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Singing: "Playa Hate-aaah; turn yo azz roooound, get on the ground; You've been robbbbed!"
How do you know he doesn't travel to rural areas? Those lasers are portable you know....
Kentucky: The Latest Battleground for Optometric Scope Expansion
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Singing: "Playa Hate-aaah; turn yo azz roooound, get on the ground; You've been robbbbed!"
How do you know he doesn't travel to rural areas? Those lasers are portable you know....
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That's exactly how it went down in Oklahoma. All the "optometric surgeons" are in or near the metropolitan areas, not rural. It's not about access at all. It's about money.
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Admittedly, I've yet to watch the whole thing, but I plan to. I did like the 1900 clinical hours in optometry training versus 17,000 in ophthalmology training. That's pretty similar, eh? You have to admit that Woody's analogy of chiropractor to spine surgeon was pretty darn funny, even if it was over the top.
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Thank you for summarizing some of the important points ... like I said, I don't have 56 minutes of my life to spare on this. Any specific clarification?
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No, no, no ...
You have it all wrong. Didn't you listen to the Kentucky AOA commercials? It's about increasing access to rural areas and allowing practitioners to utilize the full scope of their license. Any attempt to differ from this opinion is an attempt by the evil, powerful MDs to keep their easy earned, undeserved moniez from their 'customers.'
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WOW, that Atlantic article is fantastic. Seriously touched on all the big points/issues I brought up and really highlighted the problems with this situation. Fantastic! I really hope more news outlets pick up this story and I really hope the press/public continues to express this type of (natural) opinion!
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This thread title is no longer accurate, as you can now add Nebraska to the number of states pushing for OD expansion into surgery:
http://www.osteopathic.org/inside-a...aily-report-blog/Lists/Posts/Post.aspx?ID=598
It's seriously the DNP/CRNA game plan; stroke-by-stroke.
http://www.osteopathic.org/inside-a...aily-report-blog/Lists/Posts/Post.aspx?ID=598
It's seriously the DNP/CRNA game plan; stroke-by-stroke.
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This thread title is no longer accurate, as you can now add Nebraska to the number of states pushing for OD expansion into surgery:
http://www.osteopathic.org/inside-a...aily-report-blog/Lists/Posts/Post.aspx?ID=598
It's seriously the DNP/CRNA game plan; stroke-by-stroke.
WOW! Thanks for the news. You know and follow more on organized optometry than I do! I guess I need to follow your tweets if I ever need to know what's new with optometry laws!
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The interesting thing is that this was all about improving access to care. That is the angle the optometry community had to use to get this passed with the state legislature. Why make poor Mr. Jones drive to see an actual eye surgeon. Did anyone in the legislature listen to the ACTUAL public instead of just the optometrists. The percentage of citizens in rural communities actually had a higher rate that preferred an ophthalmologist 84-87%.
Look at the poll. http://mycn2.com/politics/cn2-poll-optometrist-bill
Look at the poll. http://mycn2.com/politics/cn2-poll-optometrist-bill
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So you think the patient is better at making that decision? Ask them did they take their glaucoma meds as scheduled and then check their refill history....
There is no compulsion in healthcare. The patient still and always has a choice. If they want an ophthalmologist for their minor surgeries and laser procedures then they can.
It just sounds more and more like the KY ophthalmologists are fearful of losing that arrogant grip. I just feel bad for the first OD that has an adverse event with one of these procedures; organized ophthalmology will break out the crucifiction.
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So you think the patient is better at making that decision? Ask them did they take their glaucoma meds as scheduled and then check their refill history....
There is no compulsion in healthcare. The patient still and always has a choice. If they want an ophthalmologist for their minor surgeries and laser procedures then they can.
It just sounds more and more like the KY ophthalmologists are fearful of losing that arrogant grip. I just feel bad for the first OD that has an adverse event with one of these procedures; organized ophthalmology will break out the crucifiction.
There you go, mentioning patient choice again. Unfortunately, many patients (I've seen anywhere from 33-50%) don't know the difference between an optometrist and an ophthalmologist. How, then, can there be (an informed) choice? I've been referred to as an optometrist plenty. Many just don't have a clue.
The "arrogant grip" angle is becoming a little tired, as well. There are obvious differences in the two training programs. When you have one program that has ~1900 hours of clinical training and another that has ~17,000, there's clearly a difference. I'm sure that explains why there is an optometric residency in "ocular disease." Saw Ben Gaddie, OD touting that, along with his glaucoma laser fellowship in the KET debate. Really? Why would you need additional training in ocular disease, unless the exposure in your core program is lacking? It's not arrogance. It's knowing the extent of your training. Heck, I went to medical school and was exposed to many specialties, predominantly internal medicine, but I wouldn't hang my shingle out as an internist! There's a reason for the additional training.
