Dr. Howard Purcell is one of the most well-known names in the optometry community. From his vast experience working in industry (from Johnson & Johnson to Essilor) and now his role as the President and CEO of the New England College of Optometry, Dr. Purcell truly is an influential figure in the industry.
In this episode, I had the pleasure of chatting with Dr. Purcell at NECO about a variety of topics that are affecting both students and optometrists. From changes in board exams to navigating student debt, there are a lot of topics on top of students’ minds at this time. Beyond optometry school, there are questions about the future of the profession including how to continue attracting high-quality candidates and improving access to care. Is the answer more schools? Does increased industry involvement help? How much industry involvement is ok?
This conversation will bring a lot of value to students, new grads, and veteran optometrists who are interested in thinking of new ways to improve optometry school and elevate the profession as a whole.
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How to Navigate Student Debt, Do We Need More Optometry Schools, and How Much Should Industry Be Involved in Education – Dr. Howard Purcell: President and CEO of NECO
Thank you as always for taking the time to join me here, to learn, and to grow. I’m so grateful for all the support, as always, the liking, the sharing, and everything that you do that helps the show grow so we can reach more colleagues and help support our profession. I’ll always ask the same favor off the top. If you get any value out of this, please do share it with a friend. Whether you put an Instagram picture up on Instagram, put a link on LinkedIn, or send a text to your friend. Whatever it is, let them know we’re having this conversation.
This is a very special episode. I am here at the New England College of Optometry in Boston, my alma mater. I’m so happy to be back. I haven’t been here for so long. I’m walking around town and around the school. It’s bringing back so many positive, happy memories as well as a few anxious memories of exams and all the other stuff. I’m happy to be here. I’m here with the one and only Dr. Howard Purcell. If you don’t know Dr. Purcell, he is the President of the college and also an alum of NECO, and a well-known figure in the optometric community.
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Thank you, Dr. Purcell, for being here with me on the show.
It’s a pleasure. Thank you for coming back. I’m sorry it’s been so long. We’re happy to have you back at NECO.
It’s so good to be here. I’m sorry because I butchered your intro, and I feel bad. If you could tell us a little bit about yourself, who you are, and maybe a little bit of background on yourself, then we’ll jump into the conversations that we’re going to have.
Dr. Howard Purcell’s Multifaceted Journey In Optometry
I have the honor and pleasure to be the President and CEO of NECO. I’ve served in that role for about six and a half years. I am an alum and my father’s an alum, so I’m a second-generation alum of this wonderful institution. Coming in, I didn’t have a whole lot of background in academia, to be completely honest. When I left optometry school, I joined my father’s practice in South Florida, Miami Beach, where I’m from. I spent about ten years in that practice and enjoyed every minute.
I learned a ton about the business of optometry from my dad, who was very astute when it came to those things. We had a new optometry school show up in South Florida. I spent a little time there. It was within 6 or 7 miles of my office. I was the chief of cornea contact lenses there for about 5 years, and then I went on to spend about 13 years at Johnson and Johnson Vision and about 10 years at EssilorLuxottica. I’ve been here for the past couple of years.
I feel like I’ve been incredibly fortunate in this profession to see it from so many different perspectives. The past couple of years have been incredible, being around students. They’re so excited about this profession. They’re all going to be the best optometrists that have ever lived. It’s so invigorating. I say this all the time. If you have a bad day in optometry, come and spend a day in an optometry school. You will be reinvigorated by the future of this profession. The future is in great hands, and I’m thrilled to be able to be some small part of it.
That’s amazing. It’s certainly not a small part. It’s cool to hear your journey through optometry and the experience that you have. You certainly are one of the more influential people in the profession across the board, so it’s lovely to be able to chat with you, but also cool to know that you get that enthusiasm from the students.
I haven’t been in school for a while. The days blur together, and you don’t remember what it was like. It’s nice that you get that sense of enthusiasm. Students are excited to get out there and become optometrists and practice optometry. We need that energy to help continue to move the profession forward to grow. If students are coming through here and they’re not excited to get out there, then it’ll start to become a little bit stale.
Part of my job, I believe, is not just to see my patients and provide the best service. Part of my job is also to help my profession become better. If I’m not enthusiastic about it or I’m not energized about it, I’m likely not going to put in that extra effort. It’s nice to hear that. We want to talk a little bit about student life. Given that a lot of our audience is Canadian, we want to talk about the fact that there’s a large Canadian population here and what it is like for Canadian students? What percentage of students would you say at NECO are from Canada?
It’s varied through the years, but it’s always been somewhere around 20% to 30%. Probably 25%-plus of our student body comes from Canada. That’s something that’s been part of the DNA of NECO for as long as I can remember, probably for over 40 years. I’ll even take it one step further. Many of our faculty are Canadian. I tease that with our smartest graduates, we don’t let them go back to Canada. We keep them here as faculty members. Canadian students and our faculty have been such a big part of NECO for so many years. It’s part of our DNA. It’s part of who we are. International students, in general, but in particular, Canada has always been a big part of what we do.
It’s amazing. It’s such a large portion. I’d love it if you could let some of those come back to Canada, please. We’re a little short on ODs. The best and the brightest, we need them to come back. That’s something we want to talk about. What is the journey for Canadian students when they graduate? Do they stay here? Do they go back?
