ODs doing surgery?

[doinkOD]

I am very disapointed that Dr. Doan has used this thread for doing exactly what I intended to avoid with my original posting: promoting disrespect and animosity. As a result, I am taking my original heading and original message out of this thread. I give up and hope the two sides will be able to come to terms one day and live side by side happily, while respecting each other's positions.

---

Members don't see this ad.

 

[Gleevec]

ODs should stick with what they're trained to do. If they want surgical priviledges, they should do a residency like everyone else. Its fine that ODs want something for nothing, but its wrong that ODs are willing to sacrifice patient outcomes for it.

 

[Andrew_Doan]

Thank you for your contributions to this forum! I'm still in Washington D.C. and can't type a complete response b/c my Internet TV stinks and I'm ready to throw the keyboard out of the window!

I met with several senators and representatives yesterday. The co-sponsors and non-sponsors of the VETS surgical bill do not fully understand the difference between optometry and ophthalmology. I realize that policy makers are too busy to learn what it takes to be an eye surgeon. Most of their understanding about our fields come directly from ODs and MDs. For instance, because of the aggressive push by ODs as a group, several members of congress think that ALL ODs complete an "internship" or "residency" when in fact less than 10% of ODs take this route. Our training are not equivalent and OD training is not sufficient for them to do laser AND non-laser surgery (more on this when I get my hands on a real computer).

It is true we must both work together for better patient care. This has nothing to do with money. I met hundreds of physicians (military, private, and academic) who are gathering in Washington D.C. to draw a distinct line between non-surgeons and surgeons because we want to maintain a high level of surgical care for our patients. TomOD may say that optometrists don't want to do cataract surgery; however, he is mislead. In OK, ODs have clearly stated that their future intentions are to perform non-laser surgery. In regards to the recent OK optometry bill, don't even for a second think that this was a legit bill! It was snuck in at the last minute and attached to a Pharmacy bill! This is the type of sneaky and deceitful methods organized optometry is using. More on this later b/c I have information after hearing Cynthia Bradford, MD speak.

Richard Lindstrom, MD (Chief Medical Editor of OSN) has over 200 ODs in his referring network. He has a good relationship with ODs. He states this:

"By anyone's definition over the past 25 years, I have been optometry's friend. However, I cannot in good conscience stand silent as organized optometry attempts to expand its scope of practice to include surgery. I believe this effort by optometrists is misguided, dangerous to patients and potentially self-destructive to their own profession......

The making of an eye surgeon is long, demanding, intense, and expensive, requiring in the United States 3 to 5 years of full-time training; followed by a life-time of continuing education and refinement. All of us who do ophthalmic surgery, and especially those of us who endeavor to train the next generation of eye surgeons, know there is no shortcut....

To my ophthalmologist colleagues I say, take note, as this is an issue worth fighting over. The only acceptable outcome must be unconditional surrender. Any compromise is unthinkable for our profession and our patients."

Portions of Dr. Lindstrom's original article on OSN were posted here. I'll post the full article when I have access to a computer.

BTW, Oklahoma ODs told Cynthia Bradford, MD that their goal is to replace the comphrensive ophthalmologist. This means cataract, plastics, glaucoma, and all lasers.

All medical students and physicians interested in ophthalmology must unite and draw this line between surgeons and non-surgeons. Surgeons do surgery. You all should be contributing to OPHTH PAC (organization fighting for our rights on Capital Hill) and the new surgical scope fund. I'll post links later. I gave my $100 to OPHTH PAC. It's sad how little physicians support law makers. Lawyers pay on average $1000 each to political organizations. MDs pay less than $50 each!

 

[Andrew_Doan]

All residents should try to be involved with their local ophthalmology societies as well as giving to OPHTHPAC: http://www.aao.org/aao/advocacy/ophthpac/index.cfm

You can give as little as you want. Many residents at the mid-year Forum gave $25 or more.

I have to run, but I'll post more later!

 

[JJMD]

My first post...I too received the PDF copy of the Oklahoma OD bill, Let's just say that while optoms would like to blur the distinction between MD and OD, it should be our goal to clearly delineate the differences in experience, training, and education that make ODs vastly undertrained to do intraocular surgery.

The scary part about the bill is that it delegates power of licensing to the the Oklahoma State Optometry Board, not the American Board of Ophthalmology or a local MD licensing board...Thus, they can set up whatever qualifications and grandfather clauses they wish.

Last Monday, I saw a patient in a large county ED who had been seen by an optom the preceding Saturday. He had broken a beer bottle, and felt that a shard of glass had hit his eye. The note from the optom said...?Corneal Perforation, send to P______ ER on Monday....And he had been given an RX for Vigamox that was unfilled.

Luckily for that optom, the patients lac had self-sealed and there was no infection. Unbelievable but true. What did we do? Repeatedly Seidel'd him, confirmed normal IOP, CT'd him, put a bandage CTL, and gave him an antibiotic drop.

This cases illustrates two things (in spite of the positive outcome): 1) the inability of the optom to diagnose a full-thickness K lac or Seidel him, 2) the inexperience with trauma (i.e. the possibility of occult IOFB) that led the optom to not send him to the ED stat for a CT and evaluation by an Eye MD.

