What is a State Optometry Board?
Treatment and Management of Ocular Disease (TMOD) Exam
I am an internationally educated Optometrist- how do I get licensed in the U.S.?
What is a State OptometryBoard?
The primary responsibility and obligation of a state optometry board is to protect consumers of health care through proper licensing and regulation of optometrists.
The practice of optometry is not an inherent right of an individual,but a privilege granted by the people of a state acting through their elected representatives. To protect the public from the unprofessional,improper and incompetent practice of optometry, it is necessary for the state to provide laws and regulations that outline the practice of optometry and the responsibility of the optometry board to regulate that practice. This guidance is outlined in a state statute, usually called an optometry practice act.
Optometry Board Structure
Board membership is composed of volunteers who are charged with upholding the optometry practice act in their jurisdictions.
A state optometry board is usually composed of optometrists and public members who are, in most instances, appointed by the governor. Some boards are independent in structure, exercising all licensing and disciplinary powers, while others are part of a larger umbrella agency, such as the Department of Health, exercising varied levels of responsibilities or functioning in an advisory capacity. Funding for optometry board activities comes from licensing and registration fees.
Most boards employ an administrative staff, which includes an executive officer, attorneys and investigators, with some legal services provided by the state's office of the attorney general.
Assembling a quality optometrist population to meet the needs of the public begins with licensure.
Through the licensure process the state ensures all practicing optometrists have appropriate education and training, and they abide by recognized standards of professional conduct while serving their patients. Applicants must submit proof of prior education and training and provide details about their work history. Candidates for licensure must also complete a rigorous examination, designed to assess an optometrist's ability to apply knowledge, concepts and principles that are important in health and disease and that constitute the basis of safe and effective patient care. Finally, the applicant must reveal information regarding past optometry history (including the use of habit-forming drugs, emotional or mental illness), arrests and convictions.
After optometrists are licensed in a given state, they must re-register periodically to continue their active status. During this re-registration process, optometrists are required in some states to demonstrate that they have maintained acceptable standards of ethics and optometry practice, and have not engaged in improper conduct. In all 50 states, the District of Columbia and the territories of Guam, Puerto Rico and the Virgin Islands, optometrists must also show they have participated in a program of continuing optometry education.
Regulation of Optometrists
The duty of the board goes beyond the licensing and re-registration of optometrists.
The board is charged with the responsibility of evaluating when an optometrist's professional conduct or ability to practice optometry warrants modification, suspension or revocation of the license to practice optometry. Board members devote a great deal of time and attention to overseeing the practice of optometrists by reviewing complaints from consumers, malpractice data, information from hospitals and other health care institutions, and reports from government agencies.
When a board receives a complaint about an optometrist, and there is reason to believe the optometrist has violated the law, the board has the power to investigate, hold hearings, and if necessary, imposes some form of discipline.
What is Unprofessional Conduct?
The Optometry Practice Act defines unprofessional conduct in each state.
Although laws vary from jurisdiction to jurisdiction, some examples of unprofessional conduct include:
- physical abuse of a patient
- inadequate record keeping
- not recognizing or acting on common symptoms
- prescribing drugs in excessive amounts without legitimate reason
- impaired ability to practice due to addiction, or physical or mental illness
- failing to meet continuing optometry education requirements
- performing duties beyond the scope of a license
- conviction of a felony
- delegating the practice of optometry to an unlicensed individual
Minor disagreements do not fall under misconduct, nor does poor customer service.
Whatever the complaint, practitioners are afforded the rights of due process as the board investigates a complaint of misconduct.
The tenets of due process state that an individual is innocent until proven guilty and apply to formal hearing/judicial procedures,which the optometry board carries out by following established rules and principles, to ensure that an optometrist is not treated unfairly, arbitrarily or unreasonably. In instances of severely egregious behavior, boards have the authority to summarily suspend an optometrist's license until an administrative law hearing can be scheduled.
Board Action vs. Malpractice
The differences between a board action and a malpractice suit are significant.
