future of ophtho lookin real bad??

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C

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a few attendings (non ophthos i might add) told me today that ophthos have real tough road ahead. there were many reasons, some of which were increasing procedures done by ODs, opticians, and just too many ophthos everywhere. in 5 yrs they said if u wanna practice in big cities u will make $120k tops and will be doing general eye exams to feed your family. plus laser vision correction procedures will be covered 100% by insurance. so bottom line they said avoid ophtho like plague!

i'm sure u guys know a lot more and know the "real" deal - so pls comment - i was definitely shocked today.
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Hmmm...
I'm always amazed that doctors will talk crap about specialties they are not in. How would a physician who is not an ophthalmologist know so much about what lies ahead in a field they aren't in?

I've found that no matter what rotation you're on, the attendings will have something bad to say about what you are interested in doing, unless it is their specialty.

Optometrists will never gain priveleges to do the surgical cases that ophthalmologists train for.

Opticians don't even do procedures. I think they only prescribe and grind lenses. What procedures was this seemingly omniscient attending speaking of? Where did he come up with the 120K/year figure? What insurance company is covering refractive surgery? Mind you, eve if insurance covers refractive surgery, I believe the ophthalmologist can still charge what he wants for the procedure, the patient would have to pay the difference. Certainly medicare won't be covering this.

I'm tired of people talking crap! Regardless of what I've been interested in, some know-it-all physician has tried to discourage me! When I was interested in CT surgery...the interventional cardiologists are taking over. Radiology?....teleradiology will take all the studies away. Orthopedics?....you'll be starving because you can't pay the malpractice. Primary care?.....watch out for the increasing priveleges of nurse practicioners and physician assistants. Anesthesiology?.....Nurse anesthesist are doing all the bread-and-butter cases. Maybe it's just physician penis envy. What was this guy's specialty? I'd bet money he was an FP.

All I have to say to people who talk out of their arses without any proof or actual knowledge is....STEP OFF....STEP OFF....STEP OFFF...STEP OFF....STEP OFFF....STEP OFFFFFF....STEP OFFFF....STEP OFFFFFFFF....ST-ST-ST-STEP OFFFF

Geddy
 
Ask the attending about this:


http://www.ama-assn.org/amednews/2003/08/25/prsc0825.htm

So, as you see, the demand for ophthalmologists is only increasing on a year by year basis.

The ammo for non-optho MD's:

There are very few fields in medicine where you make 300K/yr and
1) work 40 hours(regular hours) a week
2) no weekends
3) no rounds

Therein lies the envy

MEDSTUD
 
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Bottom line is go into whatever field you are interested in. You will do fine in ophthalmology. Starting salaries could be better, but the earnings when you make partner are quite nice. There aren't too many cataract cowboys around making seven figures anymore, but there are probably more in this field than most. and the hours are great. work is rewarding.
 
Geddy, You took the words out of my mouth. I hate that everyone is so down on medicine in general, and always discouraging you from going into a particular field. Good work.
 
i've been thinking about ophtho residency and the hating that goes on in practically all fields by docs in other fields. what i would like to know is why most ophthos seem to automatically discount the possibility that optometrists encroach on their current turf (i think it would suck if they did encroach). docs in other fields obviously think it's at least a possibility in the future. i am unfamiliar with od school/training, which is probably the reason for my question. is it because ods dont learn eye surgery at all? what the hell do they do in 4 years of optometry school? are the current laws requiring an md to perform eye surgery subject to change, or have they been modified at all in the past to allow for more od privileges in surgery or any aspect of eye care that they were once denied? thanks for all input.
c
 
as some one who once considered ophtho..i don't think the future is bleak...

the optometrists will never be qualified nor permitted (see NJ where they were recently shot down) to do procedures in optho...they aren't trained surgeons...thats what it comes down to...

plus you also need to take into account growth...the field is already so techinically advanced so who knows what they will be doing 10, 20 years from now...

to answer the last person..there is no surgery in optometry...
they are great at making some diagnoses...or at least some are...
or helping with glasses rx...

its a great field with good hours, interesting procedure...if you enjoy it...

i can't comment on income, b/c who knows what any of us will be making?
 
Originally posted by c diddy
"... what i would like to know is why most ophthos seem to automatically discount the possibility that optometrists encroach on their current turf (i think it would suck if they did encroach). docs in other fields obviously think it's at least a possibility in the future. i am unfamiliar with od school/training, which is probably the reason for my question. is it because ods dont learn eye surgery at all? what the hell do they do in 4 years of optometry school? are the current laws requiring an md to perform eye surgery subject to change, or have they been modified at all in the past to allow for more od privileges in surgery or any aspect of eye care that they were once denied? thanks for all input.
c
Click to expand...

Dear Forum,

It's unfortunate that members of this forum generalize about a facet of life or a segment of a population so freely. Such an inclination to approach life leads me to believe that racism, sexism, class warfare still exists despite the trappings of liberalism that we say we have.

That aside, I think that optometry training has significantly changed in the last decade and encompasses a significant amount of "hard biological sciences" such as pharmacology, molecular biology/immunology, anatomy and physiology. Admittedly, the focus is mainly "above the nose and below the forehead" but that emphasis should not lessen one's dedication to good eye care.

