Optometry school attracting the elite!

[idoc]

I am a longtime lurker and sometime contributer to this forum, and I will add that I am currently in Ophthalmology residency. I, like many of you, have become frustrated by the optometrists' collective pursuit of surgical rights. This topic has been discussed to death on this board, but I may be able to add some new insight. Most optometrists if challenged on the educational rigors of optometry school will brag about how MD's don't know how difficult it REALLY is, and how well educated they are. My impression is that most OD's feel optometry school is on a par with medical school. To be fair, I have never been to optometry school, however it is clear that optometry schools are not attracting the same type of students as medical schools are, if the below posted quote is any indication:

Taken from a current post on the Pre-Optometry forum on SDN discussing what it takes to get in to Optometry school:

For those with a low GPA, there is definitely hope for admissions to optometry. I graduated with a 2.84 in zoology. I was a bit nervous about this, so I applied to five schools and was accepted to four. Needless to say I was shocked! I mean, what about the fifth? Just kidding. I blew the interview at that one.... Seriously, though, I figured I didn't have much chance. I applied late (March). My OATs were stong, though apparently not that exceptional as I am reading lots of you received much better than I (I had a 330). I also had limited optometry viewing experience.

I think that this very limited example re-emphasizes the true difference in the quality of students going into optometry vs. the elite in medical school who match into ophthalmology. I don't think that it is even close. With all of that being said (for which I am sure I will be summarily flogged for by all lurking optom wanna be trolls on this board), intelligence does not always translate into good patient care, and there are many optometrists who do great work. I just wish they would stop trying to encroach on our turf, so we can both exist in a symbiotic relationship.

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[rubensan]

This post made me laugh. HOWEVER, before the storm of angry posts begin in this thread, I think it is important to recognize that although optometry school and medical school/internship/ophthalmology residency are two very different paths, there are many highly qualified and intelligent undergrads that choose to become optometrists. Would we not have soft contact lenses today without the famous George Jessen, O.D.? I hope people that read your post take to heart the last sentence re: symbiosis of ODs and MDs.

 

[VA Hopeful Dr]

I am a longtime lurker and sometime contributer to this forum, and I will add that I am currently in Ophthalmology residency. I, like many of you, have become frustrated by the optometrists' collective pursuit of surgical rights. This topic has been discussed to death on this board, but I may be able to add some new insight. Most optometrists if challenged on the educational rigors of optometry school will brag about how MD's don't know how difficult it REALLY is, and how well educated they are. My impression is that most OD's feel optometry school is on a par with medical school. To be fair, I have never been to optometry school, however it is clear that optometry schools are not attracting the same type of students as medical schools are, if the below posted quote is any indication:

Taken from a current post on the Pre-Optometry forum on SDN discussing what it takes to get in to Optometry school:

For those with a low GPA, there is definitely hope for admissions to optometry. I graduated with a 2.84 in zoology. I was a bit nervous about this, so I applied to five schools and was accepted to four. Needless to say I was shocked! I mean, what about the fifth? Just kidding. I blew the interview at that one.... Seriously, though, I figured I didn't have much chance. I applied late (March). My OATs were stong, though apparently not that exceptional as I am reading lots of you received much better than I (I had a 330). I also had limited optometry viewing experience.

I think that this very limited example re-emphasizes the true difference in the quality of students going into optometry vs. the elite in medical school who match into ophthalmology. I don't think that it is even close. With all of that being said (for which I am sure I will be summarily flogged for by all lurking optom wanna be trolls on this board), intelligence does not always translate into good patient care, and there are many optometrists who do great work. I just wish they would stop trying to encroach on our turf, so we can both exist in a symbiotic relationship.

I think you'll find that many practicing ODs would agree that this is a problem. There are too many schools with too many spots they're trying to fill. When you are desparate to fill all of your available slots, you start lowering your standards. Imagine what the average GPA/MCAT would be if we opened another 30 med schools with 200 spaces in each of them.