Fortunately for you and those in the optometric community bent on performing surgery, most politicians are money-hungry idiots. Just keep greasing the palms and selling the access to care sob story, and they'll be eating out of your hands. Then, as in Oklahoma and as WILL be in Kentucky, the "optometric surgeons" can go head-to-head with the ophthalmologists in the densely populated metropolitan areas, leaving the access to care issue to slowly whither and die. I'm just waiting for Ben Gaddie to announce his new glaucoma laser fellowship in Louisville.
For Frumps and others, the access to care issue is a complete sham. The reason surgeons, among other physicians, are concentrated in more populated areas is because they need patient volume for their practices to thrive. If you live in a rural area, you will always have poor access to almost every type of service. Sorry, them's the breaks.
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The smell of fear coming from all the OMDs is soo close I can almost taste it! Optometrists will continue to fight and win over and over and there will be nothing OMDs can do about it! Once they get passed their anger and fear, they will come to accept it. MY!!!MDs these days seem to be VERY full of themselves. I personally can't wait to become an Optometrist so I can surgically co-manage patiants with OMDs that will actually respect my abilities. And if you don't like whats happening? Quit and go into another speciality. That will help me get even more patiants!!!
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Learn how to spell first, kid.
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As a "pre-med(hate that term,)" who has said some stupid, irresponsible, and almost bannable things on this forum, this thread-- and other threads about the OD surgery bill- have considerably raised the bar.
Good on ya, sdn.
Good on ya, sdn.
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We need to contact our legislators to tell them to pass the "Health Care Truth and Transparency Act of 2011." I think that any consent form that is signed by a patient undergoing a procedure done by an optometrist should state something like the following; you are undergoing a surgical procedure to be performed by an optometrist who is not a licensed medical doctor or surgeon, you have the choice to have the procedure performed by an ophthalmologist who has a medical degree and completed a surgical residency training program. The patient should at least be made aware of the different training pathways of the doctor (optom/ophtho) performing surgery. Feel free to pass on ideas for the statement that should be included in the consent form. I will try to get this to be part of this legislation as well.
Sorry, it looks like optometrists can learn everything there is to learn for laser eye surgery in a weekend. A 4 hour didactic hands on training (Yap PC, PI, and SLT) sounds good enough for me.
http://www.theoptometricproceduresi...d/Laser_Surgery_for_the_Anterior_Chamber.html
Is this what they mean by "lumps and Bumps"
http://www.theoptometricproceduresi..._Procedures_for_the_Optometric_Physician.html
Sorry, it looks like optometrists can learn everything there is to learn for laser eye surgery in a weekend. A 4 hour didactic hands on training (Yap PC, PI, and SLT) sounds good enough for me.
http://www.theoptometricproceduresi...d/Laser_Surgery_for_the_Anterior_Chamber.html
Is this what they mean by "lumps and Bumps"
http://www.theoptometricproceduresi..._Procedures_for_the_Optometric_Physician.html
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See, its crap like this that pisses off even fairly pro-OD physicians like myself.
Agree. The public and legislators need to be made aware of the differences between the training that ophthalmologists and optometrists receive. Only then will this nonsense of becoming a "surgeon" by taking a weekend course stop.
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Just as a consumer has the right to know how many calories are in that piece of cheesecake that they buy at the grocery store, I think they deserve to know who is performing their eye surgery.
This just goes to show that no specialty is immune from this degree creep.
It seems physician orgs continue to lose political fight after political fight. I think it would be easier for physicians to win these political fights if more physicians are state legislators themselves. So more physicians should run for public office.
It seems physician orgs continue to lose political fight after political fight. I think it would be easier for physicians to win these political fights if more physicians are state legislators themselves. So more physicians should run for public office.
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Proof of egotism/arrogant grip right here. I've been confused for an ophthalmologist before also. And an optician. All you can do is educate and provide excellent care to the patient and that's that. Get off the title thing.
You have performed trabs in residency, yet they have glaucoma fellowships? You have performed refractive surgery in residency, yet you have refractive surgery fellowships? The additional training is as it says, additional training; does not mean inadequately trained.
He seems well qualified to teach such a fellowship. Or how about we go find another 'blatant ***** MD' as you all call it.
