ALERT: Florida optometrists gaining ground with recent bill

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No, its really not. Repeat after me: "narcotics are not all that dangerous. They are not even in the top 10 commonly used drugs if ordered by how dangerous they are"

This is ignorance. Please come tell that to nearly all of my patients at the walk-in clinic I've been assigned to this week. Cause I can tell you that 90% of the patients that walk trough the door are pain med seeking, and of the 10-15+ medical problems they have all they are interested in are narcotics, forget the other meds. And all they do is pitch a fit and get super pissed when I'm the one that has to start weaning them off. I'd love to have you come tell them that pain meds aren't dangerous or addicting. It's statements like yours that are solid evidence why we are in a pain epidemic.

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This is ignorance. Please come tell that to nearly all of my patients at the walk-in clinic I've been assigned to this week. Cause I can tell you that 90% of the patients that walk trough the door are pain med seeking, and of the 10-15+ medical problems they have all they are interested in are narcotics, forget the other meds. And all they do is pitch a fit and get super pissed when I'm the one that has to start weaning them off. I'd love to have you come tell them that pain meds aren't dangerous or addicting. It's statements like yours that are solid evidence why we are in a pain epidemic.
Please come tell me the same thing when you're actually a doctor. I can promise you that I am both more aware of the causes and implications of the opioid epidemic and doing more about it than you are, despite your week at the walk-in clinic.

Plus, I never said that they weren't addictive but its not optometrists that are causing that.

Tell you what, why don't you find me any evidence that optometrists' prescribing narcotics have resulted in any addictions or overdoses. I'll wait.

In all my years on this forum, I've seen many variations from the ophthalmologists about various things that ODs have screwed up. You know what I haven't seen? Anything said about a problem owing to pain meds. Heck, our local OD even says he prescribes it a few times per year at most. They aren't the problem. Neither are ophthalmologists, for what that's worth.
 
No

Your argument is incorrect because the 2016 jama article paper does not distinguish the second time procedures as being slt procedures done over the initial slt procedures or rte second slt procedure as being the remaining 180 degrees. This is far from an accurate study if the author is making a leap of faith and assumption strictly by using medicare data on patients that have multiple procedures by an OD. This was further substanriated by the Murray Fingeret paper reaffirming that most ODs preferring to treat 180 degrees and wait to see if desired Iop lowering is achieved. The very obvious benefit to this conservative application of 180 degrees at a time is less IOP increase post operatively because less thermal energy delivered to the eye. So , the claim that ods are doing more "repeat " procedures is false, misleading and simply downright disingenuous. Performing slt on the remaining untouched 180 degrees does NOT constitute a repeat procedure as that remaining trabecular meshwork was never touched in the first place.

Your explanation still doesn't explain the increased rate. It doesn't matter if they're doing the first 180 again or the other 180, the rate is still higher. The options are either not doing it right the first time, doing additional 180 treatment too quickly, or lasering too quickly to make more money. If anything, your lack of good explanation for the higher rate means that you don't understand the findings of the paper nor the procedure.
 
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Please come tell me the same thing when you're actually a doctor. I can promise you that I am both more aware of the causes and implications of the opioid epidemic and doing more about it than you are, despite your week at the walk-in clinic.

Plus, I never said that they weren't addictive but its not optometrists that are causing that.

Tell you what, why don't you find me any evidence that optometrists' prescribing narcotics have resulted in any addictions or overdoses. I'll wait.

In all my years on this forum, I've seen many variations from the ophthalmologists about various things that ODs have screwed up. You know what I haven't seen? Anything said about a problem owing to pain meds. Heck, our local OD even says he prescribes it a few times per year at most. They aren't the problem. Neither are ophthalmologists, for what that's worth.

Lol, last time I checked the letters M.D. after my name meant I'm a medical doctor, but thanks for the insult and attempt to belittle me.

Here is the result of a 2 second google search. Not only did he prescribe high narcotic doses to patients but then had them bring them back in and stole them to feed his own addiction: Charlotte eye doctor pleads guilty in drug scam

Lastly - I don't know what you've done to help the opioid epidemic so I won't assume. But you cannot tell me that giving more unqualified people prescribing power will help.

We agree to disagree and I'll take the conservative, safer route on this argument.
 
1 - Logically the burden of proof falls onto the person with no real experience or training in prescribing narcotics. Harmful until proven otherwise.

2 - No. So the ophthalmologist can make the correct diagnosis and offer the appropriate treatment, lol.

I'm really not trying to be rude or condescending but it's crazy that optometrists can prescribe narcotics. Furthermore no one can offer a great or even reasonable reason why they should be allowed to. I have the feeling this is falling on blind eyes (pun intended) so I'm just stopping before you find something else to haggle about.

I'm confused. Are you an ophthalmology resident?
 
Lol, last time I checked the letters M.D. after my name meant I'm a medical doctor, but thanks for the insult and attempt to belittle me.

Here is the result of a 2 second google search. Not only did he prescribe high narcotic doses to patients but then had them bring them back in and stole them to feed his own addiction: Charlotte eye doctor pleads guilty in drug scam

Lastly - I don't know what you've done to help the opioid epidemic so I won't assume. But you cannot tell me that giving more unqualified people prescribing power will help.

We agree to disagree and I'll take the conservative, safer route on this argument.
My bad, your username has "Medical Student" under it. Might want to change that. Though I am genuinely curious why you spent a week at a walk-in clinic if you're not a student - not trying to be snarky, honestly just curious.