 

[ophtho1122]

Ophthalmologists need to really band together on this issue if we are going to stop OD's from extending their own power to perform procedures that they will never be qualified to perform. OD's are well organized and obviously pour a lot of money into their political efforts. It's time we get well organized also and put up some of our money to stop them. If we don't pay now, we'll pay later and so will our patients. It's great to see people like Andrew trying to do something about this. Way to go Andrew! We do need to educate the public to the difference between OD's and Ophthalmogists. I have to explain to people on a weekly basis the difference between the two. If the public has a choice, I believe they will almost always choose to go to an Ophthalmologist, even for basic eye care. Unfortunately, if OD's sneak past legislation that give them more rights extending even into surgery, insurance companies will eventually dictate that patients must go to an OD for certain procedures because it saves the insurance company money. The public will no longer have a choice and patients will suffer from the consequences. It is much easier to stop legislation from happening than to reverse it after it already has been passed. The best way to stop this type of legislation is to get the public on our side and support our stance. The general public has no idea what is going on in these type issues. I would love to see some television ads describing the difference between OD's and Ophthalmogists and informing the public of the type of legislation that OD's are trying to get passed.

 

[Andrew_Doan]

This was posted by ophtho1122:

Oklahoma House, Senate pass bill that if fully enacted, would convert optometrists to ophthalmologists with full surgical privileges
The bill would allow Oklahoma ODs to perform non-laser eye surgeries. It was offered as an amendment to the state?s 1998 law that authorized optometrists to perform some anterior segment procedures and PRK. Please contribute to the Surgical Scope Fund today so we can immediately put your contribution to work for the future of ophthalmology. Contact Bob Palmer at [email protected], or 202.737.6662.

members of the Academy can give funds here:

http://www.aao.org/aao/advocacy/state/ssf.cfm

Sign-in on www.aao.org first, then load the above page.

I've written about the Mid-Year Forum Experience here:
http://forums.studentdoctor.net/showthread.php?t=118416

 

[DrC]

Your post is typical. That is, a typical lame, one-sided attempt to prove a point with a single experience. One case equates to incontrovertible evidence that all ODs are bad doctors? Only if you already have your mind made up. I have book (literally) of documented (not anecdotal) cases of botched eye care by OMDs and other MDs. What do those cases prove? That there are bad docs out there and that there are good docs who make errors. Academic degree does not guarantee that the practitioner is good or bad. Trust me, I have been around the block and I have seen it all. OD and OMD.

 

[Leukocyte]

I am just a lowly Carib. student who's only involvment in Ophthalmology cannot go beyong his elective rotation, but I have a question.

If optometist get to do "surgeries", who will pay their bill? I mean, don't insurance companies REQUIRE board certified Ophthalmologists before they pull out their big wallots?

Again, sorry for sneaking into your forum. (Now crawls back into his little hole, were his Carib. a** belongs).

 

[Gleevec]

Your post is typical. That is, a typical lame, one-sided attempt to prove a point with a single experience. One case equates to incontrovertible evidence that all ODs are bad doctors? Only if you already have your mind made up. I have book (literally) of documented (not anecdotal) cases of botched eye care by OMDs and other MDs. What do those cases prove? That there are bad docs out there and that there are good docs who make errors. Academic degree does not guarantee that the practitioner is good or bad. Trust me, I have been around the block and I have seen it all. OD and OMD.

So basically what youre saying, is less is more. Ie, less training makes you a better surgeon?

I guess that makes premeds some of the best surgeons in the world!

 

[exmike]

Your post is typical. That is, a typical lame, one-sided attempt to prove a point with a single experience. One case equates to incontrovertible evidence that all ODs are bad doctors? Only if you already have your mind made up. I have book (literally) of documented (not anecdotal) cases of botched eye care by OMDs and other MDs. What do those cases prove? That there are bad docs out there and that there are good docs who make errors. Academic degree does not guarantee that the practitioner is good or bad. Trust me, I have been around the block and I have seen it all. OD and OMD.

I think there is gravity to this issue beyond the OMD/OD argument. Where do we draw the line between a non physician and physician? Should chiropractors start doing orthopedic surgery if they do a bit of training? Should Occupational and Physical Therapists take over PM&R? The skill of a OD in surgical procedures is just one aspect of this dilemma. The delivery of quality health care, or even eye care is much like eating at mcdonalds. You know what you're going to get no matter if the restaurant is in NYC or Podunk, Nebraska. When you go to an ophthomalogist for eye care, especially surgery, you are ensured of a physician that is fully trained in the profession of MEDICINE, along with a comprehensive residency training in eye care and surgery. If OD's are allowed to do surgical procedures, who is going to guarantee the quality of their training? Are they willing to go through the same rigorous training that OMD's get? How can we possibly ensure the public that they will get the same level of expertise if two practitioners doing the same thing have vastly different educational backgrounds?

This is why the health care sector is carved out into niches. When one sector starts encroaching on another one, then it undermines the delivery of health care. The same reasons chiropractors dont do spine surgery is the same reason optometrists shouldnt do eye surgery. Could they do it? probably. Are they competent? Also probably true. But iif you wanted to do those procedures, you should go through the proper avenue, which is medical school.

 

[Visionary]

exmike-

That is by far one of the best posts yet on this particular topic. It avoids all of the "I'm smart, you're dumb" rhetoric and puts everything in the appropriate perspective.

Of course, I would be naive to expect this to be the end of the argument.

 

[Richard_Hom]

"...This is why the health care sector is carved out into niches. When one sector starts encroaching on another one, then it undermines the delivery of health care. The same reasons chiropractors dont do spine surgery is the same reason optometrists shouldnt do eye surgery. Could they do it? probably. Are they competent? Also probably true. But iif you wanted to do those procedures, you should go through the proper avenue, which is medical school.

Dear exmike,

Your comments about niches would be a fair characterization if ophthalmologists gave up dispensing eye glasses completely. Now, 36-40% of private practice ophthalmologists have optical dispensaries where less than 5% had them before. If ophthalmologists were so much interested in "niches" why did they pursue dispensing glasses?????

