UNLICENSED PRACTICE OF OPTOMETRY.
Practice by unlicensed optometrists awaiting licensure
In the absence of a license to practice optometry in North Carolina by either a
new graduate or practitioner licensed in another state(s) who wishes to apply for
a North Carolina license, there is no statutory provision that allows an individual
to practice except “at the direction and under the supervision” of a licensed optometrist
or physician. Therefore, pursuant to section 90-115.1.(5) of the General Statutes
of North Carolina, the Board will consider on a case by case basis and under certain
circumstances allowing optometrists holding a Doctor of Optometry degree from a
school or college of optometry accredited by the Council on Optometric Education
and who have submitted evidence satisfactory to the Board that they are eligible
to apply for licensure as an optometrist in North Carolina to perform procedures
and functions which a duly licensed optometrist may perform in accordance with Article
6 of Chapter 90 of the General Statutes of North Carolina provided that such are
performed at the direction and under the supervision of a licensed optometrist.
Ordinarily, such approval will be given by the Board only to persons who have an
opportunity to work under the supervision of a licensed optometrist or physician
in order to gain additional clinical experience prior to taking the licensing examinations
or while awaiting the results of such examination. “At the direction and under the
supervision of” shall be applied to the facts of each particular situation in which
an unlicensed optometrist, hereinafter referred to as an “extern”,
performs optometric procedures which otherwise may be performed only by a licensed
optometrist. The Board customarily will expect, however:
1 That the supervising optometrist will
be physically present within the practice location at all times the extern
is performing optometric procedures. Being absent from the practice location but
being “available by phone” or “by computer” is not acceptable.
2 The supervising optometrist will have
a formal procedure in place by which patients who may be examined by the extern
out of the physical presence of the supervising optometrist will be informed both
orally and in writing of the status of the extern and that the supervising optometrist
will personally review and approve the examination performed by the extern and will
so note in the patient’s record.
3 Prior to the patient’s being discharged
or released from the practice, the supervising optometrist must personally review
the chart of that patient who has been examined by the extern and confirm that the
examination was thorough and complete under the circumstances, the extern’s findings
and diagnosis are accurate and the treatment plan, if any, proposed by the extern
is reasonable. The supervising optometrist shall make a notation of his agreement
or disagreement with the findings of the extern in the patient’s chart and likewise
note any change(s) made in the treatment suggested by the extern; the patient will
be informed by the supervising optometrist of any changes in their diagnosis or
treatment such notation(s) would require.
4 In the event that the extern’s examination
involves a prescription, whether for pharmaceuticals, spectacle lenses, or contact
lenses, the supervising optometrist must personally review the chart of that patient
and review the findings with the patient before approving and signing any prescription(s)
to be provided to the patient.
Prior to beginning an externship with a licensed optometrist, an unlicensed optometrist
must notify the Board in writing of his desire to work under the direction and supervision
of a licensed optometrist, identifying the optometrist or optometrists under whose
direction and supervision he will be working. Such notice must specify the address(s)
and telephone number(s) of the practice(s) where the unlicensed optometrist will
be working as an extern.
The unlicensed optometrist seeking authorization to practice as an extern agrees
to the following:
a. Externs may perform those functions which
a duly licensed optometrist may perform under Article 6 of Chapter 90 of the North
Carolina General Statutes, provided that such are performed at the direction and
under the supervision of the licensed optometrist to whom the extern is registered;
provided, however, nothing herein shall be construed to permit an extern to prescribe
for any patient in his own name or prior to the patient’s chart being reviewed and
signed by the supervising optometrist. In an instance where a pharmaceutical agent
is being prescribed, the supervising optometrist shall physically examine the patient
prior to the prescription being authorized and signed by him and before such prescription
is given to the patient. Further, nothing herein shall be construed to permit an
extern to perform an injection.
b. An extern shall wear appropriate identification
at all times when involved in patient care that will identify him to patients by
his name followed by the degree “O.D.” and the word “EXTERN”.
c. Prior to an extern examining any patient,
the patient shall be made aware that the care being rendered to him is being performed
by a doctor awaiting licensure, and the patient’s record shall note the patient’s
Each licensed optometrist for whom an unlicensed optometrist (extern) is to practice
shall be required notify the Board in writing that:
1 He understands that directing and supervising
the unlicensed optometrist(s) requires his physical presence at all times when the
extern is involved in patient care.
2 He is familiar with all of the requirements
set forth in paragraphs a, b, and c above and accepts the responsibility for supervising
an unlicensed optometrist.
No externship shall be approved for a period that exceeds either six months, or
ninety days following the next regularly scheduled examination, whichever is shorter,
and may be renewed no more than once during any calendar year. The maximum number
of times that any one applicant can apply for an extern permit is three.
Should the Board receive credible evidence that one of its licensees engages in
practices believed to be in violation of the above policy, the Board may notice
a disciplinary hearing in accordance with the provisions of General Statutes section
90-121.2. Aiding and abetting in the unlawful practice of optometry subjects the
licensed optometrist to disciplinary action by the Board, including suspension or
revocation of license, monetary fines and costs of the action. An unlicensed optometrist
or extern proved to be in the unauthorized practice of optometry would likely be
refused admittance to the Board’s licensing examinations.