Fact or Fiction: Emerging Trends in Optometry Schools

Howard Purcell: Look across all standardized testing. We’re seeing decreases in scores on all standardized testing across the board. It’s not unique to optometry.

Bethany Fishbein: Hello, I am Bethany Fishbein, CEO of The Power Practice, host of The Power Hour Optometry Podcast, and one of my goals with a podcast has always been to talk about the issues that are relevant and concerning to practice owners, especially. It’s funny, I get comments from time to time from listeners who say, are you listening in to my conversations? You’re always  talking about things as I’m talking about them, and that’s my goal. So one of the things that people are talking about pretty continuously, probably in little waves over the last couple of months, maybe even last few years, is concern about students who aren’t passing their national board exams.

I feel like I’ve seen it in our clients talking to doctors on social media, sometimes from the students themselves, sometimes from doctors who are hiring students, like what’s going on with the board scores? And there’s so many theories, there’s ideas floating around. Some are probably reality, others are not, but I wanted to talk about it and I called someone who I trust, who has some knowledge on the subject. Howard Purcell is the CEO and president of New England College of Optometry, which is my alma mater. He is a friend of the podcast. Howard, this is your, what episode, how many times have you been on? Because I heard from Thanh Mai that I have to give a jacket out at five.

Howard Purcell: I think I do. I think like Saturday Night Live, after you appear for a certain number of times, you get the jacket. I think I’ve gotten the jacket, we stopped counting, but I’m always happy to be on and try to contribute and give a perspective from the schools and colleges, which I’ve learned so much about in my five years now that I’ve been here.

Bethany Fishbein: Yeah, I bet. So, thank you for being here. I mean, the perception out there, and I’m sure that you see it also, is today’s students aren’t passing their boards. So, before we get into anything going on with today’s students, is that a realistic perspective? Because I looked at the scores over the last five years, it wasn’t as shockingly different as I thought it was going to be. I tried to go back further. I couldn’t find the information from like 1997 when I graduated, but it definitely feels like more. What’s the reality?

Howard Purcell: Yeah. So first of all, look, we care about every single student and making sure that they successfully navigate through their program and the optometry schools and then pass their boards. I mean, we care about each and every person. And let me say before I go any further, also, that the opinions I’m going to share with you, I am not here representing ASCO or any organization, I’m just representing myself. I could share what’s happening at NECO, but I do have a perspective on things. So perhaps that can be helpful. But bottom line, and I think you shared it, Bethany, is that if you do look back to the data, let’s just go back to 2017 as an example.

In 2017, the what we call ultimate pass rate, which is really what probably the most important data point. Ultimately, what percentage of our graduates are passing national boards? Back in 2017, it was 91% was the average across all the schools. 2022, which we probably have the best data for, 23, we really don’t have much data for yet, it was 88%. So yes, it’s gone down. And I know and I hear the same things that you’re hearing about the perception of how students are doing. The reality and ultimate pass rate is it’s changed about 3%. I think we calculated that represents maybe 40, 45 students, and we care about those 40 to 45 students. But the sky is not falling. We certainly have to pay attention and recognize though, that some things have changed. Number one, the pandemic, the pandemic changed a lot. And I think we all have been impacted by it, the mental health issues, the fatigue that it’s caused. And perhaps even most importantly, taking a PowerPoint presentation we used to deliver in a classroom, and almost immediately having to pivot into delivering this through distance education.

We know distance education can be incredibly successful and effective. But taking PowerPoint and putting it online is not the answer. So piling all these things together, I would suggest to you, we haven’t seen likely the full impact of what all of these things, the social issues that are going on, and how they’re impacting our 21, 22, 23 year old students. They have a very significant impact on all of us and have impacted on them. So I think what you’ll see over time is that there’ll be some lingering impact. If you look at sort of part one, two and three, for those not as familiar, there are three parts to the National Board, you have to pass all three in order to be able to practice in all 50 states in the US. So reality is it becomes a critical bar to be able to get over. Keep this in mind, our faculty are doing the same things that they’ve been doing. I really do not think this is a faculty issue. Look across all standardized testing. We’re seeing decreases in scores on all standardized testing across the board. It’s not unique to optometry, but it’s an issue we do have to address.

Our students are challenged more by many different issues, and we believe that’s impacting it. So we’ll probably see, because students who’ve been impacted by this are just getting ready, in some cases, to begin taking National Boards. We haven’t seen the end of what that impact is likely to be. But big picture, the reality is it hasn’t changed dramatically yet. I think more importantly, Bethany, if I may, and I promise I’m going to let you jump in here in one second. But more importantly, I think we really need to focus on applicant pool, because that’s really at the heart of the issue. I’ll pause there.

