One more procedure?

[nanosomic]

This is not meant to start the usual debate, but if you opto doctors, students, wannabe opto doctors could include one more procedure currently outside of your scope of practice (for the most part), what will it be and why?

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[Tom_Stickel]

This is not meant to start the usual debate, but if you opto doctors, students, wannabe opto doctors could include one more procedure currently outside of your scope of practice (for the most part), what will it be and why?

Nanosomic,

First, the big question for you is why you're asking this question if not to start the usual debate.

Second, it seems that you somewhat realize that there are 50 different scopes of practice (51, counting D.C.) and they vary dramatically. Ask this question to an OD or student from Massachusetts and you'll get a drastically different answer than if you ask someone from Oklahoma. So it's not a particularly good question to ask.

Which brings about the real issue for optometry: should we be trying to expand privileges in places like OK and New Mexico until we have more standardized scopes of practice everywhere else? IMO, until we get more uniform practice laws and reciprocal licensure, lasers and scalpels should be a distant concern.

Tom Stickel
Indiana U. 2001

 

[cpw]

I'm with Tom on this one... I'd like to see more focus on bringing up states with lesser privaledges (like oral antibiotics and antivirals, etc in Florida) ... and I'd also like to see more reciprocity between states. Some states are rediculous to try to get licensed in.

 

[brendang]

I find it truly amazing how there is such discrepency among states as to what optoms are permitted to do... No wonder the field is constantly criticized as unorganized and confused... Says a lot about a profession that is limited not by science & technology but by legislation/lobbying... Yesterday's ruling concerning the state of NM was yet another notch in our cap... As far as one more procedure optoms should be interested in, here's something novel -- how about prescribing and making glasses!!! It seems as though you have all lost your way from your true station in the face of laser and intraorbital surgery...

 

[cpw]

I don't make glasses.. opticians do.

Brendang, your posts on this forum have been nothing but imflammatory. I'd like it to stop. If you have something CONSTRUCTIVE to say I'm all for healthy debate, but there's been nothing to build a debate around.

And, for the record, did I not just say I was in favor of getting equal legislation in lessor states and reciprocity, over getting lasers and surgical procedures in further advanced states?

I'm moving to Florida where I cannot write for oral antibiotics, which I am trained to do and am prescribing in Texas. Why should I lose rights ? I'd rather have that fixed, honestly, than provide teriary care. (which IMO laser procedures are)

 

[brendang]

I'd like to believe that my additions to this forum are not inflammatory... The truth is that no one seems to understand that there is a monumental difference between the qualifications and capacities of ophthalmologists and what it is you do... Until optometrists start referring to themselves as such and not by the ambigious title of "eye doctor" both in speech and in referral (business cards, discussions, billboards signs) I wish to simply state the truth and remind those who have faltered... The intention of my previous posting was simply to state that if the field of optometry was coherent and purposeful, you wouldn't have to step on everyone else's toes for validation... It is unfortunate that those of MD background find truth in my opinions and those of your perspective find inflammation. Chaque un à son gout, mon frere...

 

[nanosomic]

Nanosomic,

First, the big question for you is why you're asking this question if not to start the usual debate.

Second, it seems that you somewhat realize that there are 50 different scopes of practice (51, counting D.C.) and they vary dramatically. Ask this question to an OD or student from Massachusetts and you'll get a drastically different answer than if you ask someone from Oklahoma. So it's not a particularly good question to ask.

Which brings about the real issue for optometry: should we be trying to expand privileges in places like OK and New Mexico until we have more standardized scopes of practice everywhere else? IMO, until we get more uniform practice laws and reciprocal licensure, lasers and scalpels should be a distant concern.

Tom Stickel
Indiana U. 2001

I asked the question because I found out that (apart from laser use and surgery) opto docs in some states are allowed to do procedures (prescribing) that others in other states are not allowed to for example prescribing oral antibiotics. Also, I wanted to get the gut desire of you all. I believe laser should be within your scope of practice (this is coming from someone who will be in medical school and thinking optho). As somebody pointed out, there are not enough optho docs to do all the laser procedures people need or will be needing. In other countries (from what I have read and first hand experience), opto docs do more than here and the optho docs are not as hostile as they are here.

 

[mdkurt]

I believe laser should be within your scope of practice (this is coming from someone who will be in medical school and thinking optho). As somebody pointed out, there are not enough optho docs to do all the laser procedures people need or will be needing.

I disagree--as JennyW has stated on this forum, there are no lines around the block filled with people waiting for ALTs or PIs. If you take the most generous estimates of the prevalence of glaucoma (8% of blacks) and realize that only a small number of those will need ALT (and then only a maximum number of twice per eye) you come up with a very small slice of the total population, a number more than adequately served by the number of ophthalmologists.

I also agree with the other posts on this thread re: scope of practice. It must be very hard to be automatically demoted just because you moved across a state line.

 

[Kristene9]

... and I'd also like to see more reciprocity between states. Some states are rediculous to try to get licensed in.

I haven't really thought about different states and getting a license. I thought that all the schools prepare you to work in any state. I realized that if you were to work in Oklahoma you would probably have to go though some extra classes. What are some of the harder states to get your license in?

 

[JennyW]

I haven't really thought about different states and getting a license. I thought that all the schools prepare you to work in any state. I realized that if you were to work in Oklahoma you would probably have to go though some extra classes. What are some of the harder states to get your license in?

You will find that there is usually no corelation between scope of practice, and the degree of difficulty in getting a license in that state.

Jenny

 

[JennyW]

I find it truly amazing how there is such discrepency among states as to what optoms are permitted to do... No wonder the field is constantly criticized as unorganized and confused... Says a lot about a profession that is limited not by science & technology but by legislation/lobbying... Yesterday's ruling concerning the state of NM was yet another notch in our cap... As far as one more procedure optoms should be interested in, here's something novel -- how about prescribing and making glasses!!! It seems as though you have all lost your way from your true station in the face of laser and intraorbital surgery...