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Great post
Lol ... I don't think you should look forward to the 'respect' aspect too much.
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Meibomian -- Why are you still posting on this thread? You're still on here running your mouth about how optometrists are fully capable of doing lasers/minor surgeries -- not to mention you're getting on everyone's last nerve.
Yet you publicly humiliated yourself by not even knowing how to handle a retrobulbar hemorrhage (refer to retina? Seriously??). Thats supposed to be COMMON KNOWLEDGE for someone who spent 4 years studying nothing but the eye.
Do you realize how embarrasing that is for an optometry "attending?" With all due respect, I'd focus more on learning your craft. Your patients deserve it.
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Pwned.
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yeouch
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I love how you always cherry pick my posts, responding only to certain aspects.
Anyway, it's no more arrogant to point out that I've been called an optometrist than for you to say your been called an ophthalmologist. I wasn't denigrating optometrists or deifying ophthalmologists. My point was that many patients do not know a difference exists, so how can they be considered to have a choice, as you say?
Yes, we have fellowships to provide more advanced training in various subspecialties. There are also subspecialty fellowships for optometrists, such as the glaucoma laser fellowship that Ben Gaddie cited. That sort of post-graduate training seems perfectly understandable. Ophthalmology does not, however, offer a fellowship in ocular disease. I, honestly, found it surprising that such an optometric residency exists. With all the claims of equivalency of training, I wouldn't think there would be a need for it. Am I missing something?
Oh, and I didn't say anything about Gaddie's qualifications. I agree, he would be qualified. My point was about the sham issue of access to care that the optometric lobby likes to talk about.
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Well when you officially become an ophthalmologist, then we can talk. I spoke more out of rant than knowledge.
Anyways, the fact is optometrists are allowed to perform some surgeries; so live with it.
You contradict yourself. When you were earlier corrected that a patient with a retrobulbar hemorrhage needs an emergent lateral canthotomy/cantholysis and not a retina referral, you wrote:
"Thank you for teaching me something I did not know"
This is not ranting. This is a lack of knowledge. Frankly speaking, I would expect an ophthalmology resident in the first 3 months of residency to know this.
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You're questioning me on intra-operative complications of procedures I have not nor have no desire to do!
Just so that we stop taking things out of context, this was in reference to an adverse event case that an OPHTHALMOLOGIST used! And for the record, no optometrists I know of are doing blephs or retrobulbar blocks.
That's like me asking you what you would do to improve vision on your scleral lens fit patient???
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That's like me asking you what you would do to improve vision on your scleral lens fit patient???
Not wanting in on this tiff, but are you fitting a lot of sclerals? I think there's only one guy in my town doing that. They were making a comeback when I was in residency, presumably because of newer materials. Great for K-conus patients, assuming no significant scarring. I remember trying one on. Very odd feeling. Sort of like opening your eyes underwater. Also makes your eyes look a bit bigger.
first 3 months! gosh and here I was thinking you guys would still be stumbling around trying to learn how to use a BIO, or slit lamp. But diagnosing retrobulbar heme and treatment recommendations? Gosh you guys are smart
first 3 months! gosh and here I was thinking you guys would still be stumbling around trying to learn how to use a BIO, or slit lamp. But diagnosing retrobulbar heme and treatment recommendations? Gosh you guys are smart
It's called being on call. We see a lot of these during residency. Most ophtho residency programs are affiliated with a level 1 trauma center, which receive lots of patients with facial/ocular trauma. So while beginning ophtho residents may still be "fumbling" around with the BIO, we are very adept at recognizing and treating vision-threatening emergencies such as a retrobulbar bleed.
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first 3 months! gosh and here I was thinking you guys would still be stumbling around trying to learn how to use a BIO, or slit lamp. But diagnosing retrobulbar heme and treatment recommendations? Gosh you guys are smart
I think something like that would be fair game on step 2-3.
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I agree that most medical students know what a retrobulbar hemorrhage is. In fact I saw one in my fourth year of medical school on an ER rotation.
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If they had to give it a go (i.e. no ophtho), I guess they could. I have never heard of this happening. I think a lot of ER docs would figure out what it was, and almost all would recognize something serious was going on and page the ophtho doc on call.
It's rare. I have seen 1 or 2 cases in which ER docs attempted a lateral canthotomy/cantholysis but these did not turn out so well. These patients were in a rural ER with no ophthalmologists on-call. I credit the ER docs for trying though. Doing nothing would have been worse. Our ER was 2 hours away and by that time the patient's nerve could have been snuffed.
