Every summer I think about the most recent brigade of freshly minted ODs who have survived four years of optometric boot camp and a challenging gauntlet of National Board Exams. I picture students charging forth across the “no-man’s land” of changing healthcare landscape, lugging their backpacks full of six-figure student debt. My “tale of two state boards” is dedicated to these young comrades in arms.
The views expressed here belong to the author. They do not necessarily represent the views of Optometry Times or UBM Medica.
Charles Dickens’s words, “It was the best of times, it was the worst of times,”
could also describe my first year out of optometry school.
I was finally a Doctor of Optometry, but I was not out of the woods yet.
Every summer I think about the most recent brigade of freshly minted ODs who have survived four years of optometric boot camp and a challenging gauntlet of National Board Exams. I picture students charging forth across the “no-man’s land” of changing healthcare landscape, lugging their backpacks full of six-figure student debt.
As if that frontal assault was not treacherous enough, students are also required to serve as cannon fodder for state board examiners.
Previously from Dr. Brown: Death of the pressure patch has been slightly exaggerated
My “tale of two state boards” is dedicated to these young comrades in arms.
That first summer I settled into my residency and easily obtained a license in State A where I was located. A simple written test covering a few clinical topics and state laws was all it took.
I then decided to seek a license in nearby State B to improve my post-residency job prospects. It had a good therapeutics law and plenty of opportunities for young ODs-or so I heard.
State B’s test included a face-to-face interview with board members. Apparently, it was designed to ascertain the character and intentions of a candidate and protect the good citizens of their state from any optometric riff-raff.
When I entered the room, I looked up and saw a group of mostly middle-aged males sitting on a dais. There was a single folding chair in front of the stage that was apparently the “hot seat.”
I assumed the position and peered up at the line of men who, for that time and place, were essentially a pantheon of gods. In the middle sat a large good ol’ boy who I took to be Zeus.
They asked me a lot of “clinical” questions like:
Where are you from?
What are you doing?
Why are you here?
I explained my educational bona fides, that I was doing a residency in ocular disease in a nearby state, and that I would like to pursue opportunities in their state during that year.
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Then Zeus said, “Ya mean to tell me ya don’t already have a private practice lined up? That ya really don’t know whatcha’ll be doin’?”
“No, sir,” I said.
He said, “And what about this place where ya are now? Ain’t that one of them thar chains?”
A younger board member leaned Zeus’s way and explained to him that, no, it was a comanagement center, and the name was the corporate brand of the company that owned the practice.
Zeus scowled, seemingly unconvinced.
I left the interrogation chamber a little shaken. I worried aloud to my wife that the fix might be in.
I needed to be at my best for the practical exam the next day, so I tried to shake it off and think positive thoughts.
I showed up the next day with my wife as a “patient” (every candidate had to supply one to sit for someone else’s exam).
She had 6 mm pupils, crystal-clear media, and every line of the eye chart memorized from all the times she sat for my practice exams during school.
Somebody else brought an older woman with 2 mm pupils and moderately dense nuclear cataracts.
Most of the stations seemed to go fine.
I could not help noticing that some examiners joked and chatted amiably with certain candidates while I got nothing but stares and cold shoulders.
I came to the final station: retinoscopy and subjective refraction. The older woman with tiny pupils and cataracts was in my chair.
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It was the refraction from hell.
No matter how low I turned the lights, I could not get her pupils to dilate wide enough to scope through her cataracts. To make matters worse, she was a slow responder.
Three nerve-wracking weeks passed, and I finally received word that I had failed the exam by less than a point. I had bombed refraction, which brought my average just below the passing threshold.
I was stunned, disoriented, and angry. I suspected the older woman had been a plant intended to trip me up. I thought about lodging a protest and even ran the idea by my residency mentor.
“Don’t do that,” he said. “Just learn from it and move on.”
Come winter, I turned my sights toward a license in State C. State C had a great therapeutics law but also a board exam with an oral section that was reputed to be among the toughest in the country.
When I showed up for the State C exam, nobody asked me anything about my personal business. It was just a straight-up exam, and yes, it was hard.
But it was also fair.
Toward the end of one of the oral stations, I had answered the board members’ questions to their satisfaction and actually expounded on the topic a bit. I related new information I learned from a corneal specialist who had supervised me during my residency.
The board members were generally curious and wanted to know more. I would stop well short of calling it a “Jesus in the temple with the elders” moment, but I think it is fair to say we engaged in some collegial repartee.
About a month later, I received word that I had passed State C’s exam with an overall score of 97.
The validity, reliability, and fairness of state board exams have generally improved since my time.
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There may still be glitches and outright protectionism in some places, but more state boards than ever now accept the National Board Exams in lieu of its own less-standardized tests-in addition to a state law exam.
That progress is more in line with our fellow health professions and a boost to optometry’s credibility.
In the grand scheme of things, my failure in State B was little more than the professional equivalent of a stubbed toe with a couple of days of swelling.
Even though I have never practiced in State C, I have kept my license active, partly because I am proud I passed its tough exam, but also out of respect for my colleagues there who treated a young OD with respect and gave him a fair shake.
My curiosity got the best of me as I was writing this story. I peeked and checked to see what I would need to do at this point in my career to get a license in State B.
Aside from a lot of money, the usual law test, and multiple administrative hoops to jump through, it turns out I would only have to pass a one-question test:
Why do you wish to be admitted to practice in State B?
I think somebody is still worried about “them thar chains.”