This is the third part of this series of articles on the changing face of Opticianry.

There are some parallels in other allied health professions as well. Opticianry is not alone, but has been slow to make positive changes. Let us review other professions in transition.

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 like 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’s 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 frequently trains via apprenticeship.

Naturopathy

Naturopathic Medicine is an emerging profession facing similar challenges to Opticianry. Training of the Naturopathic health practitioner is rapidly changing as the profession finds higher levels of acceptance in mainstream medicine. There is some similarity in this field to Opticianry. Both have been around for many years, and both need to justify and solidify their education and training pathways to solidify their position in the health care delivery marketplace. There are currently four recognized schools of Naturopathic Medicine in the United States and Canada. They have received accreditation from the Council of Naturopathic Medical Education (2004). They include:

• National College of Naturopathic Medicine Portland, Oregon

• Bastyr University Bothell, Washington

• Southwest College of Naturopathic Medicine Tempe, Arizona

• Canadian College of Naturopathic Medicine Toronto, Ontario Canada

• The University of Bridgeport in Connecticut has opened a College of Naturopathic medicine, which is a candidate for accreditation, and should be added to this list upon final accreditation.

The course work required to become a Naturopathic doctor from the above schools include prerequisites in the sciences (chemistry, physics, biology) as well as English and other general education components. The student must have completed at least 90 semester hours of credit to enter the program, including the above requisite courses. Once matriculating in the professional program, the student is immersed in traditional coursework in anatomy and physiology, biochemistry, embryology, histology and others. The student is trained didactically the first two years, with the second two years being clinical, with dispersed coursework in radiography and other diagnostic techniques (Bastyr University, 2003). These students prescribe some homeopathic agents and even do minor surgery in some jurisdictions, which is included as part of their training.

According to the American Association of Naturopathic Physicians (2003), which recognizes the schools listed above as the acceptable educational institutions, Naturopathic training and education assumes a similar structure to that of the medical doctor, with an emphasis on disease prevention and wellness. They state on their website that twelve states currently license naturopathic physicians, including the following:

• Alaska, Arizona, Connecticut, Hawaii

• Kansas, Maine, Montana, New Hampshire

• Oregon, Utah, Vermont, Washington

• US Territories: Puerto Rico and Virgin Islands

• Washington, DC requires the Naturopaths register to practice, but does not require specific educational requirements.

A competing professional organization, the American Naturopathic Medical Association (2004), recognizes a wide variety of educational and training backgrounds as vehicles into the practice of Naturopathy. They see natural medicine practitioners in more of a consultative role in the wellness of patients, versus the AANP whose members are trained in the diagnosis and treatment of disease. Many members of the ANMA received their training in distance-learning institutions like Birmingham, Alabama-based Clayton College of Natural Health (2004). Clayton College of Natural Health is a distance-learning organization and delivers its content in a variety of fashions, including their correspondence program and now through web-based instruction. This institution offers degrees and certificates through the doctoral level and has graduates all over the country practicing some form of natural medicine. Many of these practitioners have no license to practice and fall under a similar situation as the Optician.

However, their graduates and graduates of other non-traditional institutions are eligible for registration in the District of Columbia. The clear division between the groups of naturopathic practitioners provides some similarity between the states that license Opticians as professionals and those that don’t. Naturopaths seek the ability to be recognized as primary care providers, while Opticianry is a secondary or ancillary provider. This is a significant difference between the two professions, but it is clear that naturopathic medicine is divided and needs to find some direction. Opticianry is in a similar position.

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, Naturopaths and others are struggling to find the path that will allow their respective professions to practice at their maximum level. 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:

• How health professionals are prepared for practice

• How that practice is regulated

• 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 health professions are educated and trained to more efficiently practice. An example of this would be 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. Opticians could become the mid-level practitioners in eye care and fill a large void in the eye care delivery system. More to follow next month!