just adequate for eyewear dispensing.
This *does* take education. I believe that the newer products and technology, if properly presented, can motivate the eyewear buying public to seek out and be willing to pay for more excellence than they do at present.

My 2 cents.

Barry

[wmcdonald]

So correct me if I am wrong, Barry. No real harm should not even require we hold a professional a license, correct? Licenses are there to protect the public, and if we can do no harm, then maybe we should not require them? I totally agree, unless we are moving towards a higher level of service. Opticians were licensed in the US basically because we were able to prove we may cause harm to the human eye because we fitted contact lenses in the initial states. Those that followed did it based on the neighboring states licensure. I want to see us do more, as many others do. I want to move beyond spectacle dispensing, adding more clinical services including low vision and contact lenses. We should be able manage.....and not just say we are managers, but know the real way to manage an organization. I want to see us expand into other clinical areas. Refraction is one, if we get the requisite education and training. We could be the PAs and NPs of the eye care world. The way it is now, anyone can do what we do legally in most places. We must do better!

I am not so sure I agree with your concept of the public's willingness to pay for "excellence". We EXPECT excellence from our health care providers. You go to a physician and expect they have achieved some level of competence. Opticians have fooled them too long. The study done in NY in the 90s indicated that the consumer thought we held a bachelors degree, like pharmacists back then. They EXPECT we have some level of education that prepares us for practice, and sadly that is not correct. I know..... NY, and Florida (that is a lower borough, isn't it?), NC and a few others require something to get in, but even in most licensed states it is simple. We have to do better. We need to develop a focused organization to lead us into the future. I want to see Opticians continually improve out lot, and we have not done that. We have sat on our posteriors and watched, as ODs advanced. We must do better!

I appreciate your comments, but I also wish you would address the question posed in paragraph 2 of my initial post. Is the CPA concept regarding testing one we need to adopt? The ABO is ridiculously simplistic for someone with any level of education. If we tighten up a bit, and demand that Opticians at least know some optics, we will be better for it. Education is key to our success. Letting anyone with a pulse take a basic exam does not make them a professional as many seem to feel. We must do better!

Warren

[rbaker]

As the graduate of one of the first two year programs of opticianry in the US I was an early supporter of formal education for both opticians and ophthalmic technologists. My early career was blessed with employment with two independent opticians whose craft and business sense was second to none so that in addition to academics I was privileged to sit at the feet of masters.

Full of **** (oops, urine) and vinegar I became very active in both state and national professional organizations and served on Boards of Directors and was President of my State Society of Dispensing Opticians. Thus began my real education.

In the late sixties nearly all retail opticians were independent or worked for optometric practices. When your name was on the sign; i.e. Emil Katow, Optician or Joe Badin, OD, a good portion of your reputation rested upon the shoulders of your employees. Quite simply stated, you did not have a bozo selling glasses in your shop. It was during this time when we first started to see corporate chains enter the business. Cripes, we called an emergency meeting of our state society when it was announced that a Pearle Vision Center was moving into the state. The reaction of my colleagues to this event was my first indication that things were not going to bode well for opticians in the coming years.

Quite simply, the majority of businesses are owned by Rumplestilskin Inc. located on the other coast or in some foreign company. Their market focus is based upon selling to the market majority, (in the chair, outta the chair, PAL with all the bells and whistles) and if it don’t work give them a new pair (no harm – no foul.) This business model hits the sweet spot of the market (most return for least investment) and does not require anything resembling a professional optician – in fact, it actually refutes any great degree of skill.

The main issue however, which seems to be unanswered is whether opticians are professionals or craftsmen. I firmly believe that they never were professionals, are not today, nor will ever be. Opticianry is a craft and not a profession. In point of fact, today it is neither a profession nor a craft – it is nothing except in the eye of the individual practitioner. The best that can be said is that a few states require licensing/registration and that there are a few schools cranking out students.

As long as opticians keep their collective heads in the sand and refuse to take a realistic look at themselves the craft will continue to decline.

[Roy R. Ferguson]

The ABO is ridiculously simplistic for someone with any level of education. If we tighten up a bit, and demand that Opticians at least know some optics, we will be better for it.
Warren

For the November 15, 2009 ABO exam in Tennessee, the candidates achieved a 51.52% pass rate. If I'm not mistaken the nationwide pass rate was 52.67. The last practical examination I administered in Tennessee had a 40% pass rate. Comments?

