Scope-of-practice battles follow a predictable path. In most cases, optometrists work with state legislators to expand the procedures they are permitted to do or drugs they can prescribe by amending existing or introducing new legislation. Ophthalmology groups – usually the relevant local society, in partnership with the Academy – respond by educating legislators about patient-safety risks and the significant differences in training between ophthalmologists and optometrists.
But what if the society facing scope-of-practice legislation represents more than 15 different island countries, each with widely different health and socioeconomic needs?
That is the case with bill number 29-0296, the “Therapeutic Pharmaceutical Agent (TPA) Certified Optometrist Act,” which is currently under consideration in the legislature of the U.S. Virgin Islands.
Academy leaders Michael Brennan, MD, and Daniel Briceland, MD, are among those working with the Ophthalmological Society of the West Indies (OSWI) on its response, but the legislation presents several unique challenges. The good news is, those challenges are also an opportunity for young ophthalmologists in the Caribbean.
Many Nations, Many Cultures
OSWI is comprised of the 17 diverse island nations that border the Caribbean. Each island not only has different health priorities, they also have different ministries of health. Therefore, what Bermuda as a country allows in terms of scope of practice could vary considerably from Martinique.
This variation in politics from island to island can make it difficult for OSWI to advocate for a unified position. Since the region’s culture and politics is very much based on who knows who, there tends to be a one-man-show approach to politicking. There is no widespread, grassroots advocacy network.
Dr. Brennan said conflict is also handled differently than in the United States, which affects the approach to advocacy. “People in the West Indies don’t really fight for a cause,” he said. “They have a strong sense of just letting things be and trusting that everything will work itself out.”
Additionally, he said there is a strong sense of respecting your elders and hierarchy among the island nations. As a result, leadership positions are often left to those that have been practicing for many years, leaving a large gap when it comes to hearing from the younger generation.
“The lack of young voices in OSWI is somewhat problematic,” Dr. Brennan said. “It is critical for all professions and organizations to groom the next generation of leaders. In this case, we need to work with OWSI to begin to develop their YOs.”
Collaboration is Key
One opportunity is presented by the structure of medical education. Lizette Mowatt, MD, a senior lecturer at the University of the West Indies (UWI), said the school’s doctorate of medicine in ophthalmology is “a relatively new six year training program. Part of our curriculum requires that the resident do five years in the Caribbean and the sixth year outside of the Caribbean.” As a result, students have the opportunity to study abroad, gaining exposure to different medical systems, approaches to leadership development and advocacy.
Nor do physicians always have to travel for cross-cultural education. Events such as OSWI’s annual symposium and a recent UWI phacoemulsification course – the first of its kind at the school – increasingly incorporate international perspectives into training and clinical discussions. (The phaco course was offered in partnership with the University of Toronto and funding from Alcon.)
Cross-cultural collaborations are bringing changes to advocacy. As a graduate of the Curso de Liderazgo, the Pan-American Association of Ophthalmology’s equivalent of the Leadership Development Program, Dr. Mowatt, who has been closely involved in OSWI’s efforts to respond to bill number 29-0296, was also exposed to advocacy efforts in other regions, such as Puerto Rico.
Dr. Briceland praised the U.S. territory as “a good example of advocacy at work. They are organized and uniform, with a unified mission,” he said. “They work with their minister of health to ensure he understands the difference between a medical eye doctor and an optometrist.”
However, Dr. Briceland said physicians in other island nations may not think in terms of going to the minister of health to express views and advocate for ophthalmology or understand about how the system works.
“Ophthalmologists in the West Indies don’t realize the impact of optometrists’ influence,” Dr. Briceland said. “In some ways, many of them are inadvertently supporting the optometric agenda. They think of ODs as technicians and refer TO them. As such, it is not part of their core personality to fight against optometry.”
YOs are the Future
With legislation like bill number 29-0296 in the Virgin Islands and a similar project recently stymied in Puerto Rico, however, the tide is changing. And in both those cases, the ophthalmologists at the head of the charge include alumni of PAAO’s Curso and the Academy LDP program.
In the near future, it’s likely they may also include participants in or graduates of the West Indies’ leadership development program, which is modeled after the LDP. “YOs, as a rule, have advanced computer skills, high energy, time and are used to competition,” Dr. Brennan said. “This makes them an extremely valuable asset.”
As YOs work more closely with ophthalmic leaders, Dr. Brennan sees tremendous potential. “Combining senior ophthalmologists, program directors and YOs can be a powerful way to work together and ensure strong leadership in ophthalmology now as well as in the future,” he said.
Such collaboration will be just as important in advocacy as it is clinically. “If you aren’t at the table, you are on the menu,” says Dr. Briceland. “What I mean by that is if we are not participating in this process, then the outcomes may not be what is best for our patients or profession.”
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About the author: Kimberly Day is a freelance health writer and medical editor and frequent contributor to YO Info. She is the co-author of Hormone Revolution and ghostwriter of Eat Papayas Naked. Additional reporting by Christi A. Foist, YO Info managing editor.