Are you at this time a medical student, resident or practicing ophthalmologist?

Regards,
Richard_Hom

 

[Visionary]

Dear exmike,

Your comments about niches would be a fair characterization if ophthalmologists gave up dispensing eye glasses completely. Now, 36-40% of private practice ophthalmologists have optical dispensaries where less than 5% had them before. If ophthalmologists were so much interested in "niches" why did they pursue dispensing glasses?????

Are you at this time a medical student, resident or practicing ophthalmologist?

Regards,
Richard_Hom

Could you clarify? What is the time-frame of the % you quote? And does that percentage include practices in which OMDs are partnered with ODs? I ask because I have not run into many OMDs that do lens prescription primarily. They may prescribe during a visit for another reason, simply because they notice a need for an updated prescription as part of the general ophthalmic workup. In that case, don't you think it seems rather unfair to ask the patient to go see another eye care professional (and shell out additional $$) for something he/she (the OMD) is perfectly capable of doing during the present visit? OMDs are, after all, trained in lens prescription.

 

[exmike]

Dear exmike,

Your comments about niches would be a fair characterization if ophthalmologists gave up dispensing eye glasses completely. Now, 36-40% of private practice ophthalmologists have optical dispensaries where less than 5% had them before. If ophthalmologists were so much interested in "niches" why did they pursue dispensing glasses?????

Are you at this time a medical student, resident or practicing ophthalmologist?

Regards,
Richard_Hom

None of the above (yet). I was commenting from the perspective of health care delivery because I have a public health background. I just found this exchange between OD/OMD's to be very interesting in its implications for the structure of health care and how it is perceived by the public and how it is actually delivered by practitioners. As much as the issue to some is ensuring the delivery of quality care, we cant ignore that a central issue to others is income and income potetial. Certainly that would explain to some degree why OD's AND OMD's would want to expand their "niche" while protecting the one they already have.

-Mike

 

[Richard_Hom]

Could you clarify? What is the time-frame of the % you quote? And does that percentage include practices in which OMDs are partnered with ODs? I ask because I have not run into many OMDs that do lens prescription primarily. They may prescribe during a visit for another reason, simply because they notice a need for an updated prescription as part of the general ophthalmic workup. In that case, don't you think it seems rather unfair to ask the patient to go see another eye care professional (and shell out additional $$) for something he/she (the OMD) is perfectly capable of doing during the present visit? OMDs are, after all, trained in lens prescription.

In the state of CA, no Optometrist can partner with an ophthalmologist. Most function as "ancillary" personnel and have no ownership interest. They, therefore, are not partners.

This time frame is NOW!.

I believe that encroachment of niches is one of economic. Believe what you may about "patient safety", etc.,etc. Look at outcomes instead. The headlong rush of ophthalmology into refractive surgery isn't due to some overall belief that it is actually beneficial like cataract extraction would be. It's cosmetic surgery, in my opinion.

Let's say this. If ophthalmology gave up all contact lens and spectacle fitting of all kinds, then there might be some discussion. However, I believe the mantra of "comprehensive ophthalmology" is the "death of optometry". In my opinion, they should not be trying to "encroach" on the niche of optometry.

Richard_Hom

 

[Richard_Hom]

None of the above (yet). I was commenting from the perspective of health care delivery because I have a public health background. I just found this exchange between OD/OMD's to be very interesting in its implications for the structure of health care and how it is perceived by the public and how it is actually delivered by practitioners. As much as the issue to some is ensuring the delivery of quality care, we cant ignore that a central issue to others is income and income potetial. Certainly that would explain to some degree why OD's AND OMD's would want to expand their "niche" while protecting the one they already have.

-Mike

Dear exmike,

If you're a public health advocate, then you would be interested in how patient access to eye care.

One of the first stirrings amongst optometrists requesting "expanded" scopes of practice came from the rural parts of the United States where ophthalmologists were loathe to practice. Ergo, the legislatures in these area recognized the quandary and tried to remedy the situation for their constituents. Thus came about the first expansion statutes.

As time progressed, it became evident that optometrists delivering what heretofore were "only ophthalmolgic" duties at similar outcomes but at much lower fixed and continuing costs appealed to other public health administrators.

Avoid the rhetoric!!! Avoid the specific poor outcomes which can be prevalent in both professions. The outcomes for the earlier optometrists in their managmenet of ocular complications of systemic conditions or ocular are similar in almost all circumstances (confined to the same degree of managment).

Despite the rhetoric and fire of both sides, I do believe that access to healthcare in the presence of bountiful manpower of each kind of doctor is actually less rather than more. I think there are much larger issues than just this jurisdictional dispute.

Richard_Hom

 

[Visionary]

In the state of CA, no Optometrist can partner with an ophthalmologist. Most function as "ancillary" personnel and have no ownership interest. They, therefore, are not partners.

This time frame is NOW!.

I believe that encroachment of niches is one of economic. Believe what you may about "patient safety", etc.,etc. Look at outcomes instead. The headlong rush of ophthalmology into refractive surgery isn't due to some overall belief that it is actually beneficial like cataract extraction would be. It's cosmetic surgery, in my opinion.

Let's say this. If ophthalmology gave up all contact lens and spectacle fitting of all kinds, then there might be some discussion. However, I believe the mantra of "comprehensive ophthalmology" is the "death of optometry". In my opinion, they should not be trying to "encroach" on the niche of optometry.

Richard_Hom

Perhaps "partner" was the wrong term. I don't know if your description of CA practice is a universal, so I can't speak on it. I was referring more to practices in which (ancillary or not), ODs work alongside OMDs--a not uncommon relationship from what I've seen.

