Critics of Optometry

[IndianaOD]

Dear ODs and OD students,

Don't believe the propaganda of naysayers. Optometrists are highly trained and educated professionals. (not allowed to practice up to their level of training) It is fully reasonable to believe that optometry should change and evolve as science and technology changes the face of medical care. I thought this summery found in a legistalive debate and publicly available would be interesting:

Optometry degree curriculum vs. medical degree curriculum
The New England College of Optometry (NEWENCO)
Dartmouth Medical School (DHMC)

"Optometrists must take almost all of courses that medical doctors do to complete their degree. Optometry students take more pharmaceutical courses than medical students. Also, optometry students must take additional, extensive, course work in the specialty of eye care during their four years, therefore, optometry students graduate with a higher number of credit hours than medical students. In addition, the information below shows that graduating optometrists are tested on this knowledge by a uniform national standard."

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[deuist]

OD's receive more training in eye care than a typical medical student. Hence, people should get their glasses from optometrists and not family physicians. No one has ever suggested otherwise. However, you've got a long way to go before trying to compare optometrists to ophthalmologists.

 

[cunikki]

I know i am biased because i am going to optometry school but i would just like to share a quick story. I had been going to an opthalmologist all my life because i was on my parent's insurance plan and that is where they went. This OMD prescribed me -6.00 DS glasses for both eyes at my last appointment, which was up a little more from my previous prescription. He was unable to refract me down to 20/20 even with this increase and so he sent me to get a topography scan. on the bottom of this scan was a number that indicated a high likelihood i had keratoconus. based on this he brought me back in and told me i had keratoconus and he was unable to get me to 20/20 and in all likelihood i would need corneal transplants because my vision would get progressively worse. this was in the summer before i started od school. when i got to school we had mandatory exams by third year students. the student got me down to 20/15 with a -4.75 prescription and some cyl in each eye. the student and the staff doctor on hand both looked at my eyes and determined there was no sign of keratoconus.
basically this omd had no freaking clue how to refract and gave out medical diagnoses based on a machine. i am not saying that all OMDs are like this but really... if you think OMD are superior to ODs in all sense you are out of your mind!!!!!!!!!!
There are many many things that ODs are far superior at, from refraction to contact lens fitting to vision therapy.... etc. just because you have a medical degree does not make you good at any of those things. It is definitely highly stressed at my school that we can be just as good at ocular disease treatment and prevention while far superior at other things that OMDs might consider soft forms of practicing. The letters MD behind your name are really not anything special.

 

[KHE]

I know i am biased because i am going to optometry school but i would just like to share a quick story. I had been going to an opthalmologist all my life because i was on my parent's insurance plan and that is where they went. This OMD prescribed me -6.00 DS glasses for both eyes at my last appointment, which was up a little more from my previous prescription. He was unable to refract me down to 20/20 even with this increase and so he sent me to get a topography scan. on the bottom of this scan was a number that indicated a high likelihood i had keratoconus. based on this he brought me back in and told me i had keratoconus and he was unable to get me to 20/20 and in all likelihood i would need corneal transplants because my vision would get progressively worse. this was in the summer before i started od school. when i got to school we had mandatory exams by third year students. the student got me down to 20/15 with a -4.75 prescription and some cyl in each eye. the student and the staff doctor on hand both looked at my eyes and determined there was no sign of keratoconus.
basically this omd had no freaking clue how to refract and gave out medical diagnoses based on a machine. i am not saying that all OMDs are like this but really... if you think OMD are superior to ODs in all sense you are out of your mind!!!!!!!!!!
There are many many things that ODs are far superior at, from refraction to contact lens fitting to vision therapy.... etc. just because you have a medical degree does not make you good at any of those things. It is definitely highly stressed at my school that we can be just as good at ocular disease treatment and prevention while far superior at other things that OMDs might consider soft forms of practicing. The letters MD behind your name are really not anything special.

Try to resist the urge to point out anectdotal cases of misdiagnosis on either side of this issue because they really prove nothing and only serve to needlessly inflame the passions of both sides of this debate.

Yes, we've all seen cases of 20/25 cataracts being operated on and we've all seen the 20/50 patient with a diopter of uncorrected cyl that was told "there's nothing wrong with you."

But spend sometime in any ophthalmology clinic and you'll see just as many weird referrals or strange diagnoses from ODs.

One of the things you will find when you start practicing is that you are going to encounter patients that have seen other docs and been given a particular diagnosis that makes you really scratch your head. You're going to wonder "what was s/he thinking?" Fact is, that doctor is going to see just as many of YOUR patients and be thinking the same thing about you. And half the time on both sides, it was the PATIENT who told that other doctor something completely different than what they told you.

So again, resist the urge to post your anecdotes about other doctors. It accomplishes nothing, and it proves nothing.

 

[exmike]

Dear ODs and OD students,

Don't believe the propaganda of naysayers. Optometrists are highly trained and educated professionals. (not allowed to practice up to their level of training) It is fully reasonable to believe that optometry should change and evolve as science and technology changes the face of medical care. I thought this summery found in a legistalive debate and publicly available would be interesting:

Optometry degree curriculum vs. medical degree curriculum
The New England College of Optometry (NEWENCO)
Dartmouth Medical School (DHMC)

"Optometrists must take almost all of courses that medical doctors do to complete their degree"

Talk about misdirection. Since when did medical school graduates without ophthalmic training diagnose and treat eye conditions? Thats comparing apples and oranges. Moreover, I didnt realize optometry students did two years of clinical rotations in medicine, surgery, ob/gyn. etc (almost all courses huh?).

