Licensure by Endorsement

by Sherry L. Cooper, Manager, AOA State Government Relations

It has become apparent to me that many students are under the impression licensure by reciprocity or endorsement will automatically qualify you for a license in a second or third state with no additional rigmarole once you have qualified for, and have been granted, your first or original license. And that you believe this process will be available to you from day one as a practicing optometrist. I hate to be the bearer of bad news but, this is just not true. Let me explain… First a brief description of the difference between reciprocity and endorsement (see box) and second a discussion of why new and nearly new doctors don’t qualify.

As described in the definition, reciprocity just doesn’t exist. And this is true for everybody, not just new graduates. Since reciprocity doesn’t exist, and since reciprocity is inherently unfair in that if you are competent but, simply do not live/practice in a state participating in a reciprocal agreement you would not be able to make use of the process. The American Optometric Association formally supports and strongly encourages the state licensing boards to adopt the licensure by endorsement process. The endorsement process allows each state licensing board to review the qualifications and competencies of each individual applicant from any state, not just from one or two states with which they might have established a reciprocal agreement. There are some states where this process has been adopted, some more true to the spirit of the concept than others.

One of the cornerstones of the endorsement process for well established optometrists (in practice 10-15 years or more) is that those candidates took "an" entry level examination when they obtained their original license. Historically the National Board examination series was not universally required by the state optometry boards quite as early as the national medical exams and some others were required by their licensing boards. Originally all health care professional state licensing boards (medicine, optometry, etc.) administered their own exam when examinations first became part of the requirements for a license (about 60-70 years ago). Eventually most professions developed national uniform and psychometrically valid exams which licensing boards began to delegate their testing responsibilities to. However, in optometry as recently as 13-15 years ago, a good dozen states still did not require the National Boards at that time. So there are a significant number of practitioners today who are only in their 40s who may not have taken the National Boards to obtain their license. But, they did take a test – the one administered by the state in which they were seeking a license. So the endorsement process is a way to allow these otherwise competent practitioners to obtain a license in another jurisdiction without having to take the National Boards – an entry level exam not designed to test established practitioners.

So you ask, how does endorsement work? A state board where endorsement has been adopted looks for certain competencies in each individual applicant. They require that candidates took "an" exam for their original license. They require that candidates have no outstanding discipline, sanctions against their license, loss of license, or other signs that competency could possibly be in question. There are several national data banks licensing boards can query to verify such information.

The only way a licensing board can judge whether you are competent or not by this method is to look for “red flags” that might indicate otherwise. However, you cannot establish a clear and defini-tive good history or track record to assure that you are indeed competent until you have been in active practice a number of years. In most states with the endorsement process this is at least five years of active practice out of the last seven years. Now it becomes more clear why new graduates and recent graduates cannot qualify for licensure by endorsement. You haven’t practiced long enough to know if any red flags are going to become apparent or not.

On the other hand, because today all states require the National Boards, you have already met the licensure requirements in every state and should have little trouble obtaining that second or third license. Unless the state is one of the 12 states that still administers a clinical exam in addition to the National Boards, you must take these exams. Even candidates who qualify for licensure by endorsement must still take these state-administered exams. In the past couple of years Alaska, Arizona, Iowa, and South Carolina have stopped giving state administered clinical exams and we are encouraging the remaining 12 states who still give an exam to do so as well. The only time a new or nearly new graduate may not have already met the licensure requirements in a state is in a state such as Florida which "dates" the National Board scores. And we are working on them in this regard as well.

There is a lot of information on the AOA Web site regarding the licensure by endorsement topic. This topic is a bit more complex than this summary has described and of course there are always exceptions to every rule. So you may want to contact me at SLCooper@AOA.org or 800-365-2219, Ext. 266 if you have any questions. This is one of my favorite topics and I would be more than happy to discuss it with you.

RECIPROCITY – Reciprocity is a relationship that exists when two or more State Boards of Optometry determine that their licensure standards are equivalent; or nearly equivalent, and enter into a contractual agreement granting licenses to applicants from one another’s state.

[NOTE: To our knowledge there are NO true reciprocal agreements between any two or more state boards of optometry.]

ENDORSEMENT – Endorsement is the process whereby the State Board of Optometry has been given authority by the state legislature to assess the equivalency of an individual applicant’s credentials to that state’s own licensure standards, regardless of interstate contractual agreements. Equivalency is ideally defined to mean "equal in effect" vs. "exact duplicate." If the Board determines that the standards are met, licensure is granted. If the Board determines that a candidate’s credentials do not sufficiently meet state standards, the Board may require additional testing, etc. prior to granting licensure. One of the cornerstones of the endorsement process is the possibility for a currently licensed competent practitioner whose license is in good standing to obtain a license in another state without being required to retake examinations designed to evaluate entry-level skills.