Roy

[Barry Santini]

Dick,

As far as the idea of craftsmen, I agree with you.

But, as many of the optiboarders who post regularly here will attest, what we do today is SOOOO much more than a craft. The way the schools teach it, even at present, is primarily as a craft.

But I and others here look at ourselves with our comprehensive skill sets and present oruselves as available eyecare gatekeepers. My clients don't need no stinkin' appointment, and they realy on me and my willingness to read learn and keep abreast of the information, literature and the times as a reliable source of authoratative information on eys and visioncare. Unfortunately, the insurance-subsidized examination part of vision care really does not. This is the root reason why the Rx "hand-off" is considered so essential to maintaining a profitable business in an refracting office at present.

Warren:
I've got Wise-Eyes, Costcos Walmarts and the internet all around me. And as much as my clients, more than ever, point out that they choose to come to me despite the other (cheaper) choices, they vote with their feet and wallet by continuing to believe and patronize my practice. So I do believe the public will seek out excellen

"Our government is built on the notion that there are aspects of our society that commerce cannot and will not support."

This is the central ongoing debate of our republic. But as far as I can see, and tendency toward this end is routinely colored as socialism, with all its apparent negative flavors.

Bottom line, Warren: Formalized Opticianry Education is "push" - what I and others like Robert Martellaro here on Optiboard bring to the public's table is "pull". Honestly, I've got too much to learn and keep up with everyday to try to change the inertia of the opticianry education establishment in this country about the way they've been going about this is all wrong and out of date in so many ways.

Teaching the skills of providing the *comprehensive eyewear experience* is not done by continual deferring to the doctor and their implied authority about eyewear. They really don't have time for it. This, then, is our domain. But graduates today are not at all ready to begin their journeymanship with their current degree in hand. And when I talk to principles of these schools, I come away with the feeling that they have been away from the front line of dispensing so long that they've lost touch with the current dynamics and changes at the dispensing desk.

I don't think we're anywhere close to obtaining a consensus about what we should be "pushing" student to learn. Rather, I think that those who will excel in our field will always recognize that their education and learning never ends, nor do they want it to. Therefore, with the availability of the internet, the information those interested parties want is available almost to all. It seems that the idea of "formal schooling" may also be eroding today.

Hell, I can't teach in *any* school in this country because I don't possess a bachelor's degree. Yet, so many tell me that they enjoy my lectures and writings and seminars, and learn from them. Heck, I've learned so much from you over the years. Yet, we weren't in a school environment, were we?

It's all about "want/pull", for the ECP and the public. I'm sorry to say that I think the idea of "need/push" may have had its day for opticianry education.

On the other hand, I'd be the first in line to argue that a 4 year education/degree is essential to begin equipping opticianry graduates for what they must begin to bring to the dispensing table. I'm just not at all ready to continue to argue this point with the current, entrenched mass of the feebleminded.

Barry

[hcjilson]

As one who came up in this industry through an apprenticeship program I was a strong believer in the system. It was one of the ways I worked my way through college. I received my degree the year I was licensed in Massachusetts and I held the view that a degree in management plus licensure through apprenticeship was all you needed for success. I held that sophmoric view for quite sometime, and in fact, did quite well professionally, thinking very little about the profession and its future.

Some years ago I had the good fortune to meet Dr's Macdonald and Ferguson who took the time (and considerable patience on their part) to re-educate me concerning the reality of why opticianry was failing to advance itself professionally. Much of their concentration appears, or will appear in this thread so I ask you all to please think about what is written here and act wherever possible to make the changes necessary for the advancement of opticianry.

The wonderful epiphany born of educatation is the simple realization that the more you learn the more you have to learn. The more you know, the more there is to know. Continuing education is not a myth, it is not a punishment, it is not to promote companies,....continuing education is a necessity.

Opticianry's problems are twofold. The first problem to address is legislative. In what state in America can you practice medicine, optometry, architecture funeral direction, or hairdressing without a license?.........think about that for a moment..........yet, in over half the states, all you need is a pulse to be an optician.

When OAA was formed, Jerry Miller told me it was their mission to promote licensing in ALL states. They have failed miserably in that regard. In a large part we're all responsible for that becuase we just sat around and were happy with the status quo. We were doing ok so who cared about Pennsylvainia, Texas and Wyoming? Before anything can happen, that has to change, because progress needs unity, and unity can only come from uniform need. If all states become licensed, minimum qualifications for licensure can be established.