It's not a coincidence that the states that have the most restrictive scope of optometric practice also have the largest number of ophthalmologists. Don't think for one second that optometry is the only profession that "lobbies." For many years, OMDs lobbied their legislatures claiming that if ODs were allowed to use topical diagnostic agents, that we would be blinding our patients with proparacaine and killing them with tropicamide.

I could tell you many stories of ridiculous OMD lobbying in my home state of New York.

Jenny

 

[JR]

I think I'll take you up on this, Jenny. I can't wait to hear about "ridiculous lobbying". All I hear and see on this forum is the lobbying efforts of non-surgeons non-physicians to start doing intraocular surgery.

It's not a coincidence that the states that have the most restrictive scope of optometric practice also have the largest number of ophthalmologists. Don't think for one second that optometry is the only profession that "lobbies." For many years, OMDs lobbied their legislatures claiming that if ODs were allowed to use topical diagnostic agents, that we would be blinding our patients with proparacaine and killing them with tropicamide.

I could tell you many stories of ridiculous OMD lobbying in my home state of New York.

Jenny

 

[PLPrincess]

here we go again....

 

[JennyW]

I think I'll take you up on this, Jenny. I can't wait to hear about "ridiculous lobbying". All I hear and see on this forum is the lobbying efforts of non-surgeons non-physicians to start doing intraocular surgery.

Happy to oblige, JR.

In my home state of New York, OMDs are constantly going to court to have the removal of foreign bodies restricted because that's "surgery", despite the fact that ODs in New York have successfully removed thousands. This battle is going on TO THIS DAY.

And even though ODs had successfully managed thousands of glaucoma patients, when Xalatan became available in the late 90s, a lawsuit was filed by OMDs trying to restrict ODs from continuing to manage glaucoma because in the original legislative formularly, "prostaglandin analogs" were not part of the formulary, and since ODs couldn't use the "most advanced" drugs, then they should be prohibited from using any. Unfortunately, a judge (who happened to be the brother-in-law of an OMD) agreed, and for a few months, ODs were restricted from writing prescriptions for any and all glaucoma medication until the legislature reconvened and the law was immediately changed to an "as taught" wording. Now wasn't that just a complete waste of everyone's time?

I could go on, but I've posted many of these stories before. Feel free to search my previous posts.

Jenny

 

[file014]

I'd like to believe that my additions to this forum are not inflammatory... The truth is that no one seems to understand that there is a monumental difference between the qualifications and capacities of ophthalmologists and what it is you do... Until optometrists start referring to themselves as such and not by the ambigious title of "eye doctor" both in speech and in referral (business cards, discussions, billboards signs) I wish to simply state the truth and remind those who have faltered... The intention of my previous posting was simply to state that if the field of optometry was coherent and purposeful, you wouldn't have to step on everyone else's toes for validation... It is unfortunate that those of MD background find truth in my opinions and those of your perspective find inflammation. Chaque un à son gout, mon frere...

I think a few heated discussions on the internet are not what goes on in the real world.

It is fortunate that most MD's understand the value of optometry and are not confused about. I'll be doing a rotation with an OMD and 2 OD's who seem to get along just fine and probably make tons of money doing it. The office where my Grandmother had cataract surgery has 2 OMD's and an OD. The OMD's were more than happy to let me watch them operate on my Grandmother. Six of my classmates are going to Miami to study ocular disease with the best ophthalmologists in the world. Need I say more? The big picture FOR EVERYONE READING THIS THREAD is that we ARE working together. I truly look forward to an outstanding professional relationship with ophthalmology.

Trabajo con nosotros, no contra nosotros, mi hermano. Paz

 

[futuredoctorOD]

I think I'll take you up on this, Jenny. I can't wait to hear about "ridiculous lobbying". All I hear and see on this forum is the lobbying efforts of non-surgeons non-physicians to start doing intraocular surgery.

Enough is enough.... I know my posts amuse you but what amuses me even more is the garbage that comes out of the mouths of many OMD's on here. The fact is I have spent about a month researching the legal histories of optometry and opthalmology and there is a long history of a purpose to keep optometry from being anything but a glass prescribing profession! It took 25 years of state by state court battles to achieve prescription rights for topical pharmaceutical agents in 50 states and oral pharms in 37 states. What Jenny says about Opthalmology in the 70's publically saying that patients would go blind if optometrists prescribed topical drugs is completely true. Your profession has done nothing but try to injure and prevent optometry from evolving. Your profession has the undeniable arrogance in believing that "your model" (allopathy--med school, residency) is the only path to enlightenment especially regarding opthalmic medicine. "non-surgeons non-physicians to start doing intraocular surgery"---what a bunch of crap. I say add surgical education and training just like podiatry and dental programs have, hire some pro-optometry opthalmologists to teach it--(so the argument about Optometry not having traditional education in surgery becomes moot) and replicate the efforts not unlike the 25 year battle for pharmaceutical privilages....but do it step by step..procedure by procedure because opthalmology (the Oil Trust of Opthalmic Medicine) will never allow it. Somehow (with the legal system---or something) create some residence based surgery training for OD's. Refractive Management is in the realm of Optometric Medicine and should include refractive surgery. Yes I said it and I can hear the backlash of responses this silly site will have.....I guess Podiatrists and Dentists are non-physicians doing surgery and optometrists will be too...lol But the difference is---I think optometrists, dentists, and podiatrists are physicians....After what I have researched and read about in my limited leisure time....I absolutely support limited optometric surgery---Especially Lasik because it is the natural extension of Refractive Management (especially especially in the future when Lasik becomes so routine that glasses and contacts are much less necessary.) I don't care what Opthalmology or the AMA Health Care Trusts think about it---I really dont. So JR, you can insult Jenny and make fun of my comments but one thing I will close this post with is that some form of optometric surgical procedures is enevitable----in 20 years there will be a new argument. And for every childish backlash type response I am going to get in the next 24 hours------I NOW SUPPORT SURGICAL SCOPE EXPANSION FOR OPTOMETRY. and equally support COOPERATION BETWEEN OPTHALMOLOGY AND OPTOMETRY---in the real world they are working together!

"You can't stop a tidal wave with an umbrella."

