Letter from the President & Registrar
Despite being the “year of vision,” 2020 was a year most of us did not see coming.
The COVID-19 pandemic presented us with many unexpected challenges: loss of work, lack of social connections and, for some, direct impacts on our health. But it also presented us with opportunities: adapting how we work, demonstrating resilience, and thinking creatively to meet new challenges.
The public’s reliance on health care and health care providers has perhaps never been more pronounced than it was in 2020. Because of this, the College’s resolve to inspire public confidence has never been stronger.
Despite setbacks and changes to timelines, the College continued to fulfill its regulatory mandate in our three main areas of responsibility: Registration, Quality Assurance, and Investigations. It is our job to ensure optometrists are qualified to join the profession; that they maintain those skills; and, when issue arise, that we investigate and follow up to ensure patients receive safe care.
We did our best to be nimble, navigating the rapid changes that were coming from local and provincial directives. Five days before the Chief Medical Officer of Health ordered health care providers cease non-essential care, the College recommended that optometrists shift their practice to provide urgent care only.
We increased communication to optometrists to ensure they had the latest information on this rapidly changing situation: the College nearly tripled the number of emails to optometrists in 2020 compared with 2019, more than half of which were COVID-19 updates alone. Additional information on COVID-19 was also provided through our monthly e-newsletter and COVID-19 FAQs, which were updated to reflect current practice as well as issues facing the profession.
Our own COVID-19 guidance was released in mid-May, approximately two months after the state of emergency was declared in Ontario. The College was among the first regulatory bodies to provide members with written guidance in advance of resuming standard care.
Throughout 2020, the College continued to look for ways to not only continue providing services to the public and optometrist, but to improve the services we provided.
Remote-proctored, online exams and registration processes gave new registrants greater flexibility. Timelines were adjusted to ensure patient complaints were reviewed and investigated, while recognizing the restrictions health care providers were under. Virtual processes were put in place to ensure quality assurance still look place, while ensuring the health and safety of optometrists, their staff, and College staff.
While 2020 can be characterized as unprecedented, challenging, and distressing -- it was also a year in which so many people worked to give their best. We recognize that optometrists are patient-facing, front-line workers who have continued to provide high-level care to the public in the face of significant uncertainty.
We would like to thank the College staff, our committee and Council members, and all optometrists for their hard work and dedication to providing safe, competent, and high-quality vision care throughout 2020.
-Dr. Patrick Quaid, President & Joe Jamieson, Registrar and CEO
Council and Committees
Committees
More than two dozen committee members support and facilitate the College's work. Our sincere thanks for the time, skill, and thoughtfulness they bring to their work on the following committees:
- Audit/Finance/Risk
- Discipline
- Executive
- Fitness to Practice
- Governance/HR
- Inquiries, Complaints, and Reports
- Patient Relations
- Quality Assurance
- Quality Assurance Subcommittee
- Registration
Ensuring Safe Care
Registration
Registering to practise as an optometrist is often a professional’s first interaction with the College, and the first area of our regulatory responsibilities that we get to fulfil: ensuring new optometrists meet the qualifications at the outset.
COVID-19 changed much about the way we work. In some cases, work was delayed. In others, COVID-19 provided us with an opportunity to adapt and be flexible in the ways in which we are meeting the needs of optometrists and the public, such as accepting registration applications electronically and extending the 2021 annual member renewal payments by three months for new registrants.
Entry to Practice
Due to COVID-19, entry-to-practice exams were delayed or cancelled in 2020, greatly affecting new registrants’ ability to join the profession. To accommodate these disruptions, we extended the two-year application time limit; provided candidates their formal registration notifications electronically; and credited candidates for any cost required to update their vulnerable sector check.
To provide registrants with increased flexibility, our online Jurisprudence exam transitioned to a 24/7 model in June 2020, allowing applicants to write the exam at any time over the course of a five-day period. This was made possible using a remote proctoring service that ensures the exam’s security. In addition, we waived the re-attempt fee for applicants who needed to re-write the Jurisprudence exam.
International Students
We continue to work to ensure internationally educated optometrists have options when it comes to registering to practise in Ontario.
The Internationally Graduated Optometrist Evaluating Examination (IGOEE) serves as the evaluating exam for internationally graduated optometrists and is administered by Touchstone Institute. Those who perform well on the IGOEE can bypass the bridging program, which was discontinued by the University of Waterloo School of Optometry and Vision Science and is not being offered after 2020.
In the absence of the bridging program, the IGOEE provides a path to registration for internationally graduated students, however, regsistration for this exam has been declining and Touchstone Institute can only maintain the IGOEE on a cost-recovery basis.
In December 2020, the College Council approved a fund to help sustain the IGOEE should registration fall below the break-even number to ensure international optometrists continue to have this option.
Consistency Across Canada
We continued our work to develop a national competency profile for optometry that would ensure consistency across Canada. Touchstone Institute held several workshops with stakeholders in February and provided final reports in August 2020. The College is now working to create a licensing agreement for the profile’s use by the Optometry Examining Board of Canada that will enable other regulators and educators to benefit from the profile.