See that guy in your example was doing something criminal. Plenty of MDs do that too. I want you to find an OD who isn't obviously breaking the law for his own financial benefit, is just trying to be a good doctor, and still causes something major problems. Perhaps I wasn't clear, so that's my fault. Trouble is, training has nothing to do with that. Its entirely a matter of criminal versus not. MDs have much more training in this, and yet not a month goes by without an MD pill-mill getting shut down.

I guess I just don't see ODs as being unqualified to be able to prescribe narcotics. There are way WAY more dangerous drugs out there that aren't controlled that I'd rather they not prescribe. I would be much more concerned about an OD (or an ophthalmologist, if I'm being honest) prescribing metformin than I am a few percocet. If you're truly worried about this an no other drugs, do what my state did and have a quantity limit.

Maybe its just that I'm not worried about it. I'm a family doctor and if the NPs and PAs want to be able to write for schedule 2 drug, I don't really care. They aren't the problem with all of this, we are.
 
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My bad, your username has "Medical Student" under it. Might want to change that. Though I am genuinely curious why you spent a week at a walk-in clinic if you're not a student - not trying to be snarky, honestly just curious.

See that guy in your example was doing something criminal. Plenty of MDs do that too. I want you to find an OD who isn't obviously breaking the law for his own financial benefit, is just trying to be a good doctor, and still causes something major problems. Perhaps I wasn't clear, so that's my fault. Trouble is, training has nothing to do with that. Its entirely a matter of criminal versus not. MDs have much more training in this, and yet not a month goes by without an MD pill-mill getting shut down.

I guess I just don't see ODs as being unqualified to be able to prescribe narcotics. There are way WAY more dangerous drugs out there that aren't controlled that I'd rather they not prescribe. I would be much more concerned about an OD (or an ophthalmologist, if I'm being honest) prescribing metformin than I am a few percocet. If you're truly worried about this an no other drugs, do what my state did and have a quantity limit.

Maybe its just that I'm not worried about it. I'm a family doctor and if the NPs and PAs want to be able to write for schedule 2 drug, I don't really care. They aren't the problem with all of this, we are.

Lol fair enough - I can't see the 'medical student' under my name so I just didn't know that was there. It's not showing up on my phone.

I hear what you're saying, I just feel like broadening prescriber power can only lead to more problems. I agree MDs are the major culprit but I'd say it's in part because prescribing narcotics becomes easy, second nature and reflexive when someone has bad pain. We will see these problems over time with anyone who can prescribe potent pain meds, optometrists included. I just don't see the NEED for them to have the ability to prescribe.

Like I said before we agree to disagree and that's fine. I'm signing off from this discussion, I'll let you have the last word. And I'm sorry if I came off being rude or insensitive to anyone, I'm just passionate about patient safety so sometimes I sound aggressive. My bad.
 
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Who put the sarcastic quarter in you.. so looking forward to sitting next to a "professional" like you in the future

I don't think ASCRS allows "Optometric Surgeons" to attend yet so I don't think we'll be able to sit next to each other unfortunately until you become a real surgeon. Maybe as a medical student I'll see you there. I think you'll find it a similar environment to this thread.

And are you ever going to address the point I'm making or just continue to skirt the question and troll this thread?

It's funny how every time someone is trying to make a point in one of these discussions, they always have the most absurd example of incompetence that they saw "just today." It's ALWAYS "just today." And the second statement will always be "yea! I see cases like that EVERY day."

The problem with these discussions is that they always bring out scenarios like this and drives a wedge between the professions. We've all seen mismanaged patients by Optometrists. We've also all seen mismanaged patients to Ophthalmologists. We're not going to bring up the 70 year old MD still operating doing ECCEs on everyone that we all think should re-train or retire. But he's out there too. However the issue is that we know the training he at least initially went through was very rigorous, we know the dense pathology that he mastered in residency because we all went through it, and we know that OD education just simply does not provide what we consider to be an adequate level of training to prepare ODs for the procedures in these bills because although rare most of us have seen complications from these 'simple' procedures.

Lets all be honest - it isn't really a 'patient access' issue when we're talking about YAG, SLT and PRK. All of the arguments about patient access to timely care are fairly absurd. Come on now. If there's not an Ophthalmologist in an area doing those procedures they'd be happy to come to an OD's office a couple of times per month and provide that service I'm sure. Believe it or not we MDs really do have legitimate concerns about patient safety - and that is our primary concern - but we also want to remain the sole provider of these procedures for control as well. I mean ODs already control all of the referrals we get for our most common surgery - cataracts - and we don't want to give you anything else to have us on a leash with.

And I think we all know good and well that many ODs introducing this bill aren't concerned about patient access - they want to do cash-only refractive procedures like YAGs and PRK without having to go medical school and match into an Ophthalmology residency. They want to do SLTs because it seems "easy" and they can make money doing them. These people went to Optometry school and then decided they wanted to be a surgeon and wanted to make a surgeon's salary but didn't want to do the work required to become one or have to deal with any difficult cases. They want their cake and they want to eat it too and have convinced themselves that they know better than those with more training who are saying that they shouldn't do them and despite the fact that there isn't another country in the world where ODs do procedures like this. At least this OD/MD guy is actually doing the right training, despite his trolling. His opinion will change as he progresses in training, if he can match.

I am also sure that there are a minority of ODs lobbying for expansion that really have patient's best interest at heart who really want to be able to offer their patients better care, but I think those ODs are a bit misinformed. KHE's points about control of the Optometry profession do not fall on deaf ears - I understand this issue and I'm willing to bet that this is why most ODs support bills like this. They want to control the future of their own profession, which is a noble goal. But I think State Medical Boards - not Optometry Boards - control access to procedures for all other appropriate medical professions and surgical scope control should fall with State Medical Boards. What ODs need and deserve is a seat at the table and place of prominence in discussions about their privileges. State Medical Boards aren't controlled by Ophthalmologists, they are comprised of multi-disciplinary MDs and DOs and are not maliciously limiting scope of practice for other professions.