On a historical note, Rhode Island took the bull by the horns and established an assoiciates degree as a prerequisite for licensure. It is my understanding that they backed off because there were so few qualified candidates. If an associates degree becomes mandatory we must insure there are institutions offering an optical degree, and students to fill the seats.

[Johns]

In a large part we're all responsible for that becuase we just sat around and were happy with the status quo. We were doing ok so who cared about Pennsylvainia, Texas and Wyoming? Before anything can happen, that has to change, because progress needs unity, and unity can only come from uniform need. If all states become licensed, minimum qualifications for licensure can be established.

Not entirely true. When Pa. was on the verge of licensure about 10 years ago, our local association petitioned the state of Ohio to send them money to help with the effort. They flatly said "no", so we, as a local group (on more than one occasion) sent money (more than $3,000) to them ourselves. This was out of our own coffers, raised by our seminars and other fundraisers.

Yes, there is often a large amount of apathy on the state levels, but not always at the locals.

[CNG]

Warren, I think you are a natural leader. You are so bright and well intentioned about opticianry . I would like to request that you be nominate or work towards being our leader in our national association so you can make changes. A leader is the problem, so how do we go about it? I have confidence in you. I beg you please get us out of the impoverish profession and make us shine again.

CNG

[rbaker]

Warren, I think you are a natural leader. You are so bright and well intentioned about opticianry . I would like to request that you be nominate or work towards being our leader in our national association so you can make changes. A leader is the problem, so how do we go about it? I have confidence in you. I beg you please get us out of the impoverish profession and make us shine again.

CNG

Two problems here.

First: Let come to some sort of consensus on the definition, scope of practice and skill set that would be required for entry into the craft. This requires organization. It also demands individuals who are willing to stand up and make waves. These individuals are few and far between.

Second: In addition to well intentioned people you need money and organization. I'm not talking about chump money but large bucks of money. Lets start out with everyone who supports an education agenda ponying up $5,000.00. We would need $100,000.00 in every state to get us started.

Don't place the burden of change on just a few individuals who are, I believe, in the minority.

[hcjilson]

Entry requirements need to be uniform from state to state. Currently, for a number of reasons, (mainly protectionist in my opinion) you cannot get states to agree on one set of standards for all states. You cannot get Virginia to agree that a PD is the same in VA as it is in FL. You cannot get FL to agree that neutralization is the same in FL as it is in MA, or that contact lenses (invented by an optician) can be fit in CT but not in TN. It's a hodge podge and until that mess is straightened out nothing can happen.

If all states would adopt an entry level which mandated an associates degree a lot of the above problems would disappear, however you would never be able to get the optometrists behind an optician's ability to fit and dispense contact lenses. Professional jealousy (and protectionism again) are at the root of this problem and frankly is one of the reasons opticians reamain fractured in their advancement.

[rbaker]

Entry requirements need to be uniform from state to state. Currently, for a number of reasons, (mainly protectionist in my opinion) you cannot get states to agree on one set of standards for all states. You cannot get Virginia to agree that a PD is the same in VA as it is in FL. You cannot get FL to agree that neutralization is the same in FL as it is in MA, or that contact lenses (invented by an optician) can be fit in CT but not in TN. It's a hodge podge and until that mess is straightened out nothing can happen.

If all states would adopt an entry level which mandated an associates degree a lot of the above problems would disappear, however you would never be able to get the optometrists behind an optician's ability to fit and dispense contact lenses. Professional jealousy (and protectionism again) are at the root of this problem and frankly is one of the reasons opticians reamain fractured in their advancement.

Licensing/registration is the responsibility of each state, independent of any national standards. While individual states may require the national ABO to set the standards we have seen a dumbing down of standards. The ABO represents that portion of the craft that does not promote the highest of standards . . . unfortunately, no one does.

Why has Massachusetts (and many other states) accepted this low standard of knowledge and education? What actually would prevent Massachusetts from requiring a formal two year program followed by a two year apprenticeship to sit for the state boards?

We all know the answer to that one. Therein lies the problem.

[wmcdonald]

Two problems here.