 

[drgregory]

as an optometrist, i couldnt agree more with all three of the above posts. we definately have a huge oversupply of ODs, and cutting back on admissions, thereby obtaining better students, would help very much. most of us realize the difficulty of med school, not to mention the everyday slog that med students go through. most of us want to be optometrists, not surgeons; simply desire the opportunities that a professional degree should afford. most of us do not want to be pseudo-physicians, we want to hold a place in healthcare that is similar to that of a podiatrist/dentist. most of us work with surgeons who do surgeries. most of all, most ODs and OMDs that i know are realizing that getting along is symbiotic. mostly, most of us do, that is.

 

[Andrew_Doan]

Thank you for keeping this discussion professional and constructive.

 

[prettygreeneyes]

I think that this very limited example re-emphasizes the true difference in the quality of students going into optometry vs. the elite in medical school who match into ophthalmology. I don't think that it is even close. With all of that being said (for which I am sure I will be summarily flogged for by all lurking optom wanna be trolls on this board), intelligence does not always translate into good patient care, and there are many optometrists who do great work. I just wish they would stop trying to encroach on our turf, so we can both exist in a symbiotic relationship.

Come on now... you want to hold up ONE example of a student with a 2.84 as evidence why optometrists shouldn't have any surgical rights? Are you serious? I, as a "lurking optom wanna be troll", don't think that optometrists should be able to do surgery. End of story. But, we aren't idiots.

You would like to paint the picture of the optmetrists as a "steller intellectual individual, weilding a scalpel, drooling perhaps, telling his/her patient "Now you hold real still, thar, Ms. Smith, and I'm gunna fix that thar eye. I gradatated wif top honors from a real prestidigous institution of high learning. Yep. "

No, optometry school may not be as difficult as medical school, but it isn't as though it's a walk in the park. There are students with *gasp* 4.0's who go to optometry school, and there are students with 3.4's, 3.5's, 3.6's who go to medical school. The one student who you so kindly chose to mock on this board was holding up his accomplishments as a light for others who may be down because of their grades. Do I think a 2.84 is a touch low? Yes... but I'd be singing a different song if it were my score. There are too many optometry schools, and as a result, students with lower scores are accepted because they need to fill the seats. Is this good for the profession? Probably not. Should you use it as a example of why "us dumb optometrists" shouldn't be able to do surgery? NO!

Now... if you'll excuse me. My optometrist friends and I are planning a "encroach on the ophthamologist's surgical turf" rally later tonight and I must prepare.

 

[I Surgeon]

Well, it was professional.

 

[qwopty99]

an optometry student class is not equivalent to a medical school class. period.

i've written about every standardized test under the sun - and have multiple friends who have gone onto dents, meds, opt, pharm. while med school DOES have a few students in every class who got there not through smarts, but through ENORMOUS book worming, by and large med students are "very bright" individuals.

as for optometry... one may simply look at average OAT scores to get a sense of the calibre of students enrolled. firstly - the OAT is about 10% the difficulty of the MCAT. the PCAT is, generously, 5% the difficulty of the MCAT. so when i see half the optom schools with average entering OATs in the 315-325 range, i'm like - my gawd....

i got 10-10-10-R on the MCAT - a decent "average" score i think of the average student attending med school (perhaps a bit above average on the essay). when i wrote the OAT, however, with essentially the same preparation - i went in with the specific GOAL to get a perfect score. i wasn't close to perfection at all, but 5/6 of my subscores were at least at the 97% percentile, i.e. 380/400. for those who don't know - IRRC, 380 (97.1-98.5%ile), 390 (98.5-99.3), 400 (99.3-100). my total science score was 400 (so an average med school student who got an average MCAT score, would be top 7/1000 writing the OAT). my sub-380 score was, anomalously, English - which came as a surprise since that's normally one of my bread and butter subtopics. but moving on...

as another aside - i'm not sure if anyone knows this here, but the OAT and DAT tests are administered by the same corporation, and their actual tests are identical in the areas where they test the same topics. (so - this serves as info that the DAT isn't anywhere as rigorous as the MCAT either).

as for "anecdotally" - i attended the canadian optom school - which can't be directly compared to the US - but the admission standards have been described as being on par with the top US school - berkeley. that said - out of my class of 60, i'd say roughly:

40 students would not be out of place in med school (with the top 10 students coming in, perhaps, the top 25%ile of an average medical school class). in fact, we had several students turn down med school acceptances (in all cases, they chose optom for the lifestyle).