Board actions are those taken against optometrists following a formal process of complaint, investigation and hearing. Whereby a sanction taken by an optometry board against an optometrist does indicate that a violation of the optometry practice act has occurred, malpractice claims are not always accurate measures of an optometrist's competence or violation of the law. The reason is twofold: 1) anyone can file a malpractice suit without showing evidence of damage; and 2) often malpractice insurance carriers opt to settle out-of-court rather than incur the expense of a court appearance (many times the optometrist's guilt, innocence or preference is not a factor in this decision).
Optometry boards may review malpractice reports to proactively identify practitioners who may be a hazard to the public by detecting a pattern of inappropriate actions.
Public Protection vs. Optometrist Discipline
Optometry boards focus on protecting the public, not on punishing practitioners.
While optometry boards do find it necessary to suspend or revoke licenses, regulators believe that many problems can be resolved with probation and by putting restrictions on an optometrist's license so the public is protected while maintaining a valuable community resource. Probation and restrictions of an optometry license can be in place as an optometrist receives further training or rehabilitation.
Sharing of Information
In the age of the Internet, disciplinary sanctions imposed by aboard are frequently reported on a state board's web site, or through a centralized repository of state licensure disciplinary actions. Visit your state regulatory board's web site to view the policy governing disclosure in your state.
State Board's are also obligated to report certain information to the Health Care Integrity & Protection Data Bank (HIP-DB), a program established by the US Department of Health & Human Services, however, this databank does not currently offer public access to the data it collects.
ARBO operates a limited national Disciplinary Data Bank that houses records of disciplinary actions reported by some of our state regulatory board members. This information is limited in scope and is only available to state optometry boards.
Responsibilities of Consumers
First and foremost, be an educated consumer.
Consumers of health care can gather a great deal of information that may be useful in selecting an optometrist. The state optometry board can assist by disclosing if an optometrist is currently licensed, if disciplinary action has ever been imposed or, in some cases, if disciplinary charges are pending. Members of the public can also inquire if the board has other public information on an optometrist's record (this may include criminal convictions and malpractice judgments).
Citizens who believe that the quality of optometry care they receive are substandard, or that an optometrist has engaged in unprofessional conduct, should contact their state optometry board. Unless such problems are brought to the attention of the optometry board, optometrists who are grossly negligent or incompetent may continue their practices unencumbered.
For more information, contact the state regulatory board for optometry in your state.
With acknowledgements and thanks to the Federation of State Medical Boards.
Treatment and Management of Ocular Disease (TMOD) Exam
I've lost my TMOD certificate and/or scores. How do I get a replacement certificate and/or printout of my scores?
You will need to contact the National Board of Examiners in Optometry (NBEO) directly for this information. A small fee may be involved. Contact information, including an email link, for the NBEO can be found at http://www.optometry.org/. When submitting your request to NBEO, be sure to supply your full name and social security number for them to correctly identify you in their records.
I need to have verification/scores of my passing the TMOD sent to a state board. How do I do this?
You need to send your request directly to the National Board of Examiners in Optometry (NBEO). They will forward this information directly to the state(s) you specify. A small fee may be involved. Contact information, including an email link, for the NBEO can be found at http://www.optometry.org/. When submitting your request to NBEO, be sure to supply your fullname and social security number for them to correctly identify you in their records.
I'm interested in taking the TMOD Exam -where can I get information?
Go to http://www.optometry.org/part_tmod.cfm for information on the TMOD exam. Information on applying to sit for the exam can also be found at this site.
I Am An Internationally Educated Optometrist - How Do I Get Licensed in the U.S.?
The US is a union of 50 separate jurisdictions (states), each with an independent governance structure. The US Constitution provides states with the authority to issue and revoke privileges of practice through the issuance of licenses. As no nationalized licensing body for Optometry exists, the process of determining the requirements to practice in the U.S. is complicated by the fact that each optometric licensing board determines its own requirements. Individuals interested in obtaining a license to practice optometry in the US must first decide which state(s) they wish to practice in, and then contact that board for specific licensure requirements. Go to http://www.optometry.org/state_requirements.cfm for a general overview of licensure requirements for each state. A listing of state boards with contact information can be found at Directory of Boards.
