From an Optometrist not actually pushing for Surgery

[qcy07]

I bet I speak for many optometrists who are too busy, or too ambivalent to comment, when I say that scalpel and/or laser surgery is not something I want. But can any ophthalmologist on this forum please tell me why we can not even practice non-surgical medical primary eye care? Is it possible that any ophthalmologist on this forum would concede that we as a profession have had to beg, and plead and grovel for the right to expand our scope and therefore training over the last 2 decades. Just as our associations can be out of touch with the mainstream of optometry, are all ophthalmologists in agreement with their associations in their effort to stop any and all perceived incursion into "OMD territory"?

Can an ophthalmologist help me understand why if I studied right along side dentists in all pharmacology, anatomy, physiology, biochem, etc. classes. If I graduated from a top tier undergraduate program and then from four years of doctoral level post graduate eduction just as dentists do. If I took three separate day long national board exams, a rigorous day long multi-proctored clinical skills evaluation, a long patient assessment and management evaluation, a state licensing examination. Why can't most ODs treat POAG in California, yet across the state line in Nevada optometrists are treating glaucoma patients today. Why does a dentist have an A or B category DEA license and I have a mid-level M DEA designation. Do optometry students lack suffficient intelligence to learn how to provide primary medial eye care in four years and yet dentists in four years can provide all medical oral care.

Is it possible it has something to do with the fact the dentists do not have a competing medical specialty. Why can't ophthalmology allow us to provide medical eye care without a fight for every single solitary thing.

As an example, I am "glaucoma certified" in California. I have become Glaucoma certified by following 50 patients over 2 years with an ophthalmologist and filling out absolutely ridiculous paperwork. When my "co-managing OMD" went to sign off on all of my paperwork after 2 years he said this was the most ridiculous thing he had ever seen. He had a chance to get to know me well over those two years and knew on week one that I was fully competent and trained to treat and manage POAG. My point is that now that I am treating glaucoma with say for example Lumigan, if I have a patient that wants Latisse, I can not Rx it to her. Why?, because it is not specifically stated in the ridiculously long OMD California Academy of Eye Physicians and Surgeons fought at every turn scope expansion bill in California. This is what I believe frustrates ODs and probably causes some of them to overreach.

I guess what I am asking is can there be compromise or are we just gonna fight it out legislatively forever. Fight for every word in law, every bottle of medication, everything.

---

Members don't see this ad.

 

[eyerat]

But can any ophthalmologist on this forum please tell me why we can not even practice non-surgical medical primary eye care?.

You had a choice to go to an optometry school or a medical school. You made your choice. Now you're an optometrist. The term "optometry" comes from the Greek words ὄψις (opsis; "view") and μέτρον (metron; "something used to measure", "measure", "rule"). There's no country in the world that allows optometrists to do more than prescribe glasses and contact lenses. Why should U.S. be different?

 

[OMD]

Well I think it's because of the way political discourse is progressing in this country unfortunately. Everyone fights for an extreme, all the while being ok with something in the middle. There is the fear that if you start in the middle, you will end up too far on the other side. So when ophtho sees Kentucky, we push back harder for tighter restrictions, just as when optom sees some onerous regulations against some medications, they push for surgery. When in reality the vast majority of both would likely be ok with medical management of most diseases without any surgical intervention. It's like Fox News vs MSNBC but thankfully most of us aren't Olberman or Hannity, but their divisive rhetoric drives many of the discussions and creates animosity.

 

[qcy07]

Brilliant, thank you for helping me understand the definition of optometry, and breaking it down into it's greek derivation was exceptionally helpful.

This is how all of my previous questions were answered?

This is the response I was expecting, and this is why optometrists will continue to fight to expand scope. It defies logic to hold down a profession from natural evolution. Evolution will occur. I am extremely over trained and over educated to refract only all day.

Again from someone not wanting surgical scope expansion, this is my answer? Do you,"eyerat" realize what I am already doing with full legal authority and the blessing of my many ophthalmology friends. (Yes I actually have many OMD friends). I guess you would want to walk back all of what I do, and just let me refract, because after all that is the definition of optometry.

Is this the consensus on the forum?

 

[qcy07]

I just got to my office and looked at the 27 patients I am seeing today, 7 of which are currently under my management for glaucoma for the last 4 years. I guess I will have to tell them to turn around and drive 1.5 hours to the OMD (who certified me for glaucoma) for their OCT, Photos,TVF, IOP check, DFE, ONH analysis, Medication refills, etc. I'm sure that especially the 4 that are over 80 years old will be thrilled to take that pleasant winter drive. I will just tell them after all that The term "optometry" comes from the Greek words ὄψις (opsis; "view") and μέτρον (metron; "something used to measure", "measure", "rule").

 

[bungo]

Dentist = optometrist argument:

Dentists undergo a more rigorous and surgically oriented 4 year program. They are taught by the unquestionable leaders in their field. Dentists advance their own field. Dentists are the best oral care provider on the planet. Dentistry is not based on prescribing a medical device to someone then convincing that same patient to purchase said device from them. Optometrists do not exist in some countries, Japan for instance. Dentists have a similar competing health care provider called oral hygienists. They can drill cavities in some states. And will continue to be granted additional privileges like the other mid level providers including optometrists.

Class based education is not as valuable as actual patient interaction. I took classes with neuroscience Phd candidates in medical school, and they are not lobbying for neurosurgery privileges. You guys just asked for and received the ability to perform laser eye removal. If your requests were uniformly reasonable, the next generation of ophthalmologists would be more willing to sit down and help you expand your scope.

 

[bungo]

This is the response I was expecting, and this is why optometrists will continue to fight to expand scope. It defies logic to hold down a profession from natural evolution. Evolution will occur. I am extremely over trained and over educated to refract only all day.

Is this the consensus on the forum?

Expanding your scope seems to be more about fulfilling some personal need. It isn't the public's problem that you are over trained for a job that consists of mostly refracting, but still grossly undertrained when compared to an ophthalmologists. Why should we, as a society, spend our health care dollars on care provided by you when an ophthalmologist costs the same per visit?