It’s a bit of a broad and vague question, but there are a lot of changes in the political climate. Back in Canada, all you hear is the word tariffs everywhere, but the word tariff is starting to become a proxy for all the other changes that may be happening, and concerns about whether I buy American or go to America to study. Are you noticing any changes in student behavior or conversations with students here, Canadian students in particular?
I’ll give you a great example of that. We have an open house because these questions have arisen so much. Individually, we’ve done our best to answer them. As we always do in NECO, we try to be as transparent as we can, so we’ll have an open house. Many of the questions that have been pre-submitted are around these very issues.
When you get unanimous agreement, those hard decisions become a little easier to make, and you get a bit more buy-in to why you’ve made them.
The best way to answer your question is this. We try to stay as close to these issues as we can. We have incredible connectivity within the community here in Boston due to the great work of so many, Dr. Gary Chu and others, who make sure we are up to date and can influence as best we can what goes on in our city and our state. I feel good about that.
We don’t have all the answers. This is a very dynamic time. Things seem to change by the minute at times. All we can do is make sure we are staying current, sharing that information, and doing everything we possibly can to make sure our Canadian students feel comfortable coming here, that the path coming back and forth is as easy as it can be, that we’re sensitive to the goings on, and that we are there to advocate on their behalf. That’s something we’ve always done.
This hasn’t changed, honestly, in the past few months with the craziness and the uncertainty that’s going on. That has been the case for NECO forever. We want to support all of our students, but with such a significant population coming from Canada, we feel an additional obligation to ensure we are staying on top of that. Dr. Chu and I spent some time in Toronto. We were listening a lot, observing, and trying to communicate everything we learned. The open house is one example of the many types of communication that we do to keep everyone informed. Whatever we know, they’re going to know.
Canadian Students & The New Board Exam Requirements In Ontario And BC
That’s good to know. That’ll be reassuring for not just current students but prospective students who are looking at American schools to NECO, given all the changes. One of the big changes that’s happened that’s not a political change, so to speak, but in optometry, a very important change is that British Columbia and Ontario both announced they’re no longer going to be accepting the NBEO as equivalent to the Canadian Board Exam, the OEBC.
I know this has been a shock to a lot because I have personally received a lot of messages from current optometry students in the US. How has NECO received that message? What do you foresee, assuming this is going to stay, and that Canadian students who have come to America to study will have to go back and take the Canadian board exam? What do you foresee? I know it’s early days, but how do you see that moving forward?
First of all, many students have already taken the Canadian exam and the national board exam. To make sure all your options were available, that was something that clearly was important to do. We, unfortunately, have nothing to say about decisions that are made by these national boards and the examination bodies. What we can do is give them our feedback. What we were particularly concerned about was the timing. It left some people in the middle a bit, having had some expenses, buying different prep materials, etc., and finding out at the last minute.
What we did do is certainly share those concerns after we had good discussions with our Canadian leadership students who have leadership here in our institution, and convey those concerns to the appropriate parties. They responded well and have been a bit more flexible in understanding that their decision and given the timing of their decision had a pretty big impact on a certain group of people that got caught in the middle. Honestly, other than that, we can continue to ask them to be as open-minded to accepting any boards, making it as easy as possible for our students.
These are, unfortunately, decisions that are beyond our control, but we can do our best to offer our suggestions. They listen. They’re open-minded to our feedback. That doesn’t mean we’re going to get everything we ask for, but it does mean we have a good channel of communication that we have used that channel of communication to express some of the immediate challenges that it created. Long-term, I hope we’ll have additional discussions and debates about the best way. I suspect that, in general, there are many reasons why the Canadian organizations made the decisions they did. I’m not privy to all of that, so I’m always a little careful about judging too much until I have all the facts.
One thing I can tell you is we are going to consistently be here to protect and defend our Canadian students where we can and make sure that their concerns are voiced both through themselves directly, but also through the institution. I feel good about what we’ve done there so far. We’re frustrated and not happy with the decision, if I have to be completely honest, but we have to live with that decision and find the best ways we can to accommodate our students and help them to be prepared to practice anywhere in the world. That is our goal.
I believe, as far as practical skills and clinical skills, NECO is certainly training students well to practice anywhere they go. However, when it comes to preparing for board exams, that’s where things start to get a little tricky. For myself included, if you studied NECO or any other American school, you could do the American boards, and I could go back to BC, fortunately. That’s where I was going anyway. A student who’s at any American school will likely not take the NBEO, assuming they want to move back to Canada, and take the OEBC before they can be licensed to practice. Do you foresee that NECO will change anything as far as preparing students for Canadian board exams, in addition to the national board exams?
That’s a fair question. There are a lot of different approaches to preparing for national board exams. We’ll call them national board exams, whichever one you want. NECO has never taken the approach that we will build our curriculum around the national boards. I’m not suggesting anyone else has, but perhaps others have maybe looked at it that way.
We don’t look at it that way. We look at it as what the necessary information is. Don’t get me wrong. We’re looking at what’s on the national board. We have done a very thorough search of our program, our curriculum, and where potential gaps may be, etc. I’m not suggesting we’re not mindful of that, but we don’t build our program around that. We feel like, “Let’s make sure we’re teaching the information that’s necessary.”
