1. Oversupply of Lawyers, Optometrists and Pharmacists Same Cause and Consequences 1

2. Mark Twain “What gets us into trouble is not what we don’t know. It’s what we know for sure that just ain’t so.” “What gets us into trouble is not what we don’t know. It’s what we know for sure that just ain’t so.” 2

3. With Too Many Schools and Graduates “The Perfect Storm” Declining Full-Time Employment Opportunities Declining Full-Time Employment Opportunities Decline in Admissions Applicants and Enrollments Decline in Admissions Applicants and Enrollments Financial Stability of Tuition-Dependent Schools and Colleges Threatened Financial Stability of Tuition-Dependent Schools and Colleges Threatened 3

4. 4 The Rapid Increase in Graduates Law Schools Law Schools Opened 19 New Law Schools Since 2000 Opened 19 New Law Schools Since 2000 Increased From 186 to 205 Schools in 15 years with More Planned Increased From 186 to 205 Schools in 15 years with More Planned Over 40,000 Graduates Annually Over 40,000 Graduates Annually

5. The Rapid Increase in Graduates Optometry Schools and Colleges Optometry Schools and Colleges 7 New Optometry Schools Founded-- 2008 to 2016 7 New Optometry Schools Founded-- 2008 to 2016 From 17 to 24 Schools in 8 Years (a 41% Increase) From 17 to 24 Schools in 8 Years (a 41% Increase) Increased Enrollments at Some Existing Schools Increased Enrollments at Some Existing Schools Increase in Graduates: 1127 in 1997 (When Supply=Demand) to 1600 in 2014 Increase in Graduates: 1127 in 1997 (When Supply=Demand) to 1600 in 2014 Graduates Could Exceed 1800 by 2020. Graduates Could Exceed 1800 by 2020. 5

6. New Schools of Optometry Founded 2008-2016 1. Midwestern University College of Optometry (AZ) 2. Univ.of the Incarnate Word School of Optometry (TX) 3. Western University College of Optometry (CA) 4. MCPHS University School of Optometry (MA) 5. Midwestern University College of Optometry (IL) 6. University of Pikeville College of Optometry (KY) 7. Alderson Braddus College of Optometry (WVA) Appalachian College of Optometry (VA) Status? Appalachian College of Optometry (VA) Status? 6

7. The Rapid Increase in Graduates Pharmacy Schools and Colleges Pharmacy Schools and Colleges  Opened 48 New Schools in 14 years Increase from 82 Schools to 130 (58.5% Increase) Increase from 82 Schools to 130 (58.5% Increase) 8,000 Graduates in 2003 to 14,000 in 2015 8,000 Graduates in 2003 to 14,000 in 2015 Now 269,900 Pharmacists in 2015 Now 269,900 Pharmacists in 2015 7

8. Oversupply of Lawyers Number of Lawyers Tripled Over Last 35 Years While US Population Increased Just 40% Number of Lawyers Tripled Over Last 35 Years While US Population Increased Just 40% Increase From 404,000 to 1.22 Million Lawyers in US During This Period Increase From 404,000 to 1.22 Million Lawyers in US During This Period 8

9. 9 Oversupply of Optometrists Oversupply of Optometrists Rand Corp-1995, Abt Assoc-2000 and Lewin Report- 2014 All Indicated Surpluses of Optometrists Rand Corp-1995, Abt Assoc-2000 and Lewin Report- 2014 All Indicated Surpluses of Optometrists Lewin Study Indicated Current 30% Excess of Optometrists or 12,672 FTE Lewin Study Indicated Current 30% Excess of Optometrists or 12,672 FTE 30,000 in 1997 (S=D) to 40,000 Optometrists in 2015 30,000 in 1997 (S=D) to 40,000 Optometrists in 2015

10. Oversupply of Pharmacists 25% Oversupply Predicted by 2018 25% Oversupply Predicted by 2018 10

11. 11 Consequences of Oversupply On Employment of Lawyers  Underemployment and Unemployment of Graduates 45% of Graduates Unable to Find Full Time Positions 45% of Graduates Unable to Find Full Time Positions Compensation Has Declined to Median Starting Salary of $61,000 Compensation Has Declined to Median Starting Salary of $61,000 Top Schools Employ 3-17% of Their Own Graduates Top Schools Employ 3-17% of Their Own Graduates

12. Consequences of Oversupply On Employment of Optometrists  Lewin 2012: 46% of Graduates under 30 yrs. Practice at Two or More Part Time Locations 11.5% Practice at 4 Locations 11.5% Practice at 4 Locations Suggests a Shortage of Full Time Positions Suggests a Shortage of Full Time Positions Lewin: Optometrists Practice at 68% of Capacity Lewin: Optometrists Practice at 68% of Capacity 12

13. Consequences of Oversupply on Employment of Pharmacists Some Graduates Can Only Find Employment as Floaters Some Graduates Can Only Find Employment as Floaters Oversupply is to Drug Chains’ Advantage by Forcing Pharmacists’ Income Down Oversupply is to Drug Chains’ Advantage by Forcing Pharmacists’ Income Down 13

14. Consequences of Oversupply on Law Schools Consequences of Oversupply on Law Schools  Applicants Down 37% and Enrollment Down 24% Since 2010 Less Qualified Students Being Admitted with LSAT Scores Less than 145 Less Qualified Students Being Admitted with LSAT Scores Less than 145 Declining Pass Rate on Bar Exam: Lowest in 13 Years Only 46.6% Passed in California Declining Pass Rate on Bar Exam: Lowest in 13 Years Only 46.6% Passed in California  Misrepresentation Law Suits by Students/Graduates 14