 

[futuredoctorOD]

I find it truly amazing how there is such discrepency among states as to what optoms are permitted to do... No wonder the field is constantly criticized as unorganized and confused... Says a lot about a profession that is limited not by science & technology but by legislation/lobbying... Yesterday's ruling concerning the state of NM was yet another notch in our cap... As far as one more procedure optoms should be interested in, here's something novel -- how about prescribing and making glasses!!! It seems as though you have all lost your way from your true station in the face of laser and intraorbital surgery...

You belong in Cenozoic period predating our dinosaur friends with comments like that.......Either have something productive to say or leave.........

 

[ReMD]

If what you say is true, then what's the point for an OMD to go through medical school? Do you think that med school and internship are useless in the training of an ophthalmologist?

 

[futuredoctorOD]

If what you say is true, then what's the point for an OMD to go through medical school? Do you think that med school and internship are useless in the training of an ophthalmologist?

Look, I respect Allopathic and Osteopathic training but it is unecessary when you are a practitioner of limited scope (ie optometrist, podiatrist, dentist.)
Dentists and Podiatrists are surgeons and do not go thru medical school.....How many times do I have to repeat this? If you add surgical training as part of the already very rigorous OD program then you will be on a like plane with those two professions.....Obviously if a Podiatrist or Dentist can perform surgical procedures without going to medical school and it is definitely possible with educational modification for Optometrists to do the same. You keep saying the training of an "Opthalmologist" and I am in no way talking about turning Optometry into opthalmology rather I am talking about the natural extension of Refractive Management----Refractive Surgery being part of the treatment modalities of optometric physicians. The optometric profession innovated refractive management over a century ago and has a mandate to mantain that with technological developments such as LASIK. I say keep optometry a primary care field BUT make available such procedures like refractive surgery for vision correction because it is a natural progression of Refractive Management.

 

[Buck Strong]

Please think through your thoughts before you start posting them on an anonymous forum. By your logic of natural progressions, Physical Therapists, with some extra training in surgery, should be allowed to do what orthopods do, making them almost "unecessary" in uncomplicated cases. I mean, PT's work with poorly functioning muscles and joints, why not get that extra training and fix them? OD's see patients with bad vision, why not go ahead and perform surgery to fix them? Absurd. Please do yourself (not to mention the real OD's on this site, who i actually feel sorry for because they're being represented by misguided people like you) a favor and go to medical school, and try to get an ophtho residency, because with your mindset, you'll never be happy as an OD now, or in twenty years, when the "enevitable" revolution is supposed to occur. (to use your own poorly spelled words)

 

[brendang]

Enough is enough.... I know my posts amuse you but what amuses me even more is the garbage that comes out of the mouths of many OMD's on here. The fact is I have spent about a month researching the legal histories of optometry and opthalmology and there is a long history of a purpose to keep optometry from being anything but a glass prescribing profession! It took 25 years of state by state court battles to achieve prescription rights for topical pharmaceutical agents in 50 states and oral pharms in 37 states. What Jenny says about Opthalmology in the 70's publically saying that patients would go blind if optometrists prescribed topical drugs is completely true. Your profession has done nothing but try to injure and prevent optometry from evolving. Your profession has the undeniable arrogance in believing that "your model" (allopathy--med school, residency) is the only path to enlightenment especially regarding opthalmic medicine. "non-surgeons non-physicians to start doing intraocular surgery"---what a bunch of crap. I say add surgical education and training just like podiatry and dental programs have, hire some pro-optometry opthalmologists to teach it--(so the argument about Optometry not having traditional education in surgery becomes moot) and replicate the efforts not unlike the 25 year battle for pharmaceutical privilages....but do it step by step..procedure by procedure because opthalmology (the Oil Trust of Opthalmic Medicine) will never allow it. Somehow (with the legal system---or something) create some residence based surgery training for OD's. Refractive Management is in the realm of Optometric Medicine and should include refractive surgery. Yes I said it and I can hear the backlash of responses this silly site will have.....I guess Podiatrists and Dentists are non-physicians doing surgery and optometrists will be too...lol But the difference is---I think optometrists, dentists, and podiatrists are physicians....After what I have researched and read about in my limited leisure time....I absolutely support limited optometric surgery---Especially Lasik because it is the natural extension of Refractive Management (especially especially in the future when Lasik becomes so routine that glasses and contacts are much less necessary.) I don't care what Opthalmology or the AMA Health Care Trusts think about it---I really dont. So JR, you can insult Jenny and make fun of my comments but one thing I will close this post with is that some form of optometric surgical procedures is enevitable----in 20 years there will be a new argument. And for every childish backlash type response I am going to get in the next 24 hours------I NOW SUPPORT SURGICAL SCOPE EXPANSION FOR OPTOMETRY. and equally support COOPERATION BETWEEN OPTHALMOLOGY AND OPTOMETRY---in the real world they are working together!

"You can't stop a tidal wave with an umbrella."

"there is a long history of a purpose to keep optometry from being anything but a glass prescribing profession!"

This is because you (Optometrists) are not the same as us (Ophthalmologists with Medical Training) and will never be!!! As Jenny mentioned previously, OD's have successfully managed glaucoma in the past, but what she fails to mention are how many patients are sub-optimally treated or even neglectfully treated... Just because OD's can remove foreign bodies does not imply that you should do it, or that you can expand your "surgical" scope... As Tyler Durden mentioned in Fight Club, "shoving feathers up your a$$ does not make you a chicken..." Unfortunately, OD's are having a difficult time understanding our inherent differences. Fortunately, patients and legislation will... Oklahoma and New Mexico have spoken... When (if!) OD's stick to what their inherent responsibilities are, then perhaps we may have a civil and sympathetic relationship. But your insistence in crossing the boundary into the land of the proverbial big boys is neglectful and unethical... The hippocratic oath stating that one should do no harm should be amended to your profession... Pleadging such would put you in your place... You do not pay malpractice insurance as an MD would and have not experienced the stresses of a medical internship. And yes, medical school was strenous (unlike OD school, I've come to understand from a friend of mine who attended a school in Chicago) but we did it regardless... Does OBGYN have anything to do with ophthalmology? No, but again, we did it... The fact is that we are physicians and surgeons and you are not. It is now time to accept it and stop making excuses why you deserve to upgrade your profession.