Unfortunately, the "NOW" statement does not answer my question. Where (when) did the 5% number come from? And does the 36-40% figure include practices with which ODs are associated?

As for refractive surgery being cosmetic, you're absolutely correct. That's why it's not covered by insurance carriers. You can always stick with glasses. The fact remains that it IS surgery, even if it does fall into the realm of vision correction. Thus, it is in the domain of the OMD.

Finally, you did not acknowledge my hypothetical. I still contend that OMDs do not routinely prescribe lenses on a primary basis--at least, I've not seen it.

 

[Richard_Hom]

"...Finally, you did not acknowledge my hypothetical. I still contend that OMDs do not routinely prescribe lenses on a primary basis--at least, I've not seen it..."

1. I believe 20/20 Magazine has those proportions for dispensaries.
2. In no state that I know of can physicians partner with non-physicians. In most circumstances, the physician has employed the optometrist.
3. In some circumstances, the optical dispensary can look and act "stand alone" but in reality it is just an accounting and business formation tool. The ophthalmology still runs the optical.
4. As a matter of fact they do. I've had the pleasure of working in GA, CA and TX and I see the same. Only subspecialty opthhalmologists may avoid this. However, I feel that ophthalmologists hiring optometrists to prescribe is no different than if the ophthalmologist did the prescribing.

Regards,
Richard_Hom

 

[Andrew_Doan]

The outcomes for the earlier optometrists in their managmenet of ocular complications of systemic conditions or ocular are similar in almost all circumstances (confined to the same degree of managment).

Please show me the data to support this.

To imply that optometrists can manage systemic illness as well as ophthalmologists is ludicrous. After graduating from one of the best medical schools in the country, I would never assert that I was ready to manage patients, as a new medical graduate, as competent as my internal medicine colleagues who completed residency! Nor would I claim that I was ready to perform abdominal surgery. I observed a dozen abdominal surgeries, but I would never claim that I should or could do it.

However, optometry is asserting this very idea. Optometrists believe they are ready to handle all the systemic and ocular diseases as well as surgery after 4 years of optometry school. Optometrists are not as knowledgeable and experienced about systemic and ocular diseases compared to ophthalmologists who complete 4 years of medical school and 4 years of post-graduate training. We see several fold the pathology and manage several fold the surgical complications during our training.

 

[Richard_Hom]

Please show me the data to support this.

To imply that optometrists can manage systemic illness as well as ophthalmologists is ludicrous. After graduating from one of the best medical schools in the country, I would never assert that I was ready to manage patients, as a new medical graduate, as competent as my internal medicine colleagues who completed residency! Nor would I claim that I was ready to perform abdominal surgery. I observed a dozen abdominal surgeries, but I would never claim that I should or could do it.

However, optometry is asserting this very idea. Optometrists believe they are ready to handle all the systemic and ocular diseases as well as surgery after 4 years of optometry school. Optometrists are not as knowledgeable and experienced about systemic and ocular diseases compared to ophthalmologists who complete 4 years of medical school and 4 years of post-graduate training. We see several fold the pathology and manage several fold the surgical complications during our training.

Dr. Doan,

I'm afraid that I must elaborate.

1.It is based empirically, whereby the largest HMO in the country, Kaiser Permanente Medical Group for NCalif and SCalif has long utilized optometrists for focused initiatives to screen for HIV AIDS reinopathy, diabetes, surveillance of plaquenil, etc. To say that only an ophthalmologist can perform "better" than an optometrist might be true but I feel that operationally the public isn't harmed and the public gets affordable healthcare.

2. The military itself has used optomerists for frontline surveillance of retiree populace in the past.

Therefore, forgive me if I did not more carefully describe my experience that backed up my post. I do have 30+ years experience that includes private ophthalmology, military, HMO and hospital-based practices. To say that these focused initiatives or the use of optometrists for their own economic interest would seem to be a disservice to the excellent service and work already done.

If you have completely been caught up yourself in the political rhetoric and will take a "hard" line in your future, I'm hoping that your practice will tolerate such an approach. In my experience, most cases whereby ophthalmology has taken a "hard line" with their optometric colleagues either in HMO or military practices, the system works suboptimally. Trust me on this. It has happened and will happen.

I also want to clarify that I meant no offense to my ophthalmologic audience on this forum by my post and do not want to absolutely equate my skill level with theirs in absolute situations. However, in focused initiatives whereby parameters are defined, I believe that optometry can provide "equivalent" outcomes.

Regards,
Richard_Hom

 

[Andrew_Doan]

I understand your point of view Richard, and I appreciate your opinions. I value the service optometry provides to society, and I think optometrists will play an invaluable role in fighting blindness as the baby boomers are aging.

However, I'm taking the "hard line" in regards to the optometrists who think they will replace the general ophthalmologist and want to perform ocular surgery. I think this effort by some optometrists and organized optometry is wrong and does not serve society well.

 

[smiegal]

"However, in focused initiatives whereby parameters are defined, I believe that optometry can provide "equivalent" outcomes." Dr. Hom[/I]

This is undoubtably true. It only makes sense for the health system to operate this way. That is why physical therapists, optometrists, etc. exist. On that note, what would be the bill for some of the screening procedures that were mentioned such as HIV or DM retinopathy for an eye MD vs. an OD. Just curious.


