Non-Optho Physicians Examining and Refracting?

[chartero]

Here in Ontario, Canada, the eye doctor's clinic next door to the optical shop often seems to be staffed by an M.D.

Things I have read suggests that the extent of M.D.-licensed non-ophtho limited-scope eye doctors may be fairly unique to Ontario. is it rare or unheard of in the U.S. Even in Canada outside Ontario? That Canada has only one English-language optometry school, at the University of Waterloo, and a French-language one at the Université de Montréal, surely contribute to the situation.

What about primary care physicians refracting doing relatively extensive, eye-doctor-like eye exams and refraction as part of their practice of medicine? Where there are lots of O.D.s trained entirely for this, it might seem too low on the value chain for a physician, and I don't know whether or to what extent it's reimbursed. Is it part of primary care medical practice... very rarely, rarely, somewhat rarely, often enough? What about rural areas where O.D.s. too could be scarce. Here I'm remembering the Northern Exposure where the circuit-riding optometrist comes through Cicely in her very nicely tricked-out eye clinic RV. Would Dr. Fleischman have filled in if she hadn't?

Meanwhile, I know, some opticians are pushing to refract. Optometrists and opthos make good arguments about the important diagnostic functions of eye exams beyond refracting, for eye health and general health... Could a PCP, with proper training in eye care, make much the same sort of arguments as to why they should be doing relatively heavy-duty eye exams and refracting? This would be for those of their patients who don't, on presenting, seem to have any very serious issues indicating referral to an ophthalmologist or advanced practice optometrist, of course.

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[jefguth]

Here in Ontario, Canada, the eye doctor's clinic next door to the optical shop often seems to be staffed by an M.D.

Things I have read suggests that the extent of M.D.-licensed non-optho limited-scope eye doctors may be fairly unique to Ontario. is it rare or unheard of in the U.S. Even in Canada outside Ontario? That Canada has only one English-language optometry school, at the University of Waterloo, and a French-language one at the Université de Montréal, surely contribute to the situation.

What about primary care physicians refracting doing relatively extensive, eye-doctor-like eye exams and refraction as part of their practice of medicine? Where there are lots of O.D.s trained entirely for this, it might seem too low on the value chain for a physician, and I don't know whether or to what extent it's reimbursed. Is it part of primary care medical practice... very rarely, rarely, somewhat rarely, often enough? What about rural areas where O.D.s. too could be scarce. Here I'm remembering the Northern Exposure where the circuit-riding optometrist comes through Cicely in her very nicely tricked-out eye clinic RV. Would Dr. Fleischman have filled in if she hadn't?

Meanwhile, I know, some opticians are pushing to refract. Optometrists and opthos make good arguments about the important diagnostic functions of eye exams beyond refracting, for eye health and general health... Could a PCP, with proper training in eye care, make much the same sort of arguments as to why they should be doing relatively heavy-duty eye exams and refracting? This would be for those of their patients who don't, on presenting, seem to have any very serious issues indicating referral to an ophthalmologist or advanced practice optometrist, of course.

There sure are alot of those "refracting MD's" in Ontario. Most of them seem to limit their practice to routine eye exams, and interestingly most of them have been in practice for eternity! The MD that practices in the WalMart in my hometown graduated medical school the in the 1950's!

As far as their training goes, I'm sure that it is very varied - a Toronto MD was recently disciplined for gross mismanagement of his patients.
Read about it here: http://www.cpso.on.ca/Info_Public/Dis_sum/disc_eg.htm#FRANKLIN
and here you can read his non-sense justification: http://www.optiboard.com/forums/showthread.php?t=21071

IMHO, I would not recommend that a general practice physician take on this kind of practice - it's really not an efficient use of the knowledge and training you already have plus there is quite a lot you're have to learn (didactically, technically, clinically) to really be a good eye care provider.

 

[chartero]

The 2004 National Physician Survey, from the CMA, CFPC and RCPSC, found that 1.8% of family physician respondents in Canada performed refraction as part of their practice; 1.5% of CCFP certificants, 2.2% of non-certificants [pdf]. By province or territory, highs of 4% in Saskatchewan and in the common pool for the territories [pdf]. Of all procedures listed refraction was performed by fewest respondents; compare to the 76.9% who performed Pap smears. The next survey, in 2007, didn't list refraction.

 

[speyeder]

I would not want a non-optometrist or non-ophthalmologist refracting me.

 

[Meibomian SxN]

I'm not sure of the laws in Canada but here in the US non-optho MDs can not refract nor prescribe glasses/contacts. Recently a friend of mines worked for a primary care MD who owned an optical and paid her as a independent contractor to refract & Rx glasses/contacts. He was disciplined and fined before for refracting.

Its more than just "Rx what the auto-refractor" says. I think that's when they get caught.

 

[jefguth]

I'm not sure of the laws in Canada but here in the US non-optho MDs can not refract nor prescribe glasses/contacts. Recently a friend of mines worked for a primary care MD who owned an optical and paid her as a independent contractor to refract & Rx glasses/contacts. He was disciplined and fined before for refracting.

Its more than just "Rx what the auto-refractor" says. I think that's when they get caught.

There are a TON of non-ophtho MD's in Ontario providing general eye care, most often at a very low level. Most of them are ancient, foreign trained MD's that are doing little more than a refraction. Several have been disciplined. In one case an MD was found guilty of professional misconduct b/c he kept grossly inadequate records, never performed applanation tonometry (his routine was to use a tonopen on the sclera/bulbar conj. without using any anesthetic!).

From what I've been told, legally they are not being held to the same standard of care (including dilation) as OD's and Ophtho's in malpractice cases and in misconduct hearings.

Another was found to be sexually assaulting patients, however strangely the college of physicians did not revoke his license, they instead restricted it to the practice of "refractive optometry," (whatever the hell that is!) no other medical practice permitted.

Unfortunately, this is a pervasive problem in Canada and not just in eyecare; there have been several high profile cases of family physcians performing cosmetic surgical procedures including breast implants/augmentation. Some patients have even expired in their hands.