Ⅰ. Introduction
In modern society, changes in the healthcare environment have led to the segmentation and specialization of medical practice and management, emphasizing the role of professionals in providing healthcare services to the public in various areas of healthcare. Improving economic standards, changing demographics and disease patterns, and the diversification of healthcare are increasing the demand for high-quality healthcare services and requiring an adequate supply of healthcare personnel in both quality and quantity. Overseas and domestic healthcare professionals are improving their professional competence, providing adequate manpower, improving the quality of healthcare services, and promoting professional development through specialization and the introducing higher professional qualifications.1)
The major countries in the world has seen a steady improvement in education, interdisciplinary, and clinical competence, led by leading countries such as the United States, the United Kingdom, Australia, and Germany, and the scope of practice has expanded and subdivided from the work of dispensing opticians to the higher professional qualification of optometrist. Optometrists are engaged in managing eye health and vision function, as well as the professional treatment and training of vision-related problems.2) This global trend has been extended to the Asian region, where countries such as Malaysia, Singapore, Vietnam, Thailand, China, and Hong Kong have introduced and are operating optometrist systems.3)
For the development of world optometry, the World Council of Optometry (WCO) has categorized the scope of optometrists into four categories: Category 1 (Optical Technology Services), Category 2 (Visual Function Services), Category 3 (Ocular Diagnostic Services), and Category 4 (Ocular Therapeutic Services). Countries around the world have standardized the World Council of Optometry (WCO)'s scope model and curriculum to introduce the qualification of an optometrists, and have realized the tasks of protecting and managing visual function, providing corrective eyewear, and proactively managing eye health.4)
In particular, advanced countries overseas are ensuring the professional stability of related practitioners through the support of examination costs for optometrists and the cost subsidy system for corrective eyewear, and optometrists are attracting attention as a socially recognized and promising profession.5)
The Korean optometrists profession has been developed with optometry as its basic discipline, but unlike the global trend, it has failed to secure the adequate quantity and quality of manpower to provide quality eye healthcare services, and it is difficult to meet the diverse health needs of the public because i t is not segmented as in maj or developed countries. The Korean optometrists system is facing many problems such as stagnation of national eye healthcare services and excessive competition among opticians due to the stagnant system and limited scope of practice for more than 30 years since the introduction of the optician licensing system in the healthcare system. In particular, the national eye healthcare and visual function management service system is not up to par with other developed countries, which can have a negative impact on the preliminary management of eye health and eye diseases and the management of visual function.6) Therefore, it is urgent to improve and develop the system for the development of Korean optometrists, and in particular, the supply of high-quality and adequate human resources and the cultivation of professional personnel who can provide high-quality healthcare services are very important.
In the meantime, discussions on the realization of adequate manpower supply and scope of work for Korean optometrists have been raised in Korea, but there has been no specific analysis of the cases of Organization for Economic Cooperation and Development (OECD) countries as a basis for proposing measures.
Therefore, this study examined the World Health Organization (WHO) and European Union (EU) occupational classification systems for optometrists,7) which are used as the basis for the Korean standard occupational classification, and examined and compared the qualification system, scope of work, and educational requirements for optometrists in 38 OECD countries,8-10) with the aim of deriving a development plan for the Korean optometrists system that can contribute to the increasing demand for eye health services and visual function management services in various ways according to the changing healthcare environment.
Ⅱ. Methods
World Health Organization (WHO) and European Union (EU) occupational classification system, Organisation for Economic Co-operation and Development (OECD) countries' legal status, national optometric associations, World Council of Optometry (WCO) member countries, International Orthoptics Association (IOA), European Council of Optometry and Optics (ECOO BLUBOOK 2020), European Commission's Occupational Regulation Database, World Federation of Healthcare Professionals' national optometry-related occupation information, and previously studied j ournals on the scope of work of optometric technicians were used as research materials to investigate and compare the qualification system, scope of work, and educational requirements of 38 OECD countries.
Ⅲ. Results
1. Occupational classification of optometrists and opticians in the World Health Organization (WHO), European Union (EU) countries and Korea
1) World Health Organization (WHO) and European Union (EU)
The World Health Organization's classification of health professions separately defines the field of optometry and consists of five levels of health personnel according to the International Standard Occupational Classification. The field of optometry is divided into the Optometrists and Ophthalmic opticians group of health professionals and the Dispensing opticians group of health associate professionals. The Optometrists and Ophthalmic opticians group is divided into Optometrist and Orthoptist, and the Dispensing opticians group is divided into Dispensing opticians and Contact lens opticians.