20 students would have no business being in med school whatsoever, with the bottom 10 (and bottom 5 in particular) students in the class being almost... hmm. let's put it this way. they weren't stupid, but i couldn't by any stretch of the imagination call them "smart". basically that. not stupid, but not in any way conceivable, "smart" people. they were average - simply average people. consider however... that we're talking about an optom school that is compared to the "best" optom school in the states in terms of selectivity. berkeley's OAT average is roughly 360 every year. a school, such as NEWENCO, which has an average of 315 - i couldn't even imagine getting a subscore that low, much less an AVERAGE score that low. and remember - when NEWENCO states their AVERAGE entering OAT is 315, it means (perhaps) that half the admitted class had scores that fell BELOW 315. do the math yourself to figure out the calibre of the average optom school student....

anyways - my $0.02. i'm an optometry school graduate.

 

[exmike]

Should you use it as a example of why "us dumb optometrists" shouldn't be able to do surgery? NO!

Now... if you'll excuse me. My optometrist friends and I are planning a "encroach on the ophthamologist's surgical turf" rally later tonight and I must prepare.

uh oh, you brought up surgery unprovoked. you done did it now

there are a million reasons besides undergraduate GPA for why ODs shouldnt do surgery, but you just had to beat that horse didnt you?

 

[qwopty99]

40 students would not be out of place in med school (with the top 10 students coming in, perhaps, the top 25%ile of an average medical school class).

i would like to clarify, that by saying "40 students would not be out of place in med school", this implies that if those individuals were studying a medical curriculum, they would probably float. this DOES NOT IMPLY that 40/60 of the students in my optom class would've been ACCEPTED to medical school.

given my "best guesstimate" as to my peers undergrad GPAs etc., and the even less certain best guess of whether or not they would've gotten passing (i.e. acceptable scores) on the MCAT, i'd reduce the number of students who would've gotten a med school acceptance to around 15: so about a quarter of my peers, probably, had they wanted to, would've been competitive for medical school. this might be a generous estimate considering what a crapshoot med school admissions can be.

my $0.02.

 

[drgregory]

id agree with 14 of spades. the bottom of the barrel of optometry school, pharm, and dental could most likely not make it in med school (at least any reputable one). i have no med school experience, but from my opinion of OD school, there was a large variance of ability in the students in my class. i cant give estimates without the knowledge of exactly what goes on in med school, but i can surmise that the level of difficulty is obviously higher.
much of this problem could be taken care of if optometry schools cut their admissions. think of it - more quality optometry students that would have more clinical patient time. linking these OD students with OMD residents for consults and surgery would forge relationships earlier and both parties would realize the benefits of such relationships. example - where i went to optometry school, we had two ophthalmologists on staff, teaching and attending OD students. these OMDs, however, didnt see any of the patients sent for surgery. an OD/OMD group saw most surgeries. wouldnt it have been better for the OD students to be able to send their surgeries to OMD residents and their attendings? correspondence via dictations and phone calls would begin between the two, and upon completion of each professional's curriculum there wouldnt be this strangeness. just a dream in my puppy-dog-tail-wagging-world, perhaps.

 

[prettygreeneyes]

uh oh, you brought up surgery unprovoked. you done did it now

there are a million reasons besides undergraduate GPA for why ODs shouldnt do surgery, but you just had to beat that horse didnt you?

I brought up surgery unprovoked?

I, like many of you, have become frustrated by the optometrists' collective pursuit of surgical rights. This topic has been discussed to death on this board, but I may be able to add some new insight.

^--PROVOCATION TO BEAT THE PROVERBIAL HORSE

The thread's title: Optometry school attracting the elite! <--MORE PROVOCATION!!!

