ABCO Frequently Asked Questions
- I Never Took the NBEO and/or TMOD Exams, Can I Still be Certified by the ABCO?
Yes. ABCO accepts as evidence of competence in general optometric practice either the national board examinations offered by the National Board of Examiners in Optometry (NBEO) or the equivalent State Board examinations. The same goes for therapeutics. If your state license permits you to prescribe therapeutic pharmaceutical agents but did not require the TMOD exam, and instead required taking and passing an alternative examination in order to obtain your TPA certification, that will be acceptable to the ABCO.
The ABCO recognizes that, until recently, many states either did not accept NBEO or TMOD exams and required, instead, that applicants for licensure or TPA certification take and pass comparable examinations given by the State, or accepted some portions of the NBEO but required additional State Examinations in addition to it. The ABCO believes that State Boards are the only authorities charged with the responsibility of determining if an optometrist has attained the requisite skills and knowledge to enter the practice of optometry and provide quality eye care to the public. Thus, the ABCO accepts the examinations required by your respective state(s) as sufficient for purposes of determining cognitive expertise for certification that you are competent to enter into and practice the profession of optometry. If you have not taken all, some, or any of the NBEO examinations, so long as you've taken and passed your State Board equivalent examination(s) you have met the ABCO testing requirement for initial certification.
- Is ABCO Certification required to be licensed to practice optometry?
No. Licensure is regulated by the individual states and by a state optometric board. ABCO Certification requires that the certified doctor have an unrestricted license in good standing with a state board of optometry. The ABCO does not have authority or purport to grant, revoke, or deny a license. ABCO Certification does not confer any legal degree of qualification, privilege, or license to practice optometry. The ABCO does not intend to interfere with or limit the professional activities of any duly licensed optometrist whom it has not certified.
- Are Certified optometrists more competent than non-Certified optometrists?
No, not necessarily. Optometric certification is a voluntary process. While ABCO Certification assures that the doctor has the knowledge, training, and skill necessary to provide quality optometric care and has an unrestricted license to practice optometry, not being ABCO certified does not necessarily mean the converse. Because certification is a voluntary process there may be many very competent optometrists who have chosen not to attain certification.
- What is the difference between ABCO and ABO Certification?
American Board of Optometry (ABO) certified optometrists are no more and no less competent than ABCO certified optometrists. ABO and ABCO certified optometrists have the same optometric education, have passed the same NBEO administered National Board and/or state licensing examinations, obtained the same licensure, and have demonstrated the same level of knowledge, skill and training in the practice of optometry. While there are some differences in the processes and criteria the two organizations use in granting their respective certifications, both certifying bodies serve the public by providing a measure of assurance, separate and distinct from licensure, that the certified doctor is competent and has maintained competency over time. In addition, ABCO Certification requires that doctors demonstrate good moral character. Neither ABO or ABCO certification is intended to provide assurance of advanced competency or competency exceeding that required for licensure. Both ABO and ABCO have maintenance of certification processes, which, again, differ in their details but both are designed to ensure that their certified doctors are maintaining knowledge and skills over time.
- Doesn't Health Care Reform now require an examination to be Board Certified?
The short answer is, no. Nothing in the new law, or any other law, requires a formal examination as a part of becoming certified. In addition, the law applies only to a temporary enhanced Medicare payment available to certain eligible providers that choose to participate in the program, and to nothing else.
Health care reform legislation was signed into law on March 23, 2010. This historic legislation includes a section, section 10327, entitled "Improvements to the Physician's Quality Reporting System," which specifically addresses qualifications for "enhanced payments" under the Physician's Quality Reporting Initiative (PQRI). There is a lot of misinformation about what this section says. Notably, and contrary to the assertions of many that claim to know, Section 10327 does not address becoming certified at all and does not require an examination as a condition of becoming certified.
Section 10327 provides for a .5% enhanced Medicare payment from 2011 through 2014 for doctors that participate in PQRI reporting. To be eligible for this .5% enhanced payment, the "eligible professional" must submit qualifying data for one year, and "more frequently than is required to qualify for or maintain board certification status — (I) participate in such a Maintenance of Certification program for a year; and (II) successfully complete a qualified Maintenance of Certification Program practice assessment for such year."