In Europe, which includes the largest number of OECD countries, the European Commission, with the support of the European Centre for the Development of Vocational Education and Training (CEDEFOP), has j ointly developed the European Classification of Skills/Competences, Qualifications and Occupations (ESCO), and the field of optometry is divided into the optometrist group of health professionals and the dispensing optician group of health associate professionals, similar to the World Health Organization. The qualifications of the optometrist group are divided into optometrists and visual function trainers, and the qualifications of the dispensing optometrist group are divided into optical technicians (Table 1).
2) Korea
In Korea's occupational classification, there is only the occupation of optician, and the hierarchical level is divided into sub-occupations divided into doctors, nurses, medical technicians, nutritionists, and healthcare workers, which falls short of the international occupational standard classification and is managed in a very low-level monotonous structure that is less specialized than that of developed countries and European countries (Table 2).
2. Optometrists and opticians in OECD countries.
The OECD has a total of 38 member countries, the qualification system of countries that are members of the OECD is divided into the following categories: ① Only Optometrist or (Optician & Optometrist), ② Optometrist or (Optician & Optometrist) + Orthoptist, ③ Dispensing Optician + Optometrist or (Optometrist & Orthoptist), ④ Dispensing Optician + Optometrist + Orthoptist, ⑤ Optician + Orthoptist, ⑥ Only Optician, ⑦ Only Dispensing Optician, and the results are shown in Table 3.
Among the 38 OECD countries, 34 countries (89.5%) have a system of optometrists, a higherlevel specialty that evolved from opticians in the past. Only two countries, France and Japan, have ‘Optician + Orthoptist’ without ‘Optometrist’ (5.2%), Korea is the only country with ‘Optician’ only (2.6%), and Turkey is the only country with ‘Dispensing optician’ without ‘Optometrist’ (2.6%).
Meanwhile, 18 countries (47.4%) separated optometrists and dispensing opticians into groups as classified by the World Health Organization (Fig. 1).
1) Scope of work and qualification system
The analysis of the scope of practice in OECD countries was categorized into four levels of scope as defined by the World Council of Optometry (WCO).
When analyzing the scope of practice for opticians and optometrists in OECD countries, the scope of practice for opticians and optometrists practicing optometry in all countries was Category 3-19 countries (50%), Category 2-10 countries (26.3%), and Category 4-6 countries (15.8%), with 25 countries (65.8%) practicing Category 3 or higher. Regarding the qualification system, the highest frequency of countries with a Category 3 scope of practice is found in countries with only an optometrist qualification (Table 4).
In contrast, the countries that do not have an optometrist system and have an optician system all perform only Category 2 scope of practice, indicating that the scope of work is more extensive in countries with an optometrist system (Fig. 2).
2) Educational Requirements and Qualification System
In OECD countries, the education level of optometrists and opticians practicing optometry was: (1) less than a bachelor's degree, (2) a bachelor's degree or higher, (3) a master's degree or higher, and (4) a bachelor's degree + 4 years of optometry education. In the OECD, 29 countries (76.6%) have a bachelor's degree or higher. Only 2 countries (5.2%) had a master's degree or higher. Two countries (5.2%) operated with a bachelor's degree plus four years of optometry education. South Korea (2.6%) is the only country with a two-year college graduation to a doctoral program, while two countries (Slovenia and Japan) have a high school diploma + completion or higher (5.26%), and Turkey is the only country not surveyed. The bachelor's degree or higher group and the master's degree or higher and bachelor's degree plus four years of optometric education group comprise 33 countries ( 87%), with the maj ority of c ountries operating at the bachelor's degree level (Table 5).
As a result, countries with an optician system have a higher educational requirement for optometrists, as all opticians have less than a bachelor's degree (Fig. 3).
3) Educational Requirements and Scope of Work
When comparing educational requirements and scope of work, 19 countries (50%) of all OECD countries with a bachelor's degree or higher operate in Category 3 scope of work (Table 6).
In addition, of the 21 countries where the scope of practice for optometrists is in Category 3, 19 (90.5%) require a bachelor's degree or higher.
In the 27 countries where optometrists' scope of practice is Category 3 or higher, the effective frequency of countries with a bachelor's degree or higher and a master's degree or higher was 100%.