You are absolutely right! There are a million reasons why ODs shouldn't do surgery. Those ODs that are fighting for surgical rights are damaging their own profession. We have bigger fish to fry! Again, let me repeat... OD's SHOULD NOT do surgery! Medical school is harder than optometry school. I also agree with Dr. Gregory that the lower portions of an OD class wouldn't make it in medical school. We have too many optometry schools and as a result the schools, in their best financial interest, are required to take students with less than stellar grades.

The OP, and several other posters, have ended their posts with cries for "a symbiotic relationship between OD's and MD's." That is great and wonderful. If it ever were to actually happen, nothing but good things would come of it. But, he/she does this in a mean-spirited post that mocks all ODs because a student got in with lower-than-average grades. This thread isn't at all professional! I was lurking through the ophthamology forum as I do with every other forum on Student Doctor Network, and when I saw this thread's title... I couldn't believe it! Everyone on this board must be incredibly intelligent if they matched into an ophthamology residency, yet they think it is OK to put down an entire profession based on 1 student's performance. Perhaps my post wasn't the most mature of posts... the drooling optometrist with the scalpel might have been a little much... but how can this type of thread be OK? Please recognize that not all OD's have a 2.84 in undergrad... some have a 4.0 or something close to it. All are compassionate health care professionals who just want to take care of their patients.

 

[Hines302]

The OP, and several other posters, have ended their posts with cries for "a symbiotic relationship between OD's and MD's." That is great and wonderful. If it ever were to actually happen, nothing but good things would come of it. But, he/she does this in a mean-spirited post that mocks all ODs because a student got in with lower-than-average grades. This thread isn't at all professional!

Agreed!! I have a great deal of respect for any medical doctor or student. However there are a few of you that need to work on your professional and personal skills.... you are doing nothing but breeding disrespect and ignorance... and you are embarrassing your respected profession (OD's and OMD's alike)

 

[JR]

Everyone is entitled to his/her own opinion; please refrain from name calling. Thanks,

Your friendly mod

Agreed!! I have a great deal of respect for any medical doctor or student. However there are a few of you that need to work on your professional and personal skills.... you are doing nothing but breeding disrespect and ignorance... and you are embarrassing your respected profession (OD's and OMD's alike)

 

[qwopty99]

Please recognize that not all OD's have a 2.84 in undergrad... some have a 4.0 or something close to it.

ur right, not all ODs had a 2.84 GPA in undergrad.

however, i deem it likely, almost certain, that NO OMD had a 2.84 GPA in undergrad.

 

[prettygreeneyes]

ur right, not all ODs had a 2.84 GPA in undergrad.

however, i deem it likely, almost certain, that NO OMD had a 2.84 GPA in undergrad.

OK... what do you want me to say? I've already said that medical school is harder, and that optometrists shouldn't be doing surgery. Shall I also concede that EVERY OMD is smarter than EVERY OD? I'm not sure what you are getting at. I'm not on this forum arguing with anyone... other than pointing out that if we are trying to avoid turf wars and have a symbiotic relationship, why are we pointing out the downfalls of a profession because of a student's low grades? A couple different optometrists or optometry students, myself included, have acknowledged the lowered standards of some optometry schools. What else can I do? Is there not one OMD or OMD resident that feels that this thread is inappropriate and slightly unfair? If not, I'll tuck my tail between my wanna be optom troll legs and run back to the optometry forum.

 

[exmike]

I brought up surgery unprovoked?

^--PROVOCATION TO BEAT THE PROVERBIAL HORSE

The thread's title: Optometry school attracting the elite! <--MORE PROVOCATION!!!

You are absolutely right! There are a million reasons why ODs shouldn't do surgery. Those ODs that are fighting for surgical rights are damaging their own profession. We have bigger fish to fry! Again, let me repeat... OD's SHOULD NOT do surgery! Medical school is harder than optometry school. I also agree with Dr. Gregory that the lower portions of an OD class wouldn't make it in medical school. We have too many optometry schools and as a result the schools, in their best financial interest, are required to take students with less than stellar grades.

