Maintenance of Competence

June 03, 2010



TO: Optometrists licensed to practice in North Carolina

FROM: North Carolina State Board of Examiners in Optometry

DATE: June 3, 2010

RE: Optometry Board’s position on “Maintenance of Competence (MOC)” to practice optometry in North Carolina: an update to the Board’s Memorandum dated September 15, 2009.

At the most recent American Optometric Association House of Delegates meeting held on June 26, 2009, in Washington, D.C. the North Carolina delegation voted “no” on the question of establishing the American Board of Optometry (“ABO”). The North Carolina delegation based its vote on a resolution opposing ABO “board certification” passed by the North Carolina State Optometric Society at its annual business meeting held on June 13, 2009.

Since that time, the North Carolina State Board of Examiners in Optometry (“the Board”) has received information indicating that at least two other entities either have been or are being formed to compete with the ABO in the “Maintenance of Competence (MOC)” and board certification arena.

This Board has a long-standing policy prohibiting the use of the term “board certified” by optometrists practicing in North Carolina because this Board does not “certify” its licensees – nor in our opinion can any other entity do so with regard to competence or maintenance of competence issues for the reasons discussed below.

The Board reviewed and considered the Founding Principles of the ABO and other information concerning board certification by that body and saw nothing which indicates it should modify this policy as it would apply to ABO board certification. The Board has also reviewed information about other proposed “board certification” or “advanced certification” programs offered or to be offered by other organizations. Whereas true board certification is specialty-based and implies experience, training, and education significantly over and above what others licensed to practice the same profession receive in a particular specialty, these programs are not specialty-based and in this Board’s opinion would denote no such superiority -- whether specialty-based or generally. The idea of “ongoing clinical competence” in the context of these organizations seems to us to be antithetical to the meaning that we believe most practitioners in the health care professions and literally all in the public attach to the term “board certified.”

Further, it is this Board’s position -- and we believe it to be the position of many other state licensing boards for optometry -- that “ongoing clinical competence” is the province of licensing boards. These board certification programs therefore usurp the authority of the individual states to determine who is competent to practice optometry and what is necessary to remain “current” and competent (MOC) in the profession. This Board is unable to conceive of any similar board certification program which likewise would not be similarly defective.

Under North Carolina law, this Board has the duty and responsibility to both initially determine a prospective licensee’s competence to practice optometry in this State (GS 90-118) and, once a license to practice has been issued, to determine whether that optometrist remains competent to practice and should be re-licensed (GS 90-118(10)) or whether that optometrist is not competent and his license should be suspended or revoked (GS 90-121.2(a)(14)). The Board believes this authority to determine competence - whether initial or continuing - to practice in North Carolina is exclusive to the Board.

It is the position of this Board that organizations or agencies seeking to validate a North Carolina optometrist’s licensure and maintenance of competence (MOC) to practice optometry in North Carolina must come to this Board for such information and validation. While the Board will review the statement of intent, principles, programs, and other information provided by each new entity offering “board certification” as they become available, we believe it unlikely that the Board’s position on board certification will change.

Accordingly, for these and other reasons, it is the intention of the North Carolina State Board of Examiners in Optometry to consider whether it may prohibit its licensees from advertising or otherwise disseminating the fact that they have received board certification from such organizations, with violation of such prohibition subjecting such licensees to disciplinary action by the Board. At a minimum, this Board intends to require that any optometrist who achieves such board certification and intends to advertise or otherwise disseminate this fact will have to append to such representation a statement indicating that the organization granting such status is not recognized by the North Carolina State Board of Examiners in Optometry, and that such board certification does not in the Board’s opinion provide evidence of any significant clinical education, training, or experience beyond that for which this Board awards licensure. The Board will require this disclaimer statement so that members of the public do not perceive that such board certification denotes competence over and above that possessed by other licensees or that it denotes some area of specialization not possessed by other licensees.

Additionally, the Board is exploring whether it and perhaps other licensing boards or individuals and organizations similarly situated should seek injunctive relief preventing such organizations from proceeding to implement their board certification programs or to seek recognition as a national entity to validate continuing competence (MOC) in the practice of optometry.

Should you have any questions, please contact the Board’s Executive Director at:

North Carolina State Board of Optometry

109 North Graham Street

Wallace, NC 28466

(910) 285-3160 or (800) 426-4457

Facsimile (910) 285-4546

Adopted June 3, 2010

Myrtle Beach, SC