First: Let come to some sort of consensus on the definition, scope of practice and skill set that would be required for entry into the craft. This requires organization. It also demands individuals who are willing to stand up and make waves. These individuals are few and far between.

Second: In addition to well intentioned people you need money and organization. I'm not talking about chump money but large bucks of money. Lets start out with everyone who supports an education agenda ponying up $5,000.00. We would need $100,000.00 in every state to get us started.

Don't place the burden of change on just a few individuals who are, I believe, in the minority.

Some view us as craftspeople. The public, based on the NY study, saw us then as professionals, and I believe that many who entered the field see themselves as professionals. That is all semantics, however. Multiple studies were done that refute your position. My own indicated vast support from the people who wanted to be educated at a higher level, and supported the need for greater education. They supported moving to expand the scope into CLs, Low Vision, and even refraction. These resultes were posted here, and discussed many times.

You make several valid points, but you speak to what is and was. I speak to what can be. We must make our own path, and follow it. You are ABSOLUTELY correct. It takes a LOT of money, but there are more out there that support us that you may believe, and many are ODs and MDs. The chains need people, and now recognize a need to folks who know what they are doing. It will take a huge amount of work, but it can be done. Show these wonderful people what can be, and they will support, much like Optometry did many years ago. We can follow a path to greater success if we wish to do so, and there are enough of us to make a difference. I would hope you would consider how we may move forward and help us.

[wmcdonald]

Entry requirements need to be uniform from state to state. Currently, for a number of reasons, (mainly protectionist in my opinion) you cannot get states to agree on one set of standards for all states. You cannot get Virginia to agree that a PD is the same in VA as it is in FL. You cannot get FL to agree that neutralization is the same in FL as it is in MA, or that contact lenses (invented by an optician) can be fit in CT but not in TN. It's a hodge podge and until that mess is straightened out nothing can happen.

If all states would adopt an entry level which mandated an associates degree a lot of the above problems would disappear, however you would never be able to get the optometrists behind an optician's ability to fit and dispense contact lenses. Professional jealousy (and protectionism again) are at the root of this problem and frankly is one of the reasons opticians reamain fractured in their advancement.

Harry,
You hit the nail on the head. The reasons Opticians cannot agree across state lines is multi-facted, but it comes down to the different definitions of Optician across those borders. If we had a clear and defined education and training cucrricula in all jurisdictions, that would go away. We have a bunch of high school educated folks who have no education telling us we do not need it. Why, because thay don't want anyone to get ahead of them. The Emperor has no clothes! How do they get elected? We elect them. Seek to find new faces in your states, and make sure they have an appreciation of education even if they lack it. We need to think proactively. My time is almost over......new faces are needed, now, that can move us forward.

[wmcdonald]

Barry,
You are a very bright man, and I appreciate you. But you, like others look to what is, and I want feel we (this "profession") need to strategically plan for the future, not mire oursleves in this past. We all have chain operations around us, and if we follow your model, we can succeed competitively, but what will happen when we are gone. I want this to be a better place when I leave, and it REQUIRES a push. Making people aware of the need for change can be difficult, but if we just do it, it wil be so worth the effort.

Warren

[wmcdonald]

Warren, I think you are a natural leader. You are so bright and well intentioned about opticianry . I would like to request that you be nominate or work towards being our leader in our national association so you can make changes. A leader is the problem, so how do we go about it? I have confidence in you. I beg you please get us out of the impoverish profession and make us shine again.

CNG

I greatly appreciate your confidence in me, but I am near the end of my career. We need new folks. Join OAA and the state associations. Make yourselves heard and changhe this thing. It is not too late.

[Jacqui]

I'm a big believer in a combination of both education and apprenticeship. First an A.A.S. degree and then at least 2 years as an apprentice, starting in the lab, before a journeyman's license is given and 3 - 5 more years for a Master's license. A good thorough test should be given at each step to ensure competency. I feel this is the only way that the public will re-accept us as professionals. I don't know if the states themselves will go for this, it may be necessary to call in the Federal government and have a national license.

[Chris Ryser]

In what state in America can you practice medicine, optometry, architecture funeral direction, or hairdressing without a license?.........think about that for a moment..........yet, in over half the states, all you need is a pulse to be an optician.


Before anything can happen, that has to change, because progress needs unity, and unity can only come from uniform need. If all states become licensed, minimum qualifications for licensure can be established.