Optometry has expanded into "medical" eye care and in nearly all circumstances, have provided excellent care. Whether optometry should venture into surgical eye care is still much debated within optometry. I, for one, am not interested in surgery. I do however, believe that optometry can deliver effective eye care in a largely medical paradigm,

Regards,
Richard Hom, OD
 
Well I have to say that I think Optometrists serve a great role. I know nothing about their training regimine, but in their current role, I believe they are very helpful and beneficial to everyone.

The debate over whether or not Optometrists should venture into surgical training is one that I personally think is ridiculous. I'm sure that there are many people out there who think that OD's doing surgery is a great idea. And plenty of people would site my position on this debate as being biased and simply "covering my own arse" or protecting "my turf".

You know what...I bet optometrists can do surgery just fine. I would also bet that you could take someone fresh out of PA school and train them to do appendectomies and lap chole's or even CABGs just as well as a general surgeon. So why aren't we doing that? Heck, I'd even venture to say you can take someone right out of high school and put them through some kind of expedited MD program and train them to be excellent surgeons, or any specialty for that matter. Why does it take 7-8 years of residency to train a CT surgeon? Or 9 years to train an interventional cardiologist? Why do we waste time rotating through pediatrics if we plan with our heart and soul to become geriatricians?

OD's doing surgery, PA's with greater and greater autonomy, CRNA's expanding their scope of anesthesia practice....where does it end? The trend is toward technician types docs who train for several specific things....hey, I'd bet money that it would work. Shoot, they might even be better than docs, because you could intensively train them on one or two surgeries, rather than wasting time learning procedures they don't ever want to do. And they would want much less in compensation since they didn't go through nearly the amount of schooling that us MD's did.

But, once we have our new, time-efficient, cost effective breed of surgeon technicians, if you will, why would anyone go through the traditional route to become and MD surgeon that can handle any odd-ball case or trauma that comes in? You can't make a living just doing the bizarre stuff...

My analogy is to OD vs OPH in surgery. If OD's take over the bread and butter surgical cases....cataracts, PRP, etc, OPH would-be's will have no incentive to become ophthalmologists.

There should just be some things in life that go by protocol. If you want to be a surgeon, you get you BS/BA, get your MD, then complete a residency in whatever kind of surgery you wan to learn. That's fair, and it trains people that can comprehensively manage the patient. You could train a fresh military officer to be a general...but it's not done that way...they come up through the ranks. You could train me to fly a 747...but guess what, those spots are reserved for people with tens of thousands of hours flying aircraft anywhere from a little cessna to jumbo jet liners. No one has ever proven that it takes that kind of training. I think the analogy works...and for all the greed in the world of wanting to do something so bad...sometimes you should just go through the channels that get you there, rather than changing legislation to make it suddenly possible.

Bottome line...it's neither fair, nor practical to train OD's to do surgery.

And let's be realistic here for a second too...only ophthalmologists know how to do surgery. What ophthalmologist in their right mind would oversee a program that aims to train OD's on surgical procedures? I guess the OD's could start from scratch, but that hardly seems like a good idea. And how many OD's are going to go through a program as intense as ophthalmology resident. Fair is fair....ophthalmologist train for 3 years to become comprehensive eye surgeons...will OD's train for the same length of time?

Anyway...that was long...I'm on a bit of a rant today anyhow.

Geddy
 
Geddy, I agree with a lot of what you said. However, I must disagree with your statement,

"There should just be some things in life that go by protocol."

If "protocol" exists for no logical reason other than the fact that it has always been that way, you should ask 2 questions.
1. How did it come to be the "protocol" in the first place?
2. Does the protocol need to be changed/updated?

Shoud intracapsular cataract surgery persisted since it was "protocol" at the time? How are we to improve on status quo, if you are not willing to question the protocol? Is this not the base of scientific inquiry and research?

Having said that, the reason ophthalmologist should be the only ones doing ocular surgery is for an entire different reason. As Geddy suggested, someone out of high school may be trained to do a cataract surgery over time. Question is, will s/he be able to recognize complication, deal with it effectively, understand the mechanical/chemical/anatomical implications associated with it, not only as it pertains to the eye, but the whole patient. A lot of ocular diseases have systemic associations and implications that can only be fully appreciated by a physician who has gone through rigorous medical training.

I have met and worked with several optometrists who are highly motivated and have done extra studying to understand these nuances. But I have also met patients who know so much about their medical condition that they have put medical students to shame. We surely cannot generalize that patients can then treat their own diseases; nor can we generalize and say ODs can perform surgeries and do everything MDs do. We also cannot selectively pick those special ODs and let them do surgeries, etc. (Oh wait we can - those are the ones who go back to medical school, internship, and residency training - I think they are called ophthalmologists)
 
how much do ODs make?
 
Optometrists who are into medical optometry and want to do more -right to surgical privileges can do it. Take MCAT's apply to med school do extremely well grades/N.Boards apply to residency and fellowships and so forth. That revenue of opportunity is still open to all those who are ambitous, motivated and qualified to go further. Optometry has no right gaining turf into surgery. As an optometrist, some of my colleagues over the years that I have worked with can't perform accurate refractions and simple contact lens fittings let alone examining the peripheral retina. Our profession (optometry) is divided among ourselves and we are our worst enemy. It's a cry for help for those dedicated and excellent optometrist that want more out of life than just being an optometrist. So what do we do? Whose our friend in helping us get to what we want? US Legislatures-politics- Senate Committees so forth.............
The majority of OD's who have glaucoma privileges do not actually use it. MD's have nothing to worry about us OD's.
 