 

[Tom_Stickel]

I asked the question because I found out that (apart from laser use and surgery) opto docs in some states are allowed to do procedures (prescribing) that others in other states are not allowed to for example prescribing oral antibiotics. Also, I wanted to get the gut desire of you all. I believe laser should be within your scope of practice (this is coming from someone who will be in medical school and thinking optho). As somebody pointed out, there are not enough optho docs to do all the laser procedures people need or will be needing. In other countries (from what I have read and first hand experience), opto docs do more than here and the optho docs are not as hostile as they are here.

Nanosomic,

I appreciate your support for our profession. The gut desire of many optometrists is difficult to gauge. I think there is a vocal (but small) minority interested in expanding scope, but the vast majority has more mundane concerns, like licensure, competition from commercial chains, exclusion from insurance plans, etc.

I believe simple anterior segment lasers should be within my scope of practice as well, i.e. capsulotomy, PI, and ALT/SLT. Honestly, people, when was the last serious YAG complication anyone has seen? And if it was and RD, did you really handle it yourself or refer it to retina just like an OD would? Do ya really think a capsulotomy is high risk surgery? And if you do, please find me one single patient in OK who's had a YAG by an OD and suffered a complication. Please, just one reported case is all I need to hear, because I have yet to hear of it. And I'm sure if organized medicine had found even one, we'd have heard a LOT about it.

That said, I don't think it's within the best public health interest to have ODs doing lasers. In the vast majority of the country, there are plenty of OMDs to do lasers. I just don't see any need that would be met by ODs doing lasers, and I don't think "because we can" is a strong enough justification for it. Personally, I'd much rather see optometry fighting for AWP (any willing provider) legislation in all 50 states.

My two cents,

Tom Stickel
Indiana U. 2001

 

[jefguth]

This thread is getting out of hand.

Brendang, you can question the qualification of optometrists all you want, and deride their education, but I fail to see how medical school at SABA would be any more strenous than the OD program at a place like the University of Waterloo, or University of California Berkeley. Seems like a no-brainer to me.

I understand that you are from Ontario, and as such are familiar with the limited scope of practice here. Optometrist in Ontario have the skills, training, and ethic to successfully manage the health of many patients that do have some unfortunate states of disease and infection but are simply limited by the legislation and the politics. Within time they will be handling more of this management without unnecessarily involving the time and limited resources of opthamology and will properly refer to you when necessary.

I stongly suggest a dose of humility, you nor opthamology have a monopoly on the capacity to achieve and to deliver excellent health care.

 

[meb302]

This thread is getting out of hand.

Brendang, you can question the qualification of optometrists all you want, and deride their education, but I fail to see how medical school at SABA would be any more strenous than the OD program at a place like the University of Waterloo, or University of California Berkeley. Seems like a no-brainer to me.

I understand that you are from Ontario, and as such are familiar with the limited scope of practice here. Optometrist in Ontario have the skills, training, and ethic to successfully manage the health of many patients that do have some unfortunate states of disease and infection but are simply limited by the legislation and the politics. Within time they will be handling more of this management without unnecessarily involving the time and limited resources of opthamology and will properly refer to you when necessary.

I stongly suggest a dose of humility, you nor opthamology have a monopoly on the capacity to achieve and to deliver excellent health care.

What happened to the motion suggesting that we ignore the fool? He does NOT have a clue, so just don't even acknowledge him.

 

[brendang]

This thread is getting out of hand.

Brendang, you can question the qualification of optometrists all you want, and deride their education, but I fail to see how medical school at SABA would be any more strenous than the OD program at a place like the University of Waterloo, or University of California Berkeley. Seems like a no-brainer to me.

I understand that you are from Ontario, and as such are familiar with the limited scope of practice here. Optometrist in Ontario have the skills, training, and ethic to successfully manage the health of many patients that do have some unfortunate states of disease and infection but are simply limited by the legislation and the politics. Within time they will be handling more of this management without unnecessarily involving the time and limited resources of opthamology and will properly refer to you when necessary.

I stongly suggest a dose of humility, you nor opthamology have a monopoly on the capacity to achieve and to deliver excellent health care.

No need to make this personal... However, my surgical rotation was completed at a Johns Hopkins-affiliated hospital; internal medicine at George Washington University, OBGYN at Cornell... etc, etc... And regardless, my training was still considered to be good enough for an ophtho residency...

 

[al-majhul]

What happened to the motion suggesting that we ignore the fool? He does NOT have a clue, so just don't even acknowledge him.

thanks meb302, for following up on that point; my message in this post is not targeted at the person in question, it is for the future OD's on this forum. I wanted to remind us all of the importance of refusing to deal with those people (or things) whose only purpose on this forum is to incite and ridicule...as jefguth mentioned, humility is key -- especially in the field of health care – but plain common decency and respect is also necessary to avoid offending 99% of the population in question through baseless rants.

Now, the funny thing is, I'm one of those students of the field who is perfectly fine WITHOUT doing LASIK and surgeries and whatnot, but it's the sheer unjustified arrogance of certain OMD's -- who shall remain nameless (as they should be ignored by the users of this forum, and so there is no need to mention their names) -- that bothers me.

For someone with that kind of mindset to come onto our forum is like saying, “hey, let's invite Hitler -- an arrogant pig, who thought he was somehow better than everyone else -- into a synagogue to have a friendly chat.” (I think the rules of debate say that if you can compare your opponent to Hitler, then you win by default). So what do we do? The only way to deal with such a situation is to remove the nuisance. Since, I'm assuming, it seems cpw cannot get permissions restricted on this forum, then we only have the one solution of imagining that those posts in question are not actually on our computer screens.

With that, I leave you with a further essential reason for not bothering to acknowledge the anti-OD posts on this forum, a quote (I don’t care who said it, but it applies)….

"Don't bother arguing with an idiot. They'll bring you down to their level and then beat you with experience." Thank you for your cooperation.

