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The cost of establishing an optometric practice today is not insignificant. To properly equip a new office today will run in the neighborhood of $12,000.
Now, this is easy to break down, and I have a list of equipment that one of the leading optical supply companies has provided me with that totals up to $12,162. I have pictures here of some of the equipment such as the ophthalmic chair which runs $2,800, projector chart which is around $350, a troposcope which is a diagnostic and training device for binocularity problems which runs close to $700, a radiuscope for contact lens analysis, a simple trial frame which, it is hard to believe, runs $90 now.
A minimum possible setup for the new graduate will approximate $7,000. This would be using secondhand equipment that is still functional, a minimal reception area, and so forth.
Now, I have not mentioned any of the special equipment that would be required for contact lens work. The diagnostic sets, and other devices to do this properly, will run $700 to $800. An eikonometer, which is a device for determining relative size of the two retinal
mages, a condition called aniseikonia, requires an instrument that costs over $1,000; the new electronic tonometer, which enables the optometrist to most accurately measure the intraocular pressure of the eye, runs $1,875. The figure $12,000 truly is probably quite conservative.
I think all of you are familiar with a professional office. There is a reception area, a business area for the receptionist. In an optometrist's office he is required to have a room 20 feet long, usually without any windows, so that the illumination can be controlled. He needs a consultation room to discuss the problems with the family. He must have a frame area where the patient with supervision selects eyewear as to color and style. In the final analysis the optometrist, however, must make the ultimate decision as to the appearance of the glasses, and he must fit them to the patient's head after they are received from the lab, analyzed and approved.
Of course, after getting this large amount of money together to properly equip the office, the optometrist then must go through the period of establishing himself as any other professional man must. This period may take several months or it may take several years. Provision must be made for the optometrist to subsist in this small town during this period. This is probably the most critical time in an optometrist's career, and the reason I think discussing it is important here is that so many men go to these rural areas where they are needed but they do not have sufficient financial backing to remain there, and we find them becoming defeatist in their attitude, returning to the larger cities, seeking associations with established practices, and we are back in our situation of no one to serve the rural people.
I do honestly believe that passage of this legislation will help solve this problem, and I know that it will in Alabama. We have many counties that do not even have an optometrist, and I hope that you will give this favorable consideration because it is a tragedy when we train these men, certainly partially at public expense, and they are unable to engage in the proper practice of the profession.
I would just like to say for the record that I am very pleased that my Congressman, Kenneth Roberts, is the author of this legislation. I think it is another example of Congressman Roberts' interest in the public welfare of the people of this
country. We are very proud of him, and off the record
(Discussion off the record.)
Mr. ROGERS of Florida. Thank you very much, Dr. Springer. We appreciate that and, of course, are pleased to have a constituent of our very distinguished chairman of this subcommittee.
You are right, he has done a great many things for the American people in the health field. And he was sorry he could not be here today, but he had very important matters that required his attention in Alabama.
(Dr. Springer's statement in full follows:)
STATEMENT OF DONALD A. SPRINGER, O.D. Mr. Chairman and members of the committee, I am a graduate of the School of Optometry at Ohio State University, Columbus, Ohio, a past president of the Alabama Optometric Association and have been in practice since 1946 in Anniston. I am at this time president of the American Academy of Optometry. The academy is an organization of optometrists and other scientists in the field of vision who are dedicated to improving professional, educational and scientific standards of optometric services provided the citizens of this country. I am speaking in support of H.R. 8546, so that:
1. Students contemplating a rewarding professional career in which proficiency in the sciences is required will be more likely to consider optometry knowing it has been designated by our Government as urgently needing additional practitioners and that if he or she encounters financial difficulties Government loans will be available to enable them to continue their education.
