UW Gazette, April 9, 1997 "Desperate times" at the school of optometry mean that even students are backing a proposal that would make optometry the first UW program with "differential" tuition fees. The UW board of governors voted last week to ask permission from the province to introduce the new fees this September. With the additional $500 charge, optometry students will face tuition fees of $2,253 per term. "This request reflects the fact that a clinical professional education is very expensive," said the director of the optometry school, Dr. Jake Sivak, when board members wondered why the fee was being proposed. "We're under considerable accreditation pressure to expand our curriculum." The board agreed that "a significant portion" of the new money would go to the budget of the optometry school. Sivak held meetings with students last fall to explain the school's financial position resulting from the latest 15 per cent budget cuts by the provincial government. Not only did optometry students agree with the proposal for an extra $500 per term fee, but, according to Sivak, they "wrote a strong letter of support" for the school's "reluctant decision to alter fees differentially". "The students see this as the only way of stemming the erosion of their program," said the dean of science, Dr. John Thompson, when the proposal came to last week's board meeting. The formal letter of support, dated March 14, was signed by Adam FitzPatrick, president of the UW Optometric Student Society, and Valeria Kao, past president of the Canadian Association of Optometry Students. It reads, in part: "On behalf of the students at the School of Optometry, we would like to express our support for a differential tuition increase. While we are not enthusiastic about the prospect of increased tuition fees, we feel that the damage resulting from shrinking budget costs imposed by the provincial government will do irreparable harm to our program, profession and ultimately the health care of our country. "As the School of Optometry at the University of Waterloo is the only English-speaking School of Optometry in Canada, we realize that our expanding curriculum cannot be sacrificed due to financial cutbacks. In Optometry, the budget situation is further complicated by the increasing role that the Optometrist is playing in the health care system, particularly with respect to the use of therapeutic pharmaceutical agents in the treatment of ocular disease. Unfortunately, these extra skills require extensive train ing, and with the proposed cutbacks, the students will not receive the high quality of education that they require. Despite tremendous support from the profession, through undertaking the School's share of the OHIP clawback, the faculty through their increased teaching loads, dedicated staff, and alumni and optometric industry through their charitable donations, the school cannot withstand the provincial government budget cuts." "It hasn't been an easy thing to deal with," said Sivak. "It's been quite stressful. None of our students are doing cartwheels about this, but I think it's extraordinary that the optometry students are as understanding as they are." Since the school does not have the flexibility of dropping courses or offering them on alternating years, "we can only increase workloads," he said. "In addition, the profession of optometry is expanding," with optometrists in some jurisdictions now authorized to treat eye diseases previously handled by ophthalmologists or general practitioners. "We're a small professional program - expensive to run, especially the clinical component - hit with budget cuts, but with less flexibility in coping with it," Sivak concluded. "We have a good program, we've worked at it for 30 years, with an excellent reputation nationally and internationally. Without this support, we can't continue to do it." According to optometry clinic director Dr. Rodger Pace, the clinic helps to generate a portion of the school's budget through Ontario Health Insurance payments and dispensing fees, but that doesn't support the entire cost of operating the clinic, salaries for the staff and teaching faculty who work in it. "I'm not sure it was ever expected that (revenue) would completely cover the costs," he added. "While operating costs are increasing, for example, OHIP fees haven't in creased since the late 1980s." There have been numerous discussions about how to boost clinic income, said Pace, and over the past couple of years improvements have been made that generated more income, including better promotion of the clinic to the campus community and a 50 per cent discount on dispensing fees for faculty, staff, and their immediate families. Revenue from the differential fees, estimated at about $240,000 a year - before the central budget takes its share, an amount still to be negotiated - will be used to restore the optometry budget item for part-time clinical supervision, and implement the clinic equipment renewal program, said optometry administrator Gary Marx. Supervision ratios at the clinic traditionally run from one supervisor for every two students in the fall of their third year, to one supervisor for every four to five students in their fourth year of the program. To supplement the supervision staff, optometrists from the community have, in the past, been brought in to provide additional part-time supervision. In an effort to deal with budget cuts, an attempt was made last year to change the supervision ratio at the clinic, he said. That cost-cutting experiment proved "unworkable". As well, the line for equipment replacement was eliminated in the 1996-97 budget and the travel budget was axed. The Woolwich optometry clinic, in operation for the past five years, was closed last July, and evening hours were implemented two nights a week at the main clinic in an attempt to increase revenue. "Diagnostic equipment for the clinic should be the latest, leading-edge technology," Marx added. "A lot of it is over 10 years old." He repeated Pace's point: "The clinic is never going to be a self-sufficient environment - not in the foreseeable future. We're doing all we can to make it as revenue-neutral as possible." The total budget of $5 million for the school of optometry includes about $3.8 million from the university budget, as well as revenue of about $1.5 million from the clinic. "We're underfunded by about one million dollars," Marx estimates. Provost Dr. Jim Kalbfleisch said at last week's meeting that the province would be asked to approve the extra fee, quite apart from the general 10 per cent increase students are facing this year, on the same principle as the higher fees now being charged at Ontario's two dental schools. One board member noted that with the $500 addition, optometry students would be paying $2,253 per term in the coming year, "roughly equal" to the $2,178 (including the co- op fee) that engineering students pay. The dean of engineering, Dr. David Burns, said the extra fee isn't, and shouldn't be, associated with students' potential earnings after graduation, or with the idea that they're entering a "profession". So are engineers, he said, and differential fees aren't being contemplated for them. The reason for the unusual arrangement is the high cost of teaching students in a clinical environment, and nothing else, he said. Optometry students begin their four years of study after spending at least one year in general science; many have undergraduate science degrees before starting their work in optometry. The program is not only demanding but already somewhat expensive, as the optometry school's Web pages make clear: "The first two years are devoted mainly to course work in the basic health sciences, optics and visual sciences, as well as general and ocular pathology. In addition, students are introduced to clinical practice. "The third and fourth years continue with academic courses but the emphasis shifts increasingly to clinical training in primary care and specialty services such as binocular vision, contact lenses, electrodiagnostics, low vision, ocular health and sports vision. The internship in cludes rotations through clinics working with special populations such as pediatric, geriatric and developmentally disabled patients. The fourth professional year consists of three, 4 month terms, one of which is spent in the United States. "Optometry students face additional costs above tuition, books and living expenses since they must purchase certain diagnostic equipment and suitable clinic attire. The estimated cost of the program is $12,000 per year." At the April 1 meeting, the board also gave approval to the general 10 per cent fee increase, after brief expressions of opposition from Mario Bellabarba, president of the Federation of Students, and Burton Empey, president of the Graduate Student Association.