The OP, and several other posters, have ended their posts with cries for "a symbiotic relationship between OD's and MD's." That is great and wonderful. If it ever were to actually happen, nothing but good things would come of it. But, he/she does this in a mean-spirited post that mocks all ODs because a student got in with lower-than-average grades. This thread isn't at all professional! I was lurking through the ophthamology forum as I do with every other forum on Student Doctor Network, and when I saw this thread's title... I couldn't believe it! Everyone on this board must be incredibly intelligent if they matched into an ophthamology residency, yet they think it is OK to put down an entire profession based on 1 student's performance. Perhaps my post wasn't the most mature of posts... the drooling optometrist with the scalpel might have been a little much... but how can this type of thread be OK? Please recognize that not all OD's have a 2.84 in undergrad... some have a 4.0 or something close to it. All are compassionate health care professionals who just want to take care of their patients.

Oh i didnt see that, sorry. I agree with your points. And I like your wit

 

[PurpleMD]

Hi. I have been reading the posts in this forum for a while now. As said previously, this topic has been talked about to death. It is fine to voice opinions about it, but when are we going to start proposing solutions to the problem. Like every problem, it will not be fixed if it is only talked about. While we are busy talking about it, the optometrist are trying to get more access to surgical procedures. Based on the comments written earlier, there are some optometrist that agree that they should not be doing surgeries. Why don't we work together to come up with a solution then? That's all that I have to say on that.

 

[drgregory]

Hi. I have been reading the posts in this forum for a while now. As said previously, this topic has been talked about to death. It is fine to voice opinions about it, but when are we going to start proposing solutions to the problem. Like every problem, it will not be fixed if it is only talked about. While we are busy talking about it, the optometrist are trying to get more access to surgical procedures. Based on the comments written earlier, there are some optometrist that agree that they should not be doing surgeries. Why don't we work together to come up with a solution then? That's all that I have to say on that.

agreed. how about all of eyecare getting together and saying to medicare "hey medicare - we're going to need a larger reimbursment instead of this dwindling one, or your beneficiary is going to have to drive a long way (with sclerotic cataracts and epiretinal membranes, none-the-less) to see any eye doctor for his/her probs". or, we as ODs taking care of some of our internal problems like docs in mall doing exams for $29. or OMDs not stealing away referred patients from ODs (which wouldnt be a problem if the OMD worked with the OD). ill say it again for the 1 millionth time, using an example. if someone came to see me (as an OD) and they needed a chronic chalazion removed, id rather tell them that "our surgeon does this much more often than me, and he's likely much better at it than i am. you know what? he's in today, and if you'll wait here, ill run it by him to see if he can take care of that today." and then seveal years later, when i tell the patient that their cataracts are the cause of their decreased vision, i can say, "remember dr. soandso who removed that bump from your eyelid? im going to set up an appointment with him so that we might consider removing those cataracts." symbiosis amigos.

 

[PBEA]

It's been a while since I've posted here, and I can see somethings never change (OMD and OD arguing over who should do what). The way I see it this bickering reflects the foolish system that exists for delivering eyecare in this country (and maybe the rest of the developed world). I've said it before and I'll say it again the need for primary, secondary, and tertiary eyecare is unquestioned right? Much like any profession that has SO much knowledge/skill there needs to be tiers of learning to provide the service to the public. It stands to reason that the educational tracts for optometrists and ophthalmologists should be the same. That's right, same school, same classes, etc. the first 4yrs graduates primary care, the creme of the crop go on for residency in given subspecialty etc. I really am surprised it didn't develop this way to begin with. Then again it seems like OMDs and ODs have always been busy fighting that they could not see the bigger picture. If it had occured in this fashion, you can be sure there would not be all these battles in the house of eye (nor would this atmosphere of disrespect exist).

 

[prettygreeneyes]

Actually, I think everyone in this thread is being pretty... nice. While I disagree with the OP (who hasn't posted anymore ) I actually would like to discuss more how we can work together. This isn't a "Should optometrists do surgery" thread. As far as this little thread goes, we've already solved that! Maybe we can discuss in a perfect world what each profession feels their roles as eyecare providers would include. How do these roles overlap? I like Dr. Gregory's ideas!

