WASHINGTON, D.C.—On Jan. 2, President Joe Biden signed into law the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act. The reform bill is notable for its sweeping list of Veterans Affairs (VA) policies, including adding optometry to the physician pay scale and giving the department the latitude to offer increased pay awards, bonuses and annual evaluations. On December 16, the House passed the bipartisan Act, four days after the Senate passed the comprehensive veterans access and benefits package, sending the bill to Biden’s desk for his signature.

This legislation has long been advocated for by the American Optometric Association (AOA) and Association of Armed Forces and Federal Optometric Services (AFOS) and provides physician-level recognition for Department of Veterans Affairs doctors of optometry, helping better meet veteran demand for eyecare by closing a widening doctor recruitment and retention gap.

“Including the over 1,000 optometrists within the physician pay administration system, the passage of the Elizabeth Dole Act will support VA’s efforts to hire the most qualified providers faster,” said Dr. Jeanette Carbone Varanelli, OD, who served 13 years as chief of optometry at John D. Dingell VA Medical Center prior to joining the Veterans Integrated Service Network (VISN) 10 Clinical Resource Hub. “Raising the entry-level salary and earning potential as a career VA optometrist provides the opportunity to offer a more competitive compensation package to retain providers that understand how to support and care for the unique needs of our nation’s veterans.” 

Vision and eye health care is the third-most requested service by veterans, behind only primary care and mental health care, with VA doctors of optometry providing roughly 70 percent of essential primary and medical eyecare services, the AOA said. Often, the only licensed independent eyecare practitioner available at their site, VA optometrists provide 95 percent of eyecare offered, and they provide 73 percent of the 2.5 million selected ophthalmic procedures and 99 percent of services in low-vision clinics and blind rehabilitation centers, according to the AOA. 

The AOA noted that despite the key role that optometry plays in the delivery of VA health care nationwide, VA optometrists were included in the general schedule (GS) pay scale, which has gone largely unchanged since 1976. When 2004 legislation created a new pay scale for allopathic and osteopathic physicians to remain competitive with private-sector opportunities, dentists, podiatrists and optometrists were initially left out. Over time, dentists and podiatrists were added to the physician pay scale, but optometry remained in the GS pay scale with a pay cap far below that of the private sector in many regions. 

The unfortunate consequence meant numerous vacant optometry positions at VA facilities went unfilled, a problem magnified by the fact that over 20 percent of the VA optometry workforce is at or near retirement, with many having reached the legislative pay cap.

“Moving optometrists to the physician pay scale appropriately recognizes the essential role optometrists play as frontline providers of eye and vision care within the VA health care system,” said Dr. H. Lindsay Wright, OD, AFOS executive director who calls signing of the VA bill a critical step forward for doctors of optometry and the veterans they serve. “This legislation ensures that we can continue to recruit and retain highly skilled doctors of optometry to deliver the quality care our veterans deserve while elevating the profession to where it belongs—alongside our physician colleagues.” 

According to the announcement, the AOA and AFOS have prioritized VA optometry’s pay scale discrepancy as a top federal priority, most recently briefing optometry’s advocates during AOA on Capitol Hill in April 2024. As far back as August 2022, the VA acknowledged the pay discrepancy with a memo that noted optometry’s current salary structure was “inadequate” and that “many VHA Optometry departments were unable to hire VA optometrists,” the AOA said. Leading Veterans Service Organizations (VSOs), including American Veterans (AMVETS) and Disabled American Veterans (DVA), also cast support behind adding optometry to the physician pay scale, so doctors of optometry could receive a market-based pay analysis in determining salaries, the AOA added. 

“VA must immediately address the issue of optometrists at the VA being among the most undervalued practitioners within the system,” said Bill Clark, AMVETS national commander, in March 2024 testimony before the Joint Hearing of House and Senate Committees on Veterans’ Affairs. “Despite their integral role in providing essential eyecare services to veterans, VA optometrists are the only independently licensed practitioners not included on the VA physician pay scales. This oversight has led to a significant and troubling trend: a mass exodus of highly qualified optometrists from the VA and considerable challenges in recruiting top-tier talent.” 

He added that addressing this disparity is essential for maintaining the standard of care that veterans need and deserve, ensuring they have access to the best possible eye and vision health care services.