 

[CKliger]

Hi,

A colleague referred me to this thread and I actually had to create a username to reply. I shortened my real name since it seems appropriate as I happen to be the Executive Vice President of the California Academy of Eye Physicians and Surgeons.

Although I will work on a cogent reply to a very complex issue (if indeed that can be written), I would actually prefer to talk to you first if you are willing. You might be surprised at what I have to say.

My cell phone is 415-637-6126. Feel free to call from a phone that is not yours (or one with a blocked number) if you wish to remain anonymous.

Craig

Craig H. Kliger, MD

 

[medduck]

I just got to my office and looked at the 27 patients I am seeing today, 7 of which are currently under my management for glaucoma for the last 4 years. I guess I will have to tell them to turn around and drive 1.5 hours to the OMD (who certified me for glaucoma) for their OCT, Photos,TVF, IOP check, DFE, ONH analysis, Medication refills, etc. I'm sure that especially the 4 that are over 80 years old will be thrilled to take that pleasant winter drive. I will just tell them after all that The term "optometry" comes from the Greek words ὄψις (opsis; "view") and μέτρον (metron; "something used to measure", "measure", "rule").

So far, I don't think you're getting responses on this board that reflect praticing ophthalmologists' opinions. As you know, you work with ophthalmologists who trust your care of glaucoma patients. As long as optometrists refer patients appropriately when there are clear signs of progression, I have no problem with them treating patients medically.

I do draw the line at surgery and laser procedures however. OMD made a good point- these battles are waged purely because optometry won't give up on surgery. I'm sure if you polled ophthalmologists, 90% would be fine with full medical privileges if organized optometry would give up the fight for surgery.

 

[orbitsurgMD]

I bet I speak for many optometrists who are too busy, or too ambivalent to comment, when I say that scalpel and/or laser surgery is not something I want. But can any ophthalmologist on this forum please tell me why we can not even practice non-surgical medical primary eye care? Is it possible that any ophthalmologist on this forum would concede that we as a profession have had to beg, and plead and grovel for the right to expand our scope and therefore training over the last 2 decades. Just as our associations can be out of touch with the mainstream of optometry, are all ophthalmologists in agreement with their associations in their effort to stop any and all perceived incursion into "OMD territory"?

Can an ophthalmologist help me understand why if I studied right along side dentists in all pharmacology, anatomy, physiology, biochem, etc. classes. If I graduated from a top tier undergraduate program and then from four years of doctoral level post graduate eduction just as dentists do. If I took three separate day long national board exams, a rigorous day long multi-proctored clinical skills evaluation, a long patient assessment and management evaluation, a state licensing examination. Why can't most ODs treat POAG in California, yet across the state line in Nevada optometrists are treating glaucoma patients today. Why does a dentist have an A or B category DEA license and I have a mid-level M DEA designation. Do optometry students lack suffficient intelligence to learn how to provide primary medial eye care in four years and yet dentists in four years can provide all medical oral care.

Is it possible it has something to do with the fact the dentists do not have a competing medical specialty. Why can't ophthalmology allow us to provide medical eye care without a fight for every single solitary thing.

As an example, I am "glaucoma certified" in California. I have become Glaucoma certified by following 50 patients over 2 years with an ophthalmologist and filling out absolutely ridiculous paperwork. When my "co-managing OMD" went to sign off on all of my paperwork after 2 years he said this was the most ridiculous thing he had ever seen. He had a chance to get to know me well over those two years and knew on week one that I was fully competent and trained to treat and manage POAG. My point is that now that I am treating glaucoma with say for example Lumigan, if I have a patient that wants Latisse, I can not Rx it to her. Why?, because it is not specifically stated in the ridiculously long OMD California Academy of Eye Physicians and Surgeons fought at every turn scope expansion bill in California. This is what I believe frustrates ODs and probably causes some of them to overreach.

I guess what I am asking is can there be compromise or are we just gonna fight it out legislatively forever. Fight for every word in law, every bottle of medication, everything.

I don't want to bash optometry. There surely are smart optometrists and I know many. That said, the argument for extension of optometric practice scope is "because we can and the law says so."

Optometry school plus or minus a general practice optometry internship year is five years versus four years of medical school and four years of ophthalmology residency. (we'll leave the longer four-year ophthalmology residencies and fellowships out of this discussion.) Optometry wants fairly unrestricted surgical privileges (based on the language of the state bills recently passed) with half of medical school time and half of "residency" time and really no surgery training. That is what they already have in Kentucky right now under the law. It is much more than about YAG capsulotomies and PIs.

Maybe you guys in optometry are twice as smart as your M.D. colleagues and can cover everything ophthalmologists do in half the time. But many ophthalmology residents who have spent three to four years on the eye still come out green at the end of residency; I just want to know how optometry plans to get the job done in half the time.

In all seriousness, I have a hard time believing optometrists will take the high road, or at least that most will take the high road by doing substantial surgical training (i.e. not a 3-day resort course on blepharoplasty and "lumps and bumps") before venturing into surgical activity. The temptation to just go out and do whatever one thinks one is "trained" to do, whether truly trained or not will for some become too great to resist. So while many will welcome their broadened privilege, have any considered the real downside of bringing the optometric profession into disrepute? Reciting the mantra of "we are going to do what we are trained to do" doesn't necessarily make you trained.

 

[qcy07]

So far, I don't think you're getting responses on this board that reflect praticing ophthalmologists' opinions. As you know, you work with ophthalmologists who trust your care of glaucoma patients. As long as optometrists refer patients appropriately when there are clear signs of progression, I have no problem with them treating patients medically.

I do draw the line at surgery and laser procedures however. OMD made a good point- these battles are waged purely because optometry won't give up on surgery. I'm sure if you polled ophthalmologists, 90% would be fine with full medical privileges if organized optometry would give up the fight for surgery.

This is the post I was hoping to see, I agree! In my opinion OMDs should do the surgery. In my relationships with ophthalmology we all work synergistically for the benefit of the patient. Trust me I am no "cowboy", I refer freely and very conservatively, and guess what, I am still learning...both from experience and ophtho colleagues (am I allowed to say colleagues?) Anyway, I think I am done with my foray into this forum. Dr. Kliger if you were referring to me in your post I would be happy to talk.

