On Feb. 17, ICO’s vice president and dean for academic affairs Stephanie Messner, OD, FAAO led a phone conversation with ICO alumni Andrew Buzzelli, OD ’73, MS and Sunny Sanders, OD ’78, FAAO. Respectively, they serve as the founding deans of the University of Pikeville Kentucky College of Optometry and the Midwestern University College of Optometry-Illinois. Depending on the accreditation process through the Accreditation Council on Optometric Education, it’s anticipated that both programs will welcome their first class in 2016 or 2017.
This conversation has been edited for length.
Dr. Messner: With regard to your position as founding dean of an optometry program, what have you found to be the most rewarding aspect, Sunny?
Dr. Sanders: We’re just getting rolling, but I think the most rewarding thing at this point is the ability to have a school where there’s no limit to what your imagination can provide. We can think about what would be the perfect educational experience for a student and build it literally from the ground up, in an effort to better educate the future of optometry. That’s almost unheard of in most environments. In long-established schools, it’s very difficult to sometimes see change occur. But here, I can actually look at a situation and say, ‘Gosh, we should be able to do this better.’ And I can come up with an answer, and I can actually make it happen.
We also have a different philosophy because it’s a different type of environment, being at a multi-discipline school versus a stand-alone school. It goes beyond just optometry and allows me to be creative in addressing just about any aspect of healthcare.
Dr. Buzzelli: What’s most rewarding is that right now we’re in a period that’s probably unlike any point in time in the profession. If you tried to predict 25 years ago how optometry would look today, who would have come up with this? And you can’t predict what optometry is going to look like in the next 25 years.
As a founding dean, you have to serve the profession. And the profession is changing by leaps and bounds. And the scope of our practice has to change. So the schools have to serve the profession and make sure that the scope of the profession is changed. And make sure students gain skills beyond the current scope of practice. We have to prepare them not just for today, but for 20 years from now.
And for me, access is very important. Here in Central Appalachia there are three main rural healthcare centers. Those three alone have a patient base of 35,000 individuals. And they have no eye care–not one optometrist, not one ophthalmologist. Last year, the rate of diabetic eye exams among that patient population was 10 percent. That’s just diabetics alone.
SM: I have to say that what you are listing as the rewards sounds a little bit like the challenges, too. But I suppose that taking on those challenges can be quite rewarding.
Another thing I want to ask you both: What do you think are the key factors that differentiate one optometry program from another? How will your programs be different from the others?
AB: What differentiates the programs, Stephanie, is mission. Some programs will have very similar missions. Some programs will have very different missions. For us, our mission is access. In addition to creating excellence in optometric education, our mission specifically states that we have to provide access for Appalachia and for rural America.
SS: At Midwestern, we have a couple of missions we’re addressing. Our program, of course, is a multi-discipline program, which is a different approach, but it goes beyond that. The term we use is ‘one health.’ We’re actually looking at educating all healthcare providers, all 18 healthcare-related programs at Midwestern.
We’re trying to go beyond even what the effect on people would be. It’s the effect on the interactions of people with other creatures on the planet, as well as the environment. How does the health of an animal, a pet, affect our health, our environment? What happens when we throw away expired prescription medications? What’s the effect on the planet, on humans and on other creatures? So we’re thinking on perhaps a grander scale than many other institutions are.
SM: Sunny, you mentioned earlier that the thing that you found rewarding was the opportunity to build a program from the ground up and to make it look like you think it should. Without any preexisting program in place, you can do your own thing and there isn’t the history there to prohibit you. With that in mind, how is the program in Downers Grove going to look different than the program in Glendale?
SS: That’s a good question. Well, I wouldn’t say it’s the Sunny School of Optometry. I’m trying to bring in other people’s opinions as well. But the Glendale program was a different design. It was designed for the state of Arizona’s healthcare system. It also has the Midwestern University flavor of a very strong basic science foundation.
The program in Downers Grove will have basic science as part of its foundation as well, but it’s actually going to be switched around a little bit to make sure that the optometry experience is right up front. In first year, students will have a lot more hands-on experience with other professionals in the clinic building. In Arizona, we have separate clinic buildings. Here, we have one clinic building. So the curriculum is built so that they’ll be interacting literally from week one of first year in this multi-discipline picture, serving the people of Illinois in a different motif and different emphasis. So they’ll be working directly with the DOs and the dental students and faculty and other professions right from the get-go, rather than a little bit later.