Bethany Fishbein: So, before we jump ahead, I just want to go backwards, because I think when we’re talking about ultimate pass rate, just real quick, define ultimate pass rate. What does that mean?

Howard Purcell: That means you ultimately pass parts one, two, and three. It could take you twice, three times, once, six times. I think you have six opportunities in each part one, two, and three. I believe I’m correct on that. They’ve been looking to adjust that a little bit, but I believe you have six opportunities. Most don’t take six opportunities. But what that essentially means is within the time frame allotted, you have passed all three parts of the National Board.

Bethany Fishbein: Do you know the time frame allotted? I’m just curious.

Howard Purcell: I believe you have six tries. I don’t think it’s actually a calendar time. It’s the number of times you take the exam.

Bethany Fishbein: So just thinking about it, I mean, this could potentially right there kind of create a little bit of that difference between what it feels like and what it actually is, right? So, let’s say somebody does take a board exam six times and is vocal on social media about their results. So, it’s, I failed, I failed, I failed five of those for one pass. Is there a statistic that measures like in each administration of the test or in one year’s administration of part one, how many people pass or failed that?

Howard Purcell: So, each of the schools gets its own report and an aggregate report. So, I know for NECO, how many people in part one in this testing cycle passed it the first time? How many people had to take it a second, third and fourth? So, we have individual data for our institutions and then we have aggregate data. It’s important. We’ve seen some adjustments and changes, but I think the ultimate test is, do you pass them all? And there’s a lot of work being done by all of the schools, including NECO, to try to assure we give our students the best opportunity to pass.

Bethany Fishbein: When you look at those individual rates, not individual by school, but individual by test, like that aggregate score for part one, part one is the one I hear people saying they’re not passing. Has that changed from 2017? Do you know?

Howard Purcell: Yeah, I can look at that. So give me one sec. I can speak to, you want the national averages on those? Is that what you were looking for?

Bethany Fishbein: Yeah. I’m just trying to see if that’s changed a bigger percent.

Howard Purcell: In 2018, the pass rate for part one was 79%. By 2023, it dropped to 73%. That was the biggest change we saw in any of the sections. Part two, or parts, I should say. Part two went from 89 to 86, and part three went from 81 to 79. So we’ve seen some changes there, but still not dramatic. But again, I want to be clear, if you’re one of those percentages, it means everything to you. And that clearly is an important issue. But the reality is the numbers have not dramatically changed. Again, we may not be seeing the full impact yet. Now what that doesn’t tell you, and I just want to be clear, is how many of the people taking it were taking it for the first time, how many for the second, third, fourth, that we don’t have.

Bethany Fishbein: Okay. So I’m with you, that it’s a concern, maybe not as much as it feels like to us. I remember back in my day, you knew the handful of people that didn’t pass, and now it feels like everybody. But let’s talk through the process a little bit. Talk about school admissions, because you identified that earlier as an area that ultimately impacts this.

Howard Purcell: So admissions are critical. And I just want to say something, we’ve all looked, and I can only speak again for NECO, what are the indicators? Because I think this is an important component, I just want to mention it before we do move on. What are the indicators that could suggest to us people are likely to pass national boards or not? A couple of very interesting outcomes from this, at least from what we’ve found, I can’t speak to all the schools, but what we found in looking at our data. Number one, entering GPA and OAT scores do not, I just want to repeat this, do not seem to be a particularly good indicator of how you’re going to do on national boards.

When we have ultimately looked at what is probably the best indicator, and this is going to be fairly intuitive, but it’s real, your GPA in optometry school is a really good predictor of how well you’ll do. And again, I know that sounds pretty obvious, but we can pretty much tell you when you get a certain GPA in optometry school at NECO, you get that and above you have an 80% plus chance of passing first time. Below a certain number, you have a 20% chance of passing first time. So we can really segment it and what it enables us to do is identify pretty early in the process, which students are likely to have those challenges and help work with them to prepare them for that. And their listeners are probably familiar, but you have KMK, you’ve got a lot of these other groups that do prep courses for students in order to prepare for national boards. Most students who are able to take advantage of those opportunities in the school tries to support them taking advantage of that. And then at the schools and colleges, we all do things.

We have assigned faculty members for each part of the exam. So for part one, we have the faculty member who’s responsible for supporting our students in that area, learning as much as they can about the test, providing and matching up students with the people that can help support them in different ways. We have someone responsible for part two and the same for part three. That funnels up then to one person who has to oversee over all three parts that can really be sure they’re looking at it holistically. So again, that’s how NECO does it. We also have an ability to assess the components of the exam and assure that in our curriculum or matching our curriculum to the components of the exam.