Licensure Eligibility Requirements
Typically, state boards require that:
All 17 schools and colleges of optometry in the US offer ACOE-accredited programs; there are also 2 Canadian programs (visit the web siteof the Association of Schools & Collegesof Optometry (ASCO) for a list of North American optometry schools,together with contact information). There are no ACOE-accredited professional optometric degree programs outside the US and Canada. Uniformly, all US-based schools and colleges of optometry incorporate sitting the NBEO exams into a mostly standardized 4-year curriculum. Thus, successful graduates from ACOE-accredited programs already meet the majority of the eligibility requirements to apply for licensure in all jurisdictions in the US.
Applying for Licensure to a US Board of Optometry - Step 1
When an internationally-educated optometrist applies for licensure to a state (or territorial) board, in general, that board will seek to determine if the curriculum offered by a school or college of optometry abroad is equivalent to that of one accredited by ACOE. Depending upon the response of a state board, they may seek to have your transcripts evaluated by one of the 17 schools and colleges of optometry here in North America for equivalency. If a school determines that your education is not equivalent, you may have to seek enrollment in one of the schools to obtain those courses for which you might be determined to be lacking. Abbreviated programs exist at some US institutions for those whose educational background places them in advanced standing. The Association of Schools & Colleges of Optometry should be able to supplya list of US institutions that offer abbreviated programs, or advanced standing for appropriately trained individuals.
The Association of Schools & Colleges of Optometry may have a list of those institutions that provide transcript evaluation, although some candidates prefer to have transcripts evaluated by an independent educational evaluation firm prior to applying for licensure. The address of a company that provides such a service is listed below:
World Education Services (WES)
P.O. Box 745
Old Chelsea Station
New York, NY 10113-0745
Tel: (212) 966-6311
ARBO in no way endorses or recommends this company; the address is being provided only as a reference. All fees related to this service are paid solely by the individual requesting the service.World Education Services (WES) has no connection or affiliation to ARBO, or, to our knowledge, any US board of optometry.
Applying for Licensure to a US Board of Optometry - Step 2
Even after completing remedial education at a US-based institution and graduating from a ACOE-accredited program, candidates for licensure must still pass the entry-level licensure examinations given by the National Board of Examinersin Optometry (NBEO) (as do all US-educated optometrists). Full instructions for all of NBEO's examinations can be found at the NBEO web site, although most institutions will likely address passage of the NBEO exams upon enrollment into a program.
Alternative Means of Establishing Eligibility
An internationally trained optometrist who wishes to forego attending remedial education may seek to take the NBEO exams directly. However, NBEO exam candidates who have not graduated from a ACOE-accredited program must be sponsored by a state board to take the exams.
It is extremely rare to secure such sponsorship and candidates who follow this route must be prepared to present a strong case to a board of optometry, justifying a level of educational and clinical experience that meets or exceeds the standards of ACOE-accredited programs.
Applying for Licensure to a US Board of Optometry - Step 3
After you have met all the qualifications of a specific board of optometry, licensure candidates may still need to pass a board's written and, possibly, clinical exam to be granted a license to practice, although in the majority of cases, passage of the NBEO exam are sufficient. Most boards of optometry also require passage of a jurisprudence, or 'law' exam, prior to the granting of a license. A listing of state board examinations required in addition to the National Board's examinations can be found at the NBEO's web-site at http://www.optometry.org/state_requirements.cfm.
Only by successfully completing all of these steps will an internationally trained optometrist become eligible for a license to practice in the US. Good luck with your endeavors.
National Board of Examiners in Optometry
200 South College Street
Charlotte, NC 28202
Association of Schools and Colleges of Optometry
6110 Executive Boulevard
Rockville, MD 20852
American Optometric Association
243 North Lindbergh Boulevard
St. Louis, MO 63141
Accreditation Council on Optometric Education
243 North Lindbergh Boulevard
St. Louis, MO 63141