So, I guess dentists are just as qualified as optometrist to treat the eye since they take a very similar curriculum as medical doctors huh?

 

[IndianaOD]

Our medical school lurkers where quick to respod. This is not comparing the eye related knowledge of ODs to basic MDs. It was comparing the pharmacology and systemic training of ODs and MDs. The analysis was in defense of scope expansion of ODs to Rx glaucoma meds. Basic MDs enjoy an unlimited scope of practice with basically unlimited prescribing rights. They have realistically no eye training but can prescribe more eye related meds that a lot of ODs can. I'm not knocking basic MDs, they are great at the systemic stuff. If you're into comparisons, I as a residency trained OD have 5 years of eye related education. A general OMD has 3. The approx. week of eye related education during a 4 year med program hardly applies. No matter how many times you tell me, I don't believe that and OMD that has been out 10+ years remembers 5% of what he/she learned in med school. You only remember what you practice.

Don't keep flaming or this thread will be closed and I'll have to keep reposting my initial post.

 

[IndianaOD]

Try to resist the urge to point out anectdotal cases of misdiagnosis on either side of this issue because they really prove nothing and only serve to needlessly inflame the passions of both sides of this debate.

Yes, we've all seen cases of 20/25 cataracts being operated on and we've all seen the 20/50 patient with a diopter of uncorrected cyl that was told "there's nothing wrong with you."

But spend sometime in any ophthalmology clinic and you'll see just as many weird referrals or strange diagnoses from ODs.

One of the things you will find when you start practicing is that you are going to encounter patients that have seen other docs and been given a particular diagnosis that makes you really scratch your head. You're going to wonder "what was s/he thinking?" Fact is, that doctor is going to see just as many of YOUR patients and be thinking the same thing about you. And half the time on both sides, it was the PATIENT who told that other doctor something completely different than what they told you.

So again, resist the urge to post your anecdotes about other doctors. It accomplishes nothing, and it proves nothing.

I agree with KHE. I have seen some abosolute terrible care from both ophthalmologists and optometrists (probably in almost equal numbers as I serve as a referal site that gets a lot of second opinions). That is an unwinnable battle as both sides don't have a leg to stand on.

 

[exmike]

If you're into comparisons, I as a residency trained OD have 5 years of eye related education. A general OMD has 3. The approx. week of eye related education during a 4 year med program hardly applies. No matter how many times you tell me, I don't believe that and OMD that has been out 10+ years remembers 5% of what he/she learned in med school. You only remember what you practice.

Your math doesnt make sense. In your initial post, it says that OD's take virtually the same classes as MDs. Then you go on to say that ODs have 5 years of eye specific training yet Ophthalmologist only have 3. So you conveniently lump those two preclinical years in with OD training to get five years, but leave them out of Ophthalmology. Great.

 

[deuist]

If you're into comparisons, I as a residency trained OD have 5 years of eye related education. A general OMD has 3.

Wait, I thought you were taking the same courses as medical students. How do you find the time to study 4 years of eye stuff during OD school and 4 years of medical school simultaneously?

Don't keep flaming or this thread will be closed and I'll have to keep reposting my initial post.

I'll flame all I want. Your posts are extremely misguided. While physicians have unrestricted medical licenses, no primary care doc is going to start writing scripts for eye products. Moreover, I still maintain that ophthalmologists are a bad choice for getting fitted for glasses---despite what insurance companies say. Ophthalmologists are eye surgeons who should be used in very severe cases. Otherwise, it's like seeing a cardio-thoracic surgeon for a beta blocker.

 

[DrEyeBall]

I think it is a mistake to look at the number of "credit hours" spent in things like phamacology.

A medical student will spend 2 years in clinical training seeing a wide range of systemic diseases and how drugs are used to treat these as well as their potenital interaction, side effects, etc. Ask a med student and they will tell you that the real understanding of pharmacology comes during the clinical years.

You are mistaken that ophthalmologists forget their "systemic" training. We use it all the time. Obviously you will find some who are using it very little but the training that occurs during clinical years in things such as general surgery, internal medicine, orthopedics, etc is real and is part of our education.

This is not to say that ODs are not well trained in eye care but the training is not the same and the ability to practice certain aspects of eye care are based upon that.

 

[IndianaOD]

Your math doesnt make sense. In your initial post, it says that OD's take virtually the same classes as MDs. Then you go on to say that ODs have 5 years of eye specific training yet Ophthalmologist only have 3. So you conveniently lump those two preclinical years in with OD training to get five years, but leave them out of Ophthalmology. Great.

Okay I see your point. Lets re-calculate. Lets count OD years 1 and 2 as 1 year of eye training since its half systemic stuff. Then its 4 to 3 for a residency trained OD or 3 and 3 for standard OD. Note I know that retina and neuro OMDs tack on quite a bit extra. In my perfect world all OMDs would be subspecialists as I feel general OMDs as redundant. Okay the perfect world would see less ODs and OMDs graduating each year with only subspecialty OMDs. I think oversupply is going to hurt both professions.

To the other poster, when is all that systemic med school stuff used in the average ophthalmology practice? I'm not being cynical I would really like to understand. I'm sure there are are few who fill in at ERs and other PCP tasks, but not many. I personally wouldn't want an OMD for my non ocular emergency but whatever. The typical OMDs that I have worked with did 5-10minute dilated exams on some days and performed surgery the other days in rapid succession (especially the cataract cowboy who basically works on an assembly line, but owns a mansion out in the country). The anesthesiologist was there for sedation. Perhaps a neuro OMD uses more of the med school knowledge but I really haven't seen the others use it at all. If there wasn't an ocular problem, it was always "go see your PCP". Which I feel is correct.

