2009.06.27 02:10:04

John McDaniel

Note: this was originally written in April of 2009 and held back from publication.  Today, June 26, 2009, the BC proposal passed.  I was very optimistic that the AOA leadership structure would find a way to serve the will of the majority of the membership.  I was wrong and am tremendously disappointed.

I, like many optometrists across the United States, have followed the board certification (BC) debate and debacle closely.  I have formed and published strong opinions opposing the current proposal.  I have spent hours researching the details of how this plan came into its present form, the communication (or lack thereof) of the plans details, and the driving forces behind it.  I have come to a conclusion that the most oppressive problems with BC have less to do with the proposals or counter proposals and much more to do with the process, motivations, and leadership of the American Optometric Association (AOA).

Here is the crux of the problem: the AOA undoubtedly spent years hammering out what they deemed a proposal that was a blend of interests.  Those interests include the desires of a few select powerful leaders in the AOA, the collective needs of the membership, and the looming changes in the health care landscape.  Nothing is inherently wrong with those interests, however, I believe there is something wrong with the prioritization of them.  It is my view that the truest of leaders in the AOA elected to put their own desires ahead of the interests of the membership and the need to effectively and efficiently address the impending health care system changes.  Note, that by definition, a leader or leadership is not always a positive thing.  Leaders get things done through their own actions and through the actions of surrogates.

The desire of the few to put a “solution” on the fast track was driven by a desire to dramatically change the profession of optometry in a real and permanent way.  The “urgencies” that purportedly drove the process are merely an excuse; a platform on which to enact a radical agenda for the profession.  It is interesting to me that the most effective leaders in the AOA were the ones behind the BC effort.  Their ability to get the BC proposal to where it is at today represents true leadership ability.  I suspect (it is only a suspicion) that if one were to dig deeper one would find that the current BC proposal can be sourced to a single person.  While I am certain that many facets have been tinkered with to create a cohesive team of top AOA folks (aka the surrogates) that support the current framework, I have little doubt that the genesis of this proposal comes from a single person.  That is not, in and of itself, a bad thing either.

The problem with leadership is that it is rare.  What are the odds that the top folks at the AOA have several real leaders in their midst that are capable of getting things done?  Statistically speaking, the odds are low.  The odds become even lower when you add in the notion of multiple leaders having substantively the same vision of a solution.  Instead, I believe we have witnessed the results of a powerful leader getting most of the AOA “leadership” to follow his/her desires.  So why do I think that is a bad thing?  Great question.

The problem lies with the motivation and methods of the original leader.  Even if I thought the current BC proposal was a good idea I would have significant issues with the process that has been used to advance it.  It seems clear to me that the process was promoted simply because of a “we can do what we want” attitude possessed by the true leader of the AOA and the BC proposal.  That is a problem; a big problem, in fact.  That attitude and process leads to negative consequences that have only begun to be felt.  The net ramifications of that mindset may ultimately weaken the stated goals of the AOA and its membership.  That, my colleagues, is a much bigger problem for optometry than the stated crisis driving the BC movement.

My proposed solution to this problem is dramatic and will likely not sit well with the current AOA leadership.  I propose a coup of sorts and an end to the status quo leadership track structure.  It is time to find some real leaders for the AOA that have the ability to overcome other leaders that desire to steamroll the membership simply because they believe no one is willing or able to stop them.  It is time for true leaders to rise to the AOA ranks that specifically lack an organizational memory and organizational experience.  The very organizational memory and experience we rely on has lead to the current status of a powerful few that feel oligarchic in their influence.  In short, I propose a house cleaning to get rid of the arrogance and self indulgent paradigm that exists in the AOA leadership structure today.  Of course, such revolution is not necessary if the power of the membership is proven to be stronger than the power of the few in the AOA leadership structure.  How does one prove where the real power resides?  A decisive “no” vote of the current BC proposal and any of its last minute modifications, concessions, and marketing tactics is how.  A “no” vote shows the leadership who is the true boss of the AOA.

Le Meas,

John G. McDaniel, OD, MLHR
President/Founder
Waugoo Consulting Group, LLC
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leadership | AOA | board cerfitication | BC

2009.04.23 22:37:08

John McDaniel

Attention: Wisconsin Optometric Association Board Members

I am writing to formally submit my opinion of the current joint board certification proposal that is to be presented this June at the AOA Congressional Meeting.  Having served on this board in the past with many of you I am confident that you will understand that I am delivering an opinion only after serious and deliberate consideration.

I have analyzed the proposal from three perspectives: the need for board certification, the real implications of the process on the state of the profession, and the pragmatic ramifications at the individual level.

On the purported need for board certification, I am admittedly divided.  I believe there may some day be a need for a method to assure continued competence but I fail to see the urgency implied by such an aggressive schedule for consideration.  Having held a society meeting on February 17, 2009, I discovered that the topic of board certification was entirely new to most of the members present.  I believe hasty presentation and elucidation of the process will only serve to alienate a non-trivial proportion of American Optometric Association and Wisconsin Optometric Association members.  The future need for a true board certification process is worthy of debate and discussion but only on a more reasonable time scale.  I also believe that the construct of “board certification” is reserved for sub-specialties that deviate from the general practice of the profession.  By definition, what is being sought can not be considered “board certification” with any significant level of cross professional respect.

With regards to the impact the process may have on the profession as a whole I see several aspects that concern me.  First, the process will serve as a means to further divide the field.  There are enough divisions in optometry already including mode of practice distinctions and State-to-State privilege variations.  The inevitable discourse the board certification effort will engender is not worth the eventual benefits.  Second, the board certified designation itself will provide a direct and visible line of demarcation between optometrists.  This division will only serve to provide additional avenues on which to discriminate against a sector of optometrists.  Thirdly, the economic costs of this proposal are exorbitant and far outweigh any proposed benefit.  When such economic costs are attached to a proposal it is only logical to “follow the money” and become cautiously suspicious about those expected to gain from its implementation.  This suspicion may also further divide our profession.

Finally, the individual optometrist has many difficult issues to deal with in day-to-day practice.   In my opinion, the most significant of these issues are access to third parties and the limitations of state-by-state licensure.  While the current board certification process purports to address the third party access issue, I believe the net impact will be negative at best for most optometrists.  The break even point for analyzing the individual costs of the board certification process and the purported increased access to third party plans may well take decades to materialize.  Even that analysis assumes that third parties will not seek an alternative reason to exclude optometrists as providers.

In summary, I am convinced that the current board certification proposal is not in the best interest of optometry, the AOA, or the WOA.  I am asking that the WOA delegates vote “no” at the AOA meeting this June.  If you have any questions regarding my recommendation please do not hesitate to contact me.

Warm Regards,

John McDaniel, OD, MLHR

BC | board certification | WOA | opinion | john mcdaniel