Harry is totally right........................... take your examples in Europe

The oldest democracy in the world, Switzerland, with its 24 Cantons (States in the USA or Provinces in Canada) there is only one license that makes you an optician and it is valid in every Canton. Further more most European countries licenses from many other countries are acepted on a reciprocal basis. However to manage a store you need a masters degree. That is a heck of a lot more qualifications needed than on this side oft the big pond.

[MarySue]

So correct me if I am wrong, Barry. No real harm should not even require we hold a professional a license, correct? Licenses are there to protect the public, and if we can do no harm, then maybe we should not require them?
Warren

Warren, in New Zealand we have a registration maintained with the Ministry of Health. Because of the "low risk of harm" as Barry explained it - anyone in the country may do the work of a dispensing optician, as long as they don't call themselves one. It's frustrating for sure. There are stringent requirements for registration based on education, the place you received your education, etc. Yet we have the added bonus of our clients assuming that everyone who works in the field is trained.

It's the equivalent to the USA version of flying from Virginia to Illinois - and receiving two completely different types of service. No licensure in IL, but VA is great! So within the States - you can be either.

My understanding is that a license would restrict activity - such as that in VA, where Opticians are deemed "important, valuable, and necessary" to the whole art of spectacles and contacts. Registration, such as we have, is meant to enable - allowing D.O.'s to increase their scope of practice. It hasn't though, as the politics of this little dance continue to plague the industry.

I think the answer lies in the Optometric community understanding we're colleagues, not competitors. The optometrist on the other side of town isn't seen as wrong, yet a fully qualified, educated, licensed d.o. is. Go figure.

[wmcdonald]

There is no such thing as a national license. In this representative republic we call America that function is delegated to the states. In licensed states, a license is a license. There is no master's license, only a validation the individual is competent to practice. We cannot change the system of licensure, only work within it.

[wmcdonald]

But Mary Sue......we ARE competitors. Optometry studies for a minium of 90 semester hours of undergraduate credit, and most schools require a bachelor's degree for admission. Then 4 years of Optometry School. 70% of their income typically comes from the fitting and dispensing of spectacles and contact lenses. We have the vast requirement of a pulse in 27 states, and wonder why they show us no respect. In the US, the enemy is not without......it is within. Apathy, and a lack of understanding of the value of education is why Opticians languish in this quagmire of mediocrity we find ourselves in. And we STILL can't see it. WE can do better.

Taking a very basic 100-125 question multiple choice exam, with no other requirements prior to testing does not make a professional. Which goes back to the original question I presented. CPAs require much prior to entry. Should we?

Warren

[Barry Santini]

I honestly don't see that the current syllabus covered by the current ABO exam covers is all that bad.

It's the syllabus that is incomplete. And there's no practical companion exam with the ABO.

In a way, our plight mirrors that of teaching:

There is an increasing desire, particularly strongly-voiced at present by the Obama administration, to raise the quality of teaching and teachers. Merit pay is but one suggested remedy.

But an article I just read in the March 8th edition of the NY Times magazine outlines the current problem with the teaching of teachers, as well as how we got here from there. It also lists many terrific teaching techniques that will improve the performance of *any* teacher.

But one thing was mentioned that smacked of our central problem: We graduate them, and throw them into the classromm without supervision or further day-to-day oversight. They mentioned that this is a main reason so many novice teachers are ineffective in the classroom.

Take a look for yourself:
http://www.nytimes.com/2010/03/07/ma...l?pagewanted=2


Barry

[cmhargrove]

Warren, I am trying to fully understand your position.

Are you advocating that anyone that ever sells RX eyewear be certified?
What about the lab personnel that grind the lenses, certified?
If adjusters are a different group, certified as well?
Or, are you saying that like an Optometry practice, there can be a "Certified" owner/manager that still has "apprentices" or "technicians" working for them?

Thanks.

[hcjilson]

Are you advocating that anyone that ever [sic] sells RX eyewear be certified?

Yes.

What about the lab personnel that grind the lenses, certified?

Only if they dispense eyewear to the public, however that is not a bad idea!

If adjusters are a different group, certified as well?

Any attempt to modify, adapt or fit a frame is considered dispensing. There are no "adjusters", it's a term I have not heard before and am unfamiliar with.

I do not presume to speak for Dr Mcdonald but I thought I would approach your question from a regulatory standpoint.