Importantly, and there is where the misinformation emanates from, subsection (c) of the section then defines what the term "Maintenance of Certification Program" means for purposes of the enhanced PQRI payment:
"(i) The term ‘Maintenance of Certification Program’ means a continuous assessment program, such as qualified American Board of Medical Specialties Maintenance of Certification program or an equivalent program (as determined by the Secretary), that advances quality and the lifelong learning and self assessment of board certified specialty physicians by focusing on the competencies of patient care, medical knowledge, practice-based learning, interpersonal and communication skills and professionalism. Such a program shall include the following:
(I) The program requires the physician to maintain a valid, unrestricted medical license in the United States.
(II) The program requires a physician to participate in educational and self-assessment programs that require an assessment of what was learned.
(III) The program requires a physician to demonstrate, through a formalized, secure examination, that the physician has the fundamental diagnostic skills, medical knowledge, and clinical judgment to provide quality care in their respective specialty.
(IV) The program requires successful completion of a qualified Maintenance of Certification Program practice assessment as described in clause (ii).
(ii) The term ‘qualified Maintenance of Certification Program practice assessment’ means an assessment of a physician’s practice that — (I) includes an initial assessment of an eligible professional’s practice that is designed to demonstrate the physician’s use of evidence-based medicine; (II) includes a survey of patient experience with care; and (III) requires a physician to implement a quality improvement intervention to address a practice weakness identified in the initial assessment under subclause (I) and then to remeasure to assess performance improvement after such intervention."
It is section III above which some erroneously cite as proof that a formal examination, such as the kind the ABO intends to require in order to obtain its certification, is required as part of a certification program. This is a misreading of the law, however. As is clear above, the law creates no requirements for initial certification and, in fact, says nothing about becoming certified or board certified. It is only the methods employed by the certifying entity's "maintenance of certification" program which are described by the statute. The "eligible professional" (e.g. the doctor) must participate in a "maintenance of certification" program which meets or exceeds the standards set forth above. Irrespective of the means employed in granting the initial board certification, any doctor in a qualifying MOC process will satisfy the requirements and can be eligible for the enhanced Medicare payments.
- Why Should I Join the ABCO if I'm Already Allowed to Say I'm "Board Certified?"
Many states permit optometrists to represent themselves as being "board certified" by virtue of having passed National Boards, State Boards, the Treatment and Management of Ocular Disease Board, and/or being certified to practice by the respective State Board of Optometry. This, of course, is entirely appropriate and entirely consistent with the foundational philosophy of the American Board of Clinical Optometry. However, this does not address the essential aspect of ABCO certification in modern health care, which is enrollment and participation in a qualified, ABMS compliant, Maintenance of Certification program as a means of demonstrating continuing competency over time.
The point of ABCO Certification is to provide a means for participation in a credible Maintenance of Certification program that satisfies the criteria established by the American Board of Medical Specialties, including evidence of life-long learning. It is this participation in a qualified MOC process that most expect will be required by third party payers in the not too distant future, and, more importantly, that ensures that the participating doctor is actively maintaining competency over time. Certification itself is not really the issue, it is just a pre-requisite to an MOC process, which is now the generally recognized and accepted means of demonstrating continued competency in health care.
Importantly, the ABCO does not hold itself out as granting "board certification" in the traditional sense. Within medicine and health care generally, being "board certified" denotes extensive post-licensure training and education leading to competence within a particular area of health care which exceeds that of other similarly licensed practitioners. ABCO Certification is not intended to suggest that the practitioner has training or education, or has demonstrated competence, beyond that required for licensure. Certification by the ABCO is a means to engage in an ABMS compliant maintenance of certification program to demonstrate that the certified doctor is committed to a program of lifelong learning and staying abreast with the profession.
- Will having two certifying entities divide the profession?
No, not at all. In fact, there is a lot of precedence in medicine for multiple organizations offering fellowships and board certification. For instance, in ophthalmology, there are at least three different organizations that certify competence. Each uses its own set of criteria for ensuring that its applicants are qualified to practice the profession before issuing them certification.
In optometry today Fellowship is offered by the American Academy of Optometry, the College of Optometrists in Vision Development, and several other organizations, and many optometrists already represent themselves as being board certified in the treatment and management of ocular disease (TMOD) by virtue of having passed the TMOD exam offered by the National Board of Examiners in Optometry. (Indeed, until very recently, the President of the American Optometric Association, Randy Brooks, O.D., described himself on his website as "an Optometric Physician board certified in the treatment and management of ocular diseases.") And the American Board of Certification in Medical Optometry (ABCMO) has recently issued its first board certifications and fellowships.
