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    A tale of two state boards


    State B exam

    I showed up the next day with my wife as a “patient” (every candidate had to supply one to sit for someone else’s exam).

    She had 6 mm pupils, crystal-clear media, and every line of the eye chart memorized from all the times she sat for my practice exams during school.

    Somebody else brought an older woman with 2 mm pupils and moderately dense nuclear cataracts.

    Most of the stations seemed to go fine.

    I could not help noticing that some examiners joked and chatted amiably with certain candidates while I got nothing but stares and cold shoulders.

    I came to the final station: retinoscopy and subjective refraction. The older woman with tiny pupils and cataracts was in my chair.

    Related: Growing up in optometry and carving my own path

    It was the refraction from hell.

    No matter how low I turned the lights, I could not get her pupils to dilate wide enough to scope through her cataracts. To make matters worse, she was a slow responder.

    Three nerve-wracking weeks passed, and I finally received word that I had failed the exam by less than a point. I had bombed refraction, which brought my average just below the passing threshold.

    I was stunned, disoriented, and angry. I suspected the older woman had been a plant intended to trip me up. I thought about lodging a protest and even ran the idea by my residency mentor.

    “Don’t do that,” he said. “Just learn from it and move on.”

    Come winter, I turned my sights toward a license in State C. State C had a great therapeutics law but also a board exam with an oral section that was reputed to be among the toughest in the country.

    State C exam

    When I showed up for the State C exam, nobody asked me anything about my personal business. It was just a straight-up exam, and yes, it was hard.

    But it was also fair.

    Toward the end of one of the oral stations, I had answered the board members’ questions to their satisfaction and actually expounded on the topic a bit. I related new information I learned from a corneal specialist who had supervised me during my residency.

    The board members were generally curious and wanted to know more. I would stop well short of calling it a “Jesus in the temple with the elders” moment, but I think it is fair to say we engaged in some collegial repartee.

    About a month later, I received word that I had passed State C’s exam with an overall score of 97.

    No two exams are alike

    The validity, reliability, and fairness of state board exams have generally improved since my time.

    Related: Six eye health tips for college students

    There may still be glitches and outright protectionism in some places, but more state boards than ever now accept the National Board Exams in lieu of its own less-standardized tests—in addition to a state law exam.

    That progress is more in line with our fellow health professions and a boost to optometry’s credibility.

    In the grand scheme of things, my failure in State B was little more than the professional equivalent of a stubbed toe with a couple of days of swelling.

    Even though I have never practiced in State C, I have kept my license active, partly because I am proud I passed its tough exam, but also out of respect for my colleagues there who treated a young OD with respect and gave him a fair shake.

    My curiosity got the best of me as I was writing this story. I peeked and checked to see what I would need to do at this point in my career to get a license in State B.

    Aside from a lot of money, the usual law test, and multiple administrative hoops to jump through, it turns out I would only have to pass a one-question test:

    Why do you wish to be admitted to practice in State B?

    I think somebody is still worried about “them thar chains.”

    Read more from Dr. Brown here

    Michael Brown, OD, MHS-CL, FAAO
    Dr. Brown has practiced medical optometry in a comanagement center and with the U.S. Department of Veterans Affairs Outpatient Clinic in ...


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