2. The profession of optometry will be better able to fulfill an assignment it has undertaken to help the military services to recruit optometric graduates as commissioned officers, and
3. More States will be encouraged to join those which now promote through scholarships and other means the study of optometry by qualified students who have completed 2 or more years of preoptometric college
work. The vast majority of optometry graduates go immediately into practice in smaller communities where their services are most needed. They must establish private offices either in a new location, or by purchasing the practice of a retiring optometrist. Many of these graduating students have so depleted their own and their families' savings in completing their education that they find it virtually impossible to get started. The loan program which would be made available to our students by the legislation we are discussing would help them to conserve some of their funds for purchase of an older practice or for building a new practice.
Costs for establishing an optometric practice today are considerable. Instruments and equipment alone total approximately $12,000. Here are pictures of only a few instruments needed by the new graduate. The optometric chair is sold by its manufacturer for $2,800. The phoropter is priced at $1,070. A project-o-chart can be purchased for $325. The lensometer retails at $575. The troposcope costs $685. The radiuscope can be had for $325. trial frame, such as this one, is $90. A field charting instrument will cost $400, and a diagnostic instrument, like this one, sells at $130. These are only some of the many instruments and items of equipment the modern optometrist must have in his practice today. The total cost of the few I have just shown you comes to a total of $6,380 ; and we haven't mentioned a single piece of office furniture or listed one of the business machines which are needed.
The optometric office consists of at least three rooms, and the beginning practitioner often should have as many as six or more rooms each serving a different function. There is a reception and waiting room with a few chairs, a table, and a magazine stand, and perhaps a "kiddy corner" equipped with toys and small table and chairs. The office assistant usually has her desk and files in this room so she can make appointments, receive patients, and prepare their records, handle the billing and correspondence, maintain the office bookkeeping records, and the like.
(Speaking of optometric aids, I was pleased to learn from last Friday's Washington Evening Star that President and Mrs. Johnson's daughter, Luci Baines Johnson, is serving as an optometrist's aid to Dr. Robert Kraskin, an optometrist who practices here in the District. We hope it may influence her to become an optometrist as our profession is short of lady 0.D.'s; less than 5 percent of all optometrists are women.)
The second essential room is the refracting room. If it is well equipped with the many instruments needed for a modern optometric examination, this room is usually at least 20 feet long and windowless, so that its illumination can be controlled. Sometimes this room includes a desk, filing cabinet, and bookcase, so that it can serve as the optometrist's personal office and consultation room for discussions with patients and their families. Often, however, the officeconsultation room is separate from the refracting room.
A third basic room is the dispensing or fitting room, where patients select their spectacle frames from an assortment of various styles and colors. Either the office assistant or the optometrist may aid the patient in this choice, but the optometrist makes all the necessary measurements to assure a comfortable and properly fitting frame. Later, when the spectacles have been received from the optical laboratory and verified for accuracy, they are fitted and adjusted to the patient's face. Adjacent to the dispensing area is a small laboratory room or area equipped with tools, instruments, and a supply of frame parts, where spectacles are repaired and assembled. The laboratory may include machines for cutting and edging lenses to be mounted in spectacle frames.
The graduating optometrist may need a separate room especially equipped and used exclusively for the fitting of contact lenses. Another room may be devoted to visual fields examinations and other special testing procedures. If the optometrist, such as Dr. Kraskin, whom I have mentioned as one of your local optometrists, does vision training in his practice, he will have a separate room for the instruments and materials needed for this type of vision care.
While the equipment and instruments I have described, may be reduced somewhat, the optometric procedures available would be reduced proportionately. The recent graduate is also faced with other initial costs of opening an officedecoration, insurance, licenses, announcements, etc.
After founding his office, the new optometrist is immediately faced with meeting the high costs of living while his practice grows and becomes self-supporting. This period may be many months but it is often several years. This time is the most critical time in the young optometrist's professional career.
The last economic study which obtained data on the net income of optometrists was made by the American Optometric Association in 1958. At the time, the average net income of optometrists 28 years of age and under was $4,450. At today's income level I would estimate that the new graduate would be fortunate to receive more than $2,500 net during his first year of practice, and $5,000 for his second year. These are bare subsistence requirements in our modern American economy.