 

[idoc]

Actually, I think everyone in this thread is being pretty... nice. While I disagree with the OP (who hasn't posted anymore ) I actually would like to discuss more how we can work together. This isn't a "Should optometrists do surgery" thread. As far as this little thread goes, we've already solved that! Maybe we can discuss in a perfect world what each profession feels their roles as eyecare providers would include. How do these roles overlap? I like Dr. Gregory's ideas!

When I start a thread, I try not to get into personal arguments with the people who post after me, so that is why I have been silent thus far. I have to say that I have been so pleasantly suprised with the comments on both sides of the issue. It is actually amazing to me. I want to sincerely thank everyone who has contributed to this post because it has educated me on an issue I was previously ignorant about. I did not realize that optometry schools had too many spots to fill with high caliber students. I am making this assumption based on the responses by many OD's on this board. I will agree that there are many optometrists who could have made it into medical school should they have applied. I think the larger issue is something that a previous poster brought up; we have all defined the various angles to the problem, now how do we fix it?

Please correct me if I am wrong but I think I understand this issue to be as follows. Some of the extremely bright optometrists out there realize that they are on a par with the Ophthalmologists who they refer their patients to. Because they are the cream of the crop, they feel there should be an avenue for which they are trained at a higher level, some even desiring surgery. If I was in their shoes I would think it to be a logical next step. But, a real solution may be to limit the number of optometry spots so that everyone trained is excellent. I am biased on this issue, but I am still strongly opposed to optometrist ever doing surgery. When I decided to pursue medical school it was because I wanted to do surgery and be a physician. It was later that I decided Ophthalmology was the correct field for me. However, when each and every optometrist decided to pursue optometry as a profession, they had to do that with the understanding that they would never do surgery. It is not that optometrists could not be trained to do surgery, let me be clear on that point. It is that their is no market need for more ophthalmic surgeons. This brings me back to my first point. When there is a relative over-supply of a profession, it dilutes out the quality of care for the entire profession. It is better in my opinion for there to be many optometrists and fewer surgeons because we all become good at what we do. Optometrists are the best refractionist, and best contact lens fitters as a group because they focus on that. Ophthalmologists are surgeons, and they are the group that the public and medical community has chosen to provide surgical care. It may not be fair, but it is what it is and we all knew that going into whatever our chosen profession may have been.

Let me apologize for any optometry prospective student, current student or current optometrist I may have offended in my original post. It may have been too inflammatory, I admit. It is my true intent to find a solution for us all to work TOGETHER in a market that suits both of our needs. SYMBIOSIS is the only way we will both survive and serve the collective needs of our communities.

 

[qwopty99]

SYMBIOSIS is the only way we will both survive and serve the collective needs of our communities.

just curious - we all seem to "agree" that the best solution is through symbiosis, and that if everyone stays true to their "traditionally defined" scope of practice, things will all be hunky-dory. as well, we seem to often "conclude" that rather than argue on the specifics of turf wars, that we should work on a solution.

i may have a slightly more passive/pessimistic view on things - but can anything REALLY be done? i mean - it seems most of these things are out of our hands (and in the hands of lawmakers). further - consider for the moment, what would actually have to be DONE by ODs to stop the political maneuvering. thinking about the cowboy ODs who push for scope expansion - i mean, i don't know them. i can choose not to participate, but as much as i don't believe in doing surgery - i don't exactly feel the "burden" to try to stop those who lobby for it. i mean, really - it would be a very difficult for an OD to fight against his fellow ODs. he would be villified. it would be equivalent to and OD helping an optician lobby to gain refraction rights - i don't know how people would treat him at CE conferences and the like...

i dunno - i don't necessarily agree with the changes going on. but to remain competitive in the environment, i admit that i WILL get TPA certification rights, and surgery rights etc (if we are given them), even though i probably wouldn't use a lot (any) of those rights. but if everyone else had the right to such things, i would feel the need to as well, just to merely have those rights displayed in my office as a sign to my patients that i offer the "forefront" of eyecare.