"If you have completely been caught up yourself in the political rhetoric and will take a "hard" line in your future, I'm hoping that your practice will tolerate such an approach. In my experience, most cases whereby ophthalmology has taken a "hard line" with their optometric colleagues either in HMO or military practices, the system works suboptimally." Dr. Hom[/I]

This statement, however, seems to discourage the establishment of parameters within which optometrists may practice. A very legitimate "hard line" approach to take in "political rhetoric" would be to prohibit non-physicians from performing certain types of surgical procedures. Certainly, there are procedures that fall into the category of "open to debate," but a "hard line" against such procedures as cataracts, filters, muscles, etc. is necessary. Right? There is every reason to be alarmed with the legislative trend in Oklahoma, this is not paranoia or stubbornness.

As far as the point that eye MD's shouldn't "encroach" into the refraction/eyeglasses turf of ODs......come on.

 

[Richard_Hom]

Dear smiegal,

1. My complaint isn't with the refraction performed by an ophthalmologist but only with the dispensing (selling) of eye glasses! If they we did "stay" in our niches as one other poster had suggested, then that would be the "deal". However, as we know economic interest is driving the glasses rule as I suspect some component of the present discussion.

2. In the discussion of "defined" initiatives, these are programs meant to focus on a specific problem and are already defined by parameters as set by the organizations involved. No other parameters needed.

3. In regards to surgical privileges for optometry, that's a subject I prefer to avoid as that isn't a productive subject for me in my current circumstance.

Regards,
Richard_Hom

 

[Visionary]

1. I believe 20/20 Magazine has those proportions for dispensaries.
2. In no state that I know of can physicians partner with non-physicians. In most circumstances, the physician has employed the optometrist.
3. In some circumstances, the optical dispensary can look and act "stand alone" but in reality it is just an accounting and business formation tool. The ophthalmology still runs the optical.
4. As a matter of fact they do. I've had the pleasure of working in GA, CA and TX and I see the same. Only subspecialty opthhalmologists may avoid this. However, I feel that ophthalmologists hiring optometrists to prescribe is no different than if the ophthalmologist did the prescribing.

Regards,
Richard_Hom

So is your contention that an established patient who visits his/her OMD for, let's say, an annual glaucoma exam, should be referred to an OD for lens prescription (and shell out extra $$) if he/she is found during the ophthalmic workup (which ALWAYS includes a VA check and refraction, if indicated) to have progression of refractive error? I don't imagine the patient would understand (or appreciate) that. Or should the OMD just not check VA at all, or at least not refract if VA is found to be decreased with improvement on pinhole? OMDs cannot help that they, as part of their training, been instructed on how to refract--it's a necessity! As for OMDs prescribing primarily, I just don't see it (even with general OMDs). I cannot think of a single person I know who goes to an OMD for their lens prescription.

 

[Richard_Hom]

So is your contention that an established patient who visits his/her OMD for, let's say, an annual glaucoma exam, should be referred to an OD for lens prescription (and shell out extra $$) if he/she is found during the ophthalmic workup (which ALWAYS includes a VA check and refraction, if indicated) to have progression of refractive error? I don't imagine the patient would understand (or appreciate) that. Or should the OMD just not check VA at all, or at least not refract if VA is found to be decreased with improvement on pinhole? OMDs cannot help that they, as part of their training, been instructed on how to refract--it's a necessity! As for OMDs prescribing primarily, I just don't see it (even with general OMDs). I cannot think of a single person I know who goes to an OMD for their lens prescription.

Dear Visionary,

Again, my contention ophthalmologic lens dispensing!!!!!!!!

Richard

 

[Visionary]

Dear Visionary,

Again, my contention ophthalmologic lens dispensing!!!!!!!!

Richard

I can see this is pointless.

 

[exmike]

Dear Visionary,

Again, my contention ophthalmologic lens dispensing!!!!!!!!

Richard

Lets think about it this way. Eye care is a continuum from fitting glasses all the way up to retinal surgery. Opticians, Optometrist, and Ophthalmologist are trained to do increasing portions of that continuum. Think of it as growing concentric circles with opticians occupying the small spot in the middle, optometrist occpuying a larger circle beyone that of opticians, and ophthalmologists occupying a circle larger and inclusive of the previous two. Generally on that continuum, the optician should stop at refracting, and the optometrist should stop at surgery, since that is what they were trained for. Since the ophthalmologist is trained to cover the entire continuum, why shouldnt they dispense lenses? The problem arises when someone attempts to practice beyoned the continuum or "concentric circle" for which they were trained.

 

[Visionary]

Thanks again to exmike--the voice of reason.

 

[Richard_Hom]

Lets think about it this way. Eye care is a continuum from fitting glasses all the way up to retinal surgery. Opticians, Optometrist, and Ophthalmologist are trained to do increasing portions of that continuum. Think of it as growing concentric circles with opticians occupying the small spot in the middle, optometrist occpuying a larger circle beyone that of opticians, and ophthalmologists occupying a circle larger and inclusive of the previous two. Generally on that continuum, the optician should stop at refracting, and the optometrist should stop at surgery, since that is what they were trained for. Since the ophthalmologist is trained to cover the entire continuum, why shouldnt they dispense lenses? The problem arises when someone attempts to practice beyoned the continuum or "concentric circle" for which they were trained.

Dear exmike,

The logic, although seemingly flawless, does fail in one respect. Prior to managed care, few ophthalmologists owned dispensaries. Only in the last 10 years have ophthalmologists sought more revenue by including glasses dispensing.

Second, the "sphere model" only works if you feel that a pair of glasses is "surgical" or "medical". Although some might consider "treatment", optometrists in general have more knowledge about ophthalmic dispensing than any ophthalmologist would.

