Up around the bend

July 3, 2013

hod sat munsonEditor’s note: this column contains excerpts from the inaugural address given by AOA President Mitch Munson, O.D., June 29 at the AOA House of Delegates.

It is truly an honor to stand before you as the 92nd president of the American Optometric Association. And to think, just 30 short years ago, I wanted to be a veterinarian. Such is the story of our lives: unpredictable, full of change and with something new, always, up around the bend. As many of you know, I grew up in Orange County, just a few miles north of here, and music was a big part of my life. I spent hours listening to Credence Clearwater Revival, and even though I only got about every third word John Fogerty ever sang, I loved their music… and “Up Around the Bend” was one of my favorites. And as I assume the reigns of this position, I want you to know that whatever the rising winds may bring, whatever is up around the bend for this profession, your AOA will be here to greet it as it has for over a century.

This year will mark my 18th year in the AOA volunteer structure. If I have learned nothing else, it is that we, you, me and our patients, are truly fortunate to have as our advocate this incredible federation we call the American Optometric Association. Under the diligent direction of our executive director, Dr. Barry Barresi, our St. Louis and Washington offices employ over 100 dedicated staff, engage the expertise of nearly 300 volunteer doctors, are made whole by the collective efforts of 52 affiliate organizations, and are led by the most dedicated and passionate group of individuals I have ever had the privilege to serve with.

Ladies and gentlemen of the AOA board, you give more to this profession than most will ever know. I applaud you, I am honored to serve with you, and I look forward to working with each of you in the upcoming year.

One does not arrive at this level of leadership without the love, support and sacrifice of those close to you… and (my family and friends continue) to make a difference in my life.

Years ago, we used to view a presidential year as somehow framed in a particular theme. But honestly, with the changes in health care, this board has little time for personal agendas. To the contrary, our agendas are formed by both circumstance and vision and guided by collective thought, experience and reason.

And as I reflect back at my time on the board, I realize that, with few exceptions, much of the board’s energy has been devoted to the issue of health care reform. And specifically, attempting to unravel the mystery of this monumental change so that our members can better understand and prepare for what’s around the bend. In March of 2010, Congress passed the Affordable Care Act, arguably one of the most controversial pieces of legislation ever considered. Were we passive during the debate? Far from it. Taking sides was really not an option for us, but making positive changes for our patients and our profession certainly was. And when the dust had settled, our lawmakers understood the importance of childhood vision examination and the need to break down discriminatory practices with regards to access.

So now what? From the standpoint of a provider with 2014 just around the bend, there is still angst among our members, and rightfully so.

What will the Affordable Care Act look like for optometry? How will the essential pediatric vision benefit play out? Will the Harkin Amendment truly break the ERISA barrier? Will my office survive the move to an electronic health record and can I afford it? What is meaningful use and can I achieve it? What will ICD-10 look like? Am I billing correctly and will I get paid fairly? What is a quality ranking and how will it affect my reimbursement? Do I really understand the Physician Quality Reporting System? Am I participating at the appropriate level and what happens if I don’t participate? Do I need to be board certified? What is an exchange? What is a health information exchange? What is an accountable care organization and can I participate? Will my profession retain its independence? Will my practice survive? All good questions, and if you haven’t asked yourself at least one of these, then you’re not paying attention.

In my candidate speech last year, I spoke of change,  and our aversion to it. Personally, I don’t like change any more than the rest of you, but change is inevitable.

Within a month of buying your new phone, a new computer or a new car, it is obsolete. Technology is changing at an exponential rate and so too is our world. So how will you cope with change and answer all of those questions about health care? Well, that’s where we come in. The AOA has never expected you, on your own, to solve all of the mysteries of practice, let alone navigate a 2,000-plus-page document that is redefining health care as we know it. In a recent presentation to the AOA Board, one of our longtime health care consultants summed up health care reform by simply saying that “there is little hope of maintaining the status quo.” Well, we’ve known that for some time, so your AOA made a commitment and an investment that put the right team in place to help us prepare for and interpret, step by step, what was happening in Washington. And we did it so our members didn’t have to. And I could not be more proud of our team in Washington lead by Mr. Jon Hymes, who you know by now was named as one of Washington’s top 10 lobbyists in 2012. Thank you, Jon, the entire Washington office staff and the St. Louis office staff, for all you do.

So what about the future? What is up around the bend for our profession? According to sources such as U.S. News, CNN, Kiplinger’s, the Wall Street Journal and many others, optometry is being referenced as one of the top professions for the future. Indeed, our little profession is on the map. Consider this: there are 300 million people in this country. And who provides care for them? A million physicians, over 2 million nurses, 240,000 dentists, 200,000 physical therapists, and 36,000 optometrists. It is estimated that we provide almost three-fourths of the eye care in this country and examine more than half of the eyes in this country every year. Now, enter the Affordable Care Act bringing an estimated 30 to 50 million more lives into the fold of care. Add to that, the Harkin Amendment breaking the ERISA barrier and allowing access to another 70 million lives that were previously barred from optometric care. Add all of this to an aging demographic, and you have a good look at the future of eye care and the future of our profession. While the number of optometrists appears to be keeping pace with the demand for primary eye care, the number of eye surgeons in this country is predicted to remain flat in the face of an increasing demand for medical eye care. So who’s going to fill the void? PAs? Nurse practitioners? We all know the answer: It’s us! Twenty-five years ago, I couldn’t prescribe a drop of antibiotic. Today, there is very little we cannot prescribe and far more that we can treat. Optometry has evolved faster than any health care profession, and there’s no reason to believe we are going to stop. In fact, there is every reason before us that we should continue to move forward.