Ⅳ. Discussion
In this study, we examined and analyzed the operation form, qualification system, and scope of work of overseas optician systems in order to derive suggestions for the development of the Korean optometrists system.
The lack of institutional change in the Korean optometrists profession can be attributed to institutional stagnation, despite the changing competencies and academic advancement of Korean optometrists. However, paradoxically, institutional changes such as expanding the scope of work presuppose the improvement of professional competence, which includes knowledge accumulation and clinical experience through academic improvement. The 1992 Constitutional Court ruling stated that it is necessary to improve the system and introduce a system for early detection and linkage of eye health and eye diseases in Korea under the condition that Korean optometrists cultivate more professional knowledge like overseas optometrists in their training programs,12) which suggests that improving the academic level and clinical competence of overseas opticians through standardized education is a way to improve the system, as shown in the results of this paper.
Currently, Korean optometrists have a mix of two-, three-, and four-year programs, all of which are eligible to take the national optician examination and obtain the same optician license. In 2008, Kim et al.13) reported that Korean universities' ophthalmic optics departments were similar in discipline to foreign optometry departments, but showed limitations in terms of curriculum. In 2014, Seo et al.14) reported that Korean optometrists' diverse majors were a problem, and the integration of majors and the establishment of a standard curriculum were solutions. Opticians around the world are standardizing and pooling their higher education and degrees, and sharing information on qualification recognition to foster global talent.
Therefore, for the institutional development of Korean optometrists, the training system for opticians should be gradually upgraded to the international standard of bachelor's degree or higher to cultivate more professional knowledge and unify standard disciplines. For this purpose, it will be necessary to integrate the various disciplines existing in Korea into a bachelor's degree with international standards and to establish an international standard curriculum system that includes practical learning.
In cases where institutional integration of disciplines is difficult, consideration should be given to providing opportunities to acquire a higher qualification system through additional education and certification for current opticians and those graduating from existing disciplines, as in the case of the United Kingdom, Germany, Hong Kong, Singapore, and Malaysia.15,16) In particular, it is imperative to provide education and acquisition opportunities for opticians who do not meet the higher qualifications according to the various disciplines that exist to obtain a license in Korea, and it is also essential to establish a system to objectively verify education and experience by establishing a certification system. Considering the situation in Korea, where graduate programs are operated in various disciplines, it is necessary to consider the introduction of various grades of optometrist qualification systems operated in Hong Kong and China.17)
After the introduction of the optometrist license in the Korean optician system, it will be necessary to introduce the visual skills trainer license as well as the subspecialist-type field-specific licenses operated in the United States, Germany, and India. In particular, the contact lens specialist, independent prescribing optometrist, advanced optometrist, advanced dispensing optometrist, and advanced contact lens optometrist, which are advanced courses for dispensing optometrists and optometrists in the United States and the United Kingdom, are improving the quality of services and expanding the scope of practice as a result of continuous specialized education.
Therefore, the Korean optician system needs to develop into an overseas-level optometrist system, and furthermore, it is necessary to institutionalize the scope of work of Category 3 and introduce a system that is subdivided by field of work. In order to institutionalize such an optometrist system, international standards of education, curriculum, and clinical experience must be supported. As a result, it is suggested that strengthening professionalism through standardized education and clinical experience is an essential factor in the development of the optometrist system in Korea and that social contributions can improve the social credibility of optometrists and provide a basis for institutional development.
Ⅴ. Conclusion
Based on the comprehensive analysis of the results of this study, the following recommendations are made for the development of the Korean optician system.
First, establish a standardized curriculum and clinical standards for optometrists based on international standards. Second, institutionally integrate the various disciplines in Korea and level them upward to a bachelor's degree or higher, or strengthen the capabilities of Korean optometrists through standardized mandatory training courses for personnel graduated from various disciplines and private certification of optometrists. Third, establish a recognized experience certification system to verify clinical experience. Fourth, institutionalize the optometrist qualification as a national qualification based on standardized and specialized private qualifications and social credibility, and expand the scope of work to overseas levels. Fifth, introduce a professional qualification system for each field that specializes and subdivides the work area.
The qualifications of optometrists with international standards of education and clinical experience and the specialized and subdivided qualifications presented in this study can efficiently improve the social costs associated with eye health through the management of various visual dysfunctions and the prevention of eye diseases occurring in modern times. If the Korean optometrists system is gradually developed based on the results of this study, it will be able to provide better eye healthcare services to the public and contribute to the development and professionalization of the optometrist profession.