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I typed a long reply but decided to delete it.

I simply put action over words. If anyone would like to see a well-equiped Optometry practice and an Optometrist that practices on the cutting edge, has a large, well cared-for glaucoma and ocular disease population, uses Ophthalmologist as referral sources only for surgery (patients are promptly returned back to me for follow-up and all future care) and makes 80% of his income (well above the above salary) from services and not materials, and who treats ANY eye disorder that does not require major surgery..........please feel free to come pay me a visit.

A private request will get you the address and a good time to visit. I'll even take you out to lunch.

Otherwise, it's all puffs and sticking your chest out.

I will put my experience and skill managing non-surgical eye conditions up against anyone on this list. Really, I enjoy visitors. NC has great weather this time of year.

Anyone?
 
Tom if that makes you feel better about yourself and sleep better at night by all means.........brag........tell these ophthalmologists how good you measure up to their skills.
 
You know, I don't even think it's a matter of whether or not OD's measure up to Ophthalmologists skills when it comes to what OD's do. I imagine there are great OD's and awful OD's, just like MD's.

I just happen to think surgery should be reserved for the MD's. Including lasers and intraocular surgery. I'm obviously biased since i chose to go the MD route. But I think GlaucomaMD makes a lot of sense with his post, and I happen to agree.

Within their current realm of practice, OD's do great work, and save MD's from dealing with some of the stuff they may not want to do, such as refractions for low myopia, glaucoma checks, etc. Personally I'm glad OD's exist for this reason.

We could argue for days about whether or not OD's could or should be trained to do ophthalmic surgery. In my opinion, they could be...but really shouldn't. Ophthalmologists are trained to do these procedures, and there is no need to train optometrists to do it.

I think also you start playing around with market dynamics when you expand the scope of practice like that. If OD's could do cataracts and lasers, a lot of students would shy away from doing OPH residencies. Why train for the same job in twice the time? That could cause a shortage on the back end of things, as subspecialist ophthalmologists could come into short supply. Certainly no one is suggesting that OD's learn to do vitrectomies, membrane peelings, etc.

If there is already an oversupply of ophthalmologists, why spend money, time and effort training a different "breed" of eye surgeons?

At least to make things fair if OD's get priveleges to do surgery, they should have to compete with us MD and DO types for OPH residency. For those OD's hoping to expand your scope of practice, is this what you want? opportunity to complete for MD OPH residencies? or is the thinking such that OD's will have their own surgical residencies where only OD's go? What kind of surgery is the OD community currently lobbying to have priveleges to perform?

Basically I think we should continue to work together with OD's rather than work against each other. It will all be fine in the end.

TomOD...thanks for you insight...I'd actually love to come visit your practice in NC....such a great state! Not to mention I'm starting to miss my days working in the OPH clinic.
 
Actually, I think we pretty much agree Geddy. We really don't need any more ophthalmic surgeons. I am busy enough with doing in-depth surgery.

But, I guess the real question is: What is surgery? Is a YAG capsulotomy surgery? How about a chalazion injection? Of course ECCE is, as is more invasive procedures such as vitrectomies. Is punctal occlusion with a plug surgery? Of course not, but in NY the medical board tried to take away Optometry's ability to instill punctal plugs after 10-15 years of doing it until some sane judge stepped in and brought some common sense into the picture. (Can you read $$$$ into that picture). :)

I know of no OD or Optometric organizations that are interested in pursuing any type of major ophthalmic surgery. It's just not going to happen. There is no need. We have Ophthalmologists around here begging for cataract referrals already.

I do know of a few states where OD's would like to perform YAG capsuls. and PI's (like OD have been successfully doing for 5-10 years in Oklahoma). These procedure are WELL within our scope.

Here in NC, we have been wrestling with the medical board for years to perform injections (for F/A and chalazions). The PA's down the street with a supervising MD off-site 2 hours away can do them??!! Isn't that odd.

Geddy, your welcome anytime. We agree much more than we disagree. My goal is to bring in a surgeon (and an Optician) so that my clinic can truely be a more well-rounded practice where I would not have to send many of my elderly patient out for cataract surgery.

I think this is the future of eyecare. There are just plenty of folks with eye problems to go around. There's no need to be territorial. The population is only getting fatter and more lazy. I predict there will be enough diabetic and HTN retinopathy, along with glaucoma to keep us all busy.
 
Originally posted by TomOD

I know of no OD or Optometric organizations that are interested in pursuing any type of major ophthalmic surgery.
Click to expand...

Academy and New Jersey Ophthalmologists Help Derail New Jersey O.D. Surgical Scope Bill


May 7, 2003


(Washington, D.C.)?Thanks to the unified efforts of the American Academy of Ophthalmology and the New Jersey Academy of Ophthalmology (NJAO), New Jersey State Assemblyman Van Drew (D), the sponsor of A-3364, the optometric surgical bill, officially withdrew his legislation from further consideration by the New Jersey State Assembly. ?Our objective was clear--the preservation of patient safety and quality care,? says Mike Brennan, MD, Academy secretary for state affairs. ?This message resonated strongly in the capital halls of Trenton and with the citizens of New Jersey.?

