Is your position that optometrists are incapable of learning how to perform these procedures into perpetuity and should therefore never be allowed to?
Absolutely not. My position is that as of now, I don't see how ODs (in the current model) are trained to perform eye surgery at the level of a board certified Ophthalmologist. Additionally, I don't see any mention of expanded training laid out in the bill ... only expanded scope. People continually speculate on how the increased training will come into play, but until I see objective proof, I don't think it's a good idea to make the surgeries legal tomorrow.
I'm not against evolution, and I'm not against an integrated, medical team based model, but I just don't think this expansion or bill is laid out well ... at all. Additionally, I've heard the same opinion echoed numerous times from OD students and practicing ODs on this board.
Anyways - the reality is, MDs always predict doom and gloom whenever there is a discussion about expansion of OD scope.
Agreed. DO/MDs are continually doom and gloom with regard to just about everything happening in the state of health care. However, at various instances, I can't blame them. It's frustrating to gain a level of proficiency at a very intimate and skilled task through years of appropriate, regulated training and then see groups try to obtain the same via slick politics and a proficient lobbying group. Especially when it's happening on so many fronts -CRNAs, DNPs, ODs, DCs, etc.
The reality is, once things are passed, the professions will all still continue to chug along, patients will get taken care of, and everyone will continue to move into the future. Do you think in 10 years, after 10 years of having this Kentucky legislation, that you'll still be on these forums complaining about the risk ODs are to their "minor surgery" patients?
It depends on how those 10 years play out. If the outcome of the scope expansion is not advantageous to patient care, of course I'll still rally against it. Why wouldn't I? Furthermore, if ODs use it as a platform to push for more and more expanded scope - without expanded training, then I'll keep opposing it a decade later or 50 years later.
Scope expansion without appropriate thought, consideration, and training is not the same thing as evolution. Don't confuse the two for a second. Additionally, I'll always oppose expansion without cause (money and healing insecurities isn't a cause) and always be open to the idea of evolution and integration because, like you said, that's simply a reality.
Why not start complaining about the fact ODs are using mydriacyl, just as your forefathers did 20 years ago? Hey, ODs are using mydriacyl!! It sure got your preceptor up in arms 20 years ago, why doesn't it concern you today? Whatever risks (e.g. death) your preceptors claimed existed 20 years ago still apply! Maybe it's cause ODs aren't as inherently incompetent/incapable at performing medicine as you make them out to be.
If you truthfully think the inability to administer eye drops (if that's the example you're using here) and restrictions on who performs laser surgery are on the same level ... then that's interesting. However, I feel like you're reaching here, and the 'expansion' from lots of restriction to letting you administer eye drops (er whatever) isn't the same an expansion into laser eye surgery. Plain and simple. Reserve these types of arguments and technicalities for the JDs.
Hey - did you know that in certain countries without optometrists (these would be countries with what we kinda know as "refracting opticians"), these R.O.s have to fight for the right to dispense contact lenses (e.g. Acuvue daily disposables)? In these countries, only OMDs are legally allowed to dispense CLs because they are classified as medical devices and OMDs argue having R.O.s dispense them is a threat to the public (patients will go blind, patients will die, etc.). On a side note, do you think any OMDs in these countries actually dispense the lenses? (Answer: No - it's their in-house techs who do, obviously) But the point is, these scope battles are just a matter of context.
1. I didn't know this
2. It's completely unrelated to the argument at hand (you're going for shock factor here)
3. This isn't the case in US - which is what we're talking about. If we lived in a country where you couldn't dispense contacts ... that's one discussion. If we lived in a country where you had all the rights and privileges withheld above and STILL wanted to dabble in laser eye surgery ... we'll that's a different discussion altogether, and I'm happy to discuss THAT topic.
Anyways, the one thing you can be sure of is that legislation will occur and professions will evolve. Even in a world of OD cataract surgeons, there will still be room for OMDs, so don't worry about that.
Here's my problem - I have not ONCE stated that I don't want physicians to lose patients or that I'm concerned about how DO/MDs will have to position themselves/compete in some sort of 'free' market (though the term never really applies to health services regardless). What I've said time and time again is that my concern is twofold:
1. Patients undergoing laser eye surgeries with practitioners who have not sufficiently trained to do so - because the model was passed in 2011 and most practicing ODs graduated years before, not because they don't have the capability to do so (this doesn't even take into consideration that technically, it's legal to do the operations under the new law and I'm not even sure if an OD would have to undergo training if they didn't want to).
2. Calling oneself an 'eye surgeon' or telling a patient that the procedure can be performed in the office is confusing as I'm sure 99% of individuals think that eye surgeries are performed by individuals who went to medical school and completed a surgical residency. It's confusing, and this lack of transparency isn't fair - especially in a demographic where a lot of older individuals, even if they prefer the DO/MD, will just get the procedure done where you tell them to.
It's the same scenario when a CRNA walks into an OR and says 'hi, I'll be performing your anesthesia today' and the patient calmly assumes it's a certified anesthesiologist they are talking to.
Frankly, the ODs on the forums are the only individuals I've heard talk about this expansion as some sort of business venture where competition and volume, not efficacy and treatment are the crucial terms.
To me, that sounds like a group which feels entitled to something, or DESERVES to be recognized as something else, not a group who really feels like this will help integrate a better model of patient care or serve the underserved.