Instead of dividing the profession, the American Board of Clinical Optometry celebrates optometric competence and thereby unites the profession through its implicit respect for the rigorous education and testing required to obtain a license to practice the profession, and which all licensed optometrists have in common. The ABCO recognizes that all licensed optometrists have the same educational background and have passed rigorous board examinations, and have thereby demonstrated entry level competence in the same fashion as have board certified physicians.
- Does the ABCO certify any optometric sub-specialties?
Currently the ABCO is in the process of establishing criteria for certification of optometric sub-specialties. The ABCO intends to expand its certification to include ABCO Certification and Maintenance of ABCO Certification in Primary Care, Contact Lenses, Pediatrics, Medical Optometry, Low Vision, Neuro-Rehabilitiative Optometry, and other recognized optometric sub-specialties in the near future. Where feasible and consistent with ABCO guidelines, ABCO may adopt organizational criteria established by such entities as COVD and ABMO as meeting ABCO criteria for sub-specialty certification in much the same way the ABMS serves the medical specialties. For sub-specialties not currently offering any form of certification ABCO intends to develop criteria, which may include a required residency, and appropriate testing, which must be met to obtain ABCO sub-specialty certification.
- Is a Residency required to become ABCO Certified?
No. Currently about 15% of optometrists complete a 1-2 year residency in one of about fifteen optometric subspecialties after completing their formal optometric education and obtaining the Doctor of Optometry degree. This is training over and above entry level competence in general optometry and is designed to provide the doctor with advanced competency in his or her area of interest. ABCO Certification in General Optometry requires entry level competence in the general practice of optometry as opposed to advanced competency in an optometric subspecialty obtained in a residency program. Satisfactory completion of an accredited optometric residency will be one of the criteria required for ABCO certification in a number of optometric subspecialties, however.
- Why doesn't ABCO Certification require a residency and examination?
Like board certification in medicine, ABCO Certification in optometry requires completion of a rigorous formal education and clinical experience, followed by examinations by independent (e.g. unaffiliated with the educational institutions) organizations. Because there is no licensure in the various medical fields of practice (e.g. there is no license to practice ophthalmology or surgery or pediatrics, only to practice "medicine"), board certification in medicine is the only way to be sure that the physician has completed a formal education (called a residency) in his or her particular medical field, fields such as pediatrics, neurology, or ophthalmology, and passed examinations to assure competency in that field of medicine.
Optometrists complete a 4-year formal education in optometry (akin to a medical residency) where they receive extensive and specialized didactic (classroom) and extensive clinical training in the field of optometry and a rigorous multi-part National Board examination administered by the independent National Board of Examiners in Optometry, typically followed by state examinations in the states in which a license is sought, as requirements for licensure. This ensures that the optometrist is competent in the field of optometry just as board certification does in medicine.
- What does Non-therapeutic ABCO Certified mean?
ABCO Certification is based on and recognizes two fundamental principals. First, it is the province of state regulatory boards to determine the requirements for demonstrating competency to practice optometry in their state. Second, some optometrists practice in specialty fields of optometry the practice of which does not require them to attain training and certification to prescribe therapeutic pharmaceutical agents. Additionally, some optometrists are licensed to practice in states that do not require all optometrists be certified in the treatment and management of ocular disease.
In deference to these realities, and to accommodate variations in state licensing requirements and the different modes of optometric practice, until January 1, 2020, the ABCO provides ABCO Certification and Non-therapeutic ABCO Certification. In addition to the requirements for licensure in the applicant's state, ABCO Certification requires the applicant to have attained and to maintain the knowledge and skills required to utilize therapeutic pharmaceutical agents in accord with his or her applicable state law. Non-therapeutic ABCO Certification is available, for a limited time, for those doctors whose state licensure does not require training in the use of therapeutic pharmaceutical agents and who are not so licensed. After January 1, 2020, all ABCO Certified doctors must be certified in the treatment and management of ocular disease.
- Can I have therapeutic certification if I am TPA certified but did not take the TMOD?