 

[CKliger]

Yes, I was referring to you qcy07.

You can call whenever you like (including over the weekend if you want).

Craig

 

[kardon93]

The answer is simple: Optometry is more a physics field than health sciences. It is focused to refracting and etc. If your interest is Medicating why didn't you enter Medical school then? or a health sciences field career. You picked a physics field career, YES LOOK IN BOOKS OF PHYSICS IS WHERE YOU WILL FIND ABOUT REFRACTING AND LIGHT AND THOSE KIND OF THINGS, NOT ON A BIOLOGY BOOK. If you want to medicate and other optometrists you all can go to medical school. Optometrist asking for medications or surgery for patientes is like a psychologist asking to do the same for his patients?? isnt that why psychiatrist exist?

 

[Visionary]

I bet I speak for many optometrists who are too busy, or too ambivalent to comment, when I say that scalpel and/or laser surgery is not something I want. But can any ophthalmologist on this forum please tell me why we can not even practice non-surgical medical primary eye care? Is it possible that any ophthalmologist on this forum would concede that we as a profession have had to beg, and plead and grovel for the right to expand our scope and therefore training over the last 2 decades. Just as our associations can be out of touch with the mainstream of optometry, are all ophthalmologists in agreement with their associations in their effort to stop any and all perceived incursion into "OMD territory"?

Can an ophthalmologist help me understand why if I studied right along side dentists in all pharmacology, anatomy, physiology, biochem, etc. classes. If I graduated from a top tier undergraduate program and then from four years of doctoral level post graduate eduction just as dentists do. If I took three separate day long national board exams, a rigorous day long multi-proctored clinical skills evaluation, a long patient assessment and management evaluation, a state licensing examination. Why can't most ODs treat POAG in California, yet across the state line in Nevada optometrists are treating glaucoma patients today. Why does a dentist have an A or B category DEA license and I have a mid-level M DEA designation. Do optometry students lack suffficient intelligence to learn how to provide primary medial eye care in four years and yet dentists in four years can provide all medical oral care.

Is it possible it has something to do with the fact the dentists do not have a competing medical specialty. Why can't ophthalmology allow us to provide medical eye care without a fight for every single solitary thing.

As an example, I am "glaucoma certified" in California. I have become Glaucoma certified by following 50 patients over 2 years with an ophthalmologist and filling out absolutely ridiculous paperwork. When my "co-managing OMD" went to sign off on all of my paperwork after 2 years he said this was the most ridiculous thing he had ever seen. He had a chance to get to know me well over those two years and knew on week one that I was fully competent and trained to treat and manage POAG. My point is that now that I am treating glaucoma with say for example Lumigan, if I have a patient that wants Latisse, I can not Rx it to her. Why?, because it is not specifically stated in the ridiculously long OMD California Academy of Eye Physicians and Surgeons fought at every turn scope expansion bill in California. This is what I believe frustrates ODs and probably causes some of them to overreach.

I guess what I am asking is can there be compromise or are we just gonna fight it out legislatively forever. Fight for every word in law, every bottle of medication, everything.

Your frustrations are similar to those that have been voiced on this forum by KHE, and I understand. I wish our two national organizations could come together and hash things out, such that optometry could get broader national medical eye care rights, while leaving the surgery to ophthalmology. As you (and KHE) say, that seems to be what the majority in each group wants. Unfortunately, the extremists seem to be running the show.

 

[PBEA]

The answer is simple: Optometry is more a physics field than health sciences. It is focused to refracting and etc. If your interest is Medicating why didn't you enter Medical school then? or a health sciences field career. You picked a physics field career, YES LOOK IN BOOKS OF PHYSICS IS WHERE YOU WILL FIND ABOUT REFRACTING AND LIGHT AND THOSE KIND OF THINGS, NOT ON A BIOLOGY BOOK. If you want to medicate and other optometrists you all can go to medical school. Optometrist asking for medications or surgery for patientes is like a psychologist asking to do the same for his patients?? isnt that why psychiatrist exist?

congratulations, you win the "stupid post of the day" award.

 

[Eyefixer]

congratulations, you win the "stupid post of the day" award.

Whaaa, look who crawled from under a rock

 

[Depakote]

please keep the discussion in this thread civil. thanks.

 

[Optogal]

There's no country in the world that allows optometrists to do more than prescribe glasses and contact lenses. Why should U.S. be different?

I guess there's no reason for any optometrists to send cataract and LASIK patients to you, since that involves more than prescribing glasses and contact lenses.

That's fine. We'll just send it to the successful OMD competitor across the street from you.

 

[Optogal]

The answer is simple: Optometry is more a physics field than health sciences. It is focused to refracting and etc. If your interest is Medicating why didn't you enter Medical school then? or a health sciences field career. You picked a physics field career, YES LOOK IN BOOKS OF PHYSICS IS WHERE YOU WILL FIND ABOUT REFRACTING AND LIGHT AND THOSE KIND OF THINGS, NOT ON A BIOLOGY BOOK. If you want to medicate and other optometrists you all can go to medical school. Optometrist asking for medications or surgery for patientes is like a psychologist asking to do the same for his patients?? isnt that why psychiatrist exist?

Using your argument, it seems optometrists are therefore well suited to refractive surgery, since the procedure is "more a physics field than health sciences" and it is further "focused to refracting".

 

[qcy07]

I know that I said I was finished posting on SDN, but I just wanted to let everyone who reads posts on this forum know that Dr. Kliger and I had a great, long, respectful phone conversation. He and I agree on many issues facing our two professions. It is too bad that "monolithic political organizations" without a face, tend to build walls, and can make enemies of what would be otherwise friendly professionals. I realize it is naive to think we can just all sit down and get along, and work all of the issues out without some fights, but I believe there is a great deal of room for compromise. We are all intelligent people... right? We should work toward amicable solutions. For my part I will spend a little more time trying to do what I can to talk to my associations and help them understand "how the real world works", because an ophthalmology and optometry relationship truly can be good for both professions. I know, I create and experience these productive, patient-benefiting relationships daily in my practice.