We have created a great preparatory opportunity led by Dr. Jen Riley. She does an absolutely fantastic job of looking at each of the parts of the board, trying to do prep work and simulations, which most of the institutions do. Everything we can do, we want to make sure we’re preparing those students. We haven’t built the curriculum around that. That’s something we continue to stick by.
Our students continue to do well on national boards. We’re happy about that. We’d like them to continue to do better. We want 100% to pass the first time. We have focused a significant amount of time and effort on assuring we’re doing everything we can possibly do to help our students prepare. There are a lot of different philosophies on that. You’ve heard this before. You know one school and another school. Everybody does things a little bit differently.
Honestly, when you look at national boards, most of the groups are within the same zone. You have a few outliers, but in general, everyone is in a similar position. We’ve seen fluctuations in board scores, and there are lots of reasons that happen. We have great students. They are incredibly smart and incredibly passionate about what’s going on. We continue to look at the national board.
You’ve seen the adaptation, at least I could speak more to the NBEO, that it has made to try to stay current and try to assure it is testing for the things that are truly necessary as we get out into the world of practice. What are those minimum competencies that are needed? I don’t know as much about OEBC, but I assume its efforts are to do the same thing. We’re all trying to achieve the same goals. The boards are in a position to protect the public. I appreciate that. We’re in a position to make sure that we’re training these students to be prepared to care for the communities that they serve in. That will continue to be what drives us and what motivates us.
That’s wonderful. That approach makes sense. If all you’re doing in school is preparing to write a board exam, I don’t think that prepares you to be the best clinician possible. Being prepared to be the best clinician, hopefully, the result will be that you do well on boards as well. A little shift in gears, in Canada, and I imagine across the USA, there seems to be a shortage of optometrists or a high demand for optometrists at this point.
I wonder if you have answers to whether it’s grassroots or somewhere in between. How do we answer that call? There’s going to be more and more optometrists or eyecare providers in general retiring and fewer filling those spots, it seems. Is the answer more optometry schools, which there seems to be some people’s approach to this, or is there something else you might recommend or have ideas about?
Expanding Access Through Distance Education
This is something we spend a great deal of time thinking about. We feel we’ve come up with something that is a potential solution for it. I’m speaking personally. These are my own views on this, if I may. I don’t know if the answer is more brick-and-mortar schools. I don’t think that is the answer. Faculty administration, the people who are ready to commit to giving their career to academia, I have so much respect for those people. They’re not making the same amount of money they could make if they were out in a normal practice, but they love what they do. They are committed to the educational process. That, for me, is so invigorating and stimulating. It gets me excited coming to work every day. We do have people, fortunately, who are committed to that.
I’ll use the states, but you could use provinces in the same manner. In the US, as an example, we have 30 states that don’t have an optometry school. If you are interested in optometry and live in one of the provinces that doesn’t have a school, then you have even bigger challenges. You only have two schools in your entire country.
Let’s imagine you’re in 1 of those provinces or 1 of those states and you’re entrenched in the community. You have a family. You can’t even consider optometry as a profession. We would like to take that obstacle away. We would like to go to places where we can deliver the didactic portion of the program through distance education.
It’s formalized education, not PowerPoint online. We are formalizing it in a way that it is delivered in this manner. It’s different. We have internal instructional designers and expertise we brought into the institution to create these programs for that media and for that platform. It’s very different and has been proven to be successful in nursing and in some other related fields which you could draw some corollaries to optometry.
We would have the opportunity to say to somebody, “If you live in 1 of these 30 states, stay where you are. We’ll deliver the didactic education through distance education. You’ll have to come to Boston here and there. We want to make sure everybody is aligned and we can create good consistency across the program. Your clinical experiences would take place on the ground in those communities with the idea that if you’re doing your clinical experience there, the likelihood is you’re going to stay in those communities.”
This works for Canada, the US, and all of North America. There are some challenges, as you might imagine. No one’s done this before. We have a wonderful group of accreditors. We continue to have good discussions with them as to how this can ultimately lay out. Our goal, ultimately, is to have an agile campus. If you want to come to class, you come to class, which not everybody learns their best sitting in a classroom. If you want to do it in whatever manner is best for you, you can do it that way.
It’s a lofty goal. I appreciate it. To answer your question, I don’t know if it’s necessarily about continuing to build more schools. It might be more about how we take the best of the best, our best person in all the different aspects of this wonderfully diverse profession, and bring them forward to help us educate in a broader way. That’s possible.
I was in DC. I fortunately got invited to a meeting with 250 deans and presidents of schools all across the country. I was the only optometry school represented there. What I recognized very quickly is we’re behind. Many reputable institutions North American-wide have moved into this way of educating. When you think about it, it is crazy to assume everybody learns the same. I happen to be one of those who like to go to class. I like to sit there. I want to listen, absorb, and engage, but I should not assume everybody learns that way. I’ll tell you why we know that’s true.
We have 130 students here. In the first two weeks of class or so, we get 130 students in class. By week three, four, or five, it starts to sort out. We provide a recorded version, as an example, of the course. Some people want to slow that down. Some people want to speed it up. Some people use it as an adjunct to come into class.
What we hear loud and clear is they’re saying, “We don’t all learn the same. Would you be able to provide some flexibility?” What we’ve done is what many schools have done, which is provide a recording of the class, but that’s not enough, in my opinion. It doesn’t solve the problem of those 30 states who don’t have a school where you have to pack your bags and then move somewhere.
