When you first finish optometry school, it can be tempting to go straight into practice.
While entering a residency program may seem like a continuation of optometry school, it is actually a great balance of learning with increased independence and exploration. It really helps to hone in on your skills and to find your niche within optometry.
It also sets the foundation for professional proficiency and sets you on the path to pursue fellowship and/or board certification next.
Why I chose to become board certified in medical optometry
I graduated from the State University of New York College of Optometry and completed my residency at the Northport Veterans Affairs Medical Center on Long Island in New York.
I chose this residency because I wanted to provide the best, medically oriented eye care possible.
I also sought to practice full-scope optometry with greater confidence (from ocular disease to vision therapy and low vision-all of which were available through the residency). I then became a fellow of the American Academy of Optometry and Board Certified in Medical Optometry.
For me, personally, it was never a question of whether or not to pursue certification.
I aspired to practice within a hospital system and believed certification would help me excel in that mode of practice.
The two greatest advantages that I saw were:
- Knowing that I possess an advanced level of optometric knowledge. I enjoy knowing I am on par with the other O.D.s across the nation who practice similarly to me.
- Having the added “proof” of proficiency in my credentials and on my resume. I have not been on “the other side of the table” but I imagine it is difficult for an employer to judge a candidate’s sincerity and capabilities based on conversation alone.
Though not monetary in nature, the value of these advantages in securing a future position of my choice greatly outweighed the cost of obtaining certification.
But you came to this article to learn whether taking the medical optometry path is right for you. Let’s start there.
What is “medical optometry”?
The American Board of Certification in Medical Optometry (A.B.C.M.O.) is a non-profit organization that provides credentialing to optometrists possessing specialized, advanced level knowledge of medical optometry.
In 2005, the National Association of Veterans Affairs Optometrists (N.A.V.A.O.) sought to establish certification and documentation of advanced competency to doctors who completed residency training at a V.A. Hospital. Though other residency programs, such as in medicine and dentistry, had standardized exit exams, optometry did not.
The lack thereof meant a lack of attestation to the level of competency achieved by optometry residents and no assurance that level of clinical knowledge expected was, in fact, achieved. It was in the interest of quantifying these entities, that the Advanced Competence in Medical Optometry (A.C.M.O) examination was created.
What are the certification requirements?
To apply for standard certification, the applicant must be able to provide the following:
- Certificate of degree as Doctor of Optometry from a North American College of Optometry
- Documentation of a current state optometric license
- Completion of a A.C.O.E. approved (or equivalently credited) medically-oriented post-graduate optometric residency of at least 1-year duration
- Recommendation letter from the residency supervisor attesting to the applicant’s qualifications
- Query from the National Practitioner Data Bank
- Curriculum vitae
- If the doctor completed residency greater than 2 years prior to application, he or she must submit proof of clinical experience over the last 2 years (a log of at least 100 patients with treatment/diagnosis plans)
- Signed waiver of consent for the board to verify all documentation
- Passage of the A.C.M.O. examination, with transcript sent via N.B.E.O. to the organization
- Application ($225) and examination fee ($780 *reduced for residents who apply during their residency year to $480)
While the certification is geared toward optometrists who have completed clinical residency in a hospital setting or at a college of optometry, it is not exclusive to this group.
For example, advanced competency can be demonstrated through Fellowship of the American Academy of Optometry, by serving as a faculty member of an optometry school, or by publishing work in peer-reviewed medical journals.
The options are explained in more detail on the website and these applicants are considered on a “case by case” basis for approval.
The certification lasts for 7 years.
When and where is the exam offered?
The A.C.M.O. exam is offered on only one date per year.
The applicants are allotted 4 hours and 30 minutes to complete the exam. The scores are released on the N.B.E.O. website within 30-days of the exam and are listed as pass/fail. On the detailed score report you can also view your raw scores and the score profile for other candidates who took the exam.
What is the exam like and how should you prepare?
The exam consists of 40 case reports with multiple-choice questions following each. The cases present patient history and examination findings alongside imaging, photos and lab testing results. The follow-up questions probe diagnosis, physiology, treatment/management, prognosis, and systemic correlations of the ocular condition.
Both the Will’s Eye Manual and the KMK Part 2 Manual are great resources for exam preparation. Keep in mind, however, if using the KMK review books, the A.C.M.O. exam does not cover optics or refractive topics, so don’t stress on that section of the book. This exam exclusively focused on ocular disease (65-75%) and ocular manifestations of systemic disease (25-35%).
According to the A.B.C.M.O. website, the following testing areas are weighted respectively:
- Heavy emphasis: glaucoma, anterior and posterior segment disease
- Moderate emphasis: neuro-ophthalmologic conditions
- Minimal emphasis: ocular trauma and post-operative conditions/management
There are sample questions as well as a tutorial available on the N.B.E.O. website.
Which bodies recognize the specialty certification?
- Federal hospitals (Department of Veteran’s Affairs Medical Centers, Army-Navy-Air Force hospitals and clinics, Indian Health Services)
- State licensed hospitals (Mayo Clinic and those affiliated with Universities)
- Academic teaching facilities
Pros of certification
The field of optometry is changing! At the completion of the 2016-2017 year, 435 more residency trained O.D.s entered the workforce and the annual numbers are increasing. While having more residency-trained optometrists greatly improves the standard of patient care, it may make it more difficult to find an optometry job and to stand out.
Certain employers are only interested in hiring residency-trained doctors. For placement in a hospital or medical setting, a residency in ocular disease is the most desirable.
Providing fellow practitioners with an indication of medical competency promotes trust and respect within the multidisciplinary team. The credentials also give patients confidence in the care being provided, knowing that the doctor went above and beyond what was required to provide excellent care.
This is a national certification and should you relocate during your career, it can attest to your clinical competence. Even if employers are not familiar with your school or residency program, you have proof of advanced competency from a nationally recognized specialty board guaranteeing a high- level practitioner.
Cons of certification
Of optometrists who graduate residency programs in the 2016-2017 year, only about 5% have gone on to become Board Certified in Medical Optometry. Given the advantages of advanced certification, why haven’t more O.D.s pursued this certification?
The price is not insignificant for residents—even with the discount. If you are fortunate enough to be employed by a hospital or academic institution, they may cover the expense or give you an allowance toward professional education to cover the cost. If you do end up paying yourself, the amount is tax deductible.
Is certification right for you?
This article is entitled “Is board certification in medical optometry right for you?” rather than “Why you should become board certified in medical optometry” for a reason.
If you, like me, have a strong interest in medical optometry or someday wish to have a faculty position at a college or hospital, I urge you to consider becoming certified.
I realize, though, not all O.D.s wish to pursue this area of optometry, which is a good thing since we cannot all have the same passion within our field. If this is the case, you may want to consider other ways to make your training unique.
Being the best doctor you can be for your patients is invaluable.
