Development of Specialists and Board Certification
Until the 1940’s, medical (MD) and osteopathic (DO) physicians and dentists frequently entered practice with only a degree, an internship and then a license.
With time, the increasing complexity of healthcare led to residency training in medical-osteopathic specialties after licensure. This accelerated with the concentration of advanced and specialized procedures at hospitals and the latter began to prefer, and often require, residency-trained specialists. Today, the 24 American Board of Medical Specialties recognized specialty boards for physicians all require specialty residency training and written specialty examinations for board certification and osteopaths and dentists have similar specialty boards. Altogether, including one optometry specialty board there are 74 recognized specialty boards for physicians, dentists, optometrists and podiatrists.
About 80% of medical-osteopathic physicians are board certified in a recognized specialty. Joint Commission accredited medical facilities require these specialists be residency trained and certified by an appropriate specialty board. There is no requirement to be board certified for private practice.
Board certification is synonymous with specialization via residency training and is required for clinical privileging of specialists at Joint Commission accredited medical facilities.
Defined-license doctoral prescribing practitioners like dentists, optometrists and podiatrists were slower to develop specialties as their training, degrees and licenses prepared them for general practice without postgraduate training or certification.
General Practice vs. Specialist Practice
Since 1986, the Joint commission has recognized that optometrists qualify for appointment to the medical staff of an accredited health care facilities by holding the O.D. degree and state license. Additional professional credentials are not required for private, or public practice of optometry, by insurance panels or state and federal medical programs.
However, to apply for credentialing as a specialist at a Joint Commission accredited health care facility optometry practitioners must document
- completion of residency training in a specialty
- passage of an examination in that specialty and
- provide the name of the recognized specialty board issuing their specialty certification.
Board Certification of General Practice Optometrists
There are significant differences between board certification as a specialist and board certification in general practice optometry. Two boards issue certifications to general optometry practitioners, National Board of Examiners in Optometry-BC (NBEO-BC) and the American Board of Optometry (ABO)].
Optometry is unique in offering board certification to general practitioners as the two boards for general optometry practitioners certify licensing-level competency rather than specialty competency.
The credentials awarded by the two organizations issuing board certifications to general practice optometrists require voluntary additional testing in general practice. Optometrists taking these additional steps to ensure their competency in general practice are to be commended.
However, the existence of different types of board certification for optometrists can produce confusion for credentialing bodies since two boards certify license-level competency and one board certifies specialist-level competency.
Specialty Residency Programs in Optometry
Optometry began to move to residency training when the Department of Veterans Affairs (VA) established hospital residency training programs for optometry in 1975. The Association of Schools and Colleges of Optometry (ASCO) since then, has designated 11 specialties for which residency training is appropriate. The Accreditation Council on Optometric Education (ACOE) accredits optometry residency programs. At this time there are about 400 residency positions at accredited specialty residency programs. Currently about 1,600 graduate from United States optometry schools and colleges each year which indicates about 25% of graduates are now electing to qualify as specialists by completing additional, post-graduate specialty residency programs.
Specialty Board Certification in Optometry
Medicine, osteopathy and dentistry have long had specialty certification boards that issue board certifications to those completing post-degree, clinical residency training programs and passing a written examination in defined specialty areas of these professions.
Specialty certification is also required of any licensed optometrist seeking credentialing as a specialist at a Joint Commission accredited facility just as it is for physicians and dentists.
Optometry has only one specialty certification board the American Board of Certification in Medical Optometry (ABCMO). The Advanced Competence in Medical Optometry examination (ACMO) administered annually by the National Board of Examiners in Optometry (NBEO) since 2005 and the American Board of Certification in Medical Optometry (ABCMO) incorporated in 2009 offer board certification in the specialty of medical optometry with a maintenance of certification requirement.
As such, it is aligned with the credentialing process used for appointment and credentialing of allopathic and osteopathic physicians, dentists and podiatrists practicing at Joint Commission accredited healthcare organizations. In this long-standing United States credentialing system, board certification recognizes achievement of advanced competency in a specific and limited specialty area within one of these professions. In this credentialing system, board certification as a specialist requires
- completing accredited specialty residency training after licensing
- passing a written examination testing competency in that specialty and
- certification by an appropriate specialty board with a maintenance of certification requirement.
This process, termed board certification, has been used for over 80 years to certify specialist-level competency. That is competency above that required for licensure.
Additional Optometry Specialty Boards Needed
Today it is virtually impossible for a medical, dental, optometry or podiatry practitioner to be fully qualified in all aspects of their profession.
While it is likely optometry will continue to primarily consist of general practitioners, there are clearly more specialty residency programs each year and a need exists to establish viable credentialing and career paths for those completing residency training.
Although optometry residency programs began in 1975, optometry has been slow to establish the credentialing and career paths of written specialty examinations and specialty certifications that benefit those completing residency specialty training in our sister medical professions.
In 2009 the American Board of Certification in Medical Optometry formed the first optometry specialty board and began to issue board certifications in the specialty of medical optometry and is now accepted at United States accredited health care organizations as the specialty board for medical optometry.
While medical optometry has the largest number of residents, there are other specialty residencies that offer valuable and needed training and those completing these residency training programs would also benefit from the credentialing path open to those optometrists certified in medical optometry.
The course of development of specialties in medicine and dentistry shows they evolved at the grass roots level rather than from the top down. Creating additional specialty boards and specialty examinations will require those residency trained in those optometry specialties to initiate and support their establishment.
This ABOS was formed to assist in the development and recognition of optometry specialties and to educate the public about the importance of optometry specialty certification. The American Board of Optometry Specialties (ABOS) serves as the national platform by which additional optometry specialty boards are assisted in forming and then being credentialed and recognized by ABOS using standards consistent with those required of specialty boards now accepted at Joint Commission accredited medical facilities.