 

[Spearmint1]

IndianaOD, get a life and lay off.

Ban Me, Warn Me all you want. Your arguments are stupid and illogical. What is your point in taking on the MD on here? You're just making yourself look bad.

 

[IndianaOD]

IndianaOD, get a life and lay off.

Have a life, thanks. Not that you can make that call. I think you better get a warning for that comment, hey moderator . (Sorry I got a warning for much, much less). This is just entertainment and a way to show others the way through the .

It must not be pointless, I get PMs in agreement.

 

[VA Hopeful Dr]

Okay I see your point. Lets re-calculate. Lets count OD years 1 and 2 as 1 year of eye training since its half systemic stuff. Then its 4 to 3 for a residency trained OD or 3 and 3 for standard OD. Note I know that retina and neuro OMDs tack on quite a bit extra. In my perfect world all OMDs would be subspecialists as I feel general OMDs as redundant. Okay the perfect world would see less ODs and OMDs graduating each year with only subspecialty OMDs. I think oversupply is going to hurt both professions.

I think something big you're overlooking here (if you're going to calculate time spent learning) is the difference between 3rd and 4th years of OD school and the 3 years of MD residency. Correct me if I'm wrong, but I'm under the impression that clinical rotations for ODs approach standard business hours, yes? If that is true, then MD training has the advantage of working much longer in a given year.

Further, much of your training (from what Dad has told me) centers around vision (refraction, optics, and contacts). The MDs spend less time on that and so more on procedures and pathology.

I think ODs and MDs are both very well trained. They have the edge in procedures, you in vision and CL.

C'mon man, chill with the rhetoric. I admire your fire, I truly do. But most of what you post on this particular subject doesn't help the OD cause. Continue being a great OD, work in politics.... just try to tone it down a touch.

 

[DrEyeBall]

Okay I see your point. Lets re-calculate. Lets count OD years 1 and 2 as 1 year of eye training since its half systemic stuff. Then its 4 to 3 for a residency trained OD or 3 and 3 for standard OD. Note I know that retina and neuro OMDs tack on quite a bit extra. In my perfect world all OMDs would be subspecialists as I feel general OMDs as redundant. Okay the perfect world would see less ODs and OMDs graduating each year with only subspecialty OMDs. I think oversupply is going to hurt both professions.

To the other poster, when is all that systemic med school stuff used in the average ophthalmology practice? I'm not being cynical I would really like to understand. I'm sure there are are few who fill in at ERs and other PCP tasks, but not many. I personally wouldn't want an OMD for my non ocular emergency but whatever. The typical OMDs that I have worked with did 5-10minute dilated exams on some days and performed surgery the other days in rapid succession (especially the cataract cowboy who basically works on an assembly line, but owns a mansion out in the country). The anesthesiologist was there for sedation. Perhaps a neuro OMD uses more of the med school knowledge but I really haven't seen the others use it at all. If there wasn't an ocular problem, it was always "go see your PCP". Which I feel is correct.

You are making my point for me.

I am not talking about treating systemic diseases or working in an ER. A knowledge about other disciplines and systemic diseases is essential to providing good ophthalmic care. You do not get these in the class room. You learn these in the hundreds of hours spent in the hospital during 2 years of med school, 80-110 a week during internship and then residency.

You seem to have formed an opinion based upon some people with whom you work that do little other than cataract surgery. That is actually a small number of ophthalmologists who practice this way but I can understand why you have formed that opinion if that is the case. It is hard to debate this issue with you because you have already formed an opinion.

 

[IndianaOD]

I don't feel that med-school is a bad route to ophthalmology, just not the most efficient. In OD school you are taught about which systemic conditions are linked to ocular conditions/findings. As we all know the eye is a very specific sensory organ. Few ocular surgeries/procedures have much, if any, effect on the other organ systems. There is nothing that anyone needs to get worked up about, these are mostly my opinions, except for the studies or other facts that I quote periodically. Perhaps my view is skewed by several of the ophthalmologists that I have intereacted with but that is more than a couple. It does appear to me though that usually the patient encounters are very brief and numerous, a basic means to get them to the OR. I've never seen an OMD preform an H&P or other physical examination. This frankly is one of the reason's I chose optometry school. I had always thought I would shoot for the OMD route since that's who I saw growing up. It just didn't seem efficient for what I wanted to do, and I wanted more interaction with my patients. To each his own.

 

[exmike]

I had always thought I would shoot for the OMD route since that's who I saw growing up. It just didn't seem efficient for what I wanted to do, and I wanted more interaction with my patients. To each his own.

That is fine, but since you chose the OD route knowing the limitations of the scope, why try to push for the expanded scope you knew you would get with ophthalmology - after the fact?

 

[IndianaOD]

That is fine, but since you chose the OD route knowing the limitations of the scope, why try to push for the expanded scope you knew you would get with ophthalmology - after the fact?

Because the scope is drastically below the education recieved in OD schools. I have zero desire for intraocular surgery. However, all medical fields are advancing due to science and technology and they must adapt. As stated before, optometry should be self-governing and should not be able to be swayed by medicine's desires. I'll lay out on the table what I think an ODs scope should be presently. Notice that some states have nearly achieved this, but several others are no where close.