But my discussion isn't about the hyptothetical but the reality. The encroachment that each side sees is one of silent agreement of years passed. If ophthalmologists did not do lens dispensing, then optometrists would stay in their area. However, managed care and Medicare reform have caused surgical reimbursement to fall. It is only their economic interest rather than a philosophical interest that they went into dispensing.

Richard

 

[smiegal]

Dr. Hom,
I misunderstood you about refracting vs. dispensing. I don't see any problem with opthalmologic glasses dispensing, but I see your point about the shifting or encroachment.

"In regards to surgical privileges for optometry, that's a subject I prefer to avoid as that isn't a productive subject for me in my current circumstance."

I may be wrong, but that sounds like support for the initiative.

Again, anyone, what would be approximate office charges for, for example, a diabetic retinopathy screen done by an ophthalmologist vs. an optometrist. Is there a large difference.

Thanks

 

[cbc]

Your logic, although seemingly flawless, also fails in one respect. The encroachment issue does not work because opthamologists are fully trained at refractive correction, therefore they do perform this procedure. However, an optometrists are not fully trained at surgery, therefore they should not. That is the issue at hand.

These arguments make no sense. Anyone entering a profession should not blindly do so, but contemplate on the change of that profession in the next 10-20 yrs. I have a close friend who recently went to optometry school. Before she applied, I warned her that lasik surgery are not performed by optometrists, and lasik surgery might soon (next few years?) entirely replace the use of glasses. She merely ignored that comment and advice without even contemplating it for 5 seconds. She is now paying 30k a year studying how to prescribe glasses with no training in surgery or pharmacology. What annoys me is that when society no longer needs her for glasses, people like her will end up lobbying for rights to procedures that they were never adequately trained in, when she has never really thought about the changes that will occur in her career.

Anyone who wants a secure job should aim to seek the most complicated and advanced training to avoid being phased out. I, too, am thinking about changes in medicine. No disrespect to FPs, but I will never pick FP just because so many NPs and PAs are threatening that sector. No disrespect to optometrists, but pre-optometrys should consider the future before selecting their careers.

I am a blunt person. The formal training to do eye surgery is to go to medical school, be top of the class in medical school, then go to residency for 4 years. There is and should have no short cuts. Unless you received that training, then don't do it. I'm not speaking as a future ophthamologist, or as a current medical student, but as a patient. If they give you a PA to do your heart surgery, you'd roll my eyes and say give me a cardiothoracic surgeon. Of course, my 12 yr old sister can perform a heart or eye surgery if the law allows her to. She'll probably be successful on certain occasions. But that is just a stupid idea, because she never received formal training in it.

If you compare salaries of optometrist with ophthamologist, you'll be convinced ophthamologists spend their time on specialized cases much more than dispensing glasses everyday like optometrists do. Their salaries are not even comparable.

I do understand why optometrists are shaking in their boots though. In 15 years, lasik is going to cost less than glasses I bet.

Dear exmike,

The logic, although seemingly flawless, does fail in one respect. Prior to managed care, few ophthalmologists owned dispensaries. Only in the last 10 years have ophthalmologists sought more revenue by including glasses dispensing.

Second, the "sphere model" only works if you feel that a pair of glasses is "surgical" or "medical". Although some might consider "treatment", optometrists in general have more knowledge about ophthalmic dispensing than any ophthalmologist would.

But my discussion isn't about the hyptothetical but the reality. The encroachment that each side sees is one of silent agreement of years passed. If ophthalmologists did not do lens dispensing, then optometrists would stay in their area. However, managed care and Medicare reform have caused surgical reimbursement to fall. It is only their economic interest rather than a philosophical interest that they went into dispensing.

Richard

 

[Yogi Bear]

i found this post in the optometry forum interesting: http://forums.studentdoctor.net/showthread.php?t=118056 (maybe someone's already linked it)

but basically, canada's allowing opticians to refract and optometrists are vehemently against it. deja vu w/ optometrists wanting to do surgery?

 

[OD.]

Anybody know a few OMD's who would be willing to train some OK optometry residents in cataract and strabismus surgery?

 

[cbc]

I also wanted to add a discretion to the OP and other optometrists, since the OP appears angered by the antagonism:

By no means was I trying to downgrade the profession of optometry. I did not mean to say optometrists are not knowledgeable or intelligent. If brain surgeons wanted legal rights to do general dentistry, I'd tell them to get the hell out of here, and I'm sure you'll think similarly. Again, my contention would be, brain surgeons have no adequate training in dental work, and should stay away. I don't mean to say that brain surgeons or optometrists are incompetent. I am just saying they are not formally trained in those specific procedures and should not do them. They should do what they are trained and are supposed to do. Thank you.

Anybody know a few OMD's who would be willing to train some OK optometry residents in cataract and strabismus surgery?

 

[Andrew_Doan]

I also wanted to add a discretion to the OP and other optometrists, since the OP appears angered by the antagonism:

Thanks for your input in this forum!

For the record, the OP is an optometrist in Canada who does not understand why OD's in the US are pushing for surgical privileges. He was angered by the fact that I posted a response to thank him for his contribution and then to elaborate further about why I think it is ludicrous that OD's have gained surgical privileges.

The OP accuses me of hijacking his thread. I could have easily started a new thread, but I was rather busy typing responses last week when I was at the AAO Mid-Year Forum in Washington D.C.