That's as honest as I can make my views about this - But nobody is being really honest here because this is politics not reality.

Whatever happens with all of these bills, I hope we can get through this soon. Because if we can't, our two professions are going to tear each other apart. And when we're all too bloodied to work together then nobody wins - patients especially. And while we're fighting each other, both of our reimbursements are steadily declining too.
 
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Ophthalmology might have some credibility if they haven't tried to stop any sort of scope expansion that Optometry has ever put on the table.

In my state Optometrists have been prescribing natcotics for years. Never has been a problem.

And why aren't Ophthalmologists going after PAs or NPs for injection rights? It's absurd to think a NP down the road is more qualified at injecting eyelids and removing lesions than I would be.
 
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And we can all play the game of corrupt/ incompetent examples.

I don't know how many times a local ophthalmologist has convinced patients with limited vision because of ARMD to upgrade the extra $6K for multifocal impants.
 
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And we can all play the game of corrupt/ incompetent examples.

I don't know how many times a local ophthalmologist has convinced patients with limited vision because of ARMD to upgrade the extra $6K for multifocal impants.

That ticks us off too.

But if they're doing that with Ophthalmology training, ODs doing more procedures is arguing that 4 less years of training would have somehow made that LESS likely to happen.

Sidenote - $6k per eye? Is my practice really undercharging for multifocals or something?
 
That ticks us off too.

But if they're doing that with Ophthalmology training, ODs doing more procedures is arguing that 4 less years of training would have somehow made that LESS likely to happen.

Sidenote - $6k per eye? Is my practice really undercharging for multifocals or something?
I believe $6500 for both. But the guy was not very well off and that amount of money was huge for him so it really was upsetting for the guy. But again it's a small percentage of "bad guys" we are talking here.

And for the record I have great relationships with Ophthalmology. But I was in a rural situation where it was 2.5 hour drive to see a retina specialist. So when we saw Ophthalmology lobbying to not let Optometrist's prescribe oral antibiotics it's just silly at this point. And since that time 20 years ago there hasn't been a peep out of them for oral antibiotics or narcotics because there have been zero cases against it.
 
The problem with these discussions is that they always bring out scenarios like this and drives a wedge between the professions. We've all seen mismanaged patients by Optometrists. We've also all seen mismanaged patients to Ophthalmologists. We're not going to bring up the 70 year old MD still operating doing ECCEs on everyone that we all think should re-train or retire. But he's out there too. However the issue is that we know the training he at least initially went through was very rigorous, we know the dense pathology that he mastered in residency because we all went through it, and we know that OD education just simply does not provide what we consider to be an adequate level of training to prepare ODs for the procedures in these bills because although rare most of us have seen complications from these 'simple' procedures.

Lets all be honest - it isn't really a 'patient access' issue when we're talking about YAG, SLT and PRK. All of the arguments about patient access to timely care are fairly absurd. Come on now. If there's not an Ophthalmologist in an area doing those procedures they'd be happy to come to an OD's office a couple of times per month and provide that service I'm sure. Believe it or not we MDs really do have legitimate concerns about patient safety - and that is our primary concern - but we also want to remain the sole provider of these procedures for control as well. I mean ODs already control all of the referrals we get for our most common surgery - cataracts - and we don't want to give you anything else to have us on a leash with.

And I think we all know good and well that many ODs introducing this bill aren't concerned about patient access - they want to do cash-only refractive procedures like YAGs and PRK without having to go medical school and match into an Ophthalmology residency. They want to do SLTs because it seems "easy" and they can make money doing them. These people went to Optometry school and then decided they wanted to be a surgeon and wanted to make a surgeon's salary but didn't want to do the work required to become one or have to deal with any difficult cases. They want their cake and they want to eat it too and have convinced themselves that they know better than those with more training who are saying that they shouldn't do them and despite the fact that there isn't another country in the world where ODs do procedures like this. At least this OD/MD guy is actually doing the right training, despite his trolling. His opinion will change as he progresses in training, if he can match.

I really wish I could convince you all that this isn't about those procedures. YAG used to be a 50/50 chance. With modern techniques, the number of patients I see needing YAG is less than 10%. At least from the two surgeons I co manage with.
Unless I'm looking at the wrong codes, YAG capsulotomy reimburses approximately $350. SLT reimburses about the same. I can sell a pair of eye wear and make more than that without the cost, hassle, follow up visits and liability of a YAG or SLT, simple as they may be.

I'm not sure how much these lasers cost but I imagine they're not cheap. And how many times in a month would I really be able to use it? I like to think that my office is about as "medical" as any optometrist's office out there and it would be a titanic waste of money for me to acquire one of these lasers.

You can't swing a dead cat by the tail in Florida without hitting ten ophthalmologists so I agree it's not a patient access issue. The only potential access issues might be medicaid patient but that's not the thrust of this.

I am also sure that there are a minority of ODs lobbying for expansion that really have patient's best interest at heart who really want to be able to offer their patients better care, but I think those ODs are a bit misinformed. KHE's points about control of the Optometry profession do not fall on deaf ears - I understand this issue and I'm willing to bet that this is why most ODs support bills like this. They want to control the future of their own profession, which is a noble goal. But I think State Medical Boards - not Optometry Boards - control access to procedures for all other appropriate medical professions and surgical scope control should fall with State Medical Boards. What ODs need and deserve is a seat at the table and place of prominence in discussions about their privileges. State Medical Boards aren't controlled by Ophthalmologists, they are comprised of multi-disciplinary MDs and DOs and are not maliciously limiting scope of practice for other professions.