'In essence, A-3364 would have created a new health care provider--the ?optometric surgeon? but without medical school education, internship training and residency. Under provisions of this bill, optometrists could have performed a wide range of eye surgeries including refractive, retina, cataract, glaucoma, and lid surgeries. A-3364 also created an independent New Jersey Optometry Board that would have the authority to approve future O.D. surgical privileges. ?It is unbelievable that the O.D board, which is comprised of non-medical providers, would have had the authority to virtually grant a plenary license to optometrists practicing in New Jersey,? says Donald Cinotti, MD, Academy regional state affairs secretariat member.

The key to successfully derailing A-3364 was the strong partnership between the NJAO and Academy working to ensure that the patient risks associated with this legislation were well understood by the general public, media and state legislators. ?NJAO stubbornly opposed the bill and through accurate media representation showed the public dangers as well as conflict of interest issues that proved the misguided nature of this legislation,? says David Ringel, DO, president of the New Jersey Academy of Ophthalmology. ?As the public became aware of the special interests? support of the bill, legislators began to distance themselves from any association with A-3364, and it fell like a rock from the legislative agenda.?


Article from the AAO (www.aao.org)
\
 
anybody know total # and new grads each yr of ophthalmologists, optometrists, and opticians in the US?
 
Originally posted by Ophtho_MudPhud
Academy and New Jersey Ophthalmologists Help Derail New Jersey O.D. Surgical Scope Bill


May 7, 2003


(Washington, D.C.)?Thanks to the unified efforts of the American Academy of Ophthalmology and the New Jersey Academy of Ophthalmology (NJAO), New Jersey State Assemblyman Van Drew (D), the sponsor of A-3364, the optometric surgical bill, officially withdrew his legislation from further consideration by the New Jersey State Assembly. ?Our objective was clear--the preservation of patient safety and quality care,? says Mike Brennan, MD, Academy secretary for state affairs. ?This message resonated strongly in the capital halls of Trenton and with the citizens of New Jersey.?

'In essence, A-3364 would have created a new health care provider--the ?optometric surgeon? but without medical school education, internship training and residency. Under provisions of this bill, optometrists could have performed a wide range of eye surgeries including refractive, retina, cataract, glaucoma, and lid surgeries. A-3364 also created an independent New Jersey Optometry Board that would have the authority to approve future O.D. surgical privileges. ?It is unbelievable that the O.D board, which is comprised of non-medical providers, would have had the authority to virtually grant a plenary license to optometrists practicing in New Jersey,? says Donald Cinotti, MD, Academy regional state affairs secretariat member.

The key to successfully derailing A-3364 was the strong partnership between the NJAO and Academy working to ensure that the patient risks associated with this legislation were well understood by the general public, media and state legislators. ?NJAO stubbornly opposed the bill and through accurate media representation showed the public dangers as well as conflict of interest issues that proved the misguided nature of this legislation,? says David Ringel, DO, president of the New Jersey Academy of Ophthalmology. ?As the public became aware of the special interests? support of the bill, legislators began to distance themselves from any association with A-3364, and it fell like a rock from the legislative agenda.?


Article from the AAO (www.aao.org)
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Andrew,

What you quote above is nothing more than Academy propaganda designed to get folks like you and others on the list into a uproar.

All the NJ Optometry board was seeking was to act as an indepenent licensing board that it is and to be able to certify OD's in that state to prescribe and perform certain optometric procedures as deemed fit.

No one had or has iinvasive surgery on their mind. In this case, the main objection was not to have to go to the medical board every time a new antibiotic medication came out to "update" their formulary. That's very time-consuming and costly.

As is typical, the AAO and others in organized medicine, tried to create unneccessary controversy by inply that OD's would all of the sudden begin doing brain surgery.

There are some that believe that Optometry should not have to ask Medicine permission for everything they do.

Please take what your Academy and our Academy says with a grain of salt. They are political organiztions first and foremost, designed to protect us financial. Don't take it as gospel until you read all the facts.

Below is more of the true story:
============

N.J. Eye Surgeons Fight ?O.D. Laser Bill?


A bill that passed the State Assembly?s Consumer Affairs Committee by a vote of 5-1 has sent ophthalmologists into a frenzy. ?It is the classic example of the optometry profession seeking to circumvent medical education through the enactment of legislation,? says David Ringel, D.O., president of the New Jersey Academy of Ophthalmology.

That?s exactly the opposite of what it would do, says optometrist Christopher J. Quinn, immediate past president of the New Jersey Society of Optometric Physicians. He says the bill requires that to expand scope of practice, any optometrist must gain accredited educational hours, which are approved by the state Board of Optometry after consultation with the state Board of Medical Examiners through a rigorous regulatory process. Among other demands, this process includes publishing the educational requirements and subjecting them to public comment, as well as obtaining final approvals from the state Attorney General?s office and Division of Consumer Affairs.

Still, ophthalmologists have been quick to say that the bill would allow O.D.s to perform LASIK, cataract and refractive surgery, even enucleation?despite that the bill specifically excludes invasive intraocular surgery and LASIK. While the bill doesn?t bar the use of lasers, says Dr. Quinn, there would be many hoops to jump through before any optometrist would be approved for such procedures. ?If the bill passes tomorrow, optometrists can?t do laser or any other procedure they currently can?t perform,? he says. ?Only after this laborious process and with the completion of additional educational requirements could potentially an optometrist be authorized to do a laser.?

