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The
American Optician
Where Do We Go From Here? Part
III |
This is the third in a series of articles designed to initiate some discussion on the professional "direction" of the Optician in the United States. The first article in the series, in our November Issue, described a need for change in Opticianry in the US. The second article last month described some of the changes that need to occur for Opticians to move to new levels of service, and some history surrounding the profession's development, or lack thereof.
This month, we look at several other health-related professions that have undergone change to move to higher levels of practice.
Nursing
The American Association of Colleges of Nursing suggested sweeping changes in nursing education. Nursing Education's Agenda for the 21st Century (1993, 1999) provides a blueprint for the expansion of nursing education to include a number of things well beyond the technical skills needed for nursing practice. Critical thinking, ethics, research capabilities, management skills and others are included in the treatise developed by nurse educations primary organization. They go on to claim the baccalaureate degree as the minimum standard for professional nursing practice due to the broad roles played by the professional nurse in today's health care environment. They separate the technical nurse trained in an Associate Degree program from the professional nurse because of the critical thinking and additional skills that the 4-year programs include.
Curriculum building for nursing education began in 1917 with the Standard Curriculum for Schools of Nursing. This curriculum was revised many times during the years following, but in 1950, there was a move to place nursing education into 2-year community and technical colleges. This was the first move away from nursing education tied to service in hospitals. Nursing curricula became focused around the standardized content, and still today many nurse educators teach from that idea of "covering the content" much the way they were taught. The focus of the August 2003 Position Statement of the National League for Nurses calls for drastic reform in the concepts of teaching nurses. They see a need for more innovative programs that are geared more toward today's fast-paced team approaches to health care, and away from the traditional hospital stays of the past. This position statement, entitled Innovation in Nursing Education: A Call to Reform (2003), makes it clear that reform is necessary for nursing to meet the needs of the health care market place of the future.
Therein lays the correlation to Opticianry. Nursing and Opticianry are different in many ways, but both are health care professions that require significant knowledge and skills that serve the betterment of their patients. It is important to note that while all levels of nursing licensure and training require some educational component, many jurisdictions require no educational component for Opticians. In states where there is a license required, most Opticians are trained through apprenticeship training programs that is more like on-the-job training with no educational requirement other than the level of knowledge the trainer provides. Opticians need to follow the lead of nursing to generate new ideas and paradigms for education and training.
Pharmacy
Opticians are very similar to Pharmacists in that they both fill prescriptions written by doctors, and provide a source of information to the public on matters related to health care issues. Patients often can go to the optical shop for advice on eye care, while the pharmacist is widely recognized as a source of general health information.
But the similarities end there. Training for pharmacists is very well defined in every state in the union and requires a significant level of education and training, as well as a license to practice. The Pharmacist of today completes a rigorous academic program of study and has to pass difficult licensing examinations in every state. The typical entry degree today is the PharmD, or Doctor of Pharmacy degree (Campbell University School of Pharmacy, 2004). It requires a minimum of six years of study; 2 years of required courses in the sciences and general education electives and 4 years of Pharmacy school, and additional degree programs are available in clinical studies and research. According to the Occupational Outlook Handbook (2002-2003) the job prospects are strong and should continue through 2010. The University of Southern California, School of Pharmacy (2004) describes the timeline of their educational history as beginning in 1905 with a 2-year degree program, and the 4-year Bachelor of Science degree in 1918. The school continued to progress educationally and today is an example of academic excellence.
Ongoing research in many areas of the country indicates a continuing need for additional pharmacists. In Texas, state sponsored research shows the need to be great; even though Texas graduates a high number of Pharmacists (second to California) and that there is a significant need in rural areas (Projecting the Need for Pharmacy Education in Texas, 2nd Draft, January 2004). The demand for Pharmacists is high all over the country, and unlike optical prescriptions, a licensed person must fill all prescriptions. Many optical prescriptions are filled by unlicensed personnel in eye doctor' offices, which could not happen in the case of pharmaceutical agents. While there are similarities in Pharmacy and Opticianry, the professions appear to be taking different paths. Pharmacy recognized the need to expand education and training, while Opticianry still trains via apprenticeship.
There are other professions, such as radiography, respiratory therapy and dental hygiene that have some correlation to this topic. All are in an upheaval and attempting to find the balance that will maximize their abilities in practice and allow for the continued success of their profession. Nursing and Pharmacy appear to have been successful in advancing their level of education and training and increasing their scope of practice. Opticians are struggling to find who and what they really are and need to become.
The Center for Health Statistics at the University of California at San Francisco (Pew Health Commissions, 1995) issued a report that is appropriate for this research. It states the following:
Because health care is a labor-intensive enterprise, the next stage in our present cycle of change will demand a rapid transformation in:
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How health professionals are prepared for practice
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How that practice is regulated
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The educational programs that prepare them for practice
The knowledge, skills, competencies, values, flexibility, commitment and morale of the health professional workforce serving the systems of care will become the most important factors contributing to the success or failure of the system. In response to these circumstances, the system that produces health professionals and the structures in which they work will shift away from its supply orientation and toward a demand-driven system. This situation will create four challenges to the ways health professionals practice and are educated and trained:
CHALLENGE 1: Redesigning the ways in which health professional work is organized in hospitals, clinics, private offices, community practices, and public health activities.
CHALLENGE 2: Re-regulating the ways in which health professionals are permitted to practice, allowing more flexibility and experimentation, but ensuring that the public's health is genuinely protected.
CHALLENGE 3: Right-sizing the health professional workforce and the institutions that produce health professionals. For the most part this will mean reducing the size of the professions and programs.
CHALLENGE 4: Restructuring education to make efficient use of the resources that are allocated to it.
The report suggests some specific issues for Allied Health professionals that would include Opticianry. Among those is a change in the way allied professions are educated and trained to more efficiently practice, for example, expanding the role of physician extenders (Pew Health Commissions, 1995). In the case of Opticianry, refraction could provide a method to reduce health care costs by allowing Opticians to perform that function under the supervision of a physician or OD. Opticians could become the mid-level practitioners in eye care.
Next month, we will compare Opticians in the US to their international counterparts. Stay tuned! (References available upon request) |