Our Membership - By the Numbers
Quality Assurance
Once we have ensured optometrists are qualified to practice through our registration processes, we must be sure that optometrists are maintaining their skills and keeping up with the latest developments in the profession.
The College’s Quality Assurance (QA) Program allows us to assess optometrists’ competence on an ongoing basis, while helping optometrists seek out new learning opportunities.
Our QA program is centred around:
• self, peer, and practice assessment;
• continuing education (CE); and
• a way to monitor optometrists’ participation in and compliance with the QA program.
The QA program is also one of the areas of work where you can most immediately see the impact from COVID-19. As per orders from the Chief Medical Officer of Health, optometrists were restricted to providing urgent care only from March 19 through May 26, 2020. In addition, once optometrists resumed regular care, appointments were modified to meet COVID-19 precautions, resulting in fewer patient visits. These changes made it challenging for optometrists to participate in practice assessments as usual.
Recognizing the ways in which COVID-19 altered routine practice, the QA Program made several adjustments in 2020:
- Practice Assessments were suspended in March 2020 and resumed in the fall.
- When Practice Assessments resumed, we made use of virtual options, such as remote remediation and electronic record submission, to ensure the health and safety of optometrists, their staff, as well as College staff. In addition, optometrists were provided with additional time to provide files for review.
- The Practice Assessment Questionnaire now asks optometrists to list any changes they’ve made to clinical or office procedures in light of infection prevention and control practices.
The Quality Assurance Program also updated its Continuing Education (CE) requirements and accepted a series of Infection Prevention and Control Core Competencies courses offered by Public health Ontario as Category A CE.
QA Redevelopment Project
As part of our QA Program redevelopment project, a new CE Policy was approved in 2020. This new policy made some significant updates to our current program, including:
- Shifting Category A and B lecture credits to Council on Optometric Practitioner Education (COPE)-approved credits.
- Every three-year cycle, optometrists must complete a minimum of 50 COPE-accredited CE hours and 20 hours of other learning opportunities. Other learning opportunities includes conferences, lectures, distance learning, among others, and provides optometrists with a wider range of options and the opportunity to make flexible choices that suit their learning needs and practice.
Investigations
Our work is centred around ensuring optometrists are qualified, competent, and providing safe care. A key aspect of this work is to respond and investigate whenever issues arise.
When the College receives a complaint or a Registrar’s Report is issued, we investigate the allegations and make decisions. The decisions can either be actions the optometrist must take to resolve the issue, to move the case onto our Discipline Committee for further hearings, or that there is no further action needed.
Complaints Process
Adjusting Processes Due to COVID-19
One of the biggest impacts COVID-19 had on complaints and investigations was that timelines in proceedings were suspended in Ontario from March to September. This created significant delays for investigations. Optometrists are typically provided 30 days to respond once they have received a copy of the complaint. Except in cases involving serious allegations, such as sexual abuse, the College provided optometrists with greater flexibility with these deadlines, acknowledging staff shortages and reduced time in practice.
To keep optometrists, patients, and investigators safe, elements of our investigation process were changed. For example, investigators no longer entered practices to obtain patient records.
In addition, in 2020 the College formalized the use of an early resolution process. In cases of very low-risk concerns, staff reach out to both parties to reach an amicable resolution to the issue.
From March to May 2020, optometrists were providing urgent care only. As a result of fewer patient visits in the early part of 2020, we received fewer complaints during this time:
How Investigations Proceeded in 2020:
Top Complaints in 2020
Most of our complaints fall into two main categories: Clinical Care and Professionalism.
Clinical Care includes: failure to diagnose/misdiagnose, issues related to eyeglasses or contact lens prescriptions, issues related to eyeglasses or contact lens dispensing, failure to refer, unsafe practices, and quality of care, which was the top complaint in this area.
Professionalism includes: unprofessional behaviour and/or communications issues, improper billing, breach of patient confidentiality, and staff supervision. Unprofessional behaviour and/or communication issues was the single biggest allegation in 2020, with 16 allegations.
Discipline Decisions
In 2020, the Discipline Committee held one discipline hearing into allegations of professional misconduct/incompetence.
Read the full decision on our website: Dr. Kashif Zoberi.
Supporting Excellence
2020 was a busy year for the College. In addition to meeting our three main regulatory functions, we continued to move forward on work that supports optometry practice as well as the public interest.
Policies, Regulation, and Communication to Members
The College led two public consultations on policy updates in 2020: amendments to the College by-laws and the new 2021-2023 Continuing Education Policy.
The College released its COVID-19 Infection Prevention and Control guidance in May, as well as the Optometric Services During Job Actions policy in June.
In October, the Spousal Exemption Regulation was passed, allowing optometrists to treat their spouse without the treatment constituting sexual abuse.
Strategic Plan
2020 also saw Council approve a new three-year strategic plan that focuses on increased transparency, engagement, and anticipating the changing regulatory and professional environment. The College is now working to operationalize the strategic plan and ensure it is aligned with the new provincial College Performance Measurement Framework.
Financials
The College Council approved the audited financial statements for the fiscal year ending December 31, 2020 at the June 18, 2021 Council meeting. See the full audited financial statements on the College website.
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