Thanks again for the conversation Dr. Kliger.

 

[JaggerPlate]

I guess there's no reason for any optometrists to send cataract and LASIK patients to you, since that involves more than prescribing glasses and contact lenses.

That's fine. We'll just send it to the successful OMD competitor across the street from you.

I know that I said I was finished posting on SDN, but I just wanted to let everyone who reads posts on this forum know that Dr. Kliger and I had a great, long, respectful phone conversation. He and I agree on many issues facing our two professions. It is too bad that "monolithic political organizations" without a face, tend to build walls, and can make enemies of what would be otherwise friendly professionals. I realize it is naive to think we can just all sit down and get along, and work all of the issues out without some fights, but I believe there is a great deal of room for compromise. We are all intelligent people... right? We should work toward amicable solutions. For my part I will spend a little more time trying to do what I can to talk to my associations and help them understand "how the real world works", because an ophthalmology and optometry relationship truly can be good for both professions. I know, I create and experience these productive, patient-benefiting relationships daily in my practice.

Thanks again for the conversation Dr. Kliger.

Isn't CA still one of the states with the harshest restrictions on ODs???

 

[qcy07]

Isn't CA still one of the states with the harshest restrictions on ODs???

Yes CA is. What is your point?

 

[EyeGuy15]

Optometrists needs to get a clue. To the OP, no one cares that you went through all that training and board exams. You are STILL AN OPTOMETRIST. You knew the restrictions when you decided to go to optometry school instead of going to medical school, then matching into an ophthalmology residency, and then possibly doing specialty fellowship. If you wanted to do more, you should have gone to medical school.

In my opinion, your job is to refract and handle the most basic of cases that ophthalmologist's do not want to handle or that insurance won't cover for ophthalmologists. You being "glaucoma certified" is a worthless point because once one of your patient's glaucoma becomes difficult to manage for you, you are going to refer them to a specialist anyways. All you have done is basically created a nuisance for the ophthalmologist who may have to perform a surgical procedure to figure out what you did to conservatively treat the patient and why you did that. Learning and understanding how to approach glaucoma is not a weekend course and exam. If they can be seen by an ophthalmologist(even one that has not even done a glaucoma fellowship), they STILL HAVE MORE TRAINING THAN YOU. You are a middle man. An unnecessary middle man that should be happy that many insurance restrictions do not cover a refraction and basic exam by an ophthalmologist.

With a saturated field in many cities, optometrists should just hope that ophthalmologists do not band together to have insurance cover refractions and basic check ups by ophthalmologists because then there would be no sense in going to an optometrist because everything can and will be done by the ophthalmologist with ease and if real pathology is seen, it can be addressed on the spot. Know your role. Refract (and be happy you can make six figures doing that), sell gucci sunglasses at the mall, and just be happy that your job exists, because 90% of what optometrists do, can be done by a licensed ophthalmic technician.

 

[PBEA]

Optometrists needs to get a clue. To the OP, no one cares that you went through all that training and board exams. You are STILL AN OPTOMETRIST. You knew the restrictions when you decided to go to optometry school instead of going to medical school, then matching into an ophthalmology residency, and then possibly doing specialty fellowship. If you wanted to do more, you should have gone to medical school.

In my opinion, your job is to refract and handle the most basic of cases that ophthalmologist's do not want to handle or that insurance won't cover for ophthalmologists. You being "glaucoma certified" is a worthless point because once one of your patient's glaucoma becomes difficult to manage for you, you are going to refer them to a specialist anyways. All you have done is basically created a nuisance for the ophthalmologist who may have to perform a surgical procedure to figure out what you did to conservatively treat the patient and why you did that. Learning and understanding how to approach glaucoma is not a weekend course and exam. If they can be seen by an ophthalmologist(even one that has not even done a glaucoma fellowship), they STILL HAVE MORE TRAINING THAN YOU. You are a middle man. An unnecessary middle man that should be happy that many insurance restrictions do not cover a refraction and basic exam by an ophthalmologist.

With a saturated field in many cities, optometrists should just hope that ophthalmologists do not band together to have insurance cover refractions and basic check ups by ophthalmologists because then there would be no sense in going to an optometrist because everything can and will be done by the ophthalmologist with ease and if real pathology is seen, it can be addressed on the spot. Know your role. Refract (and be happy you can make six figures doing that), sell gucci sunglasses at the mall, and just be happy that your job exists, because 90% of what optometrists do, can be done by a licensed ophthalmic technician.

and yet another clueless med student making rambling, inaccurate, and disrespectful comments about optometry. They sure do like to start the process of indoctrination early in med school.

 

[Shnurek]

Learning and understanding how to approach glaucoma is not a weekend course and exam. If they can be seen by an ophthalmologist(even one that has not even done a glaucoma fellowship), they STILL HAVE MORE TRAINING THAN YOU ..... 90% of what optometrists do, can be done by a licensed ophthalmic technician.

So let us learn. Create more ophthalmology residency positions. Let some of us enter those residencies. O wait, some of you rather make things more complicated by restricting slots not based on patient need. Sure thats fine. We will create our own residencies and middle level providers like optometrists will get more rights. If you cut supply, people will find other ways around that. Intravitreal injection reimbursements just got reduced by more than 25%. You see what is happening?

And yes licensed ophthalmic technicians can do a multitude of things that optometrists can do but only if a doctor is in the office. So can optometric technicians.

PS - And before I get generic comments like, "Please start optometry school first then talk". Let me just say that didactic education on how to treat eyes is not necessary to discuss health care politics that I have learned while working as an Ophthalmic Technician for an excellent Ophthalmologist. Feel free to counter my statements as I enjoy the debate and learn from it at the same time.

 

[qcy07]

Optometrists needs to get a clue. To the OP, no one cares that you went through all that training and board exams. You are STILL AN OPTOMETRIST. You knew the restrictions when you decided to go to optometry school instead of going to medical school, then matching into an ophthalmology residency, and then possibly doing specialty fellowship. If you wanted to do more, you should have gone to medical school.