Yes. The certification requirements provide that you must have taken the TMOD "or its equivalent." The ABCO will look to what the requirements were for you at the time you obtained your license to prescribe therapeutic pharmaceutical agents in determining if you've met the "or its equivalent" requirements. In states where optometrists earned TPA privileges based on criteria other than the TMOD, for instance, where the TPA law was passed before there existed a TMOD exam, so long as you met the requirements for your state license you will have likely met the "or its equivalent" requirements.
Similarly, with respect to the National Board exams (NBEO), there also exists an "equivalent state, provincial, or territorial board examination" option for those that were not required to take or pass one or more sections of the NBEO exam at the time they obtained their license. Once again, a licensed doctor can meet the "equivalent" test by demonstrating that he or she took and passed a state board examination at the time of licensure.
- What is required to maintain ABCO Certification?
An ABCO certificate is valid for five years. Once certified, in order to maintain his or her certification, a Fellow must participate in an on-going maintenance of certification program. Fellows that complete the Maintenance of ABCO Certification program during each five year period (cycle) will have their certificates renewed for another five years. The ABCO-MOC process is designed to ensure that ABCO Certified Fellows are maintaining knowledge and skills germane to the evolving practice of optometry. You can read the details of the ABCO-MOC process by clicking here.
- What is ABCO doing with the fees charged for ABCO Certification?
First, and foremost, ABCO will cover its overhead costs in operating the program. The ABCO is, however, very sensitive to the potential added financial burden on practicing optometrists of board certification and maintenance of certification, and intends to provide optometrists with a cost-effective process for those choosing to pursue their Fellowship status. Excess revenue generated by the ABCO will be returned to the profession to advance its causes and the mission of the ABCO. In particular, the ABCO will use the money to directly support local, state, and national optometric organizations through the distribution of grants and loans and for purposes generally related to the advancement of the profession. At the heart of the ABCO philosophy is improving and giving back to the profession of optometry.
- Why is Certification Necessary for an Optometrist?
As a practical matter, certification is not necessary in optometry. Licensure already requires demonstration of the same training and knowledge as does certification in general optometry. But, increasingly, various third party entities in the health care arena, including third party payers, the United States government, and various quality control entities, are considering or expecting doctors from all fields of health care to demonstrate that they are maintaining competence (continued competence) in their field. One means of doing so is through so-called MOC, or Maintenance of Certification, programs which require the health care provider to demonstrate that he or she has kept current over time. ABCO's MOC process is one such program. Participation in and completion of the ABCO-MOC program by an ABCO Certified optometrist provides assurance that the doctor has kept current and maintained the level of knowledge and skill in the practice of general optometry he or she first demonstrated upon licensure.
- What is the relationship between the AOS and the ABCO?
The American Optometric Society (AOS) and the American Board of Clinical Optometry (ABCO), are separate organizations, run by different Boards, with different structures, for different purposes.
The AOS is a member organization run by a Board of Directors directly elected by and accountable to its members. The AOS supports the ABCO concept, and the AOS holds one seat on the ABCO Board of Directors. The AOS' principal purpose is to represent the interests of its member optometrists in a variety of contexts. Politically, the AOS seeks to address the lack of accountability and lack of representation which has eroded the AOA and a variety of other issues affecting today's practicing optometrist.
The ABCO is not a "member" organization and its Board of Directors is not elected. ABCO has no political agenda or purpose. ABCO was formed to provide a credible, honest, and attainable process for demonstrating continued competence of its certified optometrists. Essentially, the ABCO believes that, if board certification is upon the profession, an option must exist that respects optometric training, testing, and competency and allows doctors a cost-effective choice in how they will demonstrate their continued competence.
ABCO is not a creation of the AOS, and AOS does not control ABCO. While the AOS currently has a seat on the ABCO Board of Directors, the two organizations operate in different ways and for different purposes. AOS support for the ABCO is consistent with the genesis and purpose of the AOS. The AOS has taken, and continues to take, a stand against the ABO proposal for Board Certification. As explained on its website, the AOS views the ABO as inherently demeaning to the profession by implying there exists today a lack of proven competency, misleading to the public by suggesting that ABO certified doctors have proven competence that non-certified doctors have not proven, and divisive to the profession by separating optometry into two groups, one claiming to have proven a greater level of competence than the other. AOS supports the ABCO because the AOS recognizes that ABCO supports the competence of optometrists as demonstrated by their education, board testing, and licensure.