That's as honest as I can make my views about this - But nobody is being really honest here because this is politics not reality.

Whatever happens with all of these bills, I hope we can get through this soon. Because if we can't, our two professions are going to tear each other apart. And when we're all too bloodied to work together then nobody wins - patients especially. And while we're fighting each other, both of our reimbursements are steadily declining too.

I think you are more honest than most and I think there are reasonable ways to come up with scenarios that satisfy both sides if both sides have the political will to do so. It would be nice if we could cooperate more on those issues that do affect us each. I am fortunate that in Connecticut, we rarely run into these issues. Optometry has a wide scope of practice here and just about everyone I know is quite satisfied doing what we're doing.
 
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1 - Logically the burden of proof falls onto the person with no real experience or training in prescribing narcotics. Harmful until proven otherwise.

2 - No. So the ophthalmologist can make the correct diagnosis and offer the appropriate treatment, lol.

Seriously though, I think it would only be wise to have a qualified physician further investigate a patient with severe eye pain before a narcotic is dealt and you'd be careless to disagree.

I'm really not trying to be rude or condescending but it's crazy that optometrists can prescribe narcotics. Furthermore no one can offer a great or even reasonable reason why they should be allowed to. I have the feeling this is falling on blind eyes (pun intended) so I'm just stopping before you find something else to haggle about.
My entire optometry residency at the University of Kentucky Department of Opthalmology/ Lexington VA medical center I had a dea license and narcotic prescribing ability and that was back in 2001.
 
I believe $6500 for both. But the guy was not very well off and that amount of money was huge for him so it really was upsetting for the guy. But again it's a small percentage of "bad guys" we are talking here.

And for the record I have great relationships with Ophthalmology. But I was in a rural situation where it was 2.5 hour drive to see a retina specialist. So when we saw Ophthalmology lobbying to not let Optometrist's prescribe oral antibiotics it's just silly at this point. And since that time 20 years ago there hasn't been a peep out of them for oral antibiotics or narcotics because there have been zero cases against it.

We do have to give some narcotics to our patients after some surgeries, but I barely prescribe them otherwise. To me, prescribing privileges for narcotics isn't that much of a deal to me. In fact, sometimes I wish I didn't have narcotic privileges so that way when my patients demand that I give them a 180 day of hydrocodone I can tell them I cannot legally do that.

Hey, maybe we should let the Florida ODs also get narcotic privileges, we can set up a direct referral train for patients that are allergic to everything but Dilaudid, Benadryl, and max dose hydrocodone and have them take over that portion of their care! Everyone would win, and our clinic flow would be so much better!!! :laugh: (kidding, of course).
 
he troll being my medical colleagues? Sure that sounds about right

No, the troll being you. I've been on this forum long enough to have seen dozens of militant optometrists/ophthalmologist-wanna-bes come and go. Take a hint and stop wasting your time. You will not change any minds on here.


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No, the troll being you. I've been on this forum long enough to have seen dozens of militant optometrists/ophthalmologist-wanna-bes come and go. Take a hint and stop wasting your time. You will not change any minds on here.


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Im sure you and i know all the same people from my training at Bascom Palmer and my tertiary care residency. What are the chances of you and i "hugging it out" and collabarating on continuing education together? We could bridge our professional gap really quickly . Where are you at now ?
 
We do have to give some narcotics to our patients after some surgeries, but I barely prescribe them otherwise. To me, prescribing privileges for narcotics isn't that much of a deal to me. In fact, sometimes I wish I didn't have narcotic privileges so that way when my patients demand that I give them a 180 day of hydrocodone I can tell them I cannot legally do that.

Hey, maybe we should let the Florida ODs also get narcotic privileges, we can set up a direct referral train for patients that are allergic to everything but Dilaudid, Benadryl, and max dose hydrocodone and have them take over that portion of their care! Everyone would win, and our clinic flow would be so much better!!! :laugh: (kidding, of course).
I've only had to prescribe it a couple times ever. But the time where a patient was almost vomitting in my trash bin because of the pain of a corneal abrasion I gave them a RX to get them through the night (yes and a bandage lens). Better that then them to go to the NP at urgent care and get a supply later when I didn't give them anything.

I think MDs should look inward when trying to put blame on the opiod epidemic.
 
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Where are these procedures done? Are optometrist buying or leasing the equipment? Assuming getting privelages at a surgery center is out of the question? Outside of academic centers how is this profitable for them?
 
Where are these procedures done? Are optometrist buying or leasing the equipment? Assuming getting privelages at a surgery center is out of the question? Outside of academic centers how is this profitable for them?
You can rent lasers. MD I worked for did that for his LASIK laser.
 
T
You can rent lasers. MD I worked for did that for his LASIK laser.
There are several "open access" surgery centers that cost anywhere from $600 to $900 as our cost basis. I have a choice of seven visx s4 lasers to choose from. Ive not yet used the alcon but may after the alcon alegretto certification. Eyefixer why dont you come join me and sit in on a few procedures so we can bridge the gap on our differences???
 
Im sure you and i know all the same people from my training at Bascom Palmer and my tertiary care residency. What are the chances of you and i "hugging it out" and collabarating on continuing education together? We could bridge our professional gap really quickly . Where are you at now ?