Federal loans during the students years of education will enable many students to enter practice more economically self-sufficient. There will be fewer young optometrists returning to the larger cities seeking association with older and better established practitioners. This failure to stay in the smaller communities is a serious problem and particularly in my State of Alabama. The smaller community, in my opinion, is where the optometrist is needed most and can best serve.
I have been associated with optometry all of my life. My father is an optometrist. I have watched many of the developments in the profession and have seen evolutionary changes take place. I have known and seen hundreds of young graduates enter practice. It is a tragedy when we train these men and they are unable to engage in proper practice due to lack of adequate funds.
I am proud that my Congressman is author of this legislation (H.R. 8546) which is so important to the public interest.
I urge that you give it your most favorable consideration.
Mr. ROGERS of Florida. The next witness is Dr. Frank M. Kitchell. vice president of the American Optometric Foundation. Is he here?
Dr. CHAPMAN. No.
STATEMENT OF FRANK M. KITCHELL, O.D.
Mr. Chairman and members of the committee, my name is Frank M. Kitchell. I am a licensed optometrist, engaged in private practice in Hempstead, N.Y., and am senior vice president of the American Optometric Foundation.
The foundation is a nonprofit organization, organized in 1947, and composed of approximately 2,600 optometrists throughout the United States. Its founders had several objectives. The most important and most urgent was to sponsor research in optometry. The profession realized then, as it does today, that the advancement of this profession will rest to a large extent upon research. Vision care is and must be a dynamic science; it cannot stand still; it deals with man's most valuable possession—his ability to see which largely enables him to be a dynamic part of his civilization.
Over the past 16 years, the foundation has awarded numerous fellowships to deserving students; most of them receiving their Ph. D. and now engage in teaching and research. These fellowships were paid for solely through voluntary contributions made by optometrists. The individuals who received those grants were not the only deserving applicants. There were many others. But foundation funds were and are limited. Lack of funds has hampered our progress in optometry. And it has prevented us from adding to those in our profession who have earned a Ph. D. Their number is far from sufficient for the needs of the profession itself and of American industry.
We do not begrudge industry its share of our Ph. D.'s. In fact, we are glad that our profession can and does make a contribution to industrial safety and efficiency. But we must have sufficient men with advanced degrees to do research and teach in our schools.
Parenthetically, it is only the graduate schools of the major universities with optometric training programs which supply teachers and researchers with the advanced degrees in physiological optics. These Ph. D.'s are found not only in industry but also in military installations and health service clinics. They occupy teaching positions in various departments of universities—medicine, physiology, psychology, and physics.
To train these men, to give them an opportunity to obtain the highest degree in our profession, is a costly undertaking for the schoolsand for the students, Optometry has supported its own all along-to the limit of its capabilities. But the limit is far short of our requirements. The demand for trained men in all health fields is rapidly, even alarmingly, increasing. I have represented the American Optometric Association at the National Health Council meetings for the past 3 years—and the statistics they gave us at those meetings gathered from 50 health professions, certainly demonstrated graphically that growing demand. What is true for the other health professions is true of optometry: We must have more researchers, teachers, and-since everything must start with a source students.
It is quite difficult for a good many students to finance even their undergraduate professional study. This problem becomes vastly more difficult when they attempt to obtain a doctorate. They have to be willing to make great sacrifices to obtain advanced degrees; they must be dedicated men and women. It takes the candidate 7 or 8 years to earn a Ph. D.; meanwhile he may be married, have a family, and yet must live on a pittance, for he can rarely afford to take enough time off from studying to earn money at an outside job. Even the man who goes into optometric practice after finishing the 5- or 6-year course depending on the school he attends has a much harder time financially than the medical doctor who at least earns some money right away during his internship. The optometrist establishing himself in his own practice cannot count on a particular income; in fact his income for the first 2 years is likely to be no more than $5,000. Meanwhile he has quite an investment in equipment, and the rent has to be paid.
