This document provides background information and summarizes the debate over funding for optometric training. The links to the left will lead you to public documents that we have found.
One of the recurring
problems in the federal financing of health care is reimbursement for medical
providers who aren't M.D.'s. For podiatrists, dentists, chiropractors, and
social workers, there has been an ongoing struggle to obtain federal funding
for services provided or for better rates for reimbursement mechanisms that
include these providers. Among these other health care professions are optometrists.
Unlike ophthalmologists, who are M.D.'s specializing in care of the eye, optometrists
are trained in their own graduate schools rather than in medical school. The
primary job of optometrists is to assess and measure vision for eyeglass or
contact lens correction. At the same time they're broadly trained and play
a vital role in identifying eye diseases and routing their customers to ophthalmologists
who can treat them. As a representative of the profession put it, "we're
primary eye care providers, we're first contact providers. People go to the
optometrist because they're available, around." He went on to note that
in many small towns and rural areas there are no ophthalmologists, making
it all the more important that optometrists receive the best training possible.
A problem that
rankles the optometry profession is that the federal government doesn't financially
support their residency training. Part of the problem explained an industry
spokesperson, is that "Physicians, dentists, podiatrists, have residency
training-that's training after their [doctor degree] for specialty areas.
Optometry has no specialty defined areas. So while we have residency training
in areas of advanced competence, if you will, there are no licensing requirements
for residency to get board certification in an area. We're not there yet."
is no immediate plans for changing residency training, optometrists decided
to push ahead for federal support without this change in their graduate education.
The American Optometric Association developed a lobbying strategy aimed at
Medicare, the federal government's program for medical care for senior citizens.
The organization did not believe it could get Health and Human Services (HHS),
the department of the federal government that administers Medicare, to take
initiative on its own support this residency training. An alternative approach,
moving a separate piece of legislation going through the Congress, was unrealistic
as well. Rather, the organization's strategy was to get legislative language
inserted in a health-related bill that would indicate to administrators that
Medicare money could be used for optometry training purposes.
language into a health bill was no easy task because legislators might believe
it necessary to reduce support for some other program to fund the optometrists'
training. (Social scientists call this kind of tradeoff a "zero sum"
game.) As one legislative aide to a Senator put it, "[you'd be] adding
a new specialty practice into an already strained program." Moreover,
ophthalmologists would put up a fight as they would see such a change as an
opening for optometrists to acquire the expertise to allow them to compete
directly with them for some eye care problems. In the end this push in the
107th Congress fell short and no new federal funding for optometry training