When I graduated in 1986, there were only a handful of optometric residencies. Today, nearly 20 percent of our 2013 graduates will attend a residency, from primary care, to contact lenses, ocular disease, binocular vision and even vitreo retina. During this administrative year, the leadership of the Association of Schools and Colleges of Optometry and the AOA will explore synergies between our organizations knowing full well that the success of our profession is truly dependent on both the advancement of optometric education and the early and continued involvement in organized optometry by our students and our new graduates. Bottom line, the students of today will shape the optometry of tomorrow.

And what about our students? Would the AOSA delegation please stand? Colleagues, Let me introduce to you our future leaders and the most well trained students in the history of our profession.

Following Dr. Carlson’s 20/20 tour in 2010 and 2011, the AOA Board adopted a policy of sending an AOA board member to visit every school and college of optometry every year so that each student can hear AOA’s message, first hand, from one of its elected leaders. While membership in the profession is free upon graduation, it will shock many of you to know that our current transition rate for new graduates is, and has been for many years, around 60 percent. We can all speculate as to why this is, but what we must do is to engage these students well before they graduate. Last year in this House, we passed a bylaw requiring that all AOSA members must also join a state affiliate. This was supported by the AOSA and, thanks to a very dedicated group of AOSA leaders working together with the AOA leadership, we have made marked strides in our reach to students. But we need to do more, and not just for students, but for all of our members as well.

So beginning this year, we have made it a priority to better connect with our members. As you heard from Dr. Terri Geist yesterday and Dr. Hopping this morning, we are streamlining and modernizing many of our communications. As some of you have already seen, our new website went live last Monday, and I think you will find it cleaner, faster and more user-friendly. We will continue to start your day, every morning, with AOA First Look, and by next year, the AOA News, our most-read publication, will undergo a significant transformation offering both news and clinical content in a fresh and contemporary format.

And much of this would not have taken place had we not made system-wide changes to our IT platforms.  Four years ago, the AOA Board of Trustees approved a significant investment in both time and capital to improve our electronic processes. And in January of this year, after years of research, internal evaluation, training, and expense, all under the guidance of our Chief Information Officer Mr. Reggie Swanigan, we went live with our new association management system. In addition to the many new processes now available to us with the AMS, I am pleased to announce that we are also nearing the launch of our affiliate enterprise system, which will, in time, connect the AOA to its affiliate organizations and to our members like never before.

Our affiliate partners are the backbone of this federation. We acknowledge that as part of our strategic plan, and over the past 18 months, the AOA has made significant internal changes to better accommodate the needs of our affiliate organizations. Overseen by our Chief Operating Officer Renee Brauns and our Affiliate Relations Director Jennifer Frawley, we have completely retooled the processes by which we communicate with our state affiliates. Better communication equals less confusion, more camaraderie and happier members.

To be sure, we are always looking for better ways to serve our members. And today, the decision this House made to transform the Paraoptometric Section and to bring all of our paraoptometrics into the fold of the AOA was the right one. Now, instead of having only 2,500 paras, we will bring an estimated 70,000 to 80,000 new paras into the fold of our Paraoptometric Resource Center housed within the AOA. Paraoptometrics that can become better trained, certified, more efficient, more confident, more valuable to their employers and more connected to our AOA.

Our AOA. Truly, an amazing organization with a lot of very passionate people moving in a lot of different directions. And as we move forward into this new era of health care, we will need all hands on deck. Whatever it is you bring to the table, then bring it. Our association is organized into over 35 different committees manned by nearly 300 volunteer optometrists from around the country. And it is these volunteers that provide the necessary strength and vitality by bringing their brand of passion to our table, and I thank you all for what you do. For the past two years, we have tested the waters with coordinating our annual volunteer meeting with Optometry’s Meeting®, and we have been pleased with the outcomes. But we need more. We need an uninterrupted, separate meeting for our volunteers. A meeting that can allow for a concentrated stream of effort, the cross-pollination of ideas, ready access to both AOA staff and leadership, and a heightened awareness of the breadth and reach of our organization. So I am happy to announce that this February, we will be reinstating the mid-year meeting for all AOA volunteers in St. Louis.

State leaders, what’s up around the bend for you? Clearly, things will change on Jan. 1, and I suspect there may be more questions than answers from your members. So my advice to you as you go forward in your respective leadership roles is to stay informed, keep an open mind and be patient. Use your AOA Board liaisons as a resource, please attend your liaison trustee conference calls and reach out to AOA staff whenever you need us. We are all here for you.

Finally, I want to thank you, our delegates, for taking the time to be here, for voicing your opinions and having the courage to do so. This is our House. It’s where we do our business; it’s where we agree; and where we agree to disagree… and that’s fine, because this is your organization, your AOA. It is the voice of optometry and the only voice that advocates for you, your patients and our profession.

I’d like to close on a personal note and express my appreciation for the support and the encouragement that you have provided during my journey on the AOA Board. I have appreciated the kind words as well as the gentle nudges because it is the sum total of both our likes and our differences that make us who we are today.

Ladies and gentlemen, it is a privilege to serve this profession, and I look forward to the challenges and the opportunities that are up around the bend.

One comment

  1. Well done and congratulations. You will do a great job and the profession has a great leader at the helm. Best of luck, and may we all hope that what is around the bend is an end to the divisive rhetoric we have all been subjected to for the past few years.

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