I love that you asked that question because it’s something we spend a lot of time thinking about. I respect the schools and colleges that have been built and the great leaders and great faculty that we have. I do worry as the numbers continue to rise where we are going to continue to find these great faculty administrators willing to put in the time and effort.
Being the president of an academic institution might not be the most sought-after job in the world. I love it, don’t get me wrong, but the pressures of it are significant. I tap into every experience I’ve ever had in my career to try to make the best decisions I can. I have a great team around me of people who’ve been in academia their entire careers and who can bring a great perspective to the table. That’s what we try to do. We try to make the best decisions we can.
I guarantee you we make mistakes. We own up to them and try not to make the same mistakes twice. We do our best to make decisions that are always in the best interest of our students. Keeping in mind what your top priority is helps to make those tough decisions a little bit easier. I learned that during my J&J days. If your audience has not looked at the J&J redo before and they are business owners, they should take a look at it. It is a wonderful way for me.
Most optometrists love what they do.
I have a quick story. When you’re a leader and you’re sitting in a room, and you have two groups come to you with their philosophies on how they want to do something, and both of them make a whole lot of sense, you’re supposed to always be the smartest person in the room and be able to listen to these two inputs and say, “That one’s better. This one’s better.” I guarantee you, you’re not always going to be the smartest one in the room. In fact, rarely am I the smartest one in the room. The people who come in and talk about things that they’re passionate about know so much more than I do about it.
Leadership Decision-Making Using The J&J Credo
What I learned during my time at J&J was this credo. It’s the first thing you learn when you join J&J. All my colleagues at J&J know this. I could tell you the credo. I could tell you at least the four components of the credo. Your number one priority is to your customer. Number two is to the people who prescribe your product. Number three, your environment. Number four, your shareholders. I haven’t worked for J&J for over twenty years, but I’ll tell you this. It’s interesting when you see the shareholders at the bottom. The natural question to ask is, “Why are they at the bottom?” If you take care of the first three, you’re not going to have to worry about your shareholders.
Here’s the key to the credo. When those two groups come to you with their great ideas and both are very valid, and you have to be the smartest person in the room, you go back and you say, “Wait a minute. We agreed on our prioritization. Our number one priority is X. Which of these two ideas rings and resonates with what our prioritization is?” What happens when you do that is there still may be 1 of those 2 people who’s not as happy as the other, but they understand why you made the decision. It isn’t that Howard thinks he’s the smartest person, so he’s going to make the decision. We all agreed on how we prioritize. Based on that, that’s how we’re going to make our decisions.
Around here, it’s students first. I know that sounds cliche, but when you have to make a difficult decision, it helps by saying, “Which one of these follows what we believe is credo?” All business owners should have their credo. It doesn’t have to be as fancy as the J&J one that’s up on the wall in every J&J facility in the world, I suspect, but it can be at least agreed upon. When you get unanimous agreement on it, those hard decisions at least become a little bit easier to make. You get a little bit more buy-in to why you’ve made those decisions again as opposed to you thinking you’re the smartest person in the room. Does it make sense?
Absolutely. It makes perfect sense. As a business owner myself, having that clear vision or having that North Star helps you in every aspect of your business, whether it’s purchasing, hiring, or dealing with a patient. If you know that that’s your priority and that’s how you’re directing your decision-making, it makes a big difference. I imagine in an academic institution, it’s very important as well.
Adapting To Rapid Technological Change In Education
In any leadership position. That’s what I’m saying from the J&J experience, I was able to bring that into academia, and it’s helped a lot. You have to get buy-in. You have to have people believe in what your priorities are, and you have to be willing to adapt those priorities. We are living in a world that is changing so quickly. Think about the technology side. There’s Artificial intelligence, virtual reality, 3D printing, and telehealth. Put all those together and what impact they can have.
The world is changing so fast. As leaders, we have to be mindful of that. We have to understand how to use those technologies as best we can, but also how we prioritize and how we make the difficult decisions around that. For me, that was such a lesson. I’ve tried to utilize that lesson for my entire career, and so far, it has paid off okay.
It seems to be doing well. Going back to how we can improve the quality of the applicant and then the quality of the doctor coming out of the other side of the academic institution, I love the approach of starting to use distance education or virtual education. Helping people to become optometrists where they are and stay where they are also is so important because we end up getting these vast areas of the country where there are not enough service providers. There’s a shortage or difficulties with access to care. If somebody lives in the middle of some state that does not have a school, but they can learn to become an optometrist, train, be there, and support their community, that’s great.
It could be a province. I’ll add that. When you talked about the need for an optometrist, I know it’s the same. You have many rural areas. We get very rural quickly. When you think of Boston, you think of a big city, but if you go a little West, even from where we are here, you see deserts where care is not being provided. You don’t have to go far to find those opportunities, that’s for sure.
Back on the subject of the way we’re looking at our education, I should mention that we launched two of our courses that were only offered through distance education or asynchronous education. It was an opportunity for us to see how that went. How did the patients compare? You’ve got the same faculty member who used to teach it in a traditional classroom teaching it in a different manner and meeting with the students. This is not that they’d never see the faculty member. It’s a little more self-paced, but they have occasions to meet with the faculty member.