 

[Fritz]

If the ODs want to do surgery than they should be subject to the same training as the MDs. The MDs go through 4 years of college ( lots of work to keep grades up) take the MCAT (lots of work to get a high score) and then go through AMCAS application, finally through medical school and then 4 years of residency. Not to mention that in order to get a residency spot they have to have high scores on the Boards and to be at the top of their class. All this training gives them the right to do surgery.
But then the ODs come along and claim the right to do surgery. I ask you then what is the purpose of going through medical school and residency, if someone with limitted training can come along and claim rights to do surgery?
I am not into ophto, but I went through the application to medical school. The whole road to becoming a doctor, any type of doctor, is hard. We work hard to earn the priviledge to practice medicine! I don't agree with anyone having less training coming along and trying to obtain the same priviledges as the people who went through the long years of training.
If the ODs are allowed to do surgery with only the limited training that they have now, then maybe we should get a butcher, train him for a year or so, and then allow him to do neurosurgery. Maybe it will work.
I am really revolted to the thought that some people would resort to something like this! If ODs want to have certain priviledges then they should go through medical school and residency and work hard to earn those priviledges!

Fritz.

 

[exmike]

I've yet to get a reply to this question I posted earlier (why is that?). I think it would be very insightful:

My question to all the OD's that want to do "simple surgical procedures" is this. If you wanted to do those, why didnt you just go to medical school and become an OMD? Then you wouldnt have had to fight for those rights, and you would be just as well trained for all the "primary care" procedures as well. Doesnt it make more sense to be trained and competent in a wide scope of practice (OMD) and choose to do what you want (may just focus on simple procedures) rather than to gain a relatively narrow scope of training and competency (OD) and attempt to expand your scope of practice beyond that after the fact?

 

[Visionary]

I've yet to get a reply to this question I posted earlier (why is that?). I think it would be very insightful:

My question to all the OD's that want to do "simple surgical procedures" is this. If you wanted to do those, why didnt you just go to medical school and become an OMD? Then you wouldnt have had to fight for those rights, and you would be just as well trained for all the "primary care" procedures as well. Doesnt it make more sense to be trained and competent in a wide scope of practice (OMD) and choose to do what you want (may just focus on simple procedures) rather than to gain a relatively narrow scope of training and competency (OD) and attempt to expand your scope of practice beyond that after the fact?

I think you didn't receive a reply because there are no good replies to the contrary. [Maybe this will get someone posting! ]

 

[Kalel]

On a side note, why don't they let non-optometrist write prescriptions for glasses and contact lens? That must take 10 minutes to train someone to do, but you still have to pay a professional to do it for $50-100. You can't argue that they need to be trained to look for abnormal pathology either, because all it takes is for them to train some tech to write down numbers that their air guns record and just recognize normal vs abnormal retinas to know when to refer. Pathologists have the right idea IMO, instead of trying to prevent allied health professionals from "invading" their field, they embraced them a long time ago and now are very efficient working as supervisors. You may need a pathologist to confirm a diagnosis on a slide, but all it takes is a trained tech to find the pathology and fix it on a slide for the MD to see. I personally like the idea of medical doctors having more allied health professionals work under them to increase their efficiency.

 

[Andrew_Doan]

I personally like the idea of medical doctors having more allied health professionals work under them to increase their efficiency.

This would be ideal; however, organized optometry has plans to replace the general ophthalmologist in the future, not work for the ophthalmologist.

 

[Nilf]

I disagree with the statement that MD should have exclusive rights to perform certain procedures.

Technology is changing... Client expectations are changing... What used to be cutting edge a decade ago, may not be so now... Why don't we let the market decide what kind of procedures can be performed only by MDs? I know what you will say... How can we endanger our patients with this laissez-faire attitude? But this has always been the case with medicine... Innovations become commonplace only if they can stand the test of time... Whether or not we're talking about work organization, or new technologies... Well you won't stop the stampede by 'protesting' new work policies, trying to have things run like in the good ole' days...

You are saying that if the ODs want to do small surgeries, they should go to med school. Your logic is flawed. What if ODs' performance will equal that of MDs'? If it does, then then you should not conclude that ODs are underqualified, but that MDs are ovequalified. Why are you afraid to wait and see if ODs' performance can equal yours?


Let's wait and see... Maybe it's not such a bad idea that many procedures can be done by highly skilled non-MDs. I believe, that ultimately the market will determine who is right.

 

[cbc]

Let's make some sense out of this. Let's allow people who were never formally trained in a procedure prove a point by risking the sight and lives of patients. Yeah, let's do that.

Yes, technology is changing. I guess that means that as an automobile driver who has experience in driving combustion and electric cars, I should be allowed to work for United Airlines without training and fly commercial jets to your destination. I mean, technology is chaning, and pilots are just overqualified in my opinion. How safe would you feel if that were to happen?

The market knows nothing. If you were given a bill to choose how our meats should be processed, how exactly police cadets should be trained, who gets to build our freeways and rockets and cars and how, will you know how to vote? Most people wouldn't, and that is why we don't let people vote on these things. The professionals and experts of each field who are delegated by the govt are responsible for defining these guidelines and procedures.

I disagree with the statement that MD should have exclusive rights to perform certain procedures.

Technology is changing... Client expectations are changing... What used to be cutting edge a decade ago, may not be so now... Why don't we let the market decide what kind of procedures can be performed only by MDs? I know what you will say... How can we endanger our patients with this laissez-faire attitude? But this has always been the case with medicine... Innovations become commonplace only if they can stand the test of time... Whether or not we're talking about work organization, or new technologies... Well you won't stop the stampede by 'protesting' new work policies, trying to have things run like in the good ole' days...

You are saying that if the ODs want to do small surgeries, they should go to med school. Your logic is flawed. What if ODs' performance will equal that of MDs'? If it does, then then you should not conclude that ODs are underqualified, but that MDs are ovequalified. Why are you afraid to wait and see if ODs' performance can equal yours?