Zero chance. I have never been or even interviewed at BP. But I would be happy to testify against your "optometric surgical outcomes" in a court of law :)


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I really wish I could convince you all that this isn't about those procedures. YAG used to be a 50/50 chance. With modern techniques, the number of patients I see needing YAG is less than 10%. At least from the two surgeons I co manage with.
Unless I'm looking at the wrong codes, YAG capsulotomy reimburses approximately $350. SLT reimburses about the same. I can sell a pair of eye wear and make more than that without the cost, hassle, follow up visits and liability of a YAG or SLT, simple as they may be.

I'm not sure how much these lasers cost but I imagine they're not cheap. And how many times in a month would I really be able to use it? I like to think that my office is about as "medical" as any optometrist's office out there and it would be a titanic waste of money for me to acquire one of these lasers.

You can't swing a dead cat by the tail in Florida without hitting ten ophthalmologists so I agree it's not a patient access issue. The only potential access issues might be medicaid patient but that's not the thrust of this.

I think you are more honest than most and I think there are reasonable ways to come up with scenarios that satisfy both sides if both sides have the political will to do so. It would be nice if we could cooperate more on those issues that do affect us each. I am fortunate that in Connecticut, we rarely run into these issues. Optometry has a wide scope of practice here and just about everyone I know is quite satisfied doing what we're doing.

I agree that there should be some solution whereby Optometrists are given greater control of their profession in the age of expanding roles in Optometry. And there should be some solution we can all agree on. But it seems like instead we getting bills that let a few Optometrists in a 'battle ground State' that end up making us all fight each other for a while and after all the dust settles a few ODs make a nice profit off of doing refractive surgery and nothing else really seems to change much. In Oklahoma are there vast sums of ODs 'going medical' in the last 15 years? I doubt it. But that's what we really need - a true expansion of Optometrists as medical care providers, not as proceduralists. And also better ways to enable ODs and MDs to work hand in hand in the management of surgical patients. We should be able to do that without all of us MDs feeling like ODs are pushing for a 'slippery slope' into being back-door MDs. I feel like these bills hinder more than hurt that cause though. That's my $0.02. Hopefully relations improve some day.


You are a douschebag
Who put the sarcastic quarter in you.. so looking forward to sitting next to a "professional" like you in the future

:poke:
 
Professionalism will be maintained, by ALL parties in this thread. If not, it will be closed.
 
Professionalism will be maintained, by ALL parties in this thread. If not, it will be closed.
oh god close it. please close it. the name dropping is almost worse than the trolling at this point. many pathetic posts in here.

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why are ophthalmologists so opposed to creating an MD route for optometrists such as in dentistry and oral surgery?

Optometrists could apply to 10-15 specific slots across the country and if accepted, they would complete 2 years of medical school and complete an ophthalmology residency.

I think this is the long-te rm solution which would be best for everyone. Otherwise these fights will never end.
 
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why are ophthalmologists so opposed to creating an MD route for optometrists such as in dentistry and oral surgery?

Optometrists could apply to 10-15 specific slots across the country and if accepted, they would complete 2 years of medical school and complete an ophthalmology residency.

I think this is the long-te rm solution which would be best for everyone. Otherwise these fights will never end.

This seems much more reasonable than simply passing legislation to expand scope of practice with the only additional training being weekend courses.

The problem is, with only 10-15 additional spots, would Optometrists as a whole be OK with this? I dont foresee even a program like this slowing down the Board of Optometry from continuing to push scope of practice expansion for optometrists who are not accepted into these programs


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why are ophthalmologists so opposed to creating an MD route for optometrists such as in dentistry and oral surgery?

Optometrists could apply to 10-15 specific slots across the country and if accepted, they would complete 2 years of medical school and complete an ophthalmology residency.

I think this is the long-te rm solution which would be best for everyone. Otherwise these fights will never end.

That seems reasonable, but we don't need to supply 15 more Ophthalmologists per year. I'd vote for bridge programs if we agreed to close a couple of the weakest programs and replace them with bridge programs elsewhere, but that would be a tough sell probably. I doubt there would be many people against such programs.

I also doubt it would accomplish much of anything, though.
 
That seems reasonable, but we don't need to supply 15 more Ophthalmologists per year. I'd vote for bridge programs if we agreed to close a couple of the weakest programs and replace them with bridge programs elsewhere, but that would be a tough sell probably. I doubt there would be many people against such programs.

I also doubt it would accomplish much of anything, though.
As others have mentioned, it's not really about the procedures themselves rather optometrists ability to control and regulate themselves. I don't think this would accomplish anything despite how reasonable it sounds
 
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Get a grip on reality. No one profession has a lock on knowledge or exclusivity towards said knowledge. As an OD and med school student these comments are both arrogant and condescending. Been at Bascom Palmer. Did my optometry residency side by side the Ophthalmology residents at University of Kentucky. Both PRK certified, SLT certified, and YAG. Come on fellas these arent difficult procedures to do. My best friend is a DO dermatologist in Broward county and he like myself will be testifying in support of the bill. I hope I am not called an "optom" when i interview for residency programs in a few years as its rude, unprofessional and condescending. Check those egos in at the door people. I AM paying my way through med school on my PRK surgeries i perform in the summer between classes. Lets drop this "uncle tom" nonsense right now.

Honestly, you sound like a troll. Your post history is essentially limited to this thread where you look to fight with us.

Also, why are you fighting SO hard with us if you are now in medical school? Did I miss something? If you think optometrists are so skilled and that the training has prepared you so well to be a healthcare provider that understands anatomy and pathophysiology on the same level as an MD, then why are you even going to medical school? So that you can do surgery? What if you can't even get an ophthalmology residency. Will you be happy as a doctor in another specialty ? I hope you thought about that. I imagine you are >35-40 years old. Age comes up in interviews.