How did that go? How did they compare? How did the grades compare? What was the feedback? We’re on the other side of that, and we’ve learned a ton. There are many students who loved it, but most of the feedback, honestly, was constructive and like, “Here’s how it could be better.” What we hope we’ll be able to do ultimately is to say, “In this environment, which we don’t have a lot of examples to show and a same course with the same instructor, here’s how these students fared.”
I can give you a little inside track on that. It is pretty equivalent, generally speaking, in terms of performance. We’re new at this, so we still have some opportunities to adapt to it and adjust it. The students are giving us great feedback that can help us improve. I wanted to make sure of that other piece. We’ve begun to go down that path, but we’re doing it slowly and calculatedly so we can demonstrate that there is, at the very least, equivalency. We’re not expecting these students to do so much better, but we certainly don’t want to see them doing any worse. If we can create that equivalency, that continues to encourage us to move forward. That’s been the case so far.
That’s excellent. I certainly am one of those students who doesn’t love being in the classroom, so we’re a little different in that.
We have two of us here. We both learn differently. There’s a great example.
Many years ago, I was certainly one of those who, halfway through the semester, didn’t always show up to class. I relied on my classmates’ notes a lot of the time, but I made it through. I did well.
Optometry As A Profession And Raising Awareness
Whatever it is, whatever way you learn, we at least owe it to the students to continue to think through ways we can create as agile or flexible a program as possible. It enables us to get more students. I don’t think anybody’s different, but I can only speak for myself. The two biggest issues we have in optometry are debt and the applicant pool.
This leadership team at this institution has spent a great deal of its time focusing on those two issues because if we don’t, we’re in trouble. We’ve seen some good things. In 2024, we had the most applicants from optometry school since we’ve been keeping records. That’s great news. On the other side, it’s still not enough. We still don’t have enough, but at least we’re seeing some good movement.
Optometry Gives Me Life is a fabulous campaign that we do in the United States to help raise awareness, and something I hope we can do in Canada as well to continue to raise awareness with the profession. Optometry is the best-kept secret in medicine. We’d prefer it not to be the best-kept secret. When you think about it, it has everything that this generation coming through is looking for. You have the credibility and respect of being a doctor. You’re going to change people’s lives every single day. You’re going to make a great living. You can have a good work-life balance if that’s what you choose.
Hopefully, you’re going to give back because you’re going to have a gift that many people can’t afford. You’re going to give that back. I’m biased, but I feel like I could sell anybody on optometry. It’s an incredible profession.. The majority of people who are not within our sphere of optometry, if you ask them, “What is an optometrist?” You’re going to get some very interesting answers to that.
You’ll certainly get one answer, which is the most common answer. You asked me which is better, 1 or 2. It’s up to us to decide what the perception of optometry is, and it certainly shouldn’t be just that. If we can provide that insight and help change the perception of the public, we’ll get more students, whether it’s high school or undergrad students, seeing the value in becoming an optometrist and the benefit of it.
May I add one thing to that, the idea of the number of students, not only debt, but the applicant pool? Our colleagues are the number one vehicle for marketing. I get to meet every student who gets an interview here at NECO. I meet them as a group. We go around the room and they tell us about themselves and why optometry.
Nine out of ten times, it’s somebody like you who has shown them the way. They were sitting in your chair as a patient, perhaps, and were leaning in a little bit. They wanted to see, and you showed them. You said to them, “Here’s what the retina looks like.” That is how we inspire these people to do it. Tell them, “Diabetes and hypertension are two of the most prominent systemic diseases that we confront in our world. We could often be the first people to identify those changes.” Those kinds of discussions lead to the wonderful students that we have sitting here. It’s the number one reason that I see, in my experience at least, but I don’t think my colleagues would disagree, that that is the number one way.
We don’t advertise that much. We go out to colleges and universities. We spend a lot of time in Canada because that’s an important constituency for us. If you went to NECO and someone said to you, “What did you think? Did you have a good experience?” and you said, “That was a horrible experience,” we’re not going to have any students here. It is so important.
In your office, when you have that opportunity and you see a young person perhaps who seems to be a little interested, I would love it if we could take that moment to say, “Let me show you something,” or, “Let me tell you why this profession is so great.” That’s why we have these incredible people here who are studying optometry and who want to be optometrists. I ask this of your readers. You can play a role in this. You could do something to help. If you love optometry, then give these people a little more insight. Show them what you do. Show them how much you enjoy what you do. Most optometrists love what they do.
It’s so true. A big part of what I spend my time doing is advocating for the profession, not to the public, but to our colleagues. Let’s stand up and do a little bit more for our profession, whether it’s getting out there and speaking about it or speaking to the students who happen to be your patients, potentially, or students who wanted to volunteer and observe in your practice. Show them what optometry is about and speak well of it. Hopefully, those people will become our colleagues and help the profession grow in the future.
A big part of what I find myself talking about in a similar vein to help our profession grow is scope expansion. Expansion is a term that’s used. Back home, we’re trying to use terms modernization or optimization. Expansion seems to have a bit more of a negative connotation around it. Scope expansion or scope optimization, is that something that you feel is a relevant conversation here at NECO? How important is growing the scope of optometry, do you feel?
Scope Expansion In Optometry And Its Impact On Education
First of all, it’s critical. I’ve watched my father, who couldn’t even use diagnostic medications, and look where we are. It’s incredible. That is from the work of so many incredible colleagues who, in many cases, dedicated their careers to ensuring our profession continues to grow. It is critical. Whatever else I say from here, I want to make that clear.