The bill has yet to be voted on by the state Assembly and Senate, which has to happen before it reaches the governor. Revising the bill is moot. ?We?re not into amending it,? says Beverly Lynch, executive director of the N.J. Academy of Ophthalmology, in an interview with Review of Ophthalmology. ?Right now, we?re in kill mode.?

Vol. No: 140:04Issue: 4/15/03

More here:
http://www.revoptom.com/index.asp?page=2_985.htm
 
Originally posted by TomOD

Below is more of the true story:
============
Click to expand...

Tom,

Similar to your argument against the AAO, the point of view you gave is just optometry propaganda from an optometric publication and website.

Certain individuals in your field definitely want to see optometric surgery become a reality. These bills were designed to help optometry launch the field into surgery (lasers first, then "minor" surgical procedures later) and gain more medical privileges.

I don't have the time to get into another debate on scope of practice for optometrists; however, I applaud my colleagues and mentors who help fight against these bills.
 
hello glaucomamd, r u a resident or attending at bascom? is bascom in downtown miami? is it safe around the hospital? i'm sure there's ample supply of hot women and weather must be great!! :D
 
Originally posted by TomOD

That?s exactly the opposite of what it would do, says optometrist Christopher J. Quinn, immediate past president of the New Jersey Society of Optometric Physicians.
Click to expand...

Quick question. When did optometrists become "Physicians"? This is misleading.
 
They didn't Andrew. The term "optometric physician" is a cry for HELP. Tom and many other hunchos colleagues of mine are in there own little world.
I agree with your statements wholeheartedly.
 
Originally posted by Ophtho_MudPhud
Quick question. When did optometrists become "Physicians"? This is misleading.
Click to expand...

I agree. Only a few states have adopted this silly term. North Carolina has wholeheartedly rejected the term 'Optometric Physician'. I think it's a silly term.
 
But the main question:

What are all of you afraid of?

That OD's are going to kill or blind people? Or that we will take money out of your pockets? Be honest.

It is on record (by many ophthalmologists and their lobby groups) that OD's would kill people if they were allowed to use diagnostic topical drops (dilation). It DIDN'T happen.

It is on record that OD's would kill people if we were allowed to use topical pharmaceauticals. It's NEVER happend (to my knowledge).

It is on record that OD's would kill people if we were to use appropriate oral medications. It has NEVER happened (and NC OD's have prescribed topical and oral meds since 1977).

It is on record that patients would be blinded by OD
co-management. DOES NOT HAPPEN.

It is on record that OK optometrist would blind or kill people if they were authorized the use of lasers. This HASN'T happened. (In 10 years??)

Now it is said that OD's will kill people if we were to inject 0.3cc of Kenalog into a lid lesion.

See, if you cry wolf long enough..........people just stop believing.


And Reality. I feel bad for you. I've offered to help you so you could quit your whining on every forum on this site. You really are pitful man. Damn. if you don't like what you do, get the hell out and do something else. It's not that complicated.

For a $50,000 consulting fee, I'll show you what need to know.....but I can't improve you attitude or get rid of your inferiorty complex.
 
TomOD,
The majority of optometrists "medically manage" glaucoma by taking disc photos and doing humphrey visual fields at every visit and watching that C:D ratio increase until it is too late for the ophthalmologist to clean up the mess. If these pt's had been seen and offered ALT/SLT, filters or shunts then their vision could be preserved. It is a travesty and I see it again and again from optometric referrals. There are bad ophthalmologists and good optometrists at managing these "medical" conditions, but they are the exceptions. Optometrists get very little exposure during training to complicated patients, and it is painfully evident in observing there practice. Their ego (much like the sounds of yours) prevents them from knowing they have reached the limit of their fund of knowledge. Stick to uncomplicated refractions, CTL, and screening for ophthalmologists.
Peace
 
Originally posted by TomOD

It is on record that patients would be blinded by OD
co-management. DOES NOT HAPPEN.
Click to expand...

Tom,

This is such a naive statement. Consider these cases.

There was a case where the OD failed to diagnose pellucid marginal degeneration and sent the patient for LASIK through a co-management deal. The patient had a horrible outcome. Both the MD and OD are being sued. They go back to the OD's office and find multple cornea topography scans clearly showing the pellucid degeneration.

Another case where an OD was co-managing post-cataract surgery. The IOP was very high, and the OD kept "burping" the cataract wound, even though there was vitreous to the wound. By the time the retina service saw the pt, there was a complete RD. Interesting "co-management" issue to have non-surgeons manage post-operative patients.

And another recent case where the patient was too nice to place blame on anyone. My patient had a sharp piece of metal hit his eye (pinpoint injury). Went to see the local OD with the complaints of slimey discharge from the eye, floaters, but 20/20 vision. OD prescribed Gatifloxacin. Pt then developed endophthalmitis. Presented 5 days later with LP vision. I look at the patient and find a vitreous strand protuding from a superior-nasal, pin-hole scleral defect. Had the defect been recognized, then one stitch in the OR with exploration would have sufficed. Instead, the patient presents with florid endophthalmitis with necrotic retina.

So be aware that when patients sue, they usually sue the surgeon. Furthermore, most patients doen't sue, and cases of negligence remain forever lost, except for the patients who live with their problems.
 