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I did one a few months back (i'm a TY intern going into ophtho this July). Ophtho was a too far out and asked me to do it with the ER doc
, turned out great ...shhhewww.I did one a few months back (i'm a TY intern going into ophtho this July). Ophtho was a too far out and asked me to do it with the ER doc
Congrats! You already have one under your belt. I'm sure you're counting down the days until July. Ophtho is an awesome field.
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Except that a retrobulbar block is sometimes indicated for laser procedures. It's scary that you think you're trained for laser procedures but you don't know how to properly treat patients that can't keep their eyes still, nor do you know how to deal with the complications.
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It is important to remember that management of an acute retrobulbar hemorrhage after a block is very different than a traumatic retrobulbar hemorrhage. Acutely, your goal is to apply pressure to stop active bleeding and determine optic nerve head perfusion status with ophthalmoscopy. If there is active bleeding, there is no point to do a canthotomy/cantholysis, the blood will just fill up a larger space, continue bleeding, and continue to raise IOP. If the nerve is perfused, there is no reason to do a canthotomy/cantholysis. If you feel that the bleeding has stopped and the nerve isn't perfused, then you would do a canthotomy/cantholysis. Presumably, based on animal models, you have ~ 90 minutes after perfusion stops to re-establish blood supply to the eye to prevent permanent damage. In a trauma patient, the blood has been there a while and there is typically not active bleeding. If they have elevated IOP to the point that the nerve isn't perfused, then a cathotomy/cantholysis is indicated. If you cannot adequately assess the nerves perfusion status and the IOP is up or there is an RAPD then it makes sense to perform one as well. Just thinks to think about. It isn't as cut and dry as any retrobulbar hemorrhage = immediated canthotomy/cantholysis.
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Thank you for this post. This is the difference between an optometrist, a wet behind the ears resident and an attending ophthalmologist; knowing the WHEN to do a procedure.
This is why optometrists do not perform blocks, blephs and other invasive procedures. We just want to practice to the extent of our knowledge; and for some of us it includes some laser and other non-invasive procedures.
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What about for the "rest of you" who aren't "wet enough behind the ears" to know they aren't ready for the laser and "non-invasive" procedures, but are still legally allowed to do them???
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In the words of Charlie Sheen, "Duh!".
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Please forgive this post. This is not representative of the optometric community as this person doesn't seem to have even been accepted to an optometry school. I on the other hand have been accepted to a college with an average matriculant GPA of 3.5 which hovers around DO schools.
Geronamo please spell patient right.
UPDATE:
This person is a music major (LOL) that took his/her prereqs at a community college and should be completely disregarded in any of these discussions if not banned from posting on the higher forums.
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"I was in the OR today with an anesthesia resident. He had just had an eye exam by a local optometrist. The optometrist saw his scrubs and asked what he did. When he found out he was an anesthesia resident he said, "I may need your services someday to perform cataract surgery." The anesthesia resident began to argue with him about training, eventually saying, "How about going to medical school and residency if you want to do those things?" The guy got so mad at him he refused to finish the exam - his tech had to come in and do it."
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This is second-hand and the optometrist may have just been joking, but I was struck by the attitude and lack of professionalism. Hope he didn't have to pay for that exam.
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This is second-hand and the optometrist may have just been joking, but I was struck by the attitude and lack of professionalism. Hope he didn't have to pay for that exam.
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Ok. This has to stop now. I have never been very political, but I am going to be now. There has to be some accountability. How about this for misleading the public. Seriously, look at how they try to inflate the education of an optometrist and then try to make it sound superior to the MD. RIDICULOUS.
http://www.theoptometricproceduresinstitute.com/[OD]On-Demand/About_US.html
http://www.theoptometricproceduresinstitute.com/[OD]On-Demand/About_US.html
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For the love of Pete! The gall is simply unbelievable.
"By the time an optometric physician completes 8+ years of pre-professional [i.e., college] and professional Optometric education including 4 years of clinical training at NSU-OCO, he or she has more didactic classroom hours, direct observational encounters, and actual clinical experience in performing ophthalmic office procedures than any U.S. Medical or Osteopathic graduate."
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I know. I just really can't believe it. I love how they add "including 4 years of clinical training" (ie, the 4 years of optometry school you already mentioned in the 8+years of preprofessional). Somehow the student does 4 years of optometry school and they try to make it sound like they have had over 12 years of eye-specific training. Good grief!