1. Able to Rx all topical medications as relates to the eye and adnexa
2. Able to Rx all oral medications as relates to conditions of the eye and adnexa
3. No descrimination of insurance access
4. FB removal, removal or injection of chalzion and other benign lesions, stromal micropuncture, NLDO probing under 25 lbs or so, flouresceine angiography
5. After 1 year of advanced laser/disease residency if you choose: YAG, (PIs), PRP, Focal/grid, intraocular injections.

Note, I have no interest in #5. However, since a good portion is based on optics it makes sense. Unless ODs can no longer make a living as is, I honestly don't see anything past this.

Again its my opinion and you don't have to like it.

The optometry forums don't have an all out BS slam fest against another profession like the (sticky of all things) OK surgical something or other thread.

 

[orangezero]

I'll flame all I want. Your posts are extremely misguided. While physicians have unrestricted medical licenses, no primary care doc is going to start writing scripts for eye products. Moreover, I still maintain that ophthalmologists are a bad choice for getting fitted for glasses---despite what insurance companies say. Ophthalmologists are eye surgeons who should be used in very severe cases. Otherwise, it's like seeing a cardio-thoracic surgeon for a beta blocker.

This is partially my feelings as well. However, the reality as I've seen it is a bit different. I visit ophthalmology websites all the time using their MD degree as the reason to see their office for services such as glasses, contacts, etc. IF I was an ophthalmologist, I'd rather be doing PI, cats, glaucoma, or specialize in retina. I'm not so sure I'd want to be doing routine exams all day, and then throw in a few IOLs in the morning. But, the reality is ophthalmologists are putting in opticals in record numbers, and using their license as THE reason to see them. No complaints by me, free market.

But it is a bit frustrating to have to tell patients, yes, we can see them if they have a corneal ulcer, or a red eye, or if they have high IOPs. I mostly see patients who are scared into thinking optometrists can't do anything but write out the numbers to their glasses, and this just isn't true.

From reading on here, it does appear as if the vast majority of medical schools teach that optometry is an apprenticeship which requires little thought or brains. The schools are doing a disservice, imo. Its thought that once ophthalmology residents get out in to the real world and deal with real optometrists instead of listening to the rhetoric in schools about optometry encroaching on ophthalmology's "turf" that perhaps things will improve. If this is the way its still being taught and dealt with, I guess this may never happen.

Are you guys med students? Where do you get your ideas about optometry?

just curious.

 

[IndianaOD]

This is partially my feelings as well. However, the reality as I've seen it is a bit different. I visit ophthalmology websites all the time using their MD degree as the reason to see their office for services such as glasses, contacts, etc. IF I was an ophthalmologist, I'd rather be doing PI, cats, glaucoma, or specialize in retina. I'm not so sure I'd want to be doing routine exams all day, and then throw in a few IOLs in the morning. But, the reality is ophthalmologists are putting in opticals in record numbers, and using their license as THE reason to see them. No complaints by me, free market.

But it is a bit frustrating to have to tell patients, yes, we can see them if they have a corneal ulcer, or a red eye, or if they have high IOPs. I mostly see patients who are scared into thinking optometrists can't do anything but write out the numbers to their glasses, and this just isn't true.

From reading on here, it does appear as if the vast majority of medical schools teach that optometry is an apprenticeship which requires little thought or brains. The schools are doing a disservice, imo. Its thought that once ophthalmology residents get out in to the real world and deal with real optometrists instead of listening to the rhetoric in schools about optometry encroaching on ophthalmology's "turf" that perhaps things will improve. If this is the way its still being taught and dealt with, I guess this may never happen.

Are you guys med students? Where do you get your ideas about optometry?

just curious.

From my experience I think they get indoctrinated in their ophthalmology residency. There are still a lot of older OMDs with their 30 year old view of optometry spewing venom to the residents. I'm greatful optometry takes the high road in education and never brainwashes hate. I have sat in some case confereces with OMD residents and the attendings. The attendings made some completely unprofessional snips about optometry with me sitting right there. They laugh when an OD made a mistake. Problem is I've seen OMDs make far worse mistakes and I don't go around yucking it up with other ODs. Its sad really if they need to do that to make themselves feel better. I'm sure this isn't the case everywhere.

 

[DiveMD]

To the other poster, when is all that systemic med school stuff used in the average ophthalmology practice? I'm not being cynical I would really like to understand. I'm sure there are are few who fill in at ERs and other PCP tasks, but not many.


If there wasn't an ocular problem, it was always "go see your PCP". Which I feel is correct.

You said it; a good physician should learn in medical school how to identify, diagnose and refer a myriad of medical conditions. A good ophthalmologist can certainly diagnose conditions outside of the ophthalmic realm, some by just looking at the patient. You’ll be surprised of how many referrals internal medicine can get from OMD’s, dermatologists, ENT’s, Plastic Surgeons and other subspecialties (especially in training hospitals). Why do you keep separating ophthalmology from medicine? Eye Surgeons are physicians…but specialized. Systemic understanding of human physiology, pathology and pharmacology is not a luxury, is a requirement for a good medical practice.

 

[IndianaOD]

You said it; a good physician should learn in medical school how to identify, diagnose and refer a myriad of medical conditions. A good ophthalmologist can certainly diagnose conditions outside of the ophthalmic realm, some by just looking at the patient. You'll be surprised of how many referrals internal medicine can get from OMD's, dermatologists, ENT's, Plastic Surgeons and other subspecialties (especially in training hospitals). Why do you keep separating ophthalmology from medicine? Eye Surgeons are physicians…but specialized. Systemic understanding of human physiology, pathology and pharmacology is not a luxury, is a requirement for a good medical practice.