(sorry for any bad grammar here - but i'm just typing away. hope everything is intelligible.)

 

[Ben Chudner]

Please correct me if I am wrong but I think I understand this issue to be as follows. Some of the extremely bright optometrists out there realize that they are on a par with the Ophthalmologists who they refer their patients to. Because they are the cream of the crop, they feel there should be an avenue for which they are trained at a higher level, some even desiring surgery. If I was in their shoes I would think it to be a logical next step.

Your post is very well stated. I would, however, disagree with the above quoted section. I don't believe it is the cream of the crop that is pushing for surgical rights, rather it is those that do not truely understand how much training ophthalmologists have compared to optometrists. I am not trying to slam OD's, but as an optometrist that spent a year at Bascom Palmer working in the same clinics as the ophthalmology residents, I learned very quickly the difference in training. I think there are those in my profession that think medical school played no role in the education to become an ophthalmologist. It is those people that believe OD's can perform surgery under an "as taught" law because they do not understand that there is much more to removing a cataract than simply learning how to operate a phaco unit.

 

[prettygreeneyes]

Let me apologize for any optometry prospective student, current student or current optometrist I may have offended in my original post. It may have been too inflammatory, I admit. It is my true intent to find a solution for us all to work TOGETHER in a market that suits both of our needs. SYMBIOSIS is the only way we will both survive and serve the collective needs of our communities.

 

[PDT4CNV]

Actually, I think everyone in this thread is being pretty... nice. While I disagree with the OP (who hasn't posted anymore ) I actually would like to discuss more how we can work together. This isn't a "Should optometrists do surgery" thread. As far as this little thread goes, we've already solved that! Maybe we can discuss in a perfect world what each profession feels their roles as eyecare providers would include. How do these roles overlap? I like Dr. Gregory's ideas!

There is another issue that isn't discussed much and that is post-op co-management. In no other surgical specialty are patients co-managed with other health care providers, physicians or otherwise. Sinus surgeons post-ops aren't co-managed with referring physicians, urologists TURP post-ops aren't sent back to referring physicians for post-op care, neurosurgeon's spine post-ops aren't co-managed with other physicians or referring health care providers, etc.. So I just do not understand why referring optometrists think they have this right to co-manage the post-operative care of eye surgical patients.

My opinion is that if a patient is referred to a surgeon for surgery, then it is the job of the surgeon not only to do the surgery but to see and care for the patient during the post-operative period as well, and then once the post-op care is complete, the patient should be sent back to the referring physician (or optometrist). Imagine if your mother had to have a her thyroid removed and the surgeon said "see-ya" in the PACU and to follow-up with the family practicioner for the post-op care, that would not go over to well with me.

The optometry department at our university actually refers their cataract patients outside the university because we will not "co-manage" with them and I just think it is absurd. There is no "stealing" of patients, nothing like that, but most physicians I work with agree that it is the surgeons responsibility to see their patients and care for them immediate post-operatively.

 

[PBEA]

There is another issue that isn't discussed much and that is post-op co-management. In no other surgical specialty are patients co-managed with other health care providers, physicians or otherwise. Sinus surgeons post-ops aren't co-managed with referring physicians, urologists TURP post-ops aren't sent back to referring physicians for post-op care, neurosurgeon's spine post-ops aren't co-managed with other physicians or referring health care providers, etc.. So I just do not understand why referring optometrists think they have this right to co-manage the post-operative care of eye surgical patients.

My opinion is that if a patient is referred to a surgeon for surgery, then it is the job of the surgeon not only to do the surgery but to see and care for the patient during the post-operative period as well, and then once the post-op care is complete, the patient should be sent back to the referring physician (or optometrist). Imagine if your mother had to have a her thyroid removed and the surgeon said "see-ya" in the PACU and to follow-up with the family practicioner for the post-op care, that would not go over to well with me.

The optometry department at our university actually refers their cataract patients outside the university because we will not "co-manage" with them and I just think it is absurd. There is no "stealing" of patients, nothing like that, but most physicians I work with agree that it is the surgeons responsibility to see their patients and care for them immediate post-operatively.