I think I mentioned earlier, finding where those gaps are, finding where the redundancies are and trying our best to ensure we’re covering that material. And I want to be clear that, again, I can only speak for NECO. We do not teach to a national board. Perhaps there are schools who do that. We look at how our teaching and our instruction lays out in our courses, and we match those to a template that shows us what is asked for on the national boards. And we find where our gaps are and where our redundancies are. And we try to make sure we’re consistently improving on that process, but we do not teach to the boards. In fact, I have to be honest. There are times where we’ll tell a student, I know we do it this way. This is the way we like it. For national boards, do it this way. So there’s oftentimes or even having to adapt a bit like that.

Good news is part three of the national board is getting ready to change. So for your listeners to know that the new test is called the PEPS test. That’s patient encounters and performance skills. It’ll be very different. A lot less of the show me how you do direct ophthalmoscopy, show me how you do a refraction, and a lot more of more patient encounters. So there’s 10 patient encounters and two performance skills stations. So you still have to do gonio and indirect and a few others, but they’re changing the dynamic of that test. And I think for many of us, we like the changes that are being made. And let me say the national board, I think really works hard to try to do a good job and keep this consistent and fair.

I have some issues with cost and with limitations on where their students are able to take tests and certain things like that. But overall, I admire what the national board has tried to do. Back to your question. Now, I think really what we should be talking about here is how do we enhance the applicant pool? Because at the heart of it is that I’ll give you some data that I think your listeners might find of some interest. If you go back, and I can go back actually all the way to 2015, number of applicants to optometry school. So let’s just talk a bit about that for a moment, 2,812 applicants back in 2015. We saw a steady decline in 2016, 2017, and 2018. And since 2019, we’ve actually seen a turnaround and an increase in the numbers of the applicant pool. By the way, coincidentally, ASCO started Optometry Gives Me Life in 2019. And that was the first time we started to see, we sort of saw a dip, dip, dip, dip. And then at least now we’re starting to see an upward swing. Are we where we need to be? Absolutely not.

I’ll give you the real numbers. This past year, applicant pool, the total applicants, what we call verified applicants, 2,773. And we have about 1,500. Give or take, I’m not going to hang my hat on the exact number, but we have about 1,500 seats available. So that tells you where we are with applicant pool. Not quite two to one, which is not a great place to be, but we need to continue working on this, enhancing this, bringing new students. Keep this in mind, Bethany, we have 30 states that don’t have an optometry school. We think there are ways we can fish in new ponds, go to new places. We have two new schools that have just opened, but yet we still have about the same number of seats. And I think that’s important for your listeners to understand. Several of the schools have actually decreased the number of seats they have.

So in spite of the addition of two schools, we actually have about the same number of seats still. Now that’s likely to increase because we’re seeing, hearing the idea of new schools opening in other places too. But we’ve got these 30 states that we could pay more attention to, that we can figure out ways to deliver education and have them clinically trained locally. So hopefully they stay in areas where we really have the great need for optometrists. So we all need to do our part in encouraging really smart, great people to enter this profession. We have a couple of great programs, if I can mention them real quick, if you don’t mind, that I hope people will think about and be interested in participating. One is the ASCO’s Eye Opener Sessions. This is a brand-new program, which encourages you to invite high schoolers, college students to come to your office, to talk to them about optometry, let them spend a half a day in your office.

It’s a little bit like the shadowing we ask students to do or applying to school, but this is earlier in the process. You know, someone’s sitting behind your phoropter and they’re flipping the goggles. They think it’s cool. When you bring the slit lamp over, they want to hear about what it is. We’re going to give you a way to talk to them about it, but also to encourage them to look at optometry as a profession. So that’s a key one. And then Optometry Gives Me Life, which is a program supported by the schools and colleges, but also supported by the industry that I believe is now we’re starting to see a positive impact that’s happening in just promoting the profession and what a great profession it is. Because many of us believe we can convince anybody that optometry is a great profession, but we got to be out there talking about it. It’s not well understood. It’s best kept secret in medicine as we talk about a lot and awareness is a key element for us.

Bethany Fishbein: I absolutely agree with you on that. We’ve talked about it before, so you know this. I think there are a lot of people who don’t agree and are so vocal about it that it’s tough. I wasn’t aware of the EyeOpener program and I love that because I think just about our office and how many high school into college students who’ve come in and shadowed or worked and maybe had other careers picked out, they were headed to be a PA or something else and all of a sudden we’re like, whoa, I love optometry and have gone in that direction. So I like that. I want to go back to just a numbers question because I’m trying to figure this out in my head. So you talk about the number of seats. So I get that the number of seats has stayed pretty stable. If a new school opens and they’ve got 40 seats and somebody else, two other schools make their class 20 smaller, it’s the same number. That’s what you’re saying, right?