Let's wait and see... Maybe it's not such a bad idea that many procedures can be done by highly skilled non-MDs. I believe, that ultimately the market will determine who is right.

 

[cbc]

One more thing, about the title "MD" in which you are referring:

I do agree qualified experts who do not have MDs should be able to perform their perfected duties. However, our society needs order. For example, no matter how qualified one is at driving a car, even you drove for 30 years in a foreign country or in the US, if you have no driver's license and are caught driving by the police you will get arrested. That is how are society keeps order to recognize who is qualified or not. To drive, you need a license. To perform surgery, you need a license. That's civilization.

 

[Nilf]

One more thing, about the title "MD" in which you are referring:

I do agree qualified experts who do not have MDs should be able to perform their perfected duties. However, our society needs order. For example, no matter how qualified one is at driving a car, even you drove for 30 years in a foreign country or in the US, if you have no driver's license and are caught driving by the police you will get arrested. That is how are society keeps order to recognize who is qualified or not. To drive, you need a license. To perform surgery, you need a license. That's civilization.

The discussion is drifting onto more philosophical grounds, and I would like to keep it less abstract. You are saying that 'our society needs order'. Sweeping generalization, and quite meaningless as well. Our society needs mainly best trained professional providing the best possible service.

Which brings me to the main point, which you did not address. What if the performance of OD's will match that of opthalmologists? Will you then also adamantly defend MD's exclusive rights to do certain procedures if evidence based medicine shows you the contrary? And how do you know that it will not? It well may, and the only way to find out is to let the client decide. What if OD's will perform the procedures and have the same rate of success as MDs?

I also disagree with your statement that 'market knows nothing'. I certainly do not know the intricacies of combustion engine or a rocket launcher, or Lasik surgery as a matter of fact. However, if I am to shell out several thousands bucks for a Lasik surgery, and I have a choice of an MD who will charge me 5K, and a OD who will charge half of that, and if the outcomes are comparable, I will choose the OD. And I don't see why legislature should tell me to do the opposite.

 

[cbc]

Requiring one to acquire a license to drive and perform surgery is meaningless and philosophical? No point in discussing a complex issue with an simplified mind.

You never answered any of my questions. But okay, I will answer yours. Yes, if evidence medicine proves a point, we should follow suit. I'll be curious though how many patients will suffer blindness and death before proving the rejection of the null hypothesis that there is no difference between ODs and ophthamologist in the US. Don't forget eye surgery is not just a single procedure, but a quality of care that depends on proper screening, diagnosis, and post-op follow ups (requiring multiple complex studies).

 

[Nilf]

Requiring one to acquire a license to drive and perform surgery is meaningless and philosophical? No point in discussing a complex issue with an simplified mind.


You're taking my words out of the context. You made a claim that 'society needs order', without defining what the 'order' is.

You never answered any of my questions. But okay, I will answer yours. Yes, if evidence medicine proves a point, we should follow suit. I'll be curious though how many patients will suffer blindness and death before proving the rejection of the null hypothesis that there is no difference between ODs and ophthamologist in the US.

Agreed. I am working under the assumption here, that before ODs are allowed to cut the patient, they must be properly trained so they don't endanger the patient.

Don't forget eye surgery is not just a single procedure, but a quality of care that depends on proper screening, diagnosis, and post-op follow ups (requiring multiple complex studies).

Yes, there are limits to what ODs can do. However, I disagree with the assumption that they some procedures are essentially sacred and should be performed only by MDs.

I don't feel that the analogy to air pilots holds true. A more proper analogy would be a following hypothetical situation: an engine jet is developed which so easy to fly, that even folks without a pilot licensure could fly it, which cuts the costs down and improves efficiency, without having adverse effects (namely, plane crashes). If such situation arises, then I believe that the qualified folks without pilot licensure should be allowed to operate jet planes.

 

[cbc]

So this is a more proper analogy because eye surgery is so easy to do that people without licensure or proof of proper training can do it? Wow, I better tell my kid sister to start doing eye surgery since it's so easy yet lucrative.

Until you can refer to the articles and meta-analyses that prove no difference between outcomes of OD and MD doing surgery, your entire argument is worthless. Heck, you can even propose, "evidence shows ODs are not equal, but 1000x better than MDs and all other health care provider at this procedure, therefore the government should promote ODs to perform it." I'm sure if you or anyone can provide this evidence, everyone including MDs and the govt will support ODs performing this procedure.

 

[exmike]

I don't feel that the analogy to air pilots holds true. A more proper analogy would be a following hypothetical situation: an engine jet is developed which so easy to fly, that even folks without a pilot licensure could fly it, which cuts the costs down and improves efficiency, without having adverse effects (namely, plane crashes). If such situation arises, then I believe that the qualified folks without pilot licensure should be allowed to operate jet planes.

I cannont envision a time when flight will be equivalent to riding a bike i.e. anyone can do it. Similarly, no matter how "simple" the procedure may seem, if you are not trained to do SURGERY, you shouldnt be, no matter how skilled you are or how "simple" the procedure becomes because of surgery.

You've stated an arguement who's conclusion is based upon opinion so there really is no point in debating it.

Order in society is important. Otherwise, why dont we train some high school kids how to refract and replace the OD? They are just as capable as a OD to learn it right? Why dont we have 12 grade students teach 11th grade classes, they know the material just as well as the teacher after going through the class. It just doesnt work that way.

 

[Andrew_Doan]

When has surgery become risk free? I guess people don't see the LASIK/refractive cases that require corneal transplants! Most surgeons don't "advertise" these cases.

It's this cavalier attitude towards surgery that scares me most.