One of the challenges we do have is that the wonderful students we have never lived in a world where they couldn’t write prescriptions for glaucoma, as an example. We often have to give them a little history lesson to say, “Let me remind you of the incredible work that’s been done to get us here. Today, we not only have to look forward, but we’ve got to look back.” You probably know this. Our colleagues in Florida are being threatened to even being able to call themselves doctors. It is a challenge. It is one that this institution plays the biggest role it possibly can.
I’ll mention Dr. Gary Chu. He leads those efforts for us. We are very close to what we call Beacon Hill, right down the street from us, which is our legislative body. We were there, trying to help students appreciate advocacy. We had a group of students from two of the institutions here in Massachusetts, MCPHS and us, and showed them, “This isn’t tough. These are people like you. They want to understand it. What an important thing to learn because wherever you’re going to wind up, we want you to continue to be an advocate. We have to continue advocating for optometry.”
Having said that, from a curriculum standpoint, and Dr. Erik Weissberg, our dean, does an incredible job with this, we have to assure that we’re training to the highest level that’s practiced anywhere. That typically means anywhere in North America, at least. It’s a burden. It’s tough on our faculty. I respect them so much for what they have to do.
Think of it this way. When my dad graduated in 1954, there was a four-year program at NECO. You can imagine the curriculum in 1954 was very different. They were great refractionists. My dad was a master refractionist, but he taught himself slit lamp, BIO, and gonioscopy. That wasn’t anything he learned in school. Fast forward to 2025, where we are, it’s still a 4-year program. It gives you a little sense of what incredible faculty we have.
Granted, we’re going through summers most of the time that we’ve added, but we love it. We love that the scope has increased. We appreciate when people ask, for example, “How come you’re not teaching more business education?” I asked the same questions when I arrived here. The challenge is you’ve got to make sure they’re learning everything to prepare them for the medical side of this wonderful practice. National boards and other boards are not testing in business management. They’re testing to make sure the acumen of knowledge is clear, knowledgeable, and that you meet some criteria that have been set.
If you want to be an entrepreneur, if you want to go into independent practice, there are two major hurdles. One is debt, and the other is that, in most cases, you’ve never run a small business before.
I don’t expect you’re going to see optometry schools increasing the amount of practice management anytime soon. We all do some of it. It wasn’t that long ago when you were a student. Your first 3 years, even part of your 4th year, it’s not that much of a priority. You’re getting through boards. You’re trying to do all the things and passing exams. When you get to your final year and you’re starting to think about a job, then it starts to become important. We have some solutions that could help.
The reality of it is this wonderful expansion scope, which we all love and want to see continue, puts a great deal of pressure on the schools and colleges to ensure every graduate who graduates can practice anywhere they want in the country, in North America, and in the world. I’ll take it one step further. We can influence other parts of the world. We can help raise their standards and raise their scope.
That is something that NECO, which I’m proud of, far before my time has been focused on with these strong relationships all over the world to do that. The World Council of Optometry does good work there, but we’d like to think that at NECO, that’s something that we have helped. We continue to support not only here where we are, which we support every day, but all over the world.
That’s wonderful. I appreciate the insight on the scope expansion and the fact that there is so much to pack into a four-year program, so the students come out with the broadest scope of education and training that they can have clinically. On my list of questions was business classes and business education. To your point, there’s very little of it. You’ve already answered the question. It’s tight to pack it in there.
Let me be clear. To say there’s very little of it, I’m not sure I’m going to go that far. At NECO, and I can only speak of NECO, I believe starting in the back half of your 3rd year and all throughout your 4th year, there is a wonderful course that’s given. It’s pass-fail. You’re out at your rotations all over the world. Your priority is seeing patients and making sure you’re caring for these people. It’s a nice thing to have and a nice thing to do, but it isn’t the top of your priority list.
I don’t want to give the wrong impression. We have some great people who work at every institution, trying to ensure students have some of the basic knowledge about the business of optometry, if you will, but it’s not enough. I’m going to be the first to admit that to you. There’s more we need. The focus on that tends to happen more right before you graduate, in the first couple of years.
I’ll give you a what-if. What if we could create together with the industry a post-graduate business of optometry course? Maybe it’s a one-week course. Maybe it’s a ten-day course. Maybe it’s a two-week course, whatever it may be. No matter what aspect of optometry you’re going into, here are some of the fundamental things that you need to understand. It does a couple of things.
One, no matter where you’re going to be, it’s going to give you that confidence to understand the business side. Two, if you want to be an entrepreneur, if you want to go into independent practice, I believe you have two major obstacles. One is debt, and we’re trying to work hard at that. We can come back to that one. The other is, in most cases, you’ve never run a small business before.
I don’t want that to be the obstacle for people to say, “My choices are now narrowed because I’ve never run a business. I don’t know how to do that.” Together with the industry, we should be able to create something that allows people to feel at least a little bit better knowing, “I’ve got the foundational knowledge. Now, the sky is the limit. I have all the different possibilities.” For us, that’s been critical.
We have to look at debt. Perhaps it’s a little less of an issue, but we have so many Canadian students in the US who are accumulating significant debt. I appreciate that, and it doesn’t go unnoticed. It’s top of mind for me every day. We’ve created some programs that help with that. One’s called sponsored pathways, which says if you make an agreement with a group to join them, there’s a quid pro quo. They’ll help you offset some of your debt. It’s that simple.