Originally posted by Ophtho_MudPhud
"...This is such a naive statement. Consider these cases..."
Click to expand...

Dr. Doan,

I'm hoping that you're not going to generalize on these cases as a reflection as optometry as a whole. In my little world where I see a plentiful amount of cases from a variety of providers, both ophthalmologic and optometric, there is plenty of faulty care to go around. I believe that the incidence of inadequate care seems to be independent of the background of the provider.

As you know, I believe in a close working relationship amongst the two professions and in such an arrangement and where confidence in each provider's competency is assured, effective management of eye problems by whichever provider will be reflected in efficient and efficacious care.


Regards,
Richard Hom, OD,FAAO
San Mateo, CA
 
Originally posted by Ophtho_MudPhud
Tom,

This is such a naive statement. Consider these cases.

There was a case where the OD failed to diagnose pellucid marginal degeneration and sent the patient for LASIK through a co-management deal. The patient had a horrible outcome. Both the MD and OD are being sued. They go back to the OD's office and find multple cornea topography scans clearly showing the pellucid degeneration.

Another case where an OD was co-managing post-cataract surgery. The IOP was very high, and the OD kept "burping" the cataract wound, even though there was vitreous to the wound. By the time the retina service saw the pt, there was a complete RD. Interesting "co-management" issue to have non-surgeons manage post-operative patients.

And another recent case where the patient was too nice to place blame on anyone. My patient had a sharp piece of metal hit his eye (pinpoint injury). Went to see the local OD with the complaints of slimey discharge from the eye, floaters, but 20/20 vision. OD prescribed Gatifloxacin. Pt then developed endophthalmitis. Presented 5 days later with LP vision. I look at the patient and find a vitreous strand protuding from a superior-nasal, pin-hole scleral defect. Had the defect been recognized, then one stitch in the OR with exploration would have sufficed. Instead, the patient presents with florid endophthalmitis with necrotic retina.

So be aware that when patients sue, they usually sue the surgeon. Furthermore, most patients doen't sue, and cases of negligence remain forever lost, except for the patients who live with their problems.
Click to expand...


Okay, I'll go:

I will be willing to bet that in your academic center you see misdiagnosed referrals from both OD's and Ophthalmologists.

I have a few for you right in my office.

A temporal lobe lesion misdiagnosed as glaucoma for 3-4 years on a patient that NEVER had a visual field from 2 seperate Ophthalmologists. She's under the care of an neurosurgeon now.

A recurrent corneal erosion misdiagnosed for years and treated with erythromycin ung for 8 months by an OMD. (Despite the 'textbook' complaint of sore, irritated eyes first thing in the morning).

A lady with 0.90/0.90 cupping treated with Restasis for dry eyes with recent, 2 month old copies of the OMD's record showing 0.30 cupping.

A foolish OMD that doesn't get my cataract referrals because he refuses to use post-operative Pred-Forte for fear of pressure spikes! He sends patient back consistanly with inflammed, red eyes and worse post-op vision.

I have case after case of patients misdiagnosed with macular degeneration with 20/15 acuity and perfect maculas (insurance fraud??)

I've had a lady with an orbital floor fracture undiagnosed by an OMD the morning before I saw her.

I've had a child with Retinopathy of Prematurity and angle-closure a week after seeing an OMD who refused to see the child that day.

I had a guy today with a lid infection that had LASIK sx 2 months ago. I've seen him 5 times over 2 years for corneal abrasions, FB's and ulcers/infiltrates. There is no way in HELL that OMD should have taken his money and did refractive surgery. He is now +2.00-1.00 x 176 20/30 and -0.75 - 1.00 x 097 20/40 in the other with scarring and corneal haze. He was -1.50 OU before. This was not a comanaged case. He just happened to be in town for a lid infection. Disgraceful.

I got cases of OBVIOUS Keratoconus undiagnosed by previous OMD's.

I've had a guy go to 3-4 different doctors (OD's and OMD's) to figure out why he couldn't see. He had very small PSC that the other doctors were either too lazy to see or still using the anitiquated slit lamps. He had cataract surgery and is doing great.

I refered a lady for M.G. that had complained to her OMD for a year about drooping eyelids and fatigue. Neuro confirmed the diagnosis.

I could go on. And these are just off the top of my head within the last 3 years.

No doubt that doctors make mistakes. But if you here telling me only OD's goof up some times and every Ophthalmologist is perfect, I have some charts I'd like to show you...some simply scribbled notes on 3 x 5 index cards with little more than "VA's and IOP's".

But if we are really talking about scope of practice and harm, most opticians in the know and most consultants can tell you that Ophthalmologists should not touch a phoropter. Their remake rate is rediculous. It's very poor optical training and skills. (How's that for a blanket statement). How many OMD's do von-Grafe phoria testing, NRA/PRA's, accommodative convergence, bi-chrome testing. Hell for that matter, how many Ophthalmologists even own near point rods? :) How many have tech's put in the autorefration and write the spectacle rx from that.


But I give up. All of you guys (and gals?) are right. I'm going to tell all my patients I'm a clown and a fraud. I'm going to make them give me that bottle of Timpotic back because it's doing them no good. I'm going to call the guy with the lid infection tomorrow morning and tell him to stop taking the dicloxicillin because I had no business giving it to him. And I'm going to tell the lady who had tears in her eyes when I told her she didn't have macula degeneration that she, in fact, does have it because the careless, sloppy OMD told her she did and he is much smarter than I am with my 90D and HRT. I'm going to sell my Lexus and my house and give the insurance companies their money back.