 

[futuredoctorOD]

"there is a long history of a purpose to keep optometry from being anything but a glass prescribing profession!"

This is because you (Optometrists) are not the same as us (Ophthalmologists with Medical Training) and will never be!!! As Jenny mentioned previously, OD's have successfully managed glaucoma in the past, but what she fails to mention are how many patients are sub-optimally treated or even neglectfully treated... Just because OD's can remove foreign bodies does not imply that you should do it, or that you can expand your "surgical" scope... As Tyler Durden mentioned in Fight Club, "shoving feathers up your a$$ does not make you a chicken..." Unfortunately, OD's are having a difficult time understanding our inherent differences. Fortunately, patients and legislation will... Oklahoma and New Mexico have spoken... When (if!) OD's stick to what their inherent responsibilities are, then perhaps we may have a civil and sympathetic relationship. But your insistence in crossing the boundary into the land of the proverbial big boys is neglectful and unethical... The hippocratic oath stating that one should do no harm should be amended to your profession... Pleadging such would put you in your place... You do not pay malpractice insurance as an MD would and have not experienced the stresses of a medical internship. And yes, medical school was strenous (unlike OD school, I've come to understand from a friend of mine who attended a school in Chicago) but we did it regardless... Does OBGYN have anything to do with ophthalmology? No, but again, we did it... The fact is that we are physicians and surgeons and you are not. It is now time to accept it and stop making excuses why you deserve to upgrade your profession.

again......a biased allopathic viewpoint that means absolutely nothing to me.....The OD I work with treats all sorts of conditions with autonomy---he wrote scripts for oral prednizone, valcyclovir----herpes zoster infection, and oral antibiotics......He treats these cases effectively and safely on HIS OWN.....You are ignorant as to what an OD is and how rigorous the training is and as far as I am concerned your opinions are too biased and mean spirited to carry any merit.....you are in no way objective........My entire family is MD's, my cousin is an opthalmologist and he refers to his OD counterparts as physicians......this is the real world I know....you are living in an allopathic fantasy land!

 

[futuredoctorOD]

"there is a long history of a purpose to keep optometry from being anything but a glass prescribing profession!"

This is because you (Optometrists) are not the same as us (Ophthalmologists with Medical Training) and will never be!!! As Jenny mentioned previously, OD's have successfully managed glaucoma in the past, but what she fails to mention are how many patients are sub-optimally treated or even neglectfully treated... Just because OD's can remove foreign bodies does not imply that you should do it, or that you can expand your "surgical" scope... As Tyler Durden mentioned in Fight Club, "shoving feathers up your a$$ does not make you a chicken..." Unfortunately, OD's are having a difficult time understanding our inherent differences. Fortunately, patients and legislation will... Oklahoma and New Mexico have spoken... When (if!) OD's stick to what their inherent responsibilities are, then perhaps we may have a civil and sympathetic relationship. But your insistence in crossing the boundary into the land of the proverbial big boys is neglectful and unethical... The hippocratic oath stating that one should do no harm should be amended to your profession... Pleadging such would put you in your place... You do not pay malpractice insurance as an MD would and have not experienced the stresses of a medical internship. And yes, medical school was strenous (unlike OD school, I've come to understand from a friend of mine who attended a school in Chicago) but we did it regardless... Does OBGYN have anything to do with ophthalmology? No, but again, we did it... The fact is that we are physicians and surgeons and you are not. It is now time to accept it and stop making excuses why you deserve to upgrade your profession.

By the way---when I am done with school do you want to go laser shopping with me so I can have the best one in my office? lol

just trying to break the ice

 

[nanosomic]

some optometrists are using laser for diagnostic purposes such as mapping the optical nerve head so saying optometrists are not trained to use lasers is dishonest. I have gone through the curricula of some optometric schools (for educational purposes) and they specifically point out that their students are well trained in therapeutic pharmaceutical agents, why then they are not allowed to use TPA's? Or are they not telling truth? I do not think so.

 

[mdkurt]

some optometrists are using laser for diagnostic purposes such as mapping the optical nerve head so saying optometrists are not trained to use lasers is dishonest.

Yes, and some of them have even used laser pointers, so obviously the training is there.

How about starting a separate "fight club" forum for optos and ophthos to work out their anger and draw some fire away from legitemate discussion?

 

[JennyW]

It took 25 years of state by state court battles to achieve prescription rights for topical pharmaceutical agents in 50 states and oral pharms in 37 states. What Jenny says about Opthalmology in the 70's publically saying that patients would go blind if optometrists prescribed topical drugs is completely true. Your profession has done nothing but try to injure and prevent optometry from evolving. Your profession has the undeniable arrogance in believing that "your model" (allopathy--med school, residency) is the only path to enlightenment especially regarding opthalmic medicine. "non-surgeons non-physicians to start doing intraocular surgery"---what a bunch of crap. I say add surgical education and training just like podiatry and dental programs have, hire some pro-optometry opthalmologists to teach it--(so the argument about Optometry not having traditional education in surgery becomes moot) and replicate the efforts not unlike the 25 year battle for pharmaceutical privilages....but do it step by step..procedure by procedure because opthalmology (the Oil Trust of Opthalmic Medicine) will never allow it. Somehow (with the legal system---or something) create some residence based surgery training for OD's. Refractive Management is in the realm of Optometric Medicine and should include refractive surgery. Yes I said it and I can hear the backlash of responses this silly site will have.....I guess Podiatrists and Dentists are non-physicians doing surgery and optometrists will be too...lol But the difference is---I think optometrists, dentists, and podiatrists are physicians....After what I have researched and read about in my limited leisure time....I absolutely support limited optometric surgery---Especially Lasik because it is the natural extension of Refractive Management (especially especially in the future when Lasik becomes so routine that glasses and contacts are much less necessary.) ."

