1 Is Optometry on the Same Path as the Legal Profession? Charles F. Mullen May 28, 2015

2 The Rapid Increase in Practitioners is Similar Law Schools Opened 19 New Law Schools Since 2000 Opened 19 New Law Schools Since 2000 From 186 to 205 Schools in 15 years -- a 10% Increase From 186 to 205 Schools in 15 years -- a 10% Increase More Schools Planned More Schools Planned Increased Enrollments at Existing Schools Increased Enrollments at Existing Schools Optometry Schools and Colleges Opened 7 New Optometry Schools From 2008 to 2016 Opened 7 New Optometry Schools From 2008 to 2016 From 17 to 24 Schools in 8 Years -- a 41% Increase From 17 to 24 Schools in 8 Years -- a 41% Increase More Schools Under Consideration More Schools Under Consideration Increased Enrollments at Some Existing Schools Increased Enrollments at Some Existing Schools

3 Consequences of Increased Supply of Lawyers  Underemployment and Unemployment of Graduates 45% of Graduates Unable to Find Full Time Positions 45% of Graduates Unable to Find Full Time Positions  Applicants Down 37% and Enrollment Down 24% Since 2010 Tuition Reduced and Financial Aid Increased Tuition Reduced and Financial Aid Increased Less Qualified Students Being Admitted with LSAT Scores Less than 145, Unlikely to Pass the Bar Less Qualified Students Being Admitted with LSAT Scores Less than 145, Unlikely to Pass the Bar Misrepresentation Law Suits by Students/Graduates Misrepresentation Law Suits by Students/Graduates At Schools Unable to Fill Classes: Faculty/Staff Layoffs, Some Law Schools Consolidating or May Close. At Schools Unable to Fill Classes: Faculty/Staff Layoffs, Some Law Schools Consolidating or May Close.  Top Schools Employ 3-17% of Their Own Graduates

4 Admissions Issues at Optometry Schools  Over 500 Entering Seats Added Over Past 7 Years  Approx. One Qualified Applicant per Entering Seat Little Change in Applicant Pool in Recent Years Little Change in Applicant Pool in Recent Years  Admissions Standards Vary Among Optometry Schools and Colleges  Increase in Number of Graduates From 1127 in 1997 to 1600 in 2014 and Will Likely Reach 1900 by 2020.

5 Supply of Optometrists Supply of Optometrists Rand Corp-1995, Abt Assoc-2000 and Lewin Report All Indicated Surpluses of Optometrists Rand Corp-1995, Abt Assoc-2000 and Lewin Report All Indicated Surpluses of Optometrists Lewin Study Indicated Current 30% Excess of Optometrists or 12,672 FTE Lewin Study Indicated Current 30% Excess of Optometrists or 12,672 FTE Possibly a Distribution Issue Possibly a Distribution Issue 3,278 FTE Needed to Provide Optometric Services in Inner-Cities and Rural Areas -- Analysis of HRSA Data. 3,278 FTE Needed to Provide Optometric Services in Inner-Cities and Rural Areas -- Analysis of HRSA Data. Bureau of Labor Statistics (BLS) Projects 8,100 FTE Additional Optometrists Needed by 2022 Bureau of Labor Statistics (BLS) Projects 8,100 FTE Additional Optometrists Needed by 2022 Inconsistent With All Previous Manpower Studies. However, BLS May Have Considered Need in Underserved Areas. Inconsistent With All Previous Manpower Studies. However, BLS May Have Considered Need in Underserved Areas.

6 Assumptions in Lewin Study Assumptions in Lewin Study  Lewin Projects a Decrease in Current Optometry Surplus of 12,672 FTE to 4,400 FTE by 2025 If Optometrists Provide the Same Scope of Practice As Ophthalmologists If Optometrists Provide the Same Scope of Practice As Ophthalmologists And 1.36 FTE OD Surplus Fill 1.0 FTE MD Shortage And 1.36 FTE OD Surplus Fill 1.0 FTE MD Shortage  However, Management of Diabetic and Elderly Patients with Multiple Medical Problems Requires: Advanced Clinical Training and Legal Authority in All States to Treat With Systemic Medications and Perform Invasive Procedures Advanced Clinical Training and Legal Authority in All States to Treat With Systemic Medications and Perform Invasive Procedures Acceptance of Optometrists Providing These Services by Insurance Carriers is Necessary Acceptance of Optometrists Providing These Services by Insurance Carriers is Necessary