Because medicine becomes a distant memory if you never practice it. Use it or loose it. I refer plenty of patients to the above medical specialists. We get training in dermatology, I look at hands and fingernails on and on. Hey I even was the first one to Dx Marfan's on a young man the other day, imagine that. This knowledge is not unique to medicine.

As the above comparison showed, ODs get plenty of physiology, pathology, pharmacology etc.

One of the things that lights my fire is the god-like pedistal MDs put themselves on. Lets be realistic there's nothing magic about it. It doesn't create respect or envy, just dislike and distrust. You can keep thinking that Ophthalmolgists know so much more than ODs, but simply put they don't. I bet ODs even understand some aspects of vision beter if you can believe that. I know you won't believe it and that's not my mission.

 

[DrEyeBall]

The problem is that you do not know what you do not know.

We can have a healthy debate about what the scope of practice should be for ODs and there is alot we can learn from each other. However, please don't try to convince me that the years spent in med school are not important for what an ophthalmologist does. You have no basis to make that claim. As I said previously, you may be tainted by the MDs with whom you have worked but there is a great deal of systemic medicine that is used in the field of ophthalmology and knowledge of that is important to the care of patients.

 

[DiveMD]

You can keep thinking that Ophthalmolgists know so much more than ODs, but simply put they don't. I bet ODs even understand some aspects of vision beter if you can believe that. I know you won't believe it and that's not my mission.

I bet all OMD's can treat patients as a whole instead of just a pair of eyes. You constantly underestimate the medical education that you don’t have and certainly don't understand. But be very careful, most providers that exhibit your level of arrogance usually can’t recognize their limitations and end up hurting those patients they supposedly “heal”.

 

[eyehope]

Okay I see your point. Lets re-calculate. Lets count OD years 1 and 2 as 1 year of eye training since its half systemic stuff. Then its 4 to 3 for a residency trained OD or 3 and 3 for standard OD. Note I know that retina and neuro OMDs tack on quite a bit extra. In my perfect world all OMDs would be subspecialists as I feel general OMDs as redundant. Okay the perfect world would see less ODs and OMDs graduating each year with only subspecialty OMDs. I think oversupply is going to hurt both professions.

Please do not compare ODs to general OMDs. The training is completely different. Since you like comparing numbers, let's calculate. Let's be conservative and pick 18 patients seen per day by an OMD resident (more third year, less first year), with 6 weeks of vacation (holidays included) per year = 4600 patients/year. Let us underestimate the number of patients seen on call as 6/night at a level 1 trauma center x 60 nights/year = 360/year. That's at least 14,500 patients seen and managed. You would have to see about 28-30 patients per day over two years with no vacation (OD clinical years) to match those numbers. Even if the numbers were to be even, the patient population is completely different - I doubt ODs have rigorous training in subspecialities like retina, pediatrics, oculoplastics, cornea just as OMD do not have rigorous training in CL, optics, refraction.

If you are worried about oversupply, perhaps you should be more concerned about the increased number of OD spots rather than competition from OMDs (residency slots have been fairly stable over the last 5-10 years). OMDs have protected their profession with these restrictions, perhaps ODs should do the same.

Every profession has its limitations. If you want to do lasers or surgeries, go to medical school, internship, and residency for 8 years. Some ODs have done it in the past, and many more will do it in the future.

 

[exmike]

Because medicine becomes a distant memory if you never practice it. Use it or loose it. I refer plenty of patients to the above medical specialists. We get training in dermatology, I look at hands and fingernails on and on. Hey I even was the first one to Dx Marfan's on a young man the other day, imagine that. This knowledge is not unique to medicine.

As the above comparison showed, ODs get plenty of physiology, pathology, pharmacology etc.

One of the things that lights my fire is the god-like pedistal MDs put themselves on. Lets be realistic there's nothing magic about it. It doesn't create respect or envy, just dislike and distrust. You can keep thinking that Ophthalmolgists know so much more than ODs, but simply put they don't. I bet ODs even understand some aspects of vision beter if you can believe that. I know you won't believe it and that's not my mission.

its like they say, you dont know what you dont know, and therein lies the danger. you'll never know what a MD knows unless you go through medical school and internship.

by the way, i didnt realize you had an in house test for the fibrillin-1 gene mutation. I'm certain you did not do enough of the physical exam to qualify your patient for the criteria for marfans sans the genetic test.

 

[qwopty99]

I'm certain you did not do enough of the physical exam to qualify your patient for the criteria for marfans sans the genetic test.

neither did the man's family doctor.

 

[hfpepperbean47]

OMG shut up. Anytime a post like this starts the bickering ensues shortly thereafter. Give it a rest.

 

[exmike]

neither did the man's family doctor.

i dont see the man's family doc posting here claiming he diagnosed marfans.

 

[broadway]

I would like to let the students/residents know that ophthalmologists are much better trained. During their residency years they see so many more pts. than ods that it takes the ods a few more years (post grad.) to feel comfortable tx the more complex cases. Most first year residents that moonlight for me are more comfortable seeing pts. than first year od grads.

 

[hfpepperbean47]

I would like to let the students/residents know that ophthalmologists are much better trained. During their residency years they see so many more pts. than ods that it takes the ods a few more years (post grad.) to feel comfortable tx the more complex cases. Most first year residents that moonlight for me are more comfortable seeing pts. than first year od grads.

and this is just your experience, that doesn't mean its always the case. Its your bias, which is fine, but don't think that whatever you experience is always the case.