In my opinion, your job is to refract and handle the most basic of cases that ophthalmologist's do not want to handle or that insurance won't cover for ophthalmologists. You being "glaucoma certified" is a worthless point because once one of your patient's glaucoma becomes difficult to manage for you, you are going to refer them to a specialist anyways. All you have done is basically created a nuisance for the ophthalmologist who may have to perform a surgical procedure to figure out what you did to conservatively treat the patient and why you did that. Learning and understanding how to approach glaucoma is not a weekend course and exam. If they can be seen by an ophthalmologist(even one that has not even done a glaucoma fellowship), they STILL HAVE MORE TRAINING THAN YOU. You are a middle man. An unnecessary middle man that should be happy that many insurance restrictions do not cover a refraction and basic exam by an ophthalmologist.

With a saturated field in many cities, optometrists should just hope that ophthalmologists do not band together to have insurance cover refractions and basic check ups by ophthalmologists because then there would be no sense in going to an optometrist because everything can and will be done by the ophthalmologist with ease and if real pathology is seen, it can be addressed on the spot. Know your role. Refract (and be happy you can make six figures doing that), sell gucci sunglasses at the mall, and just be happy that your job exists, because 90% of what optometrists do, can be done by a licensed ophthalmic technician.

It is literally not worth the energy my fingers would expend typing a response to this.

I bow out gracefully.

 

[JaggerPlate]

Yes CA is. What is your point?

Just seems odd that someone would take the time to talk to you about breaking barriers, fixing things, etc, but at the same time sit on a decision making board in a state that, as you said, has historically successfully stomped OD expansion.

My guess is that this isn't about to change anytime soon, so it makes me question intent.

 

[Visionary]

Optometrists needs to get a clue. To the OP, no one cares that you went through all that training and board exams. You are STILL AN OPTOMETRIST. You knew the restrictions when you decided to go to optometry school instead of going to medical school, then matching into an ophthalmology residency, and then possibly doing specialty fellowship. If you wanted to do more, you should have gone to medical school.

In my opinion, your job is to refract and handle the most basic of cases that ophthalmologist's do not want to handle or that insurance won't cover for ophthalmologists. You being "glaucoma certified" is a worthless point because once one of your patient's glaucoma becomes difficult to manage for you, you are going to refer them to a specialist anyways. All you have done is basically created a nuisance for the ophthalmologist who may have to perform a surgical procedure to figure out what you did to conservatively treat the patient and why you did that. Learning and understanding how to approach glaucoma is not a weekend course and exam. If they can be seen by an ophthalmologist(even one that has not even done a glaucoma fellowship), they STILL HAVE MORE TRAINING THAN YOU. You are a middle man. An unnecessary middle man that should be happy that many insurance restrictions do not cover a refraction and basic exam by an ophthalmologist.

With a saturated field in many cities, optometrists should just hope that ophthalmologists do not band together to have insurance cover refractions and basic check ups by ophthalmologists because then there would be no sense in going to an optometrist because everything can and will be done by the ophthalmologist with ease and if real pathology is seen, it can be addressed on the spot. Know your role. Refract (and be happy you can make six figures doing that), sell gucci sunglasses at the mall, and just be happy that your job exists, because 90% of what optometrists do, can be done by a licensed ophthalmic technician.

Wow. I've read some ignorant, disrespectful posts on this board, but gee whiz. I'm actually compelled to apologize for you.

 

[Eyes T]

Wow. I've read some ignorant, disrespectful posts on this board, but gee whiz. I'm actually compelled to apologize for you.

Look up his posting history. He's a very angry, annoying troll that likes to come on here and fill his empty life by trying to piss people off. Just ignore.

As a medical student starting my ophthalmology career, I really hope that most optometrists don't believe that this is the general opinion of med students and OMDs.

 

[EyeGuy15]

Not a troll by any means. Just someone who recently matched into ophtho who thinks the complaceny of ophthalmologists in this forum(residents and attendings) is absolutely absurd. Despite the fact I was incredibly disrespectful, nothing I said was technically untrue. While optometrists are out there basically disrespecting everything about an ophthalmologists training and education, everyone here in ophthalmology just resorts to ridiculous and pointless counterpoints. Can anyone really say anything I said was untrue. Mean spirited? Probably? Lies? Nope. I know plenty of ophthalmologists who will say this behind close doors but won't in a public forum. The average ophthalmologist today seems to almost always be a mild-mannered and timid person. Optometry is doing whatever they can to increase their scope and thus increase their earning power, and all I see is worthless retorts from current people in ophtho. Too borrow a line from a great movie....

"In order to protect the sheep ... you've got to go after the wolves. And to get the wolves ...you've got to be a wolf. Are you a wolf or a sheep?"

I am embarassed to think my profession is filled with a bunch of people getting punked so easily. It will start with Kentucky and Nebraska....and move to every other state once a precedent has been set. No other "surgical field" would allow this too happen, and it disgusts me it was done so easily to ophthalmologists. Would general surgery, neuro-surgery, ENT, CTS etc even entertain the idea of a non MD/DO doing what they have traditionally done for years? NOPE. I apologize I am not one of the "nice people going into ophthalmology" and quite frankly, I am happy with that. Call me a troll, but while everyone here is "debating", optometrists are slowly destroying the field of ophthalmology all the way to the bank. Hopefully the current ophthalmologists wont have screwed it up so bad that in four years, the profession won't totally be going down the drain. Man up and stop crying that I am not "nice". The truth hurts. Sorry.

 

[Eyes T]

Not a troll by any means. Just someone who recently matched into ophtho who thinks the complaceny of ophthalmologists in this forum(residents and attendings) is absolutely absurd. Despite the fact I was incredibly disrespectful, nothing I said was technically untrue. While optometrists are out there basically disrespecting everything about an ophthalmologists training and education, everyone here in ophthalmology just resorts to ridiculous and pointless counterpoints. Can anyone really say anything I said was untrue. Mean spirited? Probably? Lies? Nope. I know plenty of ophthalmologists who will say this behind close doors but won't in a public forum. The average ophthalmologist today seems to almost always be a mild-mannered and timid person. Optometry is doing whatever they can to increase their scope and thus increase their earning power, and all I see is worthless retorts from current people in ophtho. Too borrow a line from a great movie....

