##### IHS Chief Clinical Consultant for

##### OPTOMETRY FY2003 Report

*to-* IHS Chief Medical Officer (RADM W. Craig Vanderwagen)

*from-* IHS Chief Clinical Consultant for Optometry (CAPT Richard A.
Hatch)

> Gallup Indian Medical Center #18, PO Box 1337, Gallup, NM 87305
>
> 505/722-1332, fax: 505/722-1388, rhatch@gimc.ihs.gov

*date-* 30 September 2003

Craig, it has been a pleasure to serve another year as Chief Clinical
Consultant for Optometry. I have highlighted many activities of the past
fiscal year in this report and included budget information. Let me know
if you wish further details and information.

**Staff development, recruitment and retention activities** were
conducted primarily using the internet to receive and respond to
inquiries and to disseminate information to IHS facilities. Two key
essentials to recruitment success continue to be the availability of
loan repayment funds that make working in the IHS system financially
possible for optometrists and the IHS student clinical rotation and
residency programs that bolster national awareness of IHS optometry.

  ------------------------------ ----------------------- ----------------------- ----------------------- -----------------------
  **IHS Direct and 638 Programs                                                                          
  Optometrist Staffing**                                                                                 

                                 FY2000                  FY2001                  FY2002                  FY 2003

  Employed by 638 Programs       [21]{.smallcaps}        [24]{.smallcaps}        [27]{.smallcaps}        [35]{.smallcaps}

  Commissioned Corps 638         [13]{.smallcaps}        [14]{.smallcaps}        [25]{.smallcaps}        [22]{.smallcaps}

  Commissioned Corps Direct IHS  [64]{.smallcaps}        [62]{.smallcaps}        [53]{.smallcaps}        [54]{.smallcaps}

  Civil Service Direct IHS       [9]{.smallcaps}         [9]{.smallcaps}         [10]{.smallcaps}        [14]{.smallcaps}

  **Total Optometrists [on       **[107]{.smallcaps}**   **[109]{.smallcaps}**   **[115]{.smallcaps}**   **[125]{.smallcaps}**
  Duty]{.underline}**                                                                                    

  Vacant Positions in 638        [2]{.smallcaps}         [3]{.smallcaps}         [5]{.smallcaps}         [3]{.smallcaps}
  Programs                                                                                               

  Vacant Positions in Direct IHS [5]{.smallcaps}         [8]{.smallcaps}         [6]{.smallcaps}         [7]{.smallcaps}

  **Total Optometrist            **[114]{.smallcaps}**   **[120]{.smallcaps}**   **[126]{.smallcaps}**   **[135]{.smallcaps}**
  [Positions]{.underline}**                                                                              

  Residents on Duty              [9]{.smallcaps}         [5]{.smallcaps}         [5]{.smallcaps}         [5]{.smallcaps}
  ------------------------------ ----------------------- ----------------------- ----------------------- -----------------------

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-   Optometrist **positions** increased in FY2003 by 9 to a record high
    135, consisting of 60 (44%) at 638 facilities and 75 at direct IHS
    facilities.

-   There are 125 **optometrists** **on duty** including 76 commissioned
    officers (22 in 638 facilities), 14 civil servants (all at direct
    IHS facilities) and 35 employees of 638 programs. This is a net gain
    of 10 optometrists on duty in FY2003.

-   Of the record high 44 **vacancies** in FY2003, 31 were filled, 3
    were closed (Barrow, Santa Fe and Wagner) and 10 remain unfilled.

-   Commissioned officer **promotions** were supported with activities
    including individual officer counseling and participation in the
    agency recommendation process. Promoted to LCDR were 6 optometrists
    (87%), 3 to CDR (43%) and 2 to CAPT (33%).

-   **Retention** **pay** for commissioned optometry officers was
    requested by the Indian Health Service but has not yet been
    implemented by the Division of Commissioned Personnel.

-   Comments and recommendations for updating the Civil Service
    **GS-662** optometrist series were submitted to IHS Personnel for
    inclusion in the IHS GS-600 series OPM recommendations.

-   Work on a special **salary rate** **schedule** for Civil Service IHS
    optometrists has not yet come to fruition. The contract for the
    personnel consultant working on this project ended short of her
    submission of a completed proposal.

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-   The IHS **Loan** **Repayment Program** awarded a record high 19
    extensions and 9 new contracts to optometrists. There were 7
    applicants that did not receive contracts due to insufficient
    funding.

-   The IHS **Scholarship** Program graduated one optometrist, now
    working in the IHS system, and funded scholarships for a record high
    9 optometry students.

-   FY2003 saw 5 optometrists complete IHS **residency** programs
    providing some 12,000 patient visits. Two have taken IHS positions.
    Of the 62 optometrists that have completed IHS residency programs to
    date, 19 (31%) are now working in IHS direct and tribal positions.

  ------------ ---------------- -------------- -------------- --------------
  **IHS                                                       
  Optometry                                                   
  Clinical                                                    
  Training                                                    
  Programs**                                                  

  **Academic   **Scholarship    **4th Year     **Resident     **Affiliated
  Year**       Graduates**      Rotations**    Rotations**    Schools**

  1991-1992    0                78             0              12

  1992-1993    0                79             0              9

  1993-1994    1                78             1              12

  1994-1995    0                105            2              11

  1995-1996    0                104            5              11

  1996-1997    1                101            7              13

  1997-1998    3                125            9              14

  1998-1999    2                121            11             14

  1999-2000    1                126            8              14

  2000-2001    0                130            9              15

  2001-2002    3                112            5              13

  2002-2003    1                129            5              13

  **Totals**   **12**           **1,288**      **62**         **15**
  ------------ ---------------- -------------- -------------- --------------

-   In academic year 2002-2003, 129 fourth-year optometry **students**
    completed clinical rotations at IHS direct and tribal clinics. This
    translates into 55,000 patient visits provided.