I'm going to close down my office Monday and quit work and go back to medical school and learn about orthopedics and ob/gyn. That'll help me treat glaucoma better. Don't worry, I'll send all of my patient's to a real doctor in the meantime.

Really, I'm getting bored with it and my 3 year old needs some attention. We aren't going to change anyone's mind here. Remember, it's better to try to elevate yourself and your profession than to try to bring others down. You can't go forward yourself when your holding someone down to the ground.

It's time to play. I'll move aside and let anyone else who would like to respond do so.

Happy Thanksgiving everyone.:clap:
 
It's funny watching you reply to my posts. I'm not generalizing anything. I only point out the generalizations you make, and you fireback with a different argument to a point I never raised. Read back to your post. You stated:

--------------------------------------------------------------------------------
Originally posted by TomOD

It is on record that patients would be blinded by OD
co-management. DOES NOT HAPPEN.

--------------------------------------------------------------------------------

Who's making generalizations?

I realize people make mistakes. You're the one making claims that ODs are bullet proof, and you actually had the nerve to write it in all caps. :)
 
Originally posted by Richard_Hom
Dr. Doan,

I'm hoping that you're not going to generalize on these cases as a reflection as optometry as a whole. In my little world where I see a plentiful amount of cases from a variety of providers, both ophthalmologic and optometric, there is plenty of faulty care to go around. I believe that the incidence of inadequate care seems to be independent of the background of the provider.

As you know, I believe in a close working relationship amongst the two professions and in such an arrangement and where confidence in each provider's competency is assured, effective management of eye problems by whichever provider will be reflected in efficient and efficacious care.


Regards,
Richard Hom, OD,FAAO
San Mateo, CA
Click to expand...

Well said Dr. Hom. I'm not making any generalizations. Just pointing out the generalizations by TomOD. I agree that physicians make mistakes, some more than others.
 
Originally posted by glaucomflecken
Stick to uncomplicated refractions, CTL, and screening for ophthalmologists.
Peace
Click to expand...

Who should do the "complicated" refractions??:confused:
 
heh, heh....TOM OD...look man...

if you ODs, really want to do yag, or whatever...go back to undergrad, bust your ass in premed courses, rock the mcat, ace medical school, get some phenomenal research...apply for residency.....and become an eye surgeon (aka ophthalomolgist), since this is what most ophthalmologists have to do....not only will you understand our point, but you will get this rid of "i'm an insecure optometrist" thing off your back...its getting kind of tired...

again, i'm sure you guys have a rigourous curriculum, but don't sit try to make its sound its anything like what an MD has to go through....

furthermore, as i said earlier, i do feel that there are some great diagnosticians that are ODS, but that should be there role...no more, no less....
 
Originally posted by dharmabum7
furthermore, as i said earlier, i do feel that there are some great diagnosticians that are ODS, but that should be there role...no more, no less....
Click to expand...


Dear dharmabum7,

Again, your comment signifies a bias that borders on outright sexism, racsim, etc. This mentality is very similar and probably permeates the practice and treatment behavior that such persons pursue.

A rite of passage called MCAT, medical school and residency doesn't grant the holder an absolute right to be a great diagnostician or a great "doctor". It gives them credibility. As you know, the character of the person will make or break that designation of "doctor". I'm sure you're aware of the innumerable "medical mistakes" or "neglicence" cases on all sides that occur because of "non-caring" doctor", egotistical "I know everything and you're not a medical doctor" or your this kind of person or have this kind of insurance.

Despite society's need for medical doctors, the threat to this monopoly is steadily eroding because the public will no longer blindly support such a monopoly without adequate return on investment. I believe that this monopoly is in jeopardy because the results have not been completely satisfying.

Regads,
Richard Hom, OD,FAAO
LTC, USAR (ret)
San Mateo, CA
 
Rich,

First and foremost, to even imply that my arguement in someway is along the lines of racist and sexist is completely ignorant and to some degree melodramatic. Furthermore, I think its insulting to anyone who has to deal with racism, sexism, homophobia, etc so I really think you should refrain from such an arguement and you should probably apologize to those who have had to endure this. Because its INSULTING to those individuals, that you can equate their struggle with this argument.

Secondly, I would like to again emphasize, I have worked with ODs in clinics and I have a deep respect for them as diagnosticians. I just feel like people should acknowledge that eye surgery requires an eye surgeon. Furthermore, do you pay malpractice. Are you ready to take the full liability?

Here's an anology say, you are an internist. You know something about the heart, you can handle treating CHF, Afib, etc. But suddenly, based on this knowledge, you can't decide to suddenly start doing catheterization or decide to put in a pacemaker. Our system of education is based on training and schooling.

Just as they are bad ophthalmologists, there are bad optometrists. I have worked with some good optometrists but they themselves feel that the field in not uniform in terms of quality of training. So why don't you acknowledge that there are errors made on both sides of the f5555555555555ence? Why don't you sit there and find all the mistakes optometrist make also and you know they have made gross errors as well.

I'm not going to address your statements regarding uncaring physicians, since thats really not pertinent to this discussion. If you want to generalize that fine, but as a student I have worked with uncaring doctors and some of the most selfless, kind physicians as well. I used to think all surgeons were uncaring, knife-happy and my experience this past year has taught me that generalization is foolish.