None of this seems well thought out to me

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As others have mentioned, it's not really about the procedures themselves rather optometrists ability to control and regulate themselves. I don't think this would accomplish anything despite how reasonable it sounds
A bridge program is what i suggested as well. If the ophthalmology truly wants a say in this our profession has extended that courteousy. But because of the "my way or the highway approach" ophthalmology keeps losing its place at the negotiating table. Compromise is a difficult thing when your ego cannot fit through the door
 
A bridge program is what i suggested as well. If the ophthalmology truly wants a say in this our profession has extended that courteousy. But because of the "my way or the highway approach" ophthalmology keeps losing its place at the negotiating table. Compromise is a difficult thing when your ego cannot fit through the door

For someone who wants to become an ophthalmologist, you don't seem to have much respect for many people in the field.

I don't foresee a bridge program starting because there really isn't a need for a large influx of new providers. I actually think ophthalmology is ahead of the curve in terms of addressing patient access issues--teleophthalmology, deep learning algorithms, etc--when compared to other specialties.

I would be interested to know how the bridge program for OMFS started, if anyone knows.
 
This seems much more reasonable than simply passing legislation to expand scope of practice with the only additional training being weekend courses.

The problem is, with only 10-15 additional spots, would Optometrists as a whole be OK with this? I dont foresee even a program like this slowing down the Board of Optometry from continuing to push scope of practice expansion for optometrists who are not accepted into these programs


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This is a 100% accurate. If Florida wanted to do this, I'd work to train the surgery candidates. I'd ask my good friend and mentor Dr. Lew Grodin who is at the USF Tampa and Lasik Plus. Worked with him for several years and I directly pinpoint my PRK eye surgery skill and acumen and comfort to working with a man of his stature and educational caliber. Ophthalmology is pissed because it feels like we areby passing them. But, it's not like both ophthalmology and optometry have not offered to compromise on this whole issue. It's just that there are too many people with "take it or leave it egos" on this forumn and in the profession that would know compromise it fell out of the sky and landed on their face and started to wiggle. I think this is a great idea but to do that both sides have to be willing to sit down and Dr. Katz and company don't seem to be in that mode of speaking at all right now. What could be done to bring both sides to the table?
 
OMFS is often a 6 year residency. Residencies vary, but generally it's 2 years of medical school (MSII & MSIII). All core rotations are done, and there are no elective rotations allowed, they are to be spent in OMFS. The other 4 years are general surgery internship and residency.
I think it is worth noting that an MD is NOT required for OMFS. There is a 4 year option which does not involve medical school, as well as the 6 year option noted above. So it is not necessarily a "bridge" program. If you match into a 6 year OMFS program, that comes with the understanding that you will be a student for the required years.
 
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For someone who wants to become an ophthalmologist, you don't seem to have much respect for many people in the field.

I don't foresee a bridge program starting because there really isn't a need for a large influx of new providers. I actually think ophthalmology is ahead of the curve in terms of addressing patient access issues--teleophthalmology, deep learning algorithms, etc--when compared to other specialties.

I would be interested to know how the bridge program for OMFS started, if anyone knows.
My respect is diminished from seeing the ugly side of ophthalmology behavior over these last 15 years. Worked quite extensively within Lasik Plus and saw the number one volume surgeon in Lasik Plus still keep his license after being HIV positive in Minnesota after discovering pictures of barely legal boys on his surgery room computer. Watched Dr. Mendelson get out of jail and keep his license after felony charges relating to the Florida Democratic party. Watched the Dominican ophthalmologist in Florida who is about ready to start his trai shortly for Medicare fraud. I'm sorry if it comes across as not respectful but nearly every ophthalmologist I've worked with in the past does not know the meaning of personal boundaries. I once looked up to them as role models when I first got out and no longer do so. My favorites and best friends within ophthalmology are Dr. Jeff Robins, Dr. Lew Grodin, Dr. Tim Murray, Dr. Andsrew Huang, and Dr. Budenz; these are absolutely fabulous people and fabulous doctors. They truly respected optometry and are widely admired because of their impartiality and willingness to educate optometry. But, then I hear ophthalmologists calling people like them "Uncle Tom's." And when I hear such audacious behavior I will not look up to such disgusting behavior. I've been testified against in a malpractice suit by an ophthalmologist when a patient developed a craniopharyngioma six years after the original lasik eye surgery. Everyone who touched the chart got hauled in on the lawsuit. The so called expert witness was Dr. Insler , of the Lasik Vision Institute. His testimony was to say that we should have caught the craniopharyngioma back in 2008. We had a fabulous ophthalmology witness, one of the main EDITORS of refractive surgery news, on our side who said it was absolutely impossible to have picked up the craniopharyngioma back in 2008 (symptoms developed in 2013 - 2014). One OMD had to crush the testimony of Dr Insler's so called "expert opinion." Eventually everyone who touched the chart was released from the lawsuit. But, yet again another ophthalmologist doing whatever it took to make a buck even not giving fully accurate medical testimony. So, to answer your question, no I don't have a high regard for my future colleagues because I've seen disgusting behavior over the last 15 years. It's a Dr. Jekyll and Mr. Hyde profession undoubtedly and ophthalmology has done nothing AT ALL to change these audacious behaviors. When ophthalmology gains a moral compass and moral fortitude then maybe my opinion will change. I highly doubt that will happen any time soon.
 