Howard Purcell: I am saying that, but let me be clear, it has gone up through the years. I’m speaking over the last two years. We have not seen an increase. Although we’ve had two additional schools, we’ve not seen an increase in seats yet. But if you go back 10 years, we’ve certainly seen an increase.

Bethany Fishbein: Maybe this is a dumb question. I have a couple that are in my head that I’m like, should I ask this? What percentage of the seats get filled?

Howard Purcell: I can speak for my institution. I can’t say. We have a goal every year, typically, and I’m happy to share it. Our goal is 130 students. We’re one of the larger classes in the country. We have the most amazing admissions team. There’s no better than what we have led by Kristen Tobin, who’s just an incredible person who really understands this space really well. Thank goodness. And I’m knocking on my wooden table. I hope it’s real wood. I don’t know. We have not had a problem recruiting students. You know, we’re 130-year-old institution. Those who have come before us have done a great job. I can’t speak for other institutions. I think I surmise that perhaps some schools have lowered their numbers because they’re not feeling like they’re getting not only just the numbers, but the quality of students. And I understand that. So far, fortunately, NECO hasn’t had to do that. We are filling our class with quality students.

In fact, this year, I’m proud to tell you, we’ll have the highest average GPA we’ve ever had at our institution with our incoming class. So that hasn’t been a problem so far. But any good institution, and I can tell you here, we’re thinking about this, we’re not going to just say, okay, well, we’re doing great now. That means for the next 10 years, we shouldn’t have any problem recruiting students. We just can’t have that attitude. We consistently have to look at, and I mentioned it earlier, going to places where we don’t typically go, finding ways to deliver education that are unique so we can address, in particular, those 30 states that today don’t have an optometry school. So I can’t speak for all the schools. I can speak for NECO. I’m sure there are some schools who have had trouble filling the class.

Bethany Fishbein: I didn’t know if you guys had like a president’s group chat or something where you were all texting each other this information.

Howard Purcell: We do have that. To be completely candid, there’s a lot of things we openly discuss. I think the idea of how difficult of a time you’ve had recruiting students to your school is probably one that we don’t discuss very often.

Bethany Fishbein: Gotcha. I mean, you understood the reason behind my asking the question is if the goal is to fill the seats, it absolutely changes the student pool, if that’s the only goal.

Howard Purcell: You are absolutely right. And I believe, again, I’m surmising here, that some of the schools who’ve reduced their class size is just for that reason. Now, for us, as I mentioned, and very importantly, is we have 130 students again this year, we’ll have the highest entering GPA we’ve ever had. So we feel very comfortable with that. But I’ve also said earlier that GPA doesn’t necessarily correlate to passing national boards either. So this is nice. It’s a good story. But we still have to work hard to make sure 100% of our students pass national boards. By the way, I do want to mention another thing that I think is important. You will occasionally take a look, and our incoming students look at this, of course, at national board scores. And you’ll see there’s been some years where some schools have reported 100% pass rate on national boards. I think it’s important to be transparent.

There are now about seven different asterisks that are used to identify how you are coming up with your ultimate pass rate. I will allow your listeners and you to assess what you think of that. My personal opinion is it’s gaming the system. So if you want to show as an example, and I’m not picking on anyone, I’m just giving you an example, that it is possible that if you want to show 100% success rate on your national boards, you can say no one graduates unless they pass all three parts of the national board. Just as an example. No one graduates unless they pass part one of the national board. I won’t go any further, but I think you can put together what that will ultimately mean to your, or could ultimately mean to your ultimate pass rate. Personally for me, I don’t like it. I think it should go away. I think we should all, the whole idea of national boards was to have a way of assessing equivalencies. And now we have seven different ways. Go in there and look, you’ll see, I think it’s seven, six or seven different asterisks that you can have. And the answer I’ve gotten when I’ve asked this question, by the way, as well, we stipulate it right there. It says one asterisk. So students are smart enough. They’re going to look at the asterisks and they’re going to understand that we’re not comparing apples and apples. Our students are incredibly smart. I don’t know about you.

When I look at a graph, maybe the last thing I’m looking at are the asterisks. I’m just kind of looking at the general information. I don’t love it. I think we should boil it down and get rid of all that. But for now, I’m in the minority, I think.