I understand your point, but I do not agree. There is not much point in training ODs to do laser procedures like YAGs and PIs because there just is not the demand out there, even in rural areas. I practice in a rural area and most ODs work in private practice like I do. The number of patients that I send out for ALT per year is less than I can count on one hand. It doesn't make sense to have an expensive laser sitting in my office that is going to gather dust. Same with YAGs. Same with PIs. (at least if you're going to be ethical about who gets a PI)

I did about 20 YAGs and 30 PIs when I worked for the IHS. I had one complication. One PI patient developed a uveitis that took much longer to heal. I just kept them on their Pred longer, which is exactly what any OMD would have done.

The point is that while these surgeries are not technically demanding and ODs could easily be trained to do them, there is not much point. From a political standpoint, it's not worth it.

The only expansion that I would support are the removal of chalazions and verucae and the performance of fluorescein angiograms.

Jenny

 

[brendang]

I understand your point, but I do not agree. There is not much point in training ODs to do laser procedures like YAGs and PIs because there just is not the demand out there, even in rural areas. I practice in a rural area and most ODs work in private practice like I do. The number of patients that I send out for ALT per year is less than I can count on one hand. It doesn't make sense to have an expensive laser sitting in my office that is going to gather dust. Same with YAGs. Same with PIs. (at least if you're going to be ethical about who gets a PI)

I did about 20 YAGs and 30 PIs when I worked for the IHS. I had one complication. One PI patient developed a uveitis that took much longer to heal. I just kept them on their Pred longer, which is exactly what any OMD would have done.

The point is that while these surgeries are not technically demanding and ODs could easily be trained to do them, there is not much point. From a political standpoint, it's not worth it.

The only expansion that I would support are the removal of chalazions and verucae and the performance of fluorescein angiograms.

Jenny

how is it possible that you consider angio a minor procedure? what would you do if the patient bottomed out and crashed during the procedure? they teach you to run codes in OD school?

 

[JennyW]

how is it possible that you consider angio a minor procedure? what would you do if the patient bottomed out and crashed during the procedure? they teach you to run codes in OD school?

I was expecting a response like this.

The retinal specialist that I refer to said he has had exactly two patients "bottom out" in his 18 year, >10000 angiogram career and both times performed CPR, and called 911.

So no, I have never run a code, but I have yet to meet an OMD that would tube and bag a patient even if they had the equipment available which most of them do not, so lets be serious now.

Yes, I consider it a minor procedure. I have done about 40 of them myself and the only complication I ever had was one person puking on my new pair of shoes!

 

[brendang]

I was expecting a response like this.

The retinal specialist that I refer to said he has had exactly two patients "bottom out" in his 18 year, >10000 angiogram career and both times performed CPR, and called 911.

So no, I have never run a code, but I have yet to meet an OMD that would tube and bag a patient even if they had the equipment available which most of them do not, so lets be serious now.

Yes, I consider it a minor procedure. I have done about 40 of them myself and the only complication I ever had was one person puking on my new pair of shoes!

Just as a follow-up because the thought of you simply ditching a dying patient is quite alarming to me; a surgeon is measured by his or her ability to maintain composure and apply the proper care when things take a turn for the worse... Part of this means having the necessary training to do whatever it takes to stabilize the patient's cardiopulmonary compromises. Anyone can get lucky for, say, 40 procedures... But I can guarantee that something terrible will eventually happen to all of us who perform surgery and it's our training in all things related to medicine that will allow us to do everything in our power to save the life and not just the vision... I'd love to see what your reaction would be if some optom was performing an angio procedure on your mother/father/whomever, watched them code and simply threw in the towel while they were circling the drain... "Ooops, well, guess I'm good for the next 9 years!"... This is something that separates us from you and all the lobbying in the world will not change that.

On a separate note, I'm sorry to hear about your shoes... That must have been a horrible experience.

 

[file014]

Just as a follow-up because the thought of you simply ditching a dying patient is quite alarming to me; a surgeon is measured by his or her ability to maintain composure and apply the proper care when things take a turn for the worse... Part of this means having the necessary training to do whatever it takes to stabilize the patient's cardiopulmonary compromises.

Well let me ask you this. What do you do when (hypothetically) one of your parents codes and BLS shows up at the door with their GED's and their EMT-B patches on their sleeves from a 6 month EMT course? They use procedures that they have been trained in and drop a dual-lumen airway (or whatever is allowed in your state) and use the AED. Or are they supposed to assess the situation and then call ALS with their 20 credit hours and 100 hours of ambulance training, while your parent is there with no O2 going to the brain? Can the EMT's handle the pressure also? Or do we need MD's on all ambulance routes now? What IS the solution then?

Might I upgrade my previous post...yesterday we had a pediatric ophthalmologist (one of about 8 in the whole state he said) lecture to my class. He decided it was worth his time to drive for and hour each way and spend 2 hours lecturing to us about strab surgery. In fact, its so important to him that he does it every year. Oh wait, it must be because he has 4 optometrists in the family. Oh, and the glaucoma specialist, the MS doc, the epidemiologist, and the numerous GP's thought they would share their knowledge with us too. Not to mention the pathologist who taught half of our pathology class and also teaches the MD students across campus. Have you realized you are in the minority yet? Yet you insist on making blanket statements about all OMD's and MD's. Our professions get along much better than you think and want to believe.

 

[JennyW]

Just as a follow-up because the thought of you simply ditching a dying patient is quite alarming to me; a surgeon is measured by his or her ability to maintain composure and apply the proper care when things take a turn for the worse... Part of this means having the necessary training to do whatever it takes to stabilize the patient's cardiopulmonary compromises. Anyone can get lucky for, say, 40 procedures... But I can guarantee that something terrible will eventually happen to all of us who perform surgery and it's our training in all things related to medicine that will allow us to do everything in our power to save the life and not just the vision... I'd love to see what your reaction would be if some optom was performing an angio procedure on your mother/father/whomever, watched them code and simply threw in the towel while they were circling the drain... "Ooops, well, guess I'm good for the next 9 years!"... This is something that separates us from you and all the lobbying in the world will not change that.

On a separate note, I'm sorry to hear about your shoes... That must have been a horrible experience.

*yawn*

Who said anything about ditching a patient and watching them circle a drain. I can administer an epi pen. I can do CPR. I can call 911. These things are exactly what an OMD would do. I have worked in a number of OMD offices. None of them had a crash cart. None of them would tube a patient. NONE OF THEM.