I agree. post-op anything, during it's global period, can and in some cases should be managed by the surgeon. Once global period ends (or complication is dealt with), then the patient should definetely return to the primary care setting. What co-management works best for is cicumstances that truly place hardship on the patient like access (ie long travel time). I don't personally agree with an OD limiting refferral soley on the basis of a "comanagement arrangement". However if the OMD/and staff decides to pepper the patient with underhanded comments about how OD's are not qualified to perform such tasks, or OMD's want to place legal restrictions (like they tried in Florida), or have "white papers" published by their professional assoc, that are ment to prohibit or discourage comanagement, then WE have a problem. Because to me these kinds of comments are nothing more then self-serving bias that are disrespectful and full of crap.

 

[PDT4CNV]

I agree. post-op anything, during it's global period, can and in some cases should be managed by the surgeon. Once global period ends (or complication is dealt with), then the patient should definetely return to the primary care setting. What co-management works best for is cicumstances that truly place hardship on the patient like access (ie long travel time). I don't personally agree with an OD limiting refferral soley on the basis of a "comanagement arrangement".

I partially disagree with a few comments. Post-op anything should always be managed by the surgeon in my view. Eye surgeons are few in number just as are neurosurgeons, cardiovascular surgeons, head and neck surgeons, etc. These are highly specialized areas. If a patient has to travel to see the appropriate surgeon than so be it. This is true for any surgical specialty including eye surgery. There are exceptions of course, but Im talking about the rule.

The optometry community has used the "access to care" arguement in their plan for surgical rights and I don't believe this arguement is appropriate for co-management either. I agree that patients should be referred back to the referring physician (or optometrist) after post-op care is complete. However, remember that who the patient sees is the patient's choice.

In all specialties most patients continue to see or are referred back to their primary physician or referring doctor (or optometrist), but some will choose not to.

Reading your comments at the end of your last post, I get the impression that you believe that patients who do not return to their referring optometrist were told negative things by the physican or eye surgeon they were sent to. I think this is a poor point of view to have. Even within the ophthalmology community patients will sometimes choose to just stick with their glaucoma specialist or neuro-ophthalmologist and not return to their referring general ophthalmologist. This is not because negative or disparaging comments were made. If I had an aneurysm in my brain, I think I would prefer to just see a neurosurgeon about it rather than see a neurosurgeon, neurologist, and internist. Again, most patients go back to see their referall source, and those that dont, usually it has nothing to do with any type of negative commentary made. I think it is more related to personality issues, duplication of care, confidence in their provider, time away from work, money issues, etc...

 

[prettygreeneyes]

There is another issue that isn't discussed much and that is post-op co-management. In no other surgical specialty are patients co-managed with other health care providers, physicians or otherwise. Sinus surgeons post-ops aren't co-managed with referring physicians, urologists TURP post-ops aren't sent back to referring physicians for post-op care, neurosurgeon's spine post-ops aren't co-managed with other physicians or referring health care providers, etc.. So I just do not understand why referring optometrists think they have this right to co-manage the post-operative care of eye surgical patients.

My opinion is that if a patient is referred to a surgeon for surgery, then it is the job of the surgeon not only to do the surgery but to see and care for the patient during the post-operative period as well, and then once the post-op care is complete, the patient should be sent back to the referring physician (or optometrist). Imagine if your mother had to have a her thyroid removed and the surgeon said "see-ya" in the PACU and to follow-up with the family practicioner for the post-op care, that would not go over to well with me.

The optometry department at our university actually refers their cataract patients outside the university because we will not "co-manage" with them and I just think it is absurd. There is no "stealing" of patients, nothing like that, but most physicians I work with agree that it is the surgeons responsibility to see their patients and care for them immediate post-operatively.

I am puzzled over your concern regarding "co-mangament". If you feel that ANY and ALL post-op care being handled by the OMD is in the patient's best interest, then do it. If you feel that strongly, then you won't be concerned with those optometrists who decide to stop referring to you based on that