OMFS is often a 6 year residency. Residencies vary, but generally it's 2 years of medical school (MSII & MSIII). All core rotations are done, and there are no elective rotations allowed, they are to be spent in OMFS. The other 4 years are general surgery internship and residency.
I think it is worth noting that an MD is NOT required for OMFS. There is a 4 year option which does not involve medical school, as well as the 6 year option noted above. So it is not necessarily a "bridge" program. If you match into a 6 year OMFS program, that comes with the understanding that you will be a student for the required years.
Thanks. Do you know the origin of those programs? i.e. did it come out of large need for new providers?
 
My respect is diminished from seeing the ugly side of ophthalmology behavior over these last 15 years. Worked quite extensively within Lasik Plus and saw the number one volume surgeon in Lasik Plus still keep his license after being HIV positive in Minnesota after discovering pictures of barely legal boys on his surgery room computer. Watched Dr. Mendelson get out of jail and keep his license after felony charges relating to the Florida Democratic party. Watched the Dominican ophthalmologist in Florida who is about ready to start his trai shortly for Medicare fraud. I'm sorry if it comes across as not respectful but nearly every ophthalmologist I've worked with in the past does not know the meaning of personal boundaries. I once looked up to them as role models when I first got out and no longer do so. My favorites and best friends within ophthalmology are Dr. Jeff Robins, Dr. Lew Grodin, Dr. Tim Murray, Dr. Andsrew Huang, and Dr. Budenz; these are absolutely fabulous people and fabulous doctors. They truly respected optometry and are widely admired because of their impartiality and willingness to educate optometry. But, then I hear ophthalmologists calling people like them "Uncle Tom's." And when I hear such audacious behavior I will not look up to such disgusting behavior. I've been testified against in a malpractice suit by an ophthalmologist when a patient developed a craniopharyngioma six years after the original lasik eye surgery. Everyone who touched the chart got hauled in on the lawsuit. The so called expert witness was Dr. Insler , of the Lasik Vision Institute. His testimony was to say that we should have caught the craniopharyngioma back in 2008. We had a fabulous ophthalmology witness, one of the main EDITORS of refractive surgery news, on our side who said it was absolutely impossible to have picked up the craniopharyngioma back in 2008 (symptoms developed in 2013 - 2014). One OMD had to crush the testimony of Dr Insler's so called "expert opinion." Eventually everyone who touched the chart was released from the lawsuit. But, yet again another ophthalmologist doing whatever it took to make a buck even not giving fully accurate medical testimony. So, to answer your question, no I don't have a high regard for my future colleagues because I've seen disgusting behavior over the last 15 years. It's a Dr. Jekyll and Mr. Hyde profession undoubtedly and ophthalmology has done nothing AT ALL to change these audacious behaviors. When ophthalmology gains a moral compass and moral fortitude then maybe my opinion will change. I highly doubt that will happen any time soon.

Everyone knows ****ty doctors. It sounds like you are losing respect for the whole specialty on the one hand, but then on the other you list some pretty awesome guys.... so I'm a little confused

Also, while I can't put words in anyone's mouth, just because those doctors treated you with respect does not mean they don't think optometrists shouldn't be able to perform certain procedures or expand their scope of practice. Many times, even if a physician is generally outspoken they aren't going to express some views to you that you as an optometrist may find offensive. It's counterproductive to your work relationship and doesn't benefit anyone.

I've dealt with plenty of optometrists who are great and practice within their scope and then I've also seen horror story referral that were sent waaaay too late. Does that mean I think all optometrists suck and I'm going to start bashing them on this website? No. But you repeatedly sound like you have a disdain for ophthalmologists, even if Tim Murray is your best bud. Sounds like you have an inner conflict...

Also, give it up with the name dropping. It's creepy.

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So there are different theories or reasons behind it. I'm not COMPLETELY informed on the matter, but I'll share my knowledge that I have.
OMFS involves major surgery. For example, a LeFort. They also deal with oral squamous cell carcinomas frequently. Obviously there is alot more within their scope, but these are examples. Anyway, around 30 years ago there were issues with malpractice insurance; companies wanted the docs in the OR to have MD's. As a result, many of these integrated programs arose.
Today, the MD is NOT required. As an example, each of the branches of the military have their own, accredited OMFS residency programs. They are all 4 year programs. They don't NEED 6 year grads. For those that pursue that route these days, it can be any combination of reasons. One does not significantly affect scope of treatment over the other. Plenty of people graduate dental school today and go on to be excellent surgeons after 4 years of training. It's also worth noting that although it's a dental specialty, it is a medical residency, so it is funded.
I don't really think any of it arose out of a need for providers, but more out of a need to bypass red tape so they can function as a profession. Oral and Maxillofacial Surgeons are by definition, surgeons. If they aren't allowed to operate, they need to find a way to address the problem, which they did.
 
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But, it's not like both ophthalmology and optometry have not offered to compromise on this whole issue. It's just that there are too many people with "take it or leave it egos" on this forumn and in the profession that would know compromise it fell out of the sky and landed on their face and started to wiggle.

The concessions are always on the part of Ophthalmology. When was the last time Optometry ever compromised on anything? Their general strategy every legislative year is to ask for the moon and stars knowing that they will only get a few of the items. For example, they ask for all types of surgery all the while knowing this will piss everyone off. Then they turn around and say "ok, ok, we will be reasonable and just take SLT then." When was the last time that Optometry had to give up anything to another field? Give up glasses prescribing rights to opticians or technicians then.

