Weigh the Benefits and Costs before Joining any Maintenance of Certification Program

By Dr. Janet Carter

With the introduction of a program of optometric board certification by the National Board of Examiners in Optometry late last year, there are now several viable choices for those who wish to pursue certification in general optometry. But before making a decision to apply for a program, the practitioner must first determine if formal board certification is something they wish to accomplish. Board Certification in general optometry is entirely voluntary. There are currently no third-party payers that require certification of their optometric providers, no requirement for such to participate in plans offered through the Affordable Care Act ("Obamacare"), and no indication that Medicare will require board certification of optometrists in the foreseeable future. It is true that employers, hospitals, and the like may use certification as part of their determination of admitting privileges and/or salary. Perhaps more importantly, participation in the "Maintenance of Certification" (MOC) aspect of board certification represents an ongoing commitment by the practitioner to lifelong learning and to keep up with technological and scientific developments in the profession.

The practitioner must also distinguish between programs that certify optometrists in general clinical optometry and sub-specialty certification. In Medicine, the board certification system came into existence because physicians graduate with a degree that gives them broad eligibility to practice a wide variety of specialties, regardless of their actual training. The MD board certification helps to insure that they have had sufficient training and education in their chosen specialty area. Optometrists, on the other hand,

graduate having already been well-trained in their chosen specialty of eye care, and the licensing examinations do an excellent job of assessing their competency. However, optometrists may choose to "specialize" in very specific and narrow areas of the profession, such as contact lenses, medical eyecare, or binocular vision. There are several organizations that certify optometrists in these sub-specialties, including the College of Optometrists in Vision Development (COVD) and the Diplomate programs of the American Academy of Optometry. The most recent of these is the American Board of Certification in Medical Optometry (ABCMO). The ABCMO certifies US optometrists who have chosen to specialize in medical optometry, and who have completed an ACOE accredited residency in that area. The ABCMO utilizes the Advanced Competency in Medical Optometry (ACMO) examination of the NBEO. This is not a certification program designed for those in general practice, and will be of interest largely to those optometrists practicing in multi-specialty, medically oriented clinics. More information on the ABCMO can be found on their website at www.abcmo.org

The American Board of Optometry (ABO) was formed several years ago with the support and assistance of the American Optometric Association and several other groups, including the American Academy of Optometry and the American Optometric Student Association. The ABO requires that applicants have an active therapeutic license to practice optometry and accumulate 150 "points" based on their education and experience in order to be eligible for certification. The grace period in which points could be accumulated simply through time in practice has now expired. There are a number of ways applicants can now acquire the required points, and a full explanation can be had on the ABO website (www.americanboardofoptometry.org). Most ODs who have been in practice for more than a few years will have to accumulate the required points through continuing education. Once the OD is eligible for certification, they must take and pass the ABO examination to be certified. Cost of the examination is $1500, and it cannot be taken until the required points have been accumulated. The Maintenance of Certification program lasts 10 years, and has ongoing educational and financial requirements as well. The ABO examination must be taken every 10 years to maintain certification.

The American Board of Clinical Optometry (ABCO) was formed in 2010 as an alternative to the ABO certification program. The ABCO was formed with the basic premise that the examinations (specifically the NBEO) that are used for licensure are sufficient to insure the competency to practice optometry in the United States, and that no additional examinations should be required for initial certification. The ABCO firmly believes that the true value of certification programs is in the ongoing Maintenance of Certification, and that optometrists who are committed to a program of lifelong education and professional development will benefit from this process. There is no initial examination to become ABCO certified, but the optometrist must submit an application and show that they have an active therapeutic license to practice optometry and are in good standing. ABCO certification is also a ten year process,  nd does require an assessment to renew certification at the end of the ten year period, as well as ongoing educational requirements.

In 2014, the American Board of Clinical Optometry (ABCO) voted to endorse the NBEO-BC program as its Maintenance of Certification vehicle. Current ABCO fellows have been notified of their eligibility to participate in the NBEO-BC program. The ABCO strongly encourages any ODs that might be seeking new certification to utilize the NBEO-BC program. More information on the NBEO-BC at http://www.optometry.org/nbeo-bc/index.cfm.

The most recent optometric Maintenance of Certification program was initiated in late 2013 by the National Board of Examiners in Optometry (NBEO). The NBEO-BC program, as it is called, has the stated goal of recognizing and promoting professional lifelong learning to encourage excellence in optometric care for the general health and welfare of the public. The NBEO recognizes that in the past many optometrists have claimed that they were "board certified" by virtue of having passed the NBEO examinations, but this program mandates participation in their MOC program to use that designation. In order to be certified through the NBEO, the optometrist must be TPA licensed in good standing and have graduated from an ACOE accredited school or college of optometry. There is a requirement that they have been in practice for at least three years unless they have completed an ACOE accredited residency or received a score of 450 or higher on all three parts of the NBEO and TMOD, which decreases the active practice requirement. The NBEO-BC program uses the NBEO CPDO examination as an assessment tool for its MOC program. Optometrists who become certified through the NBEO program will have to complete the CPDO assessment within a time period that will vary depending on how much time has passed since they graduated and took the NBEO examinations. (The time period involved varies from three years to seven years). The CPDO assessment provides the optometrist with a breakdown of their strengths and weaknesses in clinical knowledge, and the NBEO MOC program directs the practitioner to specific continuing education to address any weaknesses. Cost of the CPDO examination is $500, and the practitioner must repeat the assessment every seven years to maintain certification. More information on the CPDO examination can be found on the NBEO website, www.optometry.org, and at the NBEO board certification website, www.NBEO-BC.org.

Participation in any of these programs is entirely optional, and many optometrists will find just as much value in charting their own course of professional development. Furthermore, some optometrists may find value in an entirely voluntary and confidential assessment such as the NBEO CPDO examination (which can be taken even if the practitioner has no plan to participate in the NBEO-BC program). It is a personal choice, and the optometrist should weigh the benefits and costs of the various choices before joining any Maintenance of Certification program.