I guess we should immediately stop all those dentists from injecting epinephrine and xylocaine into their patients. I'm sure dentists don't run a whole lot of codes in their training.

 

[futuredoctorOD]

*yawn*

Who said anything about ditching a patient and watching them circle a drain. I can administer an epi pen. I can do CPR. I can call 911. These things are exactly what an OMD would do. I have worked in a number of OMD offices. None of them had a crash cart. None of them would tube a patient. NONE OF THEM.

I guess we should immediately stop all those dentists from injecting epinephrine and xylocaine into their patients. I'm sure dentists don't run a whole lot of codes in their training.

Well Said......

 

[futuredoctorOD]

Just as a follow-up because the thought of you simply ditching a dying patient is quite alarming to me; a surgeon is measured by his or her ability to maintain composure and apply the proper care when things take a turn for the worse... Part of this means having the necessary training to do whatever it takes to stabilize the patient's cardiopulmonary compromises. Anyone can get lucky for, say, 40 procedures... But I can guarantee that something terrible will eventually happen to all of us who perform surgery and it's our training in all things related to medicine that will allow us to do everything in our power to save the life and not just the vision... I'd love to see what your reaction would be if some optom was performing an angio procedure on your mother/father/whomever, watched them code and simply threw in the towel while they were circling the drain... "Ooops, well, guess I'm good for the next 9 years!"... This is something that separates us from you and all the lobbying in the world will not change that.

On a separate note, I'm sorry to hear about your shoes... That must have been a horrible experience.

The Opthalmologist that I shadow would call 911 in a similar circumstance......You have no respect for OD's, thier training, thier credential, and it is obvious you have something to prove....WHY?

 

[Buck Strong]

While we're on the subject of respect, (plus it's a pet peeve of mine), can you guys please start spelling OPHTHALMOLOGY with two H's?

 

[brendang]

*yawn*

Who said anything about ditching a patient and watching them circle a drain. I can administer an epi pen. I can do CPR. I can call 911. These things are exactly what an OMD would do. I have worked in a number of OMD offices. None of them had a crash cart. None of them would tube a patient. NONE OF THEM.

I guess we should immediately stop all those dentists from injecting epinephrine and xylocaine into their patients. I'm sure dentists don't run a whole lot of codes in their training.

I'm still learning the subtle differences between the US and Canada, but here, crash carts ARE mandatory in every room that angio is performed... What do they teach you in OD school about treatment of ventricular arrythmias refractory to an epi pen? And don't even start to compare yourselves to Dentists... They are 10 times the physician and surgeon OD's will ever be... They also spend the better part of their first 2 years in the same classes as medical students...

 

[brendang]

The Opthalmologist that I shadow would call 911 in a similar circumstance......You have no respect for OD's, thier training, thier credential, and it is obvious you have something to prove....WHY?

because for some incredible reason, you and your fellow optoms equate the following...

OD = MD + medical internship + ophtho residency +/- fellowship training

 

[brendang]

Well let me ask you this. What do you do when (hypothetically) one of your parents codes and BLS shows up at the door with their GED's and their EMT-B patches on their sleeves from a 6 month EMT course? They use procedures that they have been trained in and drop a dual-lumen airway (or whatever is allowed in your state) and use the AED. Or are they supposed to assess the situation and then call ALS with their 20 credit hours and 100 hours of ambulance training, while your parent is there with no O2 going to the brain? Can the EMT's handle the pressure also? Or do we need MD's on all ambulance routes now? What IS the solution then?

Might I upgrade my previous post...yesterday we had a pediatric ophthalmologist (one of about 8 in the whole state he said) lecture to my class. He decided it was worth his time to drive for and hour each way and spend 2 hours lecturing to us about strab surgery. In fact, its so important to him that he does it every year. Oh wait, it must be because he has 4 optometrists in the family. Oh, and the glaucoma specialist, the MS doc, the epidemiologist, and the numerous GP's thought they would share their knowledge with us too. Not to mention the pathologist who taught half of our pathology class and also teaches the MD students across campus. Have you realized you are in the minority yet? Yet you insist on making blanket statements about all OMD's and MD's. Our professions get along much better than you think and want to believe.

"Our professions get along much better than you think and want to believe."

Sure, that's why the AAO unanimously decided to BAN optometrists from their meetings/lectures/workshops/tutorials...

A few academic MD dinosaurs don't quite count as the consensus opinion of the masses...

And if we did have MDs on ambulance routes, you could be sure that the field of EMTs would be severely compromised... Unfortunately, this will never happen... Fortunately, there is a medical/surgical field in which real doctors train and practice, diagnose and treat disease called Ophthalmology (spelling includes the oft-forgotten silent 'h')... So where does that leave you?

 

[JennyW]

I'm still learning the subtle differences between the US and Canada, but here, crash carts ARE mandatory in every room that angio is performed... What do they teach you in OD school about treatment of ventricular arrythmias refractory to an epi pen? And don't even start to compare yourselves to Dentists... They are 10 times the physician and surgeon OD's will ever be... They also spend the better part of their first 2 years in the same classes as medical students...

*yawn* again.

In that case, you might want to learn about the subtle differences between OD education (especially if your daddy is an OMD in Ontario and that's the only perspective you're getting) as well because I sat in the exact same anatomy classes as the med students, and the same biochemistry class, and had the same pathology instructor.

And I was referring to the use of an epi-pen for the treatment of anaphylaxis, not ventricular arrythmias. You probably knew that, but for some reason, felt the need to puff yourself up again.

I'm starting to wonder if having to go to SABA and then one of the lowest rated OMD programs in the country is what has made you so insecure. That's the only logical reason for your continued hostility.

I was thinking you were just an arrogant jerk, but now I'm just starting to feel sorry for you.

Jenny

 

[Loncifer]

I'm still learning the subtle differences between the US and Canada, but here, crash carts ARE mandatory in every room that angio is performed... What do they teach you in OD school about treatment of ventricular arrythmias refractory to an epi pen? And don't even start to compare yourselves to Dentists... They are 10 times the physician and surgeon OD's will ever be... They also spend the better part of their first 2 years in the same classes as medical students...

