1

Is Optometry on the Same Path as the

Legal Profession?

Charles F. Mullen

May 28, 2015

2

The Rapid Increase in Practitioners is Similar

Law Schools

Opened 19 New Law Schools Since 2000

• From 186 to 205 Schools in 15 years -- a 10% Increase

• More Schools Planned

• Increased Enrollments at Existing Schools

Optometry Schools and Colleges

Opened 7 New Optometry Schools From 2008 to 2016

• From 17 to 24 Schools in 8 Years -- a 41% Increase

• More Schools Under Consideration

• Increased Enrollments at Some Existing Schools

3

Consequences of Increased Supply of Lawyers

Underemployment and Unemployment of Graduates

• 45% of Graduates Unable to Find Full Time Positions

Applicants Down 37% and Enrollment Down 24% Since 2010

• Tuition Reduced and Financial Aid Increased

• Less Qualified Students Being Admitted with LSAT Scores Less than 145, Unlikely to Pass the Bar

• Misrepresentation Law Suits by Students/Graduates

• At Schools Unable to Fill Classes: Faculty/Staff Layoffs, Some Law Schools Consolidating or May Close.

Top Schools Employ 3-17% of Their Own Graduates

4

Admissions Issues at Optometry Schools

Over 500 Entering Seats Added Over Past 7 Years

Approx. One Qualified Applicant per Entering Seat

• Little Change in Applicant Pool in Recent Years

Admissions Standards Vary Among Optometry Schools and Colleges

Increase in Number of Graduates From 1127 in 1997 to 1600 in 2014 and Will Likely Reach 1900 by 2020.

5

Supply of Optometrists

Rand Corp-1995, Abt Assoc-2000 and Lewin Report-2014 All Indicated Surpluses of Optometrists

Lewin Study Indicated Current 30% Excess of Optometrists or 12,672 FTE

• Possibly a Distribution Issue

• 3,278 FTE Needed to Provide Optometric Services in Inner-Cities and Rural Areas -- Analysis of HRSA Data.

Bureau of Labor Statistics (BLS) Projects 8,100 FTE Additional Optometrists Needed by 2022

• Inconsistent With All Previous Manpower Studies. However, BLS May Have Considered Need in Underserved Areas.

6

Assumptions in Lewin Study

Lewin Projects a Decrease in Current Optometry Surplus of 12,672 FTE to 4,400 FTE by 2025

• If Optometrists Provide the Same Scope of Practice As Ophthalmologists

• And 1.36 FTE OD Surplus Fill 1.0 FTE MD Shortage

However, Management of Diabetic and Elderly Patients with Multiple Medical Problems Requires:

• Advanced Clinical Training and Legal Authority in All States to Treat With Systemic Medications and Perform Invasive Procedures

• Acceptance of Optometrists Providing These Services by Insurance Carriers is Necessary

7

Impact of Supply of Optometrists on

Employment of Graduates

No National Data is Available on Graduate Employment

• College Administrators Report Ample Employment Available for Graduates in Private and Commercial Sectors

• Why Not a Robust Applicant Pool?

• Lewin 2012: 46% of Graduates under 30 yrs. Practice at Two or More Part Time Locations, 11.5% at 4 Locations

8

Suggested Actions to Mitigate Effects of

Oversupply of Optometrists

Individual Schools and Colleges May Find It Prudent to Plan For Reduced Entering Classes and Enrollments

• Adjust Revenue and Expense Projections

9

External Agencies

ACOE to Consistently Enforce Requirement for Optometry Schools and Colleges to Document the Quantity and Diversity of Clinical Training Encounters Before Initial or Ongoing Accreditation is Granted

Require Explanation and/or Correction of Bureau of Labor Statistics Projections

• Used as Rationale for New Schools

Require a Realistic Strategy from ASCO to Address Weak Applicant Pool

• Marketing Alone May Not be Adequate

• Address Proliferation of New Schools

10

Curricula Measures

Make An Optometry Career More Attractive and Control Debt by Shortening the Overall Length of Education for O.D. Degree and Board Certification

• Require 1 Year of Post Graduate Training for Initial Licensure

• In the Process, Develop a Clinical Training Model to Potentially Qualify for GME

• Training Model Would Permit 4th Year Students (Now Residents) to Contribute to Billable Services

• Current Student-Centered Training Model Vulnerable to Violations of CMS Regulations

11

Explore Alternative Strategies

Consolidation of Optometry Colleges

Additional Educational Offerings in High Demand Health Care Professions

Implement a Marketing Strategy That Promotes the Uniqueness of the College

Develop/Expand Special Programs for Foreign Students

Innovative Programs within Health Sciences Centers, Universities or Affiliations with Medicine

• Six Optometry Schools are Affiliated with Osteopathic Institutions

12

Public Health Approach to Oversupply

Increase Demand for Optometrists by Addressing Need for Eye Care in Inner-City and Rural Areas

• 3278 FTE Needed in Community Health Centers

Only 20% of Federally Qualified Community Health Centers Offer Optometric Service

Inclusion of Optometry in Federal Incentive Programs: National Health Service Corps Including Scholarships and Loan Forgiveness and Practice Start-Up Support is Essential

Optometry’s Best Opportunity to Mitigate the Effects of Oversupply or Distribution Issue

13

Discussion Questions

1. Is Optometry on the Same Oversupply Path as the Legal Profession?

• Unemployment and Underemployment of Graduates?

• Reduced Applicants and Enrollments?

• Financial Issues at Schools?

• High Educational Debt?

2. What Actions are Necessary in the Event of a Serious Downturn in Applicants/Enrollment?

3. Why is There a Weak Applicant Pool If Ample Employment Opportunities Are Available?