Bethany Fishbein: I think as you talk about applicants, it absolutely is something that students look at. I know the pre-optometry students in our office have referenced board pass rates and things like that. How much of an influence does that kind of thing have? Or how much should it have on a student’s decision of what optometry school to go to? Because some of them, I mean, they look and there’s a part one pass rate below 50%. And it’s not a total anomaly, like there’s quite a few of those. So to know that, does that mean, oh, that’s not a great school, I shouldn’t go there?

Howard Purcell: That’s a fair question. And I can tell you, it’s all over the board. Some students use it as the number one thing they’re going to look at in terms of deciding where they want to go to school. Those are particularly students who’ve probably been accepted to many institutions and can choose which one they want to go to. But I will say this, ultimate pass rate to me is the real indicator. We have a lot of students, and I try to discourage this, but it happens, who say the first time I’m going to take it, I’m not going to study. I’m just going to go in and take it. I’m going to wing it, see how I do. And then I’ll decide what areas I need to focus my attention on.

Bethany Fishbein: Is that like really a thing? I feel like it was, I mean, this is a long time ago, but it was, we had a couple of weeks off from school and we were going to a live, like it was intense.

Howard Purcell: Yeah. Not everyone is as focused as you, Bethany, and different people use the test in different ways. I’m going to wing it once, see how it goes, and then I’ll come back and take it again. So ultimate pass rate, I think is what we should really be looking at. And I do think students do look at that as an indicator, but let’s back up for a minute and just say, most good schools are hovering right in the 90 plus percent pass rate. If your school has an ultimate, if the school you’re looking at is an ultimate pass rate of 50%, I believe that should be a part of your decision making.

Bethany Fishbein: Yeah. And I don’t think any of them were that low. When you look at an ultimate pass rate.

Howard Purcell: I don’t believe they do. So when you’re looking at everyone being right in the 90% range, let’s set aside asterisks, the asterisks chronicles, as we call it, let’s set aside the asterisks chronicles and just say in general, everyone’s in the 90 plus percent. You can create graphs that make it look really different, but the schools that I would suggest are doing a good job, are all hovering right in that 90% range. So 93, 89, 94, 91, you know, is that going to make a huge difference? Students will be the judge of that. But I think there are many other factors they’re also looking at that maybe we don’t think of and I didn’t think of as a student. Certain schools have certain strengths and I don’t think that’s perhaps used enough with regard to making it a certain, like if peds is my interest, there are certain schools that are really, really good at peds as an example. Certain schools really good at octasease or research or whatever it might be. So in any case, I think there are multiple factors. What we hear a lot is location and the sense they get when they are part of the interview process. Those are two things that seem to weigh heavy on their decision making. Board scores are important and it’s usually the extremes more than, well, yours is 93, theirs is 91. I’m going to go to the school that’s 93. That typically isn’t, at least in my experience, isn’t a big influence on the decision.

Bethany Fishbein: Yeah. And I mean, I don’t even know if those kinds of things get factored into this year’s list of the top 10 optometry schools. I see those kinds of things online and I can’t quite make sense of them ever. Of course, the schools that are listed in the top two or three completely believe it and post that proudly and the ones that don’t say, ah, this is bull. But like any idea where that comes from or is that all kind of some agency somewhere?

Howard Purcell: Yeah. You know, we’ve looked at that. We have an amazing lead of our marketing group, Lori Crawford, who does a great job for us. And Lori has taken a look at some of this for us. And honestly, it’s all over the board. You’ll have a couple of schools that will be in the top five best schools that have the lowest board scores in the country. It’s very ambiguous in some ways as to how they’re coming up with those ratings. We’ve even looked at that to say, can we encourage maybe a different way of looking that or a better way, a more aggregated way of if you’re going to really rate schools that way. There is no official rating for optometry schools. So anything you’re seeing out there is someone’s decision to decide how they’re going to rate them, how they’re going to aggregate them in that way. If you did it purely on board scores, it’s one way, but they don’t. There’s multiple factors that they look at.

Bethany Fishbein: And we don’t really even ever know what those are.

Howard Purcell: Typically, we don’t know. That’s right. Typically, we don’t.

Bethany Fishbein: I mean, kids choose a school. I shouldn’t say kids. There’s more non-traditional students, young students, or I shouldn’t even say that. Students choose an optometry school. And I’m feeling super old right now, but I can’t even totally remember when do you take part one?

Howard Purcell: In your third year. All the National Board stuff starts in your third year. So it’s third and fourth year. You’re taking parts one, two, and three.

Bethany Fishbein: So just talk a little bit about how the education is different today than it was 20 years ago. Because I think we had talked about this before, and the amount of knowledge that’s now packed into optometric education in the same timeframe almost that people had when they were going to go do refractions in the back of a jewelry store is kind of mind-blowing.