Due to supply and demand, as you know from working very much in favor of our graduates, in many cases, they have 4 or 5 job opportunities when they get out. The industry has no problem with that. We have seven groups that are offering such an opportunity. I hope that will continue because the industry should have some skin in the game on this. They’re hiring our great people. They’re helping them to grow either a practice, an organization, or whatever it may be.
The $40,000, $50,000, or whatever a year that it may be, that’s a lot of money. Don’t get me wrong. For them, they’re losing that monthly when they don’t have an optometrist in the office. It’s been a good program. For many of our students, it’s been very helpful. We have to focus on those two issues. This is a North American challenge, not a US challenge.
The debt thing, unfortunately for Canadians, is compounded by the fact that our dollar is significantly weaker. We come to the USA, and whatever the number might end up being that they’re in debt, you generally add about 35%. When we go back home, it looks a little bit worse. One of the questions I wanted to ask you was about industry involvement.
Given your background working in industry at J&J and Essilor, and I know that you have great, strong partnerships and relationships that you’ve brought to NECO to improve the program and connections there, I know that there’s a sentiment out there that perhaps there are two sides to that coin. Is it a bit dangerous to have too many partnerships with industry, especially in an academic setting? There are multiple aspects to this question.
The other end is when students are having these debt relief-type programs with the companies that are providing these, is it taking away from independent private practice? Is that something we have to be conscious of? Is industry then potentially affecting the long-term trajectory of optometry in that regard? Sorry. It’s two pretty big questions.
Industry Collaboration And Its Role In Optometry Education
Let me take the second one first because that one is reasonably clear for me. There is concern. We always have to be mindful of the industry having too much of an impact. Let me say this. One, there is a clear line between the industry in any way impacting our academic program. That crosses the line. That cannot happen.
Going back to the original question, they’re hiring our people anyway. There are lots of reasons why people decide to go into all different practice modalities. We leave the door open and understand there may be lots of reasons why you do that. My argument is why not have them have some skin in the game and help pay for it? It’s already happening.
When I arrived here and as all of my predecessors have seen, there’s a growth of different modalities in which you can practice. Students have a lot of different choices to go a lot of different ways. I don’t hold a grudge against anybody who chooses a certain path. That’s the path they choose that’s already going on. Having them pay for some of the education in addition to that, I have no problem with it all.
I do want to be clear again. There is a limit by which the industry can influence. They do not influence our curriculum in any way, shape, or form. I’ll make a bold statement to you. We cannot achieve the goals we want to achieve in optometric education without the industry. Without their support, and I’m speaking for myself here, we cannot do and aspire to the things we want to do without them. How do we find that good, happy median? I think we have.
Dr. Chu has created something called the Industry Collaborative. If I may say a couple of words about that. If I go back in time, I had said to Gary many times, “If I knew what I know now about optometric education when I was in industry, I could have been much more effective at what I did.” I didn’t know all the intricacies, the challenges, and what was under the hood, if you will.
Gary and I made the decision, “We’re going to create a meeting. We’re going to invite the industry to it, and we’re going to lift up the hood. We’re going to say, “We’re going to show you the good, the bad, and the ugly of what at least our perspective is of optometric education. Most of it is good. We have some challenges, and we want you to help us solve those challenges.”
Gary has done an amazing job. We’re going to be in year 4 or year 5 of this program. When we started it, we thought, “If we have 6 or 8 companies join us, that would be great.” We had 60 companies join us in year one. That has continued to grow. Students are a part of it. Most of the organizations in optometry have been kind enough to show up. The AOA is there. ASCO is there. ARBO is there. NBEO is there.
Everyone represented gives us a wonderful opportunity to say, “How do we pool our resources? How do we collaborate to solve some of the key challenges and talk about some of the sensitive issues that we have?” It’s a way to give my colleagues who are still in the industry side a better perspective of what’s going on. Therefore, they’re going to be able to be better partners.
Having come from that environment, my perspective might be a little more understanding of the value that that brings. It’s immense. I don’t mind saying that I think the industry should have some skin in the game. They should contribute and support what’s going on. Even if it’s self-serving, they need our graduates. At the very least, when you support students in optometry school, when they know they aren’t a great customer for you but you’re doing it because you care, when that company walks into your office, you’re going to open the door and let them in because you remember they were there for you when you were in school.
Honestly, we don’t have a whole lot of problems helping groups understand it. What we have challenges sometimes is there’s something going on seemingly every night at the college. We want to make sure when our partners are putting on programs that they’re well-attended and our students can be there. Other than that, it’s all upside.
You have to have a separation of church and state. That exists and has to exist. As part of our accreditation, it exists. Everybody appreciates and understands that, but that doesn’t mean we can’t build strong partnerships and find ways to support our students, help reduce the debt, and help increase the applicant pool, the things that tend to be the biggest challenges we have.
Maintaining Ethical Boundaries With Industry
That’s been my observation since you come into office as the president and CEO here. You certainly seem to be more open to those types of collaboration.
That can work for you and against you. I remember when I first arrived here, I was asked, “Is this going to be the EssilorLuxotica New England?”