Finally, to address the following "Despite society's need for medical doctors, the threat to this monopoly is steadily eroding because the public will no longer blindly support "

Look despite the flaws of the medical system, I don't see a nihilistic call to completely dismantle it. You are saying that the institution of medicine is a monopoly. I don't see people saying hell with doctors, I want to be treated by people who do not goto medical school. I agree there are changes that need to me made. But the concept of medical school and residency training is to assure individual they are getting proper care. There's a reason its so long. I don't see people trying to see that or shorten that.

Good luck.

Dharmabum
 
Originally posted by dharmabum7
"...First and foremost, to even imply that my arguement in someway is along the lines of racist and sexist is completely ignorant and to some degree melodramatic. Furthermore, I think its insulting to anyone who has to deal with racism, sexism, homophobia, etc so I really think you should refrain from such an arguement and you should probably apologize to those who have had to endure this. Because its INSULTING to those individuals, that you can equate their struggle with this argument..."
Click to expand...

Dear dharmabum7,

Your comments are welcome. It's amazing how people don't realize that this issue is not in isolation to society's other considerations despite you feelings to the contrary.

Adherents who are "dogmatic" about their position without any mitigating or ameliorating circumstance and who are rigid in applying a "black and white" solution to an often "gray" world portray the same behavior as those who are in the extreme in the behavior towards those populaces who face these feelings often.

You may or may not be a member of one of these audiences. However, the same degree of ferocity that one defends one turf or proposes one's stance is often the same type of fanaticism that is demonstrated by those extreme individuals who generalize broadly.

Yes, I'm digressing from the issue because I don't believe the real arguement is whether or not optometrists should do surgery. I don't care about surgery and I am not proposing as such. I am, however, quite astounded at the depth of emotion that this issue creates. This is the real issue which should be addressed.

How can you ably treat people as people if you're dogmatic. One just cannot turn on or off their feelings so easily. Yes, there are doctors who admirably and superbly treat their patients, but I will venture to guess that most will say:

1) I had a gunshot wound to the eye that walked into the ER...
2) I had a spontaneous retinal detachment...

You see, for most specialists and soon-to-be specialists, I'm generalizing that it's often just a numbers game to collect the types of cases and procedures to satisfy your specialty board. And thereafter, it's the number or types of cases that can buy you that house or new car.

Rather, it is at issue the characteristics and behavior patterns that except for fortuitous circumstances creates marginalization of populaces.

IMHO,
Richard Hom,OD,FAAO
LTC, USAR (ret)
 
Dear Richard,

#1 : I've not even doing ophtho....so I have no vested interest in this debate, other than the fact that its become entertaining...

#2 : I still think that one should be careful in allowing non-surgeons, to do surgery...you can interpret that statement in whatever way you'd like...thats all i have left to say on that issue...

#3 : You are making valid statements about how doctors should not generalize...but you know what...it happens...i catch myself doing it, especially on really long days...and i pray everyday that the residency process, will not suck out my sense of empathy or humanism...but time will tell...

#4: I still think you are contradicting yourself, on what you are saying....you are generalizing, yet you equate what i'm saying with being sexist or racist...do you see the irony?...
I maintain, that I can have an independent view on sexism, I have independent views on race and culture, I can have a view on abortion...Furthermore, I have views on what doctors should do, and what other occupations should do...

You cannot base my views on the original topic of this debate (should optometrist be granted some surgical privaledges) on my views on sexism and racism...as you have admitted, you are guilty of "generalizing"...

#5 I think we have more commonground that you realize...in terms of our criticisms of the medical profession..
But you are continuing to push buttons by "stereotyping"...by saying doctor are out only to get procedures...and implying they are all out just for money, cars, houses...Yeah, maybe some, but not all...

This is statement is surprising considering how you maintain how open-minded you are...You don't want physicians to generalize, but its okay for the critics of medicine to generalize...There's something wrong this kind of logic, or lack thereof...

Finally, some one once said, the traits you hate most in others, are the traits that you hate most about yourself...Perhaps this is true for you Rich...Think about it...

I wish you the best in your career and future endeavors.

Sincerely,

Dharmabum
 
This is freakin crazy. I can't believe the amount of whining from OD's about surgery. I mean REALLY g** d$(#@M. You want to steal ophthalmologists profession....go AHEAD. GO whine enough to get legislation changed to "allow" you to do surgery. What training do you have? I heard OD's take a course in which they learn to do PRP on Rabbits....that should come in handy. What else? yags on monkeys? phacos on pigs? COME ON!!!!!!!!!! Where are you going to get the training to be competent?

How are the OD's out there trained to do these procedures? Ophthalmologists train for 4 years to develop their surgical decision making, technical, and post-op management skills. WHEN to OD's train for surgery?? A change in legislation DOES NOT mean you have the skills to perform.

I still say...its protocol. Get a grip with the fact that you went the OD route....if you want surgery....get a freakin MD and stop trying to steal the OPH's turf! Once you guys get all of your surgical priveleges and start undercutting the OPH's and run them out of business....who will you refer to? Who will take care of the hard stuff? WHat's next...PA's doing CABGs? CRNP's doing interventional cardiology? GIVE ME A FREAKIN BREAK.
 
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