"In order to protect the sheep ... you've got to go after the wolves. And to get the wolves ...you've got to be a wolf. Are you a wolf or a sheep?"

I am embarassed to think my profession is filled with a bunch of people getting punked so easily. It will start with Kentucky and Nebraska....and move to every other state once a precedent has been set. No other "surgical field" would allow this too happen, and it disgusts me it was done so easily to ophthalmologists. Would general surgery, neuro-surgery, ENT, CTS etc even entertain the idea of a non MD/DO doing what they have traditionally done for years? NOPE. I apologize I am not one of the "nice people going into ophthalmology" and quite frankly, I am happy with that. Call me a troll, but while everyone here is "debating", optometrists are slowly destroying the field of ophthalmology all the way to the bank. Hopefully the current ophthalmologists wont have screwed it up so bad that in four years, the profession won't totally be going down the drain. Man up and stop crying that I am not "nice". The truth hurts. Sorry.

Last time I checked, throwing around inflammatory remarks on a message board under the veil of an anonymous user name does not make you, in your words, a "wolf." It makes you someone with no real life outlet to constructively express your views. If you really feel this strongly, get out there and get involved politically. This is a forum for constructive, useful discussion amongst colleagues. Obviously, you are not the only one on here making mean-spirited remarks, but you have a history of doing so in multiple threads, not just this one. Thus the troll tag.

I never said I disagree with the opinions buried deeply beneath your crude rhetoric. I just think you're extremely childish in the way that you express them and it makes ophthalmologists in general look bad (despite the fact that you clearly think it makes you seem like a tough guy). I dislike the optom and pre-optom people on this board who come on and basically say "nah-nah na nah-nah, we're getting more privileges and there's nothing you can do about it" without substantiating the qualifications they have for them. But these posts are what will motivate me to fight back as hard and to the fullest extent that I can (in the real world, not on studentdoctor) when I feel that they may be overstepping their limitations at the expense of patient care. However, as a reasonable "nice" person (funny how you see that as a bad thing) I also understand the importance of maintaining a good relationship with the professionals with whom we will undoubtedly be working very closely and who play an important role in eye care. With the business sense that you've touted across this website, you must also understand that optometrists are a huge source of surgical referrals that save you the hassle of doing hundreds of basic workups to generate the real money-making procedures. I'm not sure if you started at the top of this thread or just jumped in when something caught your attention, but it is titled "from an optometrist not actually pushing for surgery." Why alienate people who agree with you by making ignorant remarks like this?

On a separate note, I'm not sure what state you're from, but if you think the other surgical specialties are immune to allied health professionals poaching their income, you need to have a discussion with an otolaryngologist from New York who, by law, cannot make money from fitting and selling hearing aids. Why? Because the audiology lobby made it so. Maybe ENT's are just "too nice" as well.

 

[thecgrblue]

Not a troll by any means. Just someone who recently matched into ophtho who thinks the complaceny of ophthalmologists in this forum(residents and attendings) is absolutely absurd. Despite the fact I was incredibly disrespectful, nothing I said was technically untrue. While optometrists are out there basically disrespecting everything about an ophthalmologists training and education, everyone here in ophthalmology just resorts to ridiculous and pointless counterpoints. Can anyone really say anything I said was untrue. Mean spirited? Probably? Lies? Nope. I know plenty of ophthalmologists who will say this behind close doors but won't in a public forum. The average ophthalmologist today seems to almost always be a mild-mannered and timid person. Optometry is doing whatever they can to increase their scope and thus increase their earning power, and all I see is worthless retorts from current people in ophtho. Too borrow a line from a great movie....

"In order to protect the sheep ... you've got to go after the wolves. And to get the wolves ...you've got to be a wolf. Are you a wolf or a sheep?"

I am embarassed to think my profession is filled with a bunch of people getting punked so easily. It will start with Kentucky and Nebraska....and move to every other state once a precedent has been set. No other "surgical field" would allow this too happen, and it disgusts me it was done so easily to ophthalmologists. Would general surgery, neuro-surgery, ENT, CTS etc even entertain the idea of a non MD/DO doing what they have traditionally done for years? NOPE. I apologize I am not one of the "nice people going into ophthalmology" and quite frankly, I am happy with that. Call me a troll, but while everyone here is "debating", optometrists are slowly destroying the field of ophthalmology all the way to the bank. Hopefully the current ophthalmologists wont have screwed it up so bad that in four years, the profession won't totally be going down the drain. Man up and stop crying that I am not "nice". The truth hurts. Sorry.

Could you please tell me about podiatrists and orthopedic surgery?

 

[VA Hopeful Dr]

So let us learn. Create more ophthalmology residency positions. Let some of us enter those residencies. O wait, some of you rather make things more complicated by restricting slots not based on patient need. Sure thats fine. We will create our own residencies and middle level providers like optometrists will get more rights. If you cut supply, people will find other ways around that. Intravitreal injection reimbursements just got reduced by more than 25%. You see what is happening?

You are suffering under a fairly common misconception. The government controls the number of residency slots based on GME funding from CMS. We have no control over that, unless a hospital decides to cover the cost of extra residents on its own.

 

[eyerat]

Isn't CA still one of the states with the harshest restrictions on ODs???

That's why the job market for ophthalmologists in California is much better that in the states where the scope of optometry has been expanded.
Let's not cheat ourselves, optometrists will keep pushing for more privileges and they will be doing it in the most sneaky and unethical way, similar to the tactics they used in Kentucky. The already dismal job market for ophthalmologists will continue to get worse, while the salaries, which are already on the level of primary care FM and IM will continue to drop even lower.
Is there a way to prevent it? Possibly, if our community gets organized and gains political clout. We should also start a campaign educating the public that optometrists are not "real doctors" and they did not go to medical school. Unfortunately 50% of the patients don't know the difference and thus cannot make an educated choice of the provider. I think that this fact alone allowed optometry in the U.S. to be where it is right now. Optometrists in other countries are not "doctors" and the scope of their work is pretty much limited to refraction.

