One of my guilty pleasures is Downton Abbey, PBS’s upper-crust costume drama about the waning years of the British aristocracy. Usually, the plots concern whether Robert Crawley and his family will remain obscenely wealthy or might end up just “comfortably” wealthy. But a recent heart-breaking episode hinged on a dispute between two doctors, a generalist from Yorkshire and a specialist from London, with life-or-death consequences for a pregnant woman.

The country doctor—kindly Dr. Clarkson, a generalist—had known the patient all her life and was attuned to changes that the fancy-pants city doctor missed. The Lord of the manor, himself a slave to the rigors of the social pecking order, refused to second-guess the esteemed obstetrician. And the prideful specialist dismissed the warnings of the generalist out of hand. All watched in horror as the patient died of eclampsia, just as Dr. Clarkson had predicted. The Crawleys learned, too late, that titles don’t matter—results do.

It reminded me a bit of the battle ODs have fought for over 40 years to expand their scope of practice, which began in 1971 and continues to this day. To many, especially laypersons with no knowledge of the day-to-day workings of health care, a title automatically confers authority and stature. It’s a bias optometry has worked tenaciously to neutralize in every battle over TPA laws.

Honoring an Eyecare Education Visionary
We are pleased to announce that Jobson Healthcare is establishing a non-profit foundation in memory of Rick Bay, Publisher/President of Review of Optometry and Review of Ophthalmology, who succumbed to illness in late 2012 after a decades-long career of tireless dedication to the betterment of eyecare through publishing and live educational events.

The Rick Bay Foundation for Excellence in Eyecare Education will provide annual scholarships in both optometry and ophthalmology education. Each of the selected students will be chosen by their school based on qualities that embody Rick’s commitment to the profession, including integrity, compassion, partnership and dedication to the greater good.

The Rick Bay Excellence in Eyecare Education Scholarship in Optometry will be awarded to a student at Pennsylvania College of Optometry at Salus University, Elkins Park, Pa., and The Rick Bay Excellence in Eyecare Education Scholarship in Ophthalmology will be awarded to a student at Wills Eye Institute, Thomas Jefferson University Hospital, Philadelphia, Pa.

Those who wish to honor Rick’s memory and to help establish a lasting legacy with a contribution to the Foundation should visit

While important in its own right (to say the least), scope of practice expansion might even be eclipsed by the importance of ensuring a place for optometry in the health exchanges that will arise as part of the Patient Protection and Affordable Care Act (PPACA), which goes into effect in just under a year.

The stakes are high. As Cheryl Murphy, OD, discusses this month (see “How and Why to Get Behind Health Exchanges.), millions of patients will join the insurance rolls, and expanding primary/preventive care is a key goal of the legislation. Clearly, optometric involvement—indeed, leadership—in this facet of the PPACA makes sense in many ways: the manpower advantage over MDs, the cost effectiveness argument and the eminent suitability of optometrists for the responsibilities of primary eye care.

But optometry isn’t guaranteed a place on the provider panels of the health exchanges; rather, these must be fought for. Once on board, you cannot be discriminated against—thanks to the Harkin Amendment of the PPACA—but it will require effort, individually and collectively, for ODs to participate to the full extent of their capabilities.

Rights that come by way of the statehouse are tedious to obtain, and tenuous to maintain. The legislature giveth and the legislature can taketh away. Optometry scored a huge victory with the Harkin Amendment. Don’t let it go to waste.

As Dr. Clarkson found, skills are only of value when put to use.