 

[prettygreeneyes]

Folks, we're beating a dead horse here. Everyone entered this thread with their own preconceived notions about the quality of each profession's training, and everyone will leave with those same notions. Other than creating animosity, this thread serves no purpose.

 

[hfpepperbean47]

Folks, we're beating a dead horse here. Everyone entered this thread with their own preconceived notions about the quality of each profession's training, and everyone will leave with those same notions. Other than creating animosity, this thread serves no purpose.

poor horse

 

[broadway]

Like I said most omds. But you are free to ask other ods what they think of new grads vs. residents. I've had a good amt. of omds work for me, so I thought that was a good refrence point. BUT I'M sure you've worked with more residents /ods than I have.

 

[hfpepperbean47]

...dead horse

 

[cpw]

I just wanted to say: I love that beating a dead horse avatar. It's funny cuz it's true.

 

[prettygreeneyes]

I just wanted to say: I love that beating a dead horse avatar. It's funny cuz it's true.

I think what really makes it are the flies around the poor horse's head!

 

[IndianaOD]

I would like to let the students/residents know that ophthalmologists are much better trained. During their residency years they see so many more pts. than ods that it takes the ods a few more years (post grad.) to feel comfortable tx the more complex cases. Most first year residents that moonlight for me are more comfortable seeing pts. than first year od grads.

Wow, exactly what I'm talking about. First year residents don't know crap, let alone know how to refract. This is the BS I can't stand. OMD residents can't sign off on insurance patients because the insurance companies know they aren't ready. I love how I don't know enough about med-school, but you guys seem to be experts on optometry school. This is why I'm cutting way back on visiting these forums. Actually makes me more leary refering patients to OMDs, and I don't want to feel that way. Tough having to find OD, MDs to refer to or those who have family that are ODs that appreciate the training.

 

[still_confused]

what do OMDs think the scope of optometry should be? i think that is a fair question as IndianaOD has said what he/she wants. Do you guys agree or disagree? Do the ODs on this board share the same view? Forget the horse and lets talk about scope!

if you believe ODs should only refract why? why should ODs be allowed to do surgery? as long as you have good reasons i dont see why we cant have a good discussion.

 

[qwopty99]

i dont see the man's family doc posting here claiming he diagnosed marfans.

its because the family doctor missed it.

 

[eyehope]

Wow, exactly what I'm talking about. First year residents don't know crap, let alone know how to refract. This is the BS I can't stand. OMD residents can't sign off on insurance patients because the insurance companies know they aren't ready. I love how I don't know enough about med-school, but you guys seem to be experts on optometry school. This is why I'm cutting way back on visiting these forums. Actually makes me more leary refering patients to OMDs, and I don't want to feel that way. Tough having to find OD, MDs to refer to or those who have family that are ODs that appreciate the training.

It seems that the person making that comment (you quoted above) was an OD.

 

[exmike]

its because the family doctor missed it.

how do you know this case so intimately? didn't realize that you and indianaOD were running a genetic screening lab together. So... indianaOD was able to not only order and get results for a fibrillin-1 gene, he was also able to auscultate for a murmur/ultrasound for aortic dilation while noting his subluxed lens and measured the patients limbs to determine if the patient had qualifying skeletal abnormalities? amazing!

I'm not sure what this marfan's case has to do with this thread. The OD's role is not to diagnose systemic disease. His/her role is to diagnose (most if not all) and treat (most) ocular conditions and refer when it is outside of their area of expertise. There is no role for an OD to diagnose something like marfan's, and I'm pretty certain OD clinics are not equipped to work up a suspected case of marfans - correct me if i'm wrong.

 

[IndianaOD]

how do you know this case so intimately? didn't realize that you and indianaOD were running a genetic screening lab together. So... indianaOD was able to not only order and get results for a fibrillin-1 gene, he was also able to auscultate for a murmur/ultrasound for aortic dilation while noting his subluxed lens and measured the patients limbs to determine if the patient had qualifying skeletal abnormalities? amazing!

I'm not sure what this marfan's case has to do with this thread. The OD's role is not to diagnose systemic disease. His/her role is to diagnose (most if not all) and treat (most) ocular conditions and refer when it is outside of their area of expertise. There is no role for an OD to diagnose something like marfan's, and I'm pretty certain OD clinics are not equipped to work up a suspected case of marfans - correct me if i'm wrong.

Wow, look at that textbook definition of diagnosing a Marfan's patient. I could have ordered the genetic testing if desired. I didn't technically diagnose the patient. I wrote a letter to the pediatrician stating that he might want to consider looking into Marfans and why I suspected it. The patient had just recently had a physical. We suspected something wasn't right just by looking at the patient. Accommodation was severly reduced (weak zonules) and the palate fit the description. The lens was not really subluxated at the time, but did look suspicious.

The pediatricain confirmed the diagnosis. Since the debate is on OMDs vs. ODs are you telling be that an OMD is going to do all the above mentioned? I think not, they will do the exact same thing I did.

 

[ProZackMI]

Dear ODs and OD students,

Don't believe the propaganda of naysayers. Optometrists are highly trained and educated professionals. (not allowed to practice up to their level of training) It is fully reasonable to believe that optometry should change and evolve as science and technology changes the face of medical care. I thought this summery found in a legistalive debate and publicly available would be interesting:

Optometry degree curriculum vs. medical degree curriculum
The New England College of Optometry (NEWENCO)
Dartmouth Medical School (DHMC)

"Optometrists must take almost all of courses that medical doctors do to complete their degree. Optometry students take more pharmaceutical courses than medical students. Also, optometry students must take additional, extensive, course work in the specialty of eye care during their four years, therefore, optometry students graduate with a higher number of credit hours than medical students. In addition, the information below shows that graduating optometrists are tested on this knowledge by a uniform national standard."