I’ll be honest with you. It wasn’t my feeling or sentiment so much, but I do know that there was a little bit of a concern. At the same time, there certainly seems to be a lot of upside, especially when you’re coming from an era where there was not just a line, but a moat between a school and industry. It seems like you have certainly been one of those people to bring them closer together in other schools. It seems also then that that line may be in some scenarios, not here, has been a bit blurred and there’s some concern.
I know all the deans and presidents in North America. They are very ethical people who care deeply about their institutions and do their best to make sure that they draw that firm line. Some are more welcoming to, as an example, allow people to come into the institution versus doing it off-campus and things like that. You have to allow room for what’s comfortable for everyone and what works for them.
We only have, in the US, three private independent schools left. That’s NECO, ICO, and SCO. Southern College in Memphis and ICO in Chicago, Illinois College of Optometry. I love that environment , o be honest with you, because we don’t answer to a provost. We don’t answer to a university president. We make our own decisions. We live and die by those decisions. We’ve mostly lived. There have been a couple of wounds, but I love that.
If you would’ve talked to people many years ago, they would’ve said private independent optometry school will not survive. I could speak for NECO, but I do know my other colleagues at the other two schools. We’re doing pretty darn well. We’re thriving in many cases. That doesn’t mean it’s easy. That doesn’t mean we’re skating along. It means if you look at the colleges financially and you look at them in terms of faculty, staffing, and the output, I’m very proud of where we are with that. That’s something that is going to make a huge difference.
Gaining an understanding of what is challenging and frustrating for people is only going to help us get better at what we do.
That’s good to hear. Being an alum myself, it’s nice to hear that NECO is thriving. Whenever I get a chance, I try to nudge or direct my students this way. NECO, whether if it was not on their list before as a potential school, it always ends up being on their list. If not, they end up coming here. I’ve had the wonderful full-circle moment of a student who came into my office to observe as an undergrad student who then decided to come to NECO. He now works at my office as an associate doctor. It’s been a very pleasant and fulfilling experience.
Encouraging Feedback From Alumni And The Public
I’m so happy to hear that. Thank you. We appreciate those positive comments. It’s what makes it so that we have students here. When you say nice things about the college, someone who’s influential like yourself, it makes a huge difference. I’ll do anything I can to make sure our colleagues in North America continue to think that way.
I want to say this, too. If someone hears something or has questions about what might be going on at our institution, it’s so rare that I get those questions. I love when I do because I know if one person’s asking me that question, there are probably a lot of people thinking that. If you don’t mind, make sure that my email address is available. This is a simple one, [email protected]. We can make it available.
I’d love to hear from alums. I’d love to hear from anybody. What are your observations? What are you concerned about? Are you hearing things about our specific institution that worry you? We can’t have our eyes everywhere. We try. We welcome that. We love the feedback. Most often, it’s constructive, and it can help us be better. We have an obligation to listen a lot and observe.
When I first came here, I met with every individual who worked at this institution. They got a half an hour of my time to tell me about their job, about their ambition for the college, and about how if you were sitting in my seat, what would you focus your attention on? When you start to hear consistencies, then shame on us if we’re not paying attention to those things.
I would offer the same opportunity for alums and for anybody who’s concerned. I read a lot. Sometimes, it’s tough. They can be a little hard on the academic world, but that’s okay. Getting an understanding of what is challenging and frustrating for people out there only is going to help us to be better at what we do. I encourage your readers to share their thoughts. If you’re an alum of Montreal, Waterloo, or wherever you’re an alum of, if you hear something that you love, tell them you love it. If you hear something you don’t like, give them your feedback. It’s important.
To be honest, few people do it that when you do it, people listen. I used to think nobody would listen, but now that I’m sitting in the seat, I can tell you I might get 10 or 5 a month. I promise you that I’m reading them. Sometimes, it makes for a not-so-great lunch, but I read them. It’s important to get that feedback. I encourage people. We can’t see it through your eyes all the time. Give us your feedback. Give your alma mater feedback about what you’re seeing and hearing. It’s only going to help them to be better.
That’s great advice. I wanted to give you the mic to share any final thoughts. I know that was a very important one to make sure you reach out to your alma mater and let them know thoughts, feedback, and that type of thing. I also was going to ask for your contact information. It’s [email protected].
That’s right.
Are there any other contact points that you think would be helpful for somebody who’s reaching out to the school, whether it be a student?
I’m happy to funnel those to whomever might be the right person to get that information, but to keep it simple, send stuff to me. I have no problem with it. I’ll make sure it gets in the hands of the right person. As far as final words, knowing the Canadian audience, I want to say this to our amazing colleagues and potential students in Canada. NECO will always be a place where we will do everything possible to make sure that you feel comfortable and at home here. I can assure you that. That’s been the culture of our institution for as long as I can remember.
I promise you, as long as I have anything to say about that, it will continue to be the case. If you have any specific questions, we don’t have all the answers, I’ll admit that, but we will do everything we can to get you those answers. Do know NECO is a place where you will always feel at home. We will do everything possible to make sure everyone feels like they belong and they’re welcome at NECO. I look forward to seeing you in Boston.
I love that. That’s the perfect way to end the conversation. That was a great message. Thank you for taking time out of your busy schedule to join me here in this wonderful setup. I want to say a big thank you to NECO, Dr. Gary Chu, and Michael. Thank you for having me here at NECO. Thank you to everybody who’s tuning into the show. I’ll see you guys in the next episode.