7 Impact of Supply of Optometrists on Employment of Graduates No National Data is Available on Graduate Employment No National Data is Available on Graduate Employment College Administrators Report Ample Employment Available for Graduates in Private and Commercial Sectors College Administrators Report Ample Employment Available for Graduates in Private and Commercial Sectors Why Not a Robust Applicant Pool? Why Not a Robust Applicant Pool? Lewin 2012: 46% of Graduates under 30 yrs. Practice at Two or More Part Time Locations, 11.5% at 4 Locations Lewin 2012: 46% of Graduates under 30 yrs. Practice at Two or More Part Time Locations, 11.5% at 4 Locations

8 Suggested Actions to Mitigate Effects of Oversupply of Optometrists Suggested Actions to Mitigate Effects of Oversupply of Optometrists  Individual Schools and Colleges May Find It Prudent to Plan For Reduced Entering Classes and Enrollments Adjust Revenue and Expense Projections Adjust Revenue and Expense Projections

9 External Agencies  ACOE to Consistently Enforce Requirement for Optometry Schools and Colleges to Document the Quantity and Diversity of Clinical Training Encounters Before Initial or Ongoing Accreditation is Granted Require Explanation and/or Correction of Bureau of Labor Statistics Projections Require Explanation and/or Correction of Bureau of Labor Statistics Projections Used as Rationale for New Schools Used as Rationale for New Schools Require a Realistic Strategy from ASCO to Address Weak Applicant Pool Require a Realistic Strategy from ASCO to Address Weak Applicant Pool Marketing Alone May Not be Adequate Marketing Alone May Not be Adequate Address Proliferation of New Schools Address Proliferation of New Schools

10 Curricula Measures Make An Optometry Career More Attractive and Control Debt by Shortening the Overall Length of Education for O.D. Degree and Board Certification Make An Optometry Career More Attractive and Control Debt by Shortening the Overall Length of Education for O.D. Degree and Board Certification Require 1 Year of Post Graduate Training for Initial Licensure Require 1 Year of Post Graduate Training for Initial Licensure In the Process, Develop a Clinical Training Model to Potentially Qualify for GME In the Process, Develop a Clinical Training Model to Potentially Qualify for GME Training Model Would Permit 4 th Year Students (Now Residents) to Contribute to Billable Services Training Model Would Permit 4 th Year Students (Now Residents) to Contribute to Billable Services Current Student-Centered Training Model Vulnerable to Violations of CMS Regulations Current Student-Centered Training Model Vulnerable to Violations of CMS Regulations

11 Explore Alternative Strategies  Consolidation of Optometry Colleges Additional Educational Offerings in High Demand Health Care Professions Additional Educational Offerings in High Demand Health Care Professions Implement a Marketing Strategy That Promotes the Uniqueness of the College Implement a Marketing Strategy That Promotes the Uniqueness of the College  Develop/Expand Special Programs for Foreign Students  Innovative Programs within Health Sciences Centers, Universities or Affiliations with Medicine Six Optometry Schools are Affiliated with Osteopathic Institutions Six Optometry Schools are Affiliated with Osteopathic Institutions

12 Public Health Approach to Oversupply Increase Demand for Optometrists by Addressing Need for Eye Care in Inner-City and Rural Areas Increase Demand for Optometrists by Addressing Need for Eye Care in Inner-City and Rural Areas 3278 FTE Needed in Community Health Centers 3278 FTE Needed in Community Health Centers Only 20% of Federally Qualified Community Health Centers Offer Optometric Service Only 20% of Federally Qualified Community Health Centers Offer Optometric Service Inclusion of Optometry in Federal Incentive Programs: National Health Service Corps Including Scholarships and Loan Forgiveness and Practice Start-Up Support is Essential Inclusion of Optometry in Federal Incentive Programs: National Health Service Corps Including Scholarships and Loan Forgiveness and Practice Start-Up Support is Essential Optometry’s Best Opportunity to Mitigate the Effects of Oversupply or Distribution Issue Optometry’s Best Opportunity to Mitigate the Effects of Oversupply or Distribution Issue

13 Discussion Questions 1. Is Optometry on the Same Oversupply Path as the Legal Profession? Unemployment and Underemployment of Graduates? Unemployment and Underemployment of Graduates? Reduced Applicants and Enrollments? Reduced Applicants and Enrollments? Financial Issues at Schools? Financial Issues at Schools? High Educational Debt? High Educational Debt? 2. What Actions are Necessary in the Event of a Serious Downturn in Applicants/Enrollment? 3. Why is There a Weak Applicant Pool If Ample Employment Opportunities Are Available?