 

[Visionary]

Not a troll by any means. Just someone who recently matched into ophtho who thinks the complaceny of ophthalmologists in this forum(residents and attendings) is absolutely absurd. Despite the fact I was incredibly disrespectful, nothing I said was technically untrue. While optometrists are out there basically disrespecting everything about an ophthalmologists training and education, everyone here in ophthalmology just resorts to ridiculous and pointless counterpoints. Can anyone really say anything I said was untrue. Mean spirited? Probably? Lies? Nope. I know plenty of ophthalmologists who will say this behind close doors but won't in a public forum. The average ophthalmologist today seems to almost always be a mild-mannered and timid person. Optometry is doing whatever they can to increase their scope and thus increase their earning power, and all I see is worthless retorts from current people in ophtho. Too borrow a line from a great movie....

"In order to protect the sheep ... you've got to go after the wolves. And to get the wolves ...you've got to be a wolf. Are you a wolf or a sheep?"

I am embarassed to think my profession is filled with a bunch of people getting punked so easily. It will start with Kentucky and Nebraska....and move to every other state once a precedent has been set. No other "surgical field" would allow this too happen, and it disgusts me it was done so easily to ophthalmologists. Would general surgery, neuro-surgery, ENT, CTS etc even entertain the idea of a non MD/DO doing what they have traditionally done for years? NOPE. I apologize I am not one of the "nice people going into ophthalmology" and quite frankly, I am happy with that. Call me a troll, but while everyone here is "debating", optometrists are slowly destroying the field of ophthalmology all the way to the bank. Hopefully the current ophthalmologists wont have screwed it up so bad that in four years, the profession won't totally be going down the drain. Man up and stop crying that I am not "nice". The truth hurts. Sorry.

They really taught you well at the Gordon Gekko School of Business. Oh, and movie quotes are not the best way to back up your arguments. Movies, much like school, do not adequately represent the real world. What happened in KY, and in OK before that, IS happening to numerous surgical and medical specialties. It's not unexpected that practitioners, as their fields evolve, will seek to expand scope. You are also incorrect in stating that this was easily done to ophthalmology. The OK law was passed in 1998--that's 13 years ago. Since that time, there have been scope expansion attempts in at least 25 other states, which have been successfully defended. The KY bill was crafted in secret over an 18 month period, guided through the wrong committee, and rammed through the Senate and House without significant debate. The wheels were greased with over $400k in political contributions. It was a well-designed strategy. Hopefully, the AAO and various state organizations will not be taken by surprise again.

As for the tone of some on this board, you seem to confuse respect and professionalism with weakness. While I clearly do not agree with the aggressive surgical scope expansion attempts by organized optometry, I do not think it's appropriate to denigrate the profession. Like it or not, these are individuals who spent 4+ years in post-graduate training. These are individuals with whom most of us in the real world have professional (and personal) relationships and on whom most of us rely for referrals. To suggest that the whole profession of optometry is a "nuisance" and "unnecessary" is ludicrous and completely unproductive.

As has been stated by multiple optometrists on this board (and others to whom I've spoken personally), the majority do not want to do surgery. Most only want expanded medical privileges for those aspects of eye care they are comfortable managing. Unfortunately, the national agenda is being run by extremists (like most politics). That ends up working out okay for the majority, in this case, because broad expansion that includes surgery also secures those medical privileges that they seek.

The only way I see this playing out well for everyone is for the AAO to open up a dialogue with the more moderate majority within the optometric community to try and hammer out some agreement that would, perhaps, involve us facilitating the broadening of national medical eye care privileges for optometrists, while securing surgery for ophthalmology. The fact is that optometry is too well-organized, outnumbers ophthalmology by at least 2-1, and has more political funding. The more I learn about this, the more I understand that an all-out war is not winnable. We will end up worse off, in the end.

 

[PBEA]

I appreciate the candor of some of the neophyte ophtho's, really I do. Lets me know the depth of brainwashing that occurs in med school. The attendings beating the wardrums, etc. With that kind of attitude it is NO WONDER that ODs have to press for legislative advances in scope of practice. If were left up to medicine, ODs would be limited to refraction (as if that could be or should be done).

Does anybody here think refraction should be done as a stand alone procedure?

 

[Visionary]

That's why the job market for ophthalmologists in California is much better that in the states where the scope of optometry has been expanded.

Don't know where you're hearing this, but it's wrong. The market for ophthalmologists in California is terribly saturated. Has nothing to do with optometrists.

 

[orbitsurgMD]

I appreciate the candor of some of the neophyte ophtho's, really I do. Lets me know the depth of brainwashing that occurs in med school. The attendings beating the wardrums, etc. With that kind of attitude it is NO WONDER that ODs have to press for legislative advances in scope of practice. If were left up to medicine, ODs would be limited to refraction (as if that could be or should be done).

Does anybody here think refraction should be done as a stand alone procedure?

Yes and no. I think it serves your interest to have it as a separate code, because to include it in another code, say for example all the 920xx codes might require you to refract essentially for the price of the examination, or in other words for "free." The same effect would apply to bundling the code or excluding the code when combined with an examination.

Now, that said, do I think anyone ought to be doing refractions and prescribing spectacles and contact lenses who cannot also examine an eye
and the patient attached to it? No.

 

[Visionary]

Now, that said, do I think anyone ought to be doing refractions and prescribing spectacles and contact lenses who cannot also examine an eye and the patient attached to it? No.

Agreed. A couple of my technicians, who are excellent refractionists, joked after the KY bill passed that they were going to go lobby for the privilege to prescribe glasses and contact lenses. There's definitely more to it than just refracting.

 

[eyerat]

Don't know where you're hearing this, but it's wrong. The market for ophthalmologists in California is terribly saturated. Has nothing to do with optometrists.

