Unlicensed Practice


Practice by unlicensed optometrists awaiting licensure

In the absence of a license to practice optometry in North Carolina by either a new graduate or practitioner licensed in another state(s) who wishes to apply for a North Carolina license, there is no statutory provision that allows an individual to practice except “at the direction and under the supervision” of a licensed optometrist or physician. Therefore, pursuant to section 90-115.1.(5) of the General Statutes of North Carolina, the Board will consider on a case by case basis and under certain circumstances allowing optometrists holding a Doctor of Optometry degree from a school or college of optometry accredited by the Council on Optometric Education and who have submitted evidence satisfactory to the Board that they are eligible to apply for licensure as an optometrist in North Carolina to perform procedures and functions which a duly licensed optometrist may perform in accordance with Article 6 of Chapter 90 of the General Statutes of North Carolina provided that such are performed at the direction and under the supervision of a licensed optometrist. Ordinarily, such approval will be given by the Board only to persons who have an opportunity to work under the supervision of a licensed optometrist or physician in order to gain additional clinical experience prior to taking the licensing examinations or while awaiting the results of such examination. “At the direction and under the supervision of” shall be applied to the facts of each particular situation in which an unlicensed optometrist, hereinafter referred to as an “extern”, performs optometric procedures which otherwise may be performed only by a licensed optometrist. The Board customarily will expect, however:

1 That the supervising optometrist will be physically present within the practice location at all times the extern is performing optometric procedures. Being absent from the practice location but being “available by phone” or “by computer” is not acceptable.

2 The supervising optometrist will have a formal procedure in place by which patients who may be examined by the extern out of the physical presence of the supervising optometrist will be informed both orally and in writing of the status of the extern and that the supervising optometrist will personally review and approve the examination performed by the extern and will so note in the patient’s record.

3 Prior to the patient’s being discharged or released from the practice, the supervising optometrist must personally review the chart of that patient who has been examined by the extern and confirm that the examination was thorough and complete under the circumstances, the extern’s findings and diagnosis are accurate and the treatment plan, if any, proposed by the extern is reasonable. The supervising optometrist shall make a notation of his agreement or disagreement with the findings of the extern in the patient’s chart and likewise note any change(s) made in the treatment suggested by the extern; the patient will be informed by the supervising optometrist of any changes in their diagnosis or treatment such notation(s) would require.

4 In the event that the extern’s examination involves a prescription, whether for pharmaceuticals, spectacle lenses, or contact lenses, the supervising optometrist must personally review the chart of that patient and review the findings with the patient before approving and signing any prescription(s) to be provided to the patient.

Prior to beginning an externship with a licensed optometrist, an unlicensed optometrist must notify the Board in writing of his desire to work under the direction and supervision of a licensed optometrist, identifying the optometrist or optometrists under whose direction and supervision he will be working. Such notice must specify the address(s) and telephone number(s) of the practice(s) where the unlicensed optometrist will be working as an extern.

The unlicensed optometrist seeking authorization to practice as an extern agrees to the following:

a. Externs may perform those functions which a duly licensed optometrist may perform under Article 6 of Chapter 90 of the North Carolina General Statutes, provided that such are performed at the direction and under the supervision of the licensed optometrist to whom the extern is registered; provided, however, nothing herein shall be construed to permit an extern to prescribe for any patient in his own name or prior to the patient’s chart being reviewed and signed by the supervising optometrist. In an instance where a pharmaceutical agent is being prescribed, the supervising optometrist shall physically examine the patient prior to the prescription being authorized and signed by him and before such prescription is given to the patient. Further, nothing herein shall be construed to permit an extern to perform an injection.

b. An extern shall wear appropriate identification at all times when involved in patient care that will identify him to patients by his name followed by the degree “O.D.” and the word “EXTERN”.

c. Prior to an extern examining any patient, the patient shall be made aware that the care being rendered to him is being performed by a doctor awaiting licensure, and the patient’s record shall note the patient’s consent.”

Each licensed optometrist for whom an unlicensed optometrist (extern) is to practice shall be required notify the Board in writing that:

1 He understands that directing and supervising the unlicensed optometrist(s) requires his physical presence at all times when the extern is involved in patient care.

2 He is familiar with all of the requirements set forth in paragraphs a, b, and c above and accepts the responsibility for supervising an unlicensed optometrist.

No externship shall be approved for a period that exceeds either six months, or ninety days following the next regularly scheduled examination, whichever is shorter, and may be renewed no more than once during any calendar year. The maximum number of times that any one applicant can apply for an extern permit is three.

Should the Board receive credible evidence that one of its licensees engages in practices believed to be in violation of the above policy, the Board may notice a disciplinary hearing in accordance with the provisions of General Statutes section 90-121.2. Aiding and abetting in the unlawful practice of optometry subjects the licensed optometrist to disciplinary action by the Board, including suspension or revocation of license, monetary fines and costs of the action. An unlicensed optometrist or extern proved to be in the unauthorized practice of optometry would likely be refused admittance to the Board’s licensing examinations.