SM: Where do you see your program fitting into the landscape of optometric education overall?
AB: Well, Stephanie, first of all, a place in the landscape has to be earned. We’ve got 21 great schools out there. And so we’ve got to come up to at least where they are.
After that, where I see our program fitting in is particularly expansion of scope of practice. There is no eye care in our location. Our students will be coming into a place where they are the eye care. So they’re going to have to know a lot about medicine, a lot of the surgical procedures, laser procedures and other ophthalmic procedures. Since in Kentucky we can do these procedures, I really see our niche as providing clinical experiences for the expanded scope of practice.
SM: Do you anticipate that the majority of graduates from your institution will practice in under-served rural areas?
AB: Stephanie, you mentioned challenges before, and that’s probably got to be in the top five of my challenges. That’s my mission. But how do you do that? The biggest thing I have to do is recruit from the area. I also have to count on the state and other venues for scholarship-type of funding for students, so that some of the expenses can be relieved if graduates are going to practice in these areas.
There are only three ophthalmologists that serve this whole region, and only two of them are even in the hospital. So the hospital here will be part of our major clinical training ground. Our students will rub shoulders with the other men and women from the other professions, who are committed to serving in rural areas. Last year, our medical school ranked fifth in the nation in terms of rural medicine. Our students will take classes with the medical students. So by continued exposure from day one over the course of four years, my anticipation is that graduates will continue to practice in rural areas.
SM: With more than 160 students per class, ICO class sizes are larger than they used be–a fact that’s drawn criticism from some of our alumni. If you look at the data from the 2013-14 OptomCAS cycle, it indicates that now there’s only about 1.4 applicants per seat available in the 21 existing optometry schools in the United States and Puerto Rico. What concerns do you have with regard to the applicant pool and the appearance that the number of qualified applicants per available seat is dwindling?
SS: Obviously, the entire profession is concerned about that. I think every school is definitely concerned about the quality of the applicant pool. I’m sure all the schools go out and talk about the profession of optometry from high-school-age groups on up. I personally will go and talk about optometry because it’s a profession that’s honorable and worthwhile and beneficial for every being that it touches.
Yes, I think there’s going to be a decision that’s going to have to be made about what to do about existing programs as well as the new programs. But I think we have to be part of the solution. We all have to get out and do our part to find those applicants that are appropriate for this profession.
I’ve already proposed a schedule to go to various states around Illinois that don’t have schools of optometry and talk to young people about the profession. Because it’s not just the first year we have to fill, it’s every other year going forward. And it’s not just for Midwestern, but for the entire profession of optometry.
I am also concerned about the number of educators that our profession has and should have. Part of our program is lifelong learning, and that was put together to try to help create the future educators for the profession. I’m pretty serious about contributing to this profession by helping young people become the future educators of optometrists. And so that starts with them going through a program and then going for advanced degrees and residencies and on and on. We have to create those individuals as well.
AB: The applicant pool has just been discussed for so long, I think it’s just a blip on the radar. Optometry is so young. We think of ourselves as being middle-aged. I mean, I was taught that in school, and it’s not true. Optometry and the way it’s practiced today occurred after World War II, when all those hundreds of men and women came out of the service and went into optometry. They saw it as a bright future. And everything expanded to meet that.
Medicine goes back to Hippocrates, that’s 400 B.C. So we’re a baby profession that has made incredible strides, more than any other profession. And right now, it’s on the verge of its next big explosion, and that’s directly tied to expansion of scope of practice.
Why do we need more optometrists? I think the answer is right there in the workforce study that the AOA did. You need them when you expand the scope of practice. And that’s what the new schools and all schools have to do. We have to make graduates understand the importance of becoming members of their state optometric associations, because strength in numbers expands the scope of practice. And if we expand the scope of practice, 10 years down the road we’ll never be able to handle the number of applicants to optometry programs.
We also need to address the expense of education. I’m in discussions now with a lot of the community colleges around here. At Incarnate Word, I instituted a Bachelor of Science in Vision Science, put in a two-plus-two program. Students can stay at home, save money, do the first two years of the BSVS at area community colleges, then transfer and start the third year of the bachelor’s program. That’s how we made sure that we recruited for access. So we have to begin to create the applicant pool. We can’t stand there and continue to recruit when these individuals are in their junior and senior years in college. It has to start before that.