At this moment, we have eight applications for fellowships. Our funds allow us to give out only three. And this at a moment in history when we badly need more educators.
During the past 4 years the foundation has expended approximately $10,000 annually in grants to its applicants. Small amounts, surely, for a big job.
Small amounts when you consider the urgent need for more highly trained men. Now, there was an article in the Optical Journal-Review recently concerning eye research. It reported the findings of a survey conducted under sponsorship of Research to Prevent Blindness, Inc., a voluntary, medical research foundation, by Dr. Thomas D, Duane, head of the department of opthalmolrgy at Jufferson Medical College in Philadelphia.
Dr. Duane says that the number of scientists engaged in eye research must be increased by 75 percent in the near future, the number of supporting personnel by 05 percent.
There must be a large expansion in laboratory space_415 percent according to Dr. Duane's survey-which will cost some $15 million. A minimum investment figure for new equipment : $10 million. And the number of electron microscopes must be doubled.
These are the suggestions Dr. Duane put before the Labor, Health, Education, and Welfare Subcommittee on Appropriations of the House of Representatives, calling on the Federal Government to double its support of eye research.
Of course research is important. But so is trained manpower. Optometry is aware of its responsibility to do research to further the cause of vision care. But it is also aware of the fact that you must have a steady-and increasingbody of students from which pool you can eventually draw researchers and educators. There is no river without its source; there is no profession without its students who will be tomorrow's teachers, practitioners, and researchers.
And I am proud to tell this committee that there is no dearth of applicants for optometric college training nor of interest on the part of young people in optometry.
For example, in April 1964 alone, the American Optometric Association received 305 requests for information; while during the period May 1963 to May 1964, it received a total of 2,196 such requests.
And we know that there are far more applicants in every college and university than-barring financial aid for the student—they can possibly accept. For example, by early May of this year, Southern College of Optometry of Memphis, Tenn., had already 400 applications for the 1964 winter semester. In recent years, Southern's acceptance ratio has been 1 out of 3 student applicants ; last year the ratio increased to 1 out of 4, and with rising numbers of applicants, the college reports this ratio will again increase this year.
What is particularly sad about this situation is that students with promise have to be turned away. Most of those who are not accepted are not turned down for scholastic reasons. It is simply a question of dollars and cents ; dollars and cents unavailable to either the student or the educational institution.
The American Optometric Foundation views such a state of affairs with grave misgivings. Our profession is desperately in need of additional high-caliber teachers; our profession is in need of more researchers. And here we are turning away high-caliber students who could help to fill those needs.
I mentioned earlier that the foundation had to limit its fellowships because of lack of funds. Again, the human potential—the research potential was there, but we could not put it all to work.
Yet, like the optometric profession as a whole, we have gone forward, regardless of financial and other obstacles.
The foundation is now engaged in a 3-year study at Indiana University School of Optometry to determine the factors involved in night driving, including not only the visual skills required, but automobile design and environmental factors as they affect safe night driving.
Recently the foundation made a grant to a young Ph. D. at Pennsylvania State College of Optometry to develop an improved tonometer, an instrument that detects glaucoma. This will eventually be available in general practice.
We are proud of our accomplishments. We shall continue to meet the chal.. lenges of research to the limit of our resources. I think that, looking at the entire field of optometry, it is amazing how much has been accomplished in the field of vision care and its advancement without the aid of outside funds. But the cost of education in all the health professions is high and probably will go higher; this is true of optometry. Considering our small amount of available loan funds, much more could be accomplished if the existing law is amended to make Federal loan funds available to optometry scholars and colleges.
The enhancement and preservation of the priceless gift of vision is the primary concern of the American Optometric Foundation, whose officers and directors serve without material compensation. Their only reward is the knowledge that their efforts will eventually play a part in the improvement of the vision—and