It is admirable that you are defending your chosen profession, but really now, aren't you starting to sound like the chiropractors who say "Our DC degree is the same as an MD degree!". Hmmm, no matter how many classes you take that med students take, your degree is still....OD, not MD or DO. By that very fact alone, the degrees are different.

I have never been to optometry school, but I've been to medical school. There are many out there in the health care communuity (NPs, PAs, pods, psychologists, chiros) who say med school is easier than their program, or their program is just as hard. Unless you're an OD and MD, it's hard to make this statement without looking silly.

I appreciate your love of optometry, but honestly, you're going about it the wrong way. You know what the biggest problem is? Public awareness! Think about it. In the US, for example, how many little kids or teens out there, grow up even contemplating optometry school? Probably very few. Why? The sad truth is: there are no TV shows about optometrists, pharmacists, vets, PTs, chiros.

New this fall, "House: OD". Coming this summer on NBC, "Chicago Chiro Hope". Instead of "ER", what about a new show about PAs called "ER jr"? See my point? Unfortunately, research shows that coveted career paths (those with the most exposure due to early desire) are formed by exposure in the public culture (usually TV, books, movies) or exposure from the career dirctly (usually from parents who work in that profession or close associates).

In other words, if little Johnny doesn't see "House OD" every week, portraying optometry as fascinating and cool, or "House Rx", and his mommy/daddy/auntie/grandma aren't working as PharmDs, or ODs, then how would he know about them? Why would he care?

And...you'd be surprised how many so called educated Americans have no clue what kind of training you guys go through. None. All you do is turn dials and sell glasses, right? All pharmacists do is count pills, right? I'm an MD and JD. My fiance is a PharmD and MPH. We were at a wedding recently and sitting next to this couple in their 50s. I'm 36 and my fiance is 32. We were talking about careers. The guy, who was an assistant school principal, with a master's, and his wife, a teacher with a master's, actually thought law school was a one-year degree "like a master's degree" and that pharmacy school was like a six month "vocational degree" like from ITT or something. Once we told them, they were shocked both professions required a doctorate, etc. I wonder what they thought about optometry? How many people out there confuse ODs with opticians? Or ODs with MDs? Once you tell them, I'm an optometrist, not a physician, maybe they give you that blank look and say "oh". People simply don't know.

Point being: public awareness is a powerful thing. If you want to inform patients and the public about your training and services, then you need to market yourself in an ethical, honest, and direct fashion. Making posts about whose degree is bigger, his or yours, or who took this in school, etc. is...well, it's not supporting your cause much.

I appreciate your zeal and passion, but your post comes off as being somewhat immature. I'm sorry to be critical here. Many in the psychology forum have similar views and have made similar posts, and as much as I support them, I still can't help but poke holes in their arguments and shake my head.

Rather than say "my degree is just as good as yours", why not say "I went to optometry school for 4 years. In order to get in, I had to take x, y, and z. Once I got in, I had to take...A, B, and C. I had to pass a rigourous licesning exam. So, in many ways, my educational path is similar to that of a physician, dentist, lawyer, etc. By law, I can do x, y, and z." In other words, inform people.

Don't end up being like so many chiros.
Peace,
Zack

 

[ProZackMI]

Our medical school lurkers where quick to respod. This is not comparing the eye related knowledge of ODs to basic MDs. It was comparing the pharmacology and systemic training of ODs and MDs. The analysis was in defense of scope expansion of ODs to Rx glaucoma meds. Basic MDs enjoy an unlimited scope of practice with basically unlimited prescribing rights. They have realistically no eye training but can prescribe more eye related meds that a lot of ODs can. I'm not knocking basic MDs, they are great at the systemic stuff. If you're into comparisons, I as a residency trained OD have 5 years of eye related education. A general OMD has 3. The approx. week of eye related education during a 4 year med program hardly applies. No matter how many times you tell me, I don't believe that and OMD that has been out 10+ years remembers 5% of what he/she learned in med school. You only remember what you practice.

Don't keep flaming or this thread will be closed and I'll have to keep reposting my initial post.

Look, you definitely have passion, but you're going about your quest for recognition the wrong way. I hate using personal anecdotes, but I'll give you one. I'm a board certified psychiatrist. I do not include my undegrad education as part of my medical training, so I'm only focusing on my medical training.

Med school = four years
Internship = one year
Residency in IM/Psych = four years
Boards

That's about 9-10 (if you count board prep) years of training in my field. Plus, I have work experience too. Most psychiatrists are in the same boat as me. This is why we tend to think of ourselves being the "top dog" in the mental health arena: our type and quality of training is unparalleled.

However, some surpass us or come close. My fiance is a psychiatric clinical pharmacist. She has an undergrad degree in biochem, but her CV is impressive:

PharmD = 4 years
Residency in pharm practice = 1 year
Residency in psych pharm = 2 years
ABPP (Board Cert in psych pharm)
Fellowship in psychopharm = 3 years

Your average psychiatrist only has 3 years of post MD residency. You could say that my fiance is better educated than many psychiatrists. However, that would not be true. She has more education in a different area. She never went to medical school. She never took the USMLE I and II. She never did clinical rotations through IM, EM, Peds, hem/onc, cardio, etc. Her training is significant, but vastly different from mine.