Exactly! Optometrists have nothing to do with the California market for ophthalmologists being so saturated. It is bad for a lot of different reasons but it is bad pretty much everywhere. What I'm saying is that it would be even worse if the scope of optometry in CA was broader that what it is currently.

 

[Frumps]

That's why the job market for ophthalmologists in California is much better that in the states where the scope of optometry has been expanded.
Let's not cheat ourselves, optometrists will keep pushing for more privileges and they will be doing it in the most sneaky and unethical way, similar to the tactics they used in Kentucky. The already dismal job market for ophthalmologists will continue to get worse, while the salaries, which are already on the level of primary care FM and IM will continue to drop even lower.
Is there a way to prevent it? Possibly, if our community gets organized and gains political clout. We should also start a campaign educating the public that optometrists are not "real doctors" and they did not go to medical school. Unfortunately 50% of the patients don't know the difference and thus cannot make an educated choice of the provider. I think that this fact alone allowed optometry in the U.S. to be where it is right now. Optometrists in other countries are not "doctors" and the scope of their work is pretty much limited to refraction.

You can help by contacting your legislator in regard to passing the Health Care Truth and Transparency Act. I have nothing against optometrists being called Dr. (who isn't these days), but it should be phrased Doctor of Optometry, as in Doctor of physical therapy, Doctor of chiropractic, Doctor of Veterinary medicine, Doctor of Pharmacy, etc.
http://www.govtrack.us/congress/billtext.xpd?bill=h112-451

 

[Visionary]

Exactly! Optometrists have nothing to do with the California market for ophthalmologists being so saturated. It is bad for a lot of different reasons but it is bad pretty much everywhere. What I'm saying is that it would be even worse if the scope of optometry in CA was broader that what it is currently.

Sorry, eyerat! My sarcasm detector has been faltering recently.

 

[PBEA]

Yes and no. I think it serves your interest to have it as a separate code, because to include it in another code, say for example all the 920xx codes might require you to refract essentially for the price of the examination, or in other words for "free." The same effect would apply to bundling the code or excluding the code when combined with an examination.

Now, that said, do I think anyone ought to be doing refractions and prescribing spectacles and contact lenses who cannot also examine an eye
and the patient attached to it? No.

Thank you, yes 92015 is charged separately, my question was what you addressed in the second part, and I agree completely. It is a separate procedure but not a "stand alone" procedure.

 

[CKliger]

Hmm...maybe we all need to take a deep breath here.

I am reminded of the following:

http://www.skeptic.ca/Woody_Allen_Speech_to_Graduates.htm

Indeed the most poignant parts are the first four sentences and the last three (the latter set of which appear smaller than the rest for some reason...at least in my browser).

But the rest can be funny too (assuming you like Mr. Allen's humor, which some might find awkward, or possibly offensive. [sorry if that is the case])

Nevertheless, sometimes it helps to put things in perspective

 

[Shnurek]

You are suffering under a fairly common misconception. The government controls the number of residency slots based on GME funding from CMS. We have no control over that, unless a hospital decides to cover the cost of extra residents on its own.

Thanks for clearing that up for me.

We should also start a campaign educating the public that optometrists are not "real doctors" and they did not go to medical school. Unfortunately 50% of the patients don't know the difference and thus cannot make an educated choice of the provider. I think that this fact alone allowed optometry in the U.S. to be where it is right now. Optometrists in other countries are not "doctors" and the scope of their work is pretty much limited to refraction.

Yes, Medical Doctors went to medical school but Oculus Doctors (OD's) went to optometry school where they focused solely on the eyes and their related systemic disorders. Also, optometry school in most other countries is not a 4 year post-undergraduate doctorate program. In some countries it is merely an undergraduate degree with a 1 year graduate internship and in others 2-3 years of graduate study. But we are the United States. We let in the best and the brightest from all over the world. Usually we lead the way in how things should be done.

Example: Chinese highway system that they are building now is basically copying ours: http://2.bp.blogspot.com/_nsti1VlX3Cs/THCvfRsi46I/AAAAAAAAF6A/54EYHqV9TZk/s1600/China+060.jpg
(Notice the green signs with white letters on them)

 

[VA Hopeful Dr]

Yes, Medical Doctors went to medical school but Oculis Doctors (OD's) went to optometry school where they focused solely on the eyes and their related systemic disorders. Also, optometry school in most other countries is not a 4 year post-undergraduate doctorate program. In some countries it is merely an undergraduate degree with a 1 year graduate internship and in others 2-3 years of graduate study. But we are the United States. We let in the best and the brightest from all over the world. Usually we lead the way in how things should be done.

Example: Chinese highway system that they are building now is basically copying ours: http://2.bp.blogspot.com/_nsti1VlX3Cs/THCvfRsi46I/AAAAAAAAF6A/54EYHqV9TZk/s1600/China+060.jpg
(Notice the green signs with white letters on them)

Don't bother. If someone holds the viewpoint you're arguing against, nothing you say is going to change his/her mind.

 

[ophthoapp2010]

But we are the United States. We let in the best and the brightest from all over the world. Usually we lead the way in how things should be done.

Example: Chinese highway system that they are building now is basically copying ours: http://2.bp.blogspot.com/_nsti1VlX3Cs/THCvfRsi46I/AAAAAAAAF6A/54EYHqV9TZk/s1600/China+060.jpg
(Notice the green signs with white letters on them)

Are you seriously using that as an example? Green signs with white letters?

 

[Shnurek]

Are you seriously using that as an example? Green signs with white letters?

Yes, it was a random example I thought of off the top of my head. There are plenty of other examples, abortion rights, diversification of the populace, military technology, gay rights etc. that you can look up yourself. The point is, most other countries look up to us and model themselves after us because we are successful, even with this temporary recession.

 

[kardon93]

if you wanted a bigger scope of practice, in this case more primary care why didnt you simply picked opthalmology? Next time you choose a career read about the scope of practice....if you dont like it then pick other career.

 

[Shnurek]

if you wanted a bigger scope of practice, in this case more primary care why didnt you simply picked opthalmology? Next time you choose a career read about the scope of practice....if you dont like it then pick other career.

Thanks for your valuable input.