Whenever I read posts like this from arrogant, self-aggrandizing jerks from Canada, it makes me a little ashamed. Brendan obviously feels insecure (and probably got a hard time over) his Carribean med school background and feels better about himself for putting others down. For a nice reminder that med school doesn't automatically make you an Ubermensch please see this post by BelugaMD at the bottom of the page:

http://forums.studentdoctor.net/showthread.php?t=119156&page=3&pp=20

This is in no way meant to diminish the achievements of med school grads, but rather to remind OD students to study hard, achieve much and to have confidence necessary to practice to the fullest scope that law and their training allows. Don't ever let anyone, no matter what qualifying descriptors they put after their name, undermine your training or knowledge base.

P.S. brendang, as you're so fond of correcting other people's spelling (ophthalmology), you spelled arrhythmia incorrectly.

 

[cpw]

They also spend the better part of their first 2 years in the same classes as medical students...

so do ODs if you go to certain OD schools. NOVA puts the ODs, dentists and meds in one class. So does UAB. UH doesn't have a med program or we probably would too.

And, today in clinic... I was teaching Baylor med third years how to use a slit lamp and direct ophthalmoscope. many of them said "this is the first time I actually saw more than the red reflex". It was a good day. They were all very grateful.

 

[brendang]

*yawn* again.

In that case, you might want to learn about the subtle differences between OD education (especially if your daddy is an OMD in Ontario and that's the only perspective you're getting) as well because I sat in the exact same anatomy classes as the med students, and the same biochemistry class, and had the same pathology instructor.

And I was referring to the use of an epi-pen for the treatment of anaphylaxis, not ventricular arrythmias. You probably knew that, but for some reason, felt the need to puff yourself up again.

I'm starting to wonder if having to go to SABA and then one of the lowest rated OMD programs in the country is what has made you so insecure. That's the only logical reason for your continued hostility.

I was thinking you were just an arrogant jerk, but now I'm just starting to feel sorry for you.

Jenny

Again, no need to make this personal (it seems like that's what y'all do on this forum when there is nothing of value to say), but I'm quite secure with what I've accomplished... Getting into an ophtho residency as a canadian and graduate of a caribbean school is much tougher than getting into optom school. I'm actually damn proud of myself... And as far as LSU being one of the lowest-rated OMD programs, I'd have to disagree... Their extra year is a blessing in disguise... The extra year is standard in Canadian residency training and provides one with a superior technical skill upon completion of residency training. This had a lot to do with one's ability to gain acceptance into and perform well in competitive fellowship appointments... And above all this, I never had to settle to become an optometrist.

 

[brendang]

Whenever I read posts like this from arrogant, self-aggrandizing jerks from Canada, it makes me a little ashamed. Brendan obviously feels insecure (and probably got a hard time over) his Carribean med school background and feels better about himself for putting others down. For a nice reminder that med school doesn't automatically make you an Ubermensch please see this post by BelugaMD at the bottom of the page:

http://forums.studentdoctor.net/showthread.php?t=119156&page=3&pp=20

This is in no way meant to diminish the achievements of med school grads, but rather to remind OD students to study hard, achieve much and to have confidence necessary to practice to the fullest scope that law and their training allows. Don't ever let anyone, no matter what qualifying descriptors they put after their name, undermine your training or knowledge base.

P.S. brendang, as you're so fond of correcting other people's spelling (ophthalmology), you spelled arrhythmia incorrectly.

i guess that's what you get for going to med school in the caribbean, eh?

 

[brendang]

so do ODs if you go to certain OD schools. NOVA puts the ODs, dentists and meds in one class. So does UAB. UH doesn't have a med program or we probably would too.

And, today in clinic... I was teaching Baylor med third years how to use a slit lamp and direct ophthalmoscope. many of them said "this is the first time I actually saw more than the red reflex". It was a good day. They were all very grateful.

So what's your point? I had a drug rep from Alcon teach me how to use "stuff" a couple of weeks ago in California. Should he be allowed to perform intra-ocular surgery too?

 

[PLPrincess]

Again, no need to make this personal (it seems like that's what y'all do on this forum when there is nothing of value to say), but I'm quite secure with what I've accomplished... Getting into an ophtho residency as a canadian and graduate of a caribbean school is much tougher than getting into optom school. I'm actually damn proud of myself... And as far as LSU being one of the lowest-rated OMD programs, I'd have to disagree... Their extra year is a blessing in disguise... The extra year is standard in Canadian residency training and provides one with a superior technical skill upon completion of residency training. This had a lot to do with one's ability to gain acceptance into and perform well in competitive fellowship appointments... And above all this, I never had to settle to become an optometrist.

I (and I'm sure many other pre-opt or optometrists) didn't "settle" on becoming optometrists, it is what we WANTED, as our first choice/decision.

I guess just because you had to settle for a carribean school you assume everyone in their life settles for something or other. Maybe some people do, but I can honestly say I have not had to "settle" for anything, especially when it comes to the choices I made regarding my eduaction.

 

[Loncifer]

Again, no need to make this personal (it seems like that's what y'all do on this forum when there is nothing of value to say), but I'm quite secure with what I've accomplished... Getting into an ophtho residency as a canadian and graduate of a caribbean school is much tougher than getting into optom school. I'm actually damn proud of myself... And as far as LSU being one of the lowest-rated OMD programs, I'd have to disagree... Their extra year is a blessing in disguise... The extra year is standard in Canadian residency training and provides one with a superior technical skill upon completion of residency training. This had a lot to do with one's ability to gain acceptance into and perform well in competitive fellowship appointments... And above all this, I never had to settle to become an optometrist.

According to the AAO:
"However, in the most recent match over 80 percent of participating U.S. seniors obtained a position and about 20 percent of participating international medical graduates were successful in obtaining a position."
Now does this mean that only the bottom 20% of U.S. seniors applying failed to get into Ophthalmology? If so, there are OD and Vet Med schools that are harder to get into.