Apples to oranges. Same is true wsith a colleague of mine (psychologist). She has a BS in psychology (mine was in government!), an MA in clinical psychology, and a PhD in clinical psychology (from Stanford). She did a year post doc internship and then a 4 year post doc fellowship in medical psych plus a post doc MS in pharmacology.

In many ways, she knows more than many psychiatrists, but...and I stress this, her training is vastly different from ours in psychiatry. Not better. Not worse. Different. These differences help define who we are and what we can do/should do as professionals.

 

[ProZackMI]

Because medicine becomes a distant memory if you never practice it. Use it or loose it. I refer plenty of patients to the above medical specialists. We get training in dermatology, I look at hands and fingernails on and on. Hey I even was the first one to Dx Marfan's on a young man the other day, imagine that. This knowledge is not unique to medicine.

As the above comparison showed, ODs get plenty of physiology, pathology, pharmacology etc.

One of the things that lights my fire is the god-like pedistal MDs put themselves on. Lets be realistic there's nothing magic about it. It doesn't create respect or envy, just dislike and distrust. You can keep thinking that Ophthalmolgists know so much more than ODs, but simply put they don't. I bet ODs even understand some aspects of vision beter if you can believe that. I know you won't believe it and that's not my mission.

You had training in derm? You practiced medicine? Did you also receive training in systemic disease management? No. I am not doubting your veracity here, but derm? This sounds remarkably like many chiros who go around comparing their DC degree to an MD and say things like we "We have more clinical hours of X and more classroom time in Y than MDs!" Or, and I love this one, the chiros who claim to have had classes in OB-GYN and cardio. WHY?

Why would a DC, who cannot legally perform pelvics, have GYN? Um, since when does back cracking involve the use of a speculum? Why, oh why, would an OD receive comprehensive training in derm? Do you lance sebaceous cysts and impacted follicles in between eye exams? I hope not!

When I was a kid, about 12, my dentist told me my tonsils were inflamed and said to have it examined. I did and they got yanked shortly thereafter. Smart dentist. In your Marfan's example, good work, but seriously, and I'm speaking as an attorney here, do not practice medicine. Do not risk your license and all that training to play House MD. If you, while performing within the scope of your training, spot something, then make a dx or inform the FP, internist, OMD. If you're doing a fund exam on an NIDDM and see signs of PDR, vitreal bleeds, exudates, AV nicking, macular edema, etc., then refer away.

I respect your training, but honestly, reading your posts, you seem like a frustrated OD and it seems like you really wanted to be an MD.

Not all physicians look down on ODs or other health professionals. Over the years, people like KHE and drgregory have taught me a great deal about what optometry really is. To be honest, in medical school, I had a lot of misinformation and preconceived notions. I have a new found respect for you guys, but...posts like seem instigatory, defensive, and immature IMO.

 

[prettygreeneyes]

Rather than say "my degree is just as good as yours", why not say "I went to optometry school for 4 years. In order to get in, I had to take x, y, and z. Once I got in, I had to take...A, B, and C. I had to pass a rigourous licesning exam. So, in many ways, my educational path is similar to that of a physician, dentist, lawyer, etc. By law, I can do x, y, and z." In other words, inform people.

Don't end up being like so many chiros.
Peace,
Zack

Fantastic post Zack!

 

[eyestrain]

Fantastic three posts, Zack.

 

[Opii]

Fantastic three posts, Zack.

That is why I call Zack my new best friend!

 

[Opii]

I respect your training, but honestly, reading your posts, you seem like a frustrated OD and it seems like you really wanted to be an MD.

Not all physicians look down on ODs or other health professionals. Over the years, people like KHE and drgregory have taught me a great deal about what optometry really is. To be honest, in medical school, I had a lot of misinformation and preconceived notions. I have a new found respect for you guys, but...posts like seem instigatory, defensive, and immature IMO.

Agreed.


Between undergraduate school and optometry school I worked in eyecare with several ODs and OMDs in my hometown of about 2 million population. I have only seen this anomosity between ODs and OMDs that haven't been out there too much. ODs that go straight from school to their residency then stay in academia still carry those misconceptions in their mind (because in their mind they are still 22 year old kids and still act as such, even with the long grey beards they are sporting)... In the real world I have seen many OMDs and ODs with great symbiotic relationships with each other. It is too bad ODs who have been shielded from the real world under the academic umbrella teach these thoughts to impressionable young students.

I pride myself in my objectivity, and I have to say OMDs (not these newbie goofballs in these threads) but "out there in the real world OMDs" have taught me alot more than ODs have. ODs seem to be too busy backstabbing each other, even fourth year clinicians start acting like competitors with the fourth year students (what kind of mentor is that?).

We have a great problem in our profession. Oversaturation, very different educational backgrounds (old school ODs vs new school ODs), some old school ODs have gotten "grandfathered" into everything, so optometry school and thus NBEO is very different than what they experienced 30 years ago, yet unfortunatly these people are the ones calling the shots in our profession. And these people are the ones successfully brainwashing these new breed of academic ODs who in reallity haven't experienced much of the real world of eyecare and just spout hate to elevate themselves. The cycle repeats itself inside the bubble of academia.

I can't wait for school to be over, counting down the days... because I have a job with the best most respected OMD in my hometown. And I wouldn't trade it for anything else. He is a great teacher too, we'll be getting 4th year ODs rotating from 2 OD schools. He already hired 2 ODs from prior classes and everybody is one big happy familly in that location.

Have fun whinning about each other boyz and girlz (ODs and OMDs), when you get to the real world you'll see both of you will be needing each other more than you think...