Howard Purcell: It is. And it’s something you and I have talked about. And it’s something I recognized pretty early in my tenure here, which was my dad went to this school and graduated in 1954. It was a four-year program. And today, 2023, it’s a four-year program. I am amazed by our faculty and the commitment, the dedication. And I would say faculty at optometry schools across the country, this is true. They could walk out of our institution tomorrow, by the way, and probably make 25 to 30% more than they’re making. But their commitment to the educational process is just, it encourages me every day to do what I do because of the commitment that they make to what’s happening. So the reality is, I’m not sure I could get through optometry school today.

I see what we put our students through, the rigors of it. You get a little time off for your first year in the summer, otherwise you’re going straight through. And that’s one of the ways we fill in some of the gaps. And by the way, Bethany, I’ll tell you this, I’ll get a call almost monthly from one state or another saying, hey, we’re going for this legislation. We want to be able to show what are you teaching in this area? And I love it. And it puts pressure on the schools and colleges to assure we’re teaching laser procedures. We’re teaching surgical procedures. So I’m not going to speak for ASCO, but I’ll tell you, I know this for a fact that we all make sure we are preparing our students to practice anywhere in the world. And what that essentially means is anywhere in the United States, because that’s where we have the best scope of practice laws of anywhere in the world. So the rigors of the program are immense. The pressures of it are significant. And if you graduated more than 10 or 15 years ago, it is very different than when you went to school. And I think we have to be careful about judging it. It is an incredible challenge. I admire these students. They are the best clinicians we have ever graduated. Do they have other weaknesses? Of course, the business side, we can’t spend, I’m happy to chat about that, but we can’t spend it. It’s very difficult to spend a whole lot of time on the business side of optometry, and we need the industry’s help to help support some of that right after graduation, perhaps, or other ways that we can do it. If anyone hears this and is looking for that, I know some people. Yes, exactly. But that would be great. It would be great to have a postgraduate program that we could offer that is sort of the business of optometry. And it could be a two-week crash course type of thing, those kinds of opportunities that we’ve all been talking about that I know we’d like to do. But that aside, we are graduating the best clinicians that we’ve ever graduated. They are so sharp, they are so committed, and they want to make sure they can practice to the full scope of their licensure, and that’s an issue we continue to work on.

Bethany Fishbein: Talk about it a little bit, because if you’re feeling that the strength of the clinicians is stronger than ever, what is it that is making people struggle with passing this test? Even like an ultimate pass rate of 90-something, I mean, that’s 13 people in your class who took it a series of times. There’s so much clinical education, there’s not time to study for it. Is it there’s more material on it than there was? Do the students have other outside issues or stressors that are affecting it?

Howard Purcell: Well, I think it’s all of those things, but I would frame it a little differently. From the time we started giving national boards, which is not that long ago, by the way, to now, we really haven’t seen a big change in that, yet we have added so much more. So I would frame it as what an incredible job our faculty and our students are doing at taking in all of this information and still being pretty consistent in how they ultimately score on these national exams. It is a ton of information. Now, yes, on the other side of things, we want them all to pass. They’re never all going to pass. And Bethany, let’s get into a little bit, and I’m a little reluctant, but I’ll dive in on this one. When you compare our pass rates to other national exams, we tend to be a little lower. We’re a little tougher.

Bethany Fishbein: Like optometry in general, you’re talking about compared to like…

Howard Purcell: Other professions who have national exams.

Bethany Fishbein: Like real estate license or cosmetology.

Howard Purcell: Oh, I’m trying to keep it a little more on the medical side. So PAs and nursing and things of that nature, physicians, where they do have to take national exams. We tend to see our scores being a little bit lower. And I think all credit to the national board, but I think they recognize that what are you really testing? Is it minimum competency to be able to practice? And those are definitions that I think can be challenging to define. You get talked to three optometrists, you may have three different opinions on what that looks like. But my feeling is that we’re sensitive to that, that the national board is looking at that. I think it’s one of the reasons you’re seeing an adjustment in the test to adapt in a way that doesn’t raise the bar too high, but puts the bar where it needs to be to assure we protect the public and we prepare and are ensuring we’re preparing students to be able to practice this wonderful field of optometry.