At the University of Pikeville, they have what’s called the Scholar’s Program. They take single parents with children, and they arrange to have the children and the parents fed and housed. The parents go to school. Childcare is provided. And tuition is taken care of so long as grades are maintained. I intend to expand that program into the optometry school. We have to become innovative in our creation of the applicant pool. And it’s not just through marketing.
SM: Your referenced the AOA workforce study. And if you look at the study, one can spin its conclusions pretty much any way they want. But I gather from what you’re saying that you’re not concerned about an oversupply of optometrists in the future?
AB: No, because the workforce study answered that, very clearly. If we expand the scope of practice, we can’t produce enough optometrists. And the ophthalmologists’ production rate, as you remember from the study, is flat. And Bureau of Labor Statistics data shows there’s a tremendous need for more optometrists than we’re currently producing. But I think the AOA workforce study says if we do not expand the scope of practice, we are going to run into a problem. If we graduate optometrists with the same skills we have now, that’s not going to help the patients. It’s not going to help the profession. It’s not going to help the students. So the key is expanding the scope of practice.
SM: I don’t disagree with you with regard to scope of practice. I think the workforce study even said that if currently practicing optometrists practiced to the full level of privileges, we’d be in reasonably good shape.
A concern that some of our students raised was about how the opening of new schools would impact clinical education. Midwestern is opening its doors 25 miles from our institution. Sunny, what are your thoughts about patient base and optometric education between institutions that are proximate to one another?
SS: I actually experienced this before being at Southern California College of Optometry, which was about a 15-minute drive from Western University of Health Sciences’ College of Optometry. Western’s program actually started when I was on faculty at SCCO. And of course, the same questions were asked then. And I’m not saying that it’s bad to ask those questions. The patients literally could drive between the two clinics and get there within, a 15- to 30-minute drive. So did that impact the patient numbers that we’re seeing in either clinic? No, it didn’t. And both schools obviously are functioning at the level that they need to function at because they’re both accredited. And the students are still getting excellent clinical exposures.
I think if we bring that forward to the state of Illinois, yes, we will have a second school close to the first school. But look at the population of Illinois, look at the need in the state, look at the impact of the Affordable Care Act on the nation and, in particular, Illinois. I’ve researched this a lot because I want to make sure we’re going to be able to help patients and not dilute the clinical exposure for the students. And there’s thousands and thousands of patients who will now be able to access appropriate eye care in just local area around Downers Grove. So within Illinois and, in particular, around Chicagoland, there’s no end to the number of patients that all of these clinics are going to be able to service.
SM: One last question. Considering the challenges on the horizon with the expansion of degree programs–optometry degree programs and physician assistantship programs and all of these programs that are expanding in the health realm–as well as the changes that are being brought on by the Affordable Care Act, what do you envision for the future of optometric education?
SS: I think we have to be progressive, and keep pushing our profession forward. We need to keep pushing the expansion of our scope of practice. And that’s really the bottom line. Andy is absolutely right: If we keep our profession moving forward in the healthcare realm, we will always be winning, our students will be winning, and our institutions will continue to grow.
I think where we’ll possibly stumble is if we become somewhat shortsighted in worrying about the things that are always going to get in the way–new schools opening, should we treat a particular condition. I mean, we know what our skillset is about. We know where we can expand. And I think optometry, as a profession, has endless, endless possibilities. And so our schools should have the same. That’s how I look at our profession. We’re the limiting factor. It’s not the profession.
AB: The future of optometric education involves closer partnerships between the schools. I think the schools are very independent, and we do an excellent job in education. But I think a little more interdependency would serve us all very well. I think the leader in this has to be ASCO. ASCO does a great job with some things. But I think ASCO has to now lead the way in innovation as to how we recruit, innovation as to when we start the processes. And ASCO needs to begin to look at what the schools have in common, so we can share and the education process grows for all of us and not just grows for individual schools.
SS: Regardless of where a student comes from, we all want them to be good doctors.
SM: I would certainly agree with that.
SS: And so it’s really all about making sure the students get what they need.
SM: Well, thank you both so much. It’s been really been interesting to hear your perspectives on developing new programs. I know that some of the questions I asked you were on controversial topics. But I think it’s always good to hear opinions on these topics. And I thank you for sharing them with us.