15. 15 Consequences of Oversupply on Optometry Schools and Colleges  1.5 Applicants per Entering Seat: Only 1.2 are Likely Qualfied for Admission Applicants Apply to an Average of 5 Schools Applicants Apply to an Average of 5 Schools Small Positive Changes in Applicant Pool in Recent Years Are Quickly Absorbed by New Schools Small Positive Changes in Applicant Pool in Recent Years Are Quickly Absorbed by New Schools Cyclical Variations in the Applicant Pool Have Occurred in the Past Cyclical Variations in the Applicant Pool Have Occurred in the Past

16. Admission Standards and NBEO Pass Rate  Admissions Standards Vary Significantly Among Optometry Schools and Colleges: Entering GPA 3.61 to 3.18 Entering GPA 3.61 to 3.18 Mean Science OAT 350 to 287 Mean Science OAT 350 to 287  Pass Rate on NBEO Also Varies: 100% to 77% 16

17. Consequences of Oversupply on Pharmacy Schools and Colleges Applications for Admission Down 8.1% Applications for Admission Down 8.1% 17

18. Comprehensive Approach to Mitigate the Effects of Oversupply of Optometrists Schools and Colleges Profession 18

19. Optometry Schools and Colleges Decrease Enrollments Consolidations and Affiliations Modify Curricula Modify Curricula 19

20. Decrease Enrollments, Consolidations and Affiliations Reduce Entering Class Size and Overall Enrollments Reduce Entering Class Size and Overall Enrollments  Consolidation of Schools and Colleges  Pursue Innovative Programs and Affiliations with Health Sciences Centers and Universities for Private Schools 20

21. 21 Curricula Modifications Make An Optometry Career More Attractive and Control Debt by Shortening the Overall Length of Education for O.D, While Developing a Clinical Training Model to Potentially Qualify for $15 Billion GME Program Make An Optometry Career More Attractive and Control Debt by Shortening the Overall Length of Education for O.D, While Developing a Clinical Training Model to Potentially Qualify for $15 Billion GME Program Would Permit Current 4 th Year Students (Who Become Residents) to Contribute to Billable Services and Receive Stipends. Would Permit Current 4 th Year Students (Who Become Residents) to Contribute to Billable Services and Receive Stipends.  Explore Additional Educational Offerings in High Demand Health Care Professions

22. Profession of Optometry Responsibilities Accreditation Actions Publish an Employment Index Aggressive/Consistent Federal Advocacy 22

23. 23 Profession’s Responsibility  Do Not Accredit New Schools of Optometry Until There is a Market Correction to the Supply and Demand of Optometrists: Currently, there is 12,672 FTE Surplus Currently, there is 12,672 FTE Surplus In the Future Accredit New Schools to a Maximum Enrollment In the Future Accredit New Schools to a Maximum Enrollment  Develop and Annually Publish an Index of the Number of Graduates to Practice Openings in the Private, Goverment and Commerical Sectors

24. Aggressive and Consistent Federal Advocacy  Seek Inclusion of Optometry in Federal Programs: GME, National Health Service Corps, Scholarships, Loan Forgiveness and Practice Start-Up Support  Require Explanation and/or Correction of Bureau of Labor Statistics Projections -Rationale for New Schools Bureau of Labor Statistics (BLS) Projects 11,000 FTE Additional Optometrists Needed by 2024 Bureau of Labor Statistics (BLS) Projects 11,000 FTE Additional Optometrists Needed by 2024 Inconsistent With All Previous Manpower Studies Inconsistent With All Previous Manpower Studies 24

25. Increase Demand for Optometric Services Address Underserved Areas Consistent Student Marketing Restructure the Practice of Optometry 25

26. 26 Public Health Approach to Oversupply Increase Demand for Optometrists by Addressing Need for Eye Care in Inner-City and Rural Areas Increase Demand for Optometrists by Addressing Need for Eye Care in Inner-City and Rural Areas 3,278 FTE Needed in Community Health Centers 3,278 FTE Needed in Community Health Centers Only 20% of Federally Qualified Community Health Centers Offer Optometric Service Only 20% of Federally Qualified Community Health Centers Offer Optometric Service

27. Student Marketing Develop and Implement a Comprehensive and Sustained Marketing Program in Collaboration with ASCO and the AOA Develop and Implement a Comprehensive and Sustained Marketing Program in Collaboration with ASCO and the AOA 27

28. 28 Restructure Optometric Practice: Lewin Study Suggested Actions Restructure Optometric Practice: Lewin Study Suggested Actions  Lewin Projects a Decrease in Current Optometry Surplus of 12,672 FTE to 4,400 FTE by 2025 If Optometrists Provide the Same Scope of Practice As Ophthalmologists If Optometrists Provide the Same Scope of Practice As Ophthalmologists And 1.36 FTE OD Surplus Fill 1.0 FTE MD Shortage And 1.36 FTE OD Surplus Fill 1.0 FTE MD Shortage

29. Are Lewin’s Suggestions Realistic?  Management of Diabetic and Elderly Patients with Multiple Medical Problems Requires: Advanced Clinical Training Advanced Clinical Training Legal Authority in All States to Treat With Systemic Medications and Perform Invasive Procedures Legal Authority in All States to Treat With Systemic Medications and Perform Invasive Procedures Acceptance of Optometrists Providing These Procedures by Insurance Carriers is Necessary Acceptance of Optometrists Providing These Procedures by Insurance Carriers is Necessary 29