So there’s lots of way to look at things. To me, we don’t have a crisis with our national boards at this point, score wise. I think the schools and colleges have recognized a dip. We are all reacting to that, adjusting and adapting and providing more support. And it does get a little into the student of today, right? The student of today, let me give you a little feel for that, because now that I’ve been here for five years, they’re amazing. They’re incredibly driven. They’re going to be the best optometrists that ever lived. So I’ll share all that. However, they are also very comfortable talking about mental health issues that they have, where in my class, I’m sure we had colleagues that had mental health issues, but none of us would ever talk about it. Today, our students are very open about it. Many more of them needing support, needing some of the services that are provided to those who have some type of mental health issues that impact their ability to be successful. So it’s a different student. And I’m a parent of these students. So I can appreciate we coddled them. We gave them all trophies. We did all the things we thought were the right things to do as a parent and then add to that a pandemic. So with all due respect to our students who may listen to this, I will say the current 21 to 22 year old in terms of their life experiences, in terms of their preparation to be a doctor, to go to a postgraduate rigorous program, they’re two to three years behind what we’ve seen in the past, just in terms of experience and knowledge and comfort and the ability to tackle these types of things.

So as an institution, we’re having to do more things today than before. A more robust student services group that can support our students in a way perhaps we haven’t had to do in the past. More mental health services that support our students’ efforts. And that’s everything from anxiety over exams to more serious mental health issues. I personally have been in the emergency room twice to support students who have had mental health issues at our institution just in the past year. So things are different and it is a challenge because we want to support them. Some of our faculty will say, no, these students, they need to buckle it up and do their thing. And others say we need to do everything we can to support them. I think we have to try to find a good, happy medium there. And it’s things like mentoring and tutoring and doing the things that all the schools and colleges I know do to help support our students. But it even goes beyond that in supporting them with mental health issues and having open dialogue and providing success plans for them as they matriculate through. Those are things in the past we didn’t do. We probably needed it just as much before, but people didn’t speak up about it.

Bethany Fishbein: I wonder if that speaking up, that willingness to speak up is contributing to the publicity or the public nature of this also. So just like you said, somebody is more apt to be open about a mental health issue or somebody is more apt to be open about diagnosis of neurodivergence, something that makes them require something extra. Maybe they’re also more open to post on a giant Facebook group that they didn’t pass boards where people in our class, it was like a big hush hush. Like you heard that someone didn’t pass boards. It was, you didn’t want people to know. I remember stories from our class about people flying out of state coincidentally to go to a family wedding and taking boards across the nation because they didn’t want to retake it in local. I mean, there definitely could be a sense that people are just being vocal about it. When you are interacting with students, is it, I mean, I guess if you’re in a class where it is 50% or 60% on each iteration of the test, if you didn’t pass, you’re in good company.

Howard Purcell: Well, perhaps. Yeah. I agree with you that I think students are more willing to have conversations and to speak up. I will tell you, it is different. It is very different that way. Look, when I was in school, I’ll date myself. There was no social media. We didn’t have the ability to share all this information as broadly as we do. And in particular, I think when you have a challenge, when you feel it hasn’t gone well for you, and perhaps you want to blame the institution, whatever you want to blame, you tend to be perhaps a little more public about your feelings about it and what the school and the colleges, and again, I’ll just speak for NECO, what we want to do is help support our students in any way that we can. And we have found multiple ways to try to do that, be it through the student services side, the tutoring, the mentoring. We do a mock exam. So for part three, we do a mock exam to assure that our students at least have gone through it one time and have had the opportunity to sort of see what it’s like to go through the steps in the process, just as one example. And I know many of the other schools do that as well.

Bethany Fishbein: As you said, like you guys are acknowledging that there’s been a dip based on what’s happened with COVID. You feel like, it sounds to me like you’re saying it might get worse before it gets better. What are the modifications that you’re making or like, what’s the response to that? How are you reacting to at least be giving the best odds here