Here's a great idea. Have Ophthalmology and Optometry create this "training bridge" program for 15 Optometry students. In exchange, Optometry should close down half of their schools. That will solve two problems at once (ie, Optometry scope expansion and the oversupply of optometrists).
 
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The concessions are always on the part of Ophthalmology. When was the last time Optometry ever compromised on anything? Their general strategy every legislative year is to ask for the moon and stars knowing that they will only get a few of the items. For example, they ask for all types of surgery all the while knowing this will piss everyone off. Then they turn around and say "ok, ok, we will be reasonable and just take SLT then." When was the last time that Optometry had to give up anything to another field.

Here's a great idea. Have Ophthalmology and Optometry create this "training bridge" program for 15 Optometry students. In exchange, Optometry should close down half of their schools. That will solve two problems at once (ie, Optometry scope expansion and the oversupply of optometrists).

For sure. Optometry school is turning into the new law school bubble.
 
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Yup the fundus photos are "HD Retinal Imaging" and FDT fields are "brain tumor tests." Cash only, of course.

My other favorite thing is that glaucoma suspects come in q2-3 months for exams. I just had a patient today who I inherited from an optom in another state. C/D 0.6, 89 years old with pre-treatment IOP of 16. The treatment plan (which had been going on for years):

"f/u 2 months HVF
f/u 4 months OCT
f/u 6 months Photos
f/u 8 months glasses/comp" ... repeat repeat repeat

In all of the years of this testing had never been a documented HVF defect or thinning anywhere on OCT.

Since we are telling fun stories...

My favourite was the lady I recently saw being treat for several years for primary open angle glaucoma with a prostaglandin analogue. Except when I met her she was in angle closure in one eye. The other eye was narrow. I guess Gonio isn't part of the glaucoma standard of care?

Oh and Optos is great... except when someone doesn't know how to interpret artifact or distortion in the peripheral retinal photo. That's why I was up in the middle of the night backing up the first year doing a scléral depressed exam on absolutely nothing. Of course the patient was already freaking because she was told she had an RD...


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Since we are telling fun stories...

My favourite was the lady I recently saw being treat for several years for primary open angle glaucoma with a prostaglandin analogue. Except when I met her she was in angle closure in one eye. The other eye was narrow. I guess Gonio isn't part of the glaucoma standard of care?

Oh and Optos is great... except when someone doesn't know how to interpret artifact or distortion in the peripheral retinal photo. That's why I was up in the middle of the night backing up the first year doing a scléral depressed exam on absolutely nothing. Of course the patient was already freaking because she was told she had an RD...


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I feel like we could start a pretty successful thread with these kinds of stories....
 
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I posted this in the NC thread as well; the only way NC physicians got through to legislatures for a similar bill was to voice the concerns of patients. Here is how they did it:

Poll: N.C. Voters Strongly Oppose HB 36

Legislatures will be inundated with ophthalmologists and optometrists voicing their opinions... they need to hear from patients.
 
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I posted this in the NC thread as well; the only way NC physicians got through to legislatures for a similar bill was to voice the concerns of patients. Here is how they did it:

Poll: N.C. Voters Strongly Oppose HB 36

Legislatures will be inundated with ophthalmologists and optometrists voicing their opinions... they need to hear from patients.
So would you recommend all of my patients that successfully had laser eye surgery from me contact them regarding its efficacy and safety then my colleague and my friend???
 
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So would you recommend all of my patients that successfully had laser eye surgery from me contact them regarding its efficacy and safety then my colleague and my friend???

Absolutely. This is not a one sided argument.
 
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Absolutely. This is not a one sided argument.

This article explains why so many professionals in both optometry AND the medical community KNOW that the study published in 2016 by the JAMA was a sham, a false front for political purposes. This is the part of medicine that makes me sick to my stomache. Bending, manipulating and twisting medical data for political purposes. Happens all the time in eye care though. I remember being a part of the big Restasis and lasik surgery outcomes study back in 2007 to 2008 at Lasik Plus Tampa. Every single one of the patients got Restasis ahead of the surgery to evaluate if Restasis influenced final outcome procedures. It's a shame that educated professionals manipulate to this degree to get their way. With no major adverse outcomes on over 25,000 laser procedures the success rate speaks for itself. Yet, pride, ego and arrogance are really at the heart of this issue AND maintaining monopolistic competition. The bigger the degree the more the lying. This JAMA 2016 article was ripped apart by both MD's and OD's alike and yet OMD's push it down the throats of unsuspecting citizens and legislators.. Not alot of pride in a future profession when the truth just cannot be told..Eye Docs Push Back On NC Surgery Bill
 
Yet, pride, ego and arrogance are really at the heart of this issue AND maintaining monopolistic competition. The bigger the degree the more the lying. This JAMA 2016 article was ripped apart by both MD's and OD's alike and yet OMD's push it down the throats of unsuspecting citizens and legislators.. Not alot of pride in a future profession when the truth just cannot be told..Eye Docs Push Back On NC Surgery Bill

Again, this is not a pride or ego issue. The most humble Ophthalmologists I know are not in support of bills such as these.

And you posted a comment on that article using your public facebook account. You may wish to remove that. You continue to over-expose yourself and your colleagues who you reference by name. It is your choice to have a public online identity but your acquaintances may not wish to be referenced so often.

I also disagree with your comment on that news article that these procedures are "mind numbingly easy to perform" and "a push of a button." Those are your words, and to mislead the public to believe that a procedure such as refractive surgery is simple is far more manipulative than insinuating that re-op rates are higher for ODs than MDs. If you actually have done PRK I hope you realize that holding down the button on the excimer is not the difficult part of that surgery.
 
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