**Optometry program development activities** included the efforts of
many optometry staff members.

-   **Deputy Chief** Clinical Consultants for Optometry were appointed,
    one being a tribal employee to better relate to and serve tribal
    programs.

-   The IHS Eye Care **Newsletter** was published in two editions.

-   An optometrist **deployment role** was submitted to better enable
    the Commissioned Corps Readiness Force to utilize the skills of IHS
    and other PHS optometry officers.

-   IHS optometry collaborated with other federal optometry programs in
    developing federal optometry clinical **coding and billing**
    guidelines.

-   Refinement continued of **PCC Plus** optometry prototype forms and
    recommended practices.

-   Led by the IHS Eye Care **Diabetes** Committee, efforts to improve
    access to diabetic eye disease screening and treatment were
    continued. GPRA data collection reflects success in improving access
    to screening through expansion of tele-imaging systems and
    protocols.

-   Standardized optometry medical **record audit** standards and forms
    were reviewed and refined.

-   The IHS Eye Care **Directory** was updated regularly and refined. It
    was published to IHS staff, professional organizations such as the
    American Optometric Association and schools and colleges of
    optometry as well as interested individuals and applicants.

-   Optometry participated in or conducted the following **IHS
    meetings**.

> IHS Area Chief Clinical Consultants for Optometry Meeting
>
> IHS Eye Care Coordination Committee Meetings (3 via teleconference and
> 1 at the IHS National Councils Meeting
>
> IHS HSO Category Agency Recommendation Meetings (via teleconference)
>
> IHS Loan Repayment Program Meetings
>
> IHS National Councils Meeting
>
> IHS Navajo Area Optometry Meeting

-   IHS optometry was represented and relations cultivated at the
    following **national meetings**.

> American Academy of Optometry Convention (An IHS optometrist
> participated with optometry officers from other services in a
> colorguard honoring those fighting in the war on terrorism.)
>
> American Optometric Association Convention (An exhibit hall
> recruitment booth was operated.)
>
> American Optometric Association Federal Service Chiefs of Optometry
> Meeting
>
> American Optometric Student Association Meeting
>
> Armed Forces Optometric Society Meetings
>
> Association of Military Surgeons of the United States Optometry
> Section Meeting
>
> Commissioned Officers Association Meeting
>
> Federal Service Optometry Meeting
>
> National Eye Health Education Program Meeting (A National Eye
> Institute project, NEHEP published "Diabetic Eye Disease and American
> Indians and Alaska Natives -- Findings from Focus Groups and Key
> Informant Interviews".)
>
> Southern Educational Congress of Optometry (An exhibit hall
> recruitment booth was operated.)

**Chief Clinical Consultant for Optometry** **funds** are essential to
the many activities listed above that support and extend the quality and
quantity of IHS eye care. The IHS Eye Care Biennial Meeting will be held
at the Southern California College of Optometry, May 10-14, 2004.
Nationally prominent lecturers are scheduled for this meeting to present
on topics tailored to the unique clinical challenges common in IHS eye
clinics. Some 70% of IHS eye care providers are expected to attend.

-   FY2003 Chief Clinical Consultant for Optometry funds were used as
    follows, augmented by other IHS and American Optometric Association
    support.

> Travel expenses for the FY2002 IHS Eye Care Coordination Committee
> Meeting held in conjunction with the IHS National Councils Meeting
> (One participant's travel reimbursement to their facility was not
> processed in FY2002.) \$922.50
>
> Travel expenses for the Association of Military Surgeons of the United
> States Optometry Section Meeting \$1,551.57
>
> Travel expenses for the Federal Service Optometry Meeting \$1,439.34
>
> Travel expenses for the IHS Eye Care Coordination Committee Meeting
> held in conjunction with the IHS National Councils Meeting \$3,537.33
>
> Travel expenses for the Armed Forces Optometric Society Meeting held
> in conjunction with the Southern Education Congress of Optometry
> Meeting \$2,262.57
>
> Travel expenses for the Area Chief Clinical Consultants for Optometry
> Meeting \$5,718.42
>
> Travel expenses for the Navajo Area Optometry Meeting \$249.48
>
> Travel expenses for the American Optometric Association Convention
> \$854.01
>
> Retirement recognition plaque \$121.00
>
> Travel expenses for the American Optometric Association Federal
> Service Chiefs Meeting \$600.50
>
> **TOTAL \$17,256.72**

-   FY2004 Chief Clinical Consultant for Optometry funds are requested
    as follows.

> Travel expenses for the Association of Military Surgeons of the United
> States Optometry Section meeting (We are responsible for organizing
> and conducting this meeting.) \$1,600.00
>
> Travel expenses for the Federal Service Optometry Meeting \$1,200.00
>
> Travel expenses for the IHS Eye Care Coordination Committee Meeting to
> be held in conjunction with IHS National Councils Meeting \$3,000.00
>
> Travel expenses for the Area Chief Clinical Consultants for Optometry
> Meeting \$6,000.00
>
> **SUBTOTAL 11,800.00**
>
> Travel expenses and support costs for the IHS Eye Care Biennial
> Meeting \$15,000.00
>
> **TOTAL \$26,800.00**