Howard Purcell: Right. So a couple of things, the way I would answer that. First of all, once we recognize that, A, the stresses and tremendous sort of fatigue and mental health issues that we’re seeing just increasing over this time, we already began to instigate ways to help support this. So this is not something we’ve just recognized and all of a sudden things are happening. And I hope we’ll see for all the schools and colleges, the impact of the efforts that everyone’s making as a recognition that our students are struggling a bit more for lots of reasons. If we get to sort of our learning and where we go from here and what adaptations, I can speak to Necco. I do not want to find ourselves ever in a position again, where if for some reason, and who knows what that reason will be, that we have to shut down our campus, that we’re not well prepared in moving forward. And to me, what that means is building assets to support our educational program. Each of our faculty members today are working with learning designers, helping them create assets, interactive components that can be used for the current way we deliver our education or actually could be used to deliver education in more unique ways to tie together a little bit of what we talked about earlier of trying to go places where there’s not optometry schools and not force people to pack their bags and move, which many great future optometrists wouldn’t be able to do unless we delivered it that way. So we do not want to find ourselves in a similar position. Again, we need to be more nimble. We need to be more adaptable. And we do that by building assets. PowerPoint online, most everybody agrees, is not the way to deliver education when you don’t have someone live and in person. But there are ways to deliver that education both synchronously and asynchronously in a way that’s incredibly effective, that is well proven, that is even well proven in many medical fields like physician’s assistance and nursing and something you could draw some corollaries to what we do. So I think one of the outcomes of this is a recognition we need to support our students more and each school is going to find its way to do that. But in addition to that, happens to you once, okay, happens to you twice, shame on us, right? So we better begin to adapt our programming and build assets to protect ourselves from any of these type of things that may happen. Look, we’re in the Northeast, you know, snow days. There aren’t actually snow days anymore because we can deliver our education through different ways, right? So how do we make sure we’re making that more robust? It’s not PowerPoint online. That’s not the answer, but there are answers. And I think it’s forced us, hopefully all of us, but I can speak for NECO to take a look at this and assure we have built flexibilities. We’ve built adaptabilities. We’ve built a program that is much more dynamic, but also much more flexible in the way it’s delivered it. It’s many times referred to as an agile campus. How do we make our campus more agile? And I would like to think all the schools and colleges are looking at that.

Bethany Fishbein: And just to close, as president of the school, you have an opportunity here to speak to practice owners, some of whom probably started listening to this with a mindset of fear, of questioning, of uncertainty around the future of optometry. We hear it in hiring. Should I wait to hire somebody? Is it not a good idea to hire someone? Board’s pending, et cetera, et cetera, et cetera. So you’ve given a lot of information that’s absolutely making me feel differently about this. What’s your message to the doctors out there?

Howard Purcell: My message, first of all, is nine out of 10 of them are going to pass all three parts to the national board. So you had a pretty good shot of them doing well. Number one, they are the best trained clinicians we’ve ever graduated in our history. They are so motivated and so excited. I’ve said this before, but if you have a down day in optometry, go to an optometry school and spend the day there and you will see the enthusiasm, the excitement for what we do. But we have to adapt. And what can your listeners do is identify great people for this profession. When you see someone that you think could be a great optometrist or shows any interest at all, point them to ASCO. Let us begin to nurture that relationship. I get to meet all of our applicants who come for an interview and I meet them in an aggregate group. And I will tell you, nine out of every 10 that I meet, the reason they’re sitting there is because of another optometrist. Because they were inspired by another optometrist. They saw what you did and they believe that’s something they would want to do and could do. So at the heart of all of the things we’ve talked about today is the idea of identifying these incredible students and bringing to us so that, wow, next time you and I talk, we’ve got 3,500 applicants. We’ve got 4,000 applicants. We’ve got 5,000 applicants. That will impact on many of the challenges and problems, if you will, that we’ve talked about today. So I just ask our colleagues, support the program that I mentioned. Support the ASCO eye-opener session. It’s not a whole lot of your time. You’ll be hearing about it soon. My friends at ASCO, I hope, aren’t going to be mad at me for mentioning it. We’re just getting ready to launch it. But I wanted your listeners to be aware of it because I think your listeners are some of the key people that it can help drive this. It’s not a whole lot of your time. If you hate optometry, okay, we don’t want you to participate if you don’t want to participate. But the majority of us love what we do. We know that optometry has been so good to us. I mean, look at me, my family, my dad, myself. I can’t imagine not being part of this optometric community and what it’s done for my family. So think about that. Think about how wonderful it’s been. And let’s try to inspire the future. You guys are the ones that are going to help us do this. We can recruit. We can do all this. But if you’re telling the students this isn’t a good profession or not giving them an opportunity to see how much you enjoy and love what you do, then we miss an opportunity. So please help us. And if any of the schools and colleges are through ASCO, I’m sure they’d be happy to provide any resources you need. But we’re going to try to make it super easy. There’ll be like a QR code that if someone shows an interest, boom, they scan it, get all the information they need. They can access ASCO and thereby all the schools and colleges. So that would be a fantastic outcome from this, Bethany. But thank you. Appreciate the opportunity to join you. I love what you guys are doing and bringing important issues to the table. I’m happy to participate anytime I can.

Bethany Fishbein: Thank you so much, Howard. Thank you for being willing to share your opinions, for being willing to talk about your experience, and for taking such good care of the school that I care about. So thank you.

Howard Purcell: We want to make you proud. That’s for sure.

Bethany Fishbein: You absolutely are. I appreciate you. Everybody out there, thank you for listening.