Optometrist/Midlevel creep in Ophthalmology

[ddhopeful]

I came across this Ocular Surgery Fellowship: The Ocular Surgery Fellowship - College of Optometry

How much is/will be the encroachment in ophthalmology from optometrists completing such a fellowship?

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[wysdoc]

Optometrists are still not allowed to do anything surgical in Texas, as far as I know

 

[mjohnsonets]

I came across this Ocular Surgery Fellowship: The Ocular Surgery Fellowship - College of Optometry

How much is/will be the encroachment in ophthalmology from optometrists completing such a fellowship?

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eyesoneyecare.com

That's a site that will tell you everything. I see OD scope continuing to expand due to lack of coverage in many areas. Ophthalmologists en masse would have to do much more long-distance satelliting or move to rural areas. I can tell you many state lifestyle as one of the reasons for pursing ophtho and long-distance satelliting hurts that. Most people now grew up in a city or suburb of a city and most wil not live in places smaller than where they grew up so less are going to rural areas over time. Not really a lot to point in the direction of stopping encroachment.

 

[RetinaDude]

In many smaller and medium cities, the number of ophthalmologists is dwindling. Truthfully, the number of ODs as well. For both ophthalmology and optometry, I know a lot of practices that have been trying to hire new docs to take over because the older doc(s) want to retire. There are too many “good” jobs in larger cities so younger people are not moving to these small/medium towns unless they have some type of strong connection (family, went to school locally, etc….). With that being said, entrepreneurial ODs may see these communities as prime opportunities to expand surgical options. A lot of the ODs I know have no interest in performing surgery but there are always some who are maniacal in their desire to become surgeons without the proper training (MD/DO the residency/fellowship)

 

[MstaKing10]

A Complete Guide On How To Get Your Optometry License In All 50 States

States have varying optometry licensing procedures, use this guide to learn how to get an optometry license to practice in your state.

eyesoneyecare.com

That's a site that will tell you everything. I see OD scope continuing to expand due to lack of coverage in many areas. Ophthalmologists en masse would have to do much more long-distance satelliting or move to rural areas. I can tell you many state lifestyle as one of the reasons for pursing ophtho and long-distance satelliting hurts that. Most people now grew up in a city or suburb of a city and most wil not live in places smaller than where they grew up so less are going to rural areas over time. Not really a lot to point in the direction of stopping encroachment.

Im not convinced of this lack of access argument. It’s more justification than fact. Just like MD, OD prefer bigger cities to rural areas. They will use the lack of access argument to get legislation passed then set up shop in the big cities.

 

[Slide]

A Complete Guide On How To Get Your Optometry License In All 50 States

States have varying optometry licensing procedures, use this guide to learn how to get an optometry license to practice in your state.

eyesoneyecare.com

That's a site that will tell you everything. I see OD scope continuing to expand due to lack of coverage in many areas. Ophthalmologists en masse would have to do much more long-distance satelliting or move to rural areas. I can tell you many state lifestyle as one of the reasons for pursing ophtho and long-distance satelliting hurts that. Most people now grew up in a city or suburb of a city and most wil not live in places smaller than where they grew up so less are going to rural areas over time. Not really a lot to point in the direction of stopping encroachment.

Based on what I saw from the Mid Year Forum update (I wasn't there but someone shared the slides with me), I think scope expansion is inevitable. PE now has a vested interest in scope expansion and there's still too much lethargy in the general ophthalmology community against it. To me it's telling that many heads of state societies and scope funds to lobby against it are specialists. The argument that lobbying against it'll kill comprehensive referrals is pretty unconvincing in the areas that need care the most.

 

[bergmistro]

Based on what I saw from the Mid Year Forum update (I wasn't there but someone shared the slides with me), I think scope expansion is inevitable. PE now has a vested interest in scope expansion and there's still too much lethargy in the general ophthalmology community against it. To me it's telling that many heads of state societies and scope funds to lobby against it are specialists. The argument that it'll kill comprehensive referrals is pretty unconvincing in the areas that need care the most.

Anywhere we can find those slides?

 

[eyeeye_captain]

A lot of scope creep is political theater. Most ODs don’t want to do procedures. I’m sure I won’t be able to find a survey on that because it would go against the AOA’s agenda and cost them donations. It’s “look how important we are” at most. I think the reason the comp folks don’t go after this stuff as much as they probably should is that they don’t think it will truly lead to competition.

Also, where/how did the ODs at this “fellowship” train to let them perform and teach quality procedural care? Will ODs want to shell out cash for a laser? I doubt the 50% working retail can get corporate on board. Where will they get malpractice insurance?

What is even useful there? A PCO needing a YAG, a chalazion, narrow angles, and chronic POAG don’t really need “access”. Maybe if there’s a rare angle closure, but I’d be shocked if an OD would touch it. If a patient has an IOL, clearly they can drive to an ophthalmologist. If they have glaucoma that can’t be controlled on max medical therapy, SLT isn’t the answer.

 

[mjohnsonets]

Im not convinced of this lack of access argument. It’s more justification than fact. Just like MD, OD prefer bigger cities to rural areas. They will use the lack of access argument to get legislation passed then set up shop in the big cities.

There are about 2.25 ODs for every Ophthalmologist in the US (per stats I can find). So in these rural areas with 1 MD provider, there should be at least 2 ODs. I'd say that's easy numbers for convincing a policy maker it would "expand access 3 fold". As you stated though, this will quickly move into the cities.

 

[Slide]

A lot of scope creep is political theater. Most ODs don’t want to do procedures. I’m sure I won’t be able to find a survey on that because it would go against the AOA’s agenda and cost them donations. It’s “look how important we are” at most. I think the reason the comp folks don’t go after this stuff as much as they probably should is that they don’t think it will truly lead to competition.

Also, where/how did the ODs at this “fellowship” train to let them perform and teach quality procedural care? Will ODs want to shell out cash for a laser? I doubt the 50% working retail can get corporate on board. Where will they get malpractice insurance?

What is even useful there? A PCO needing a YAG, a chalazion, narrow angles, and chronic POAG don’t really need “access”. Maybe if there’s a rare angle closure, but I’d be shocked if an OD would touch it. If a patient has an IOL, clearly they can drive to an ophthalmologist. If they have glaucoma that can’t be controlled on max medical therapy, SLT isn’t the answer.

Doesn’t matter, it’s not about access to care really, it’s about expanding the pipeline of procedures optometrists can perform to help optometry colleges keep up enrollment numbers ($$$). Most current ODs don’t want the privileges, it’s the future ones. We’ve seen this with APPs/other mid levels in other fields - once you expand privileges there’s no takebacks.

 

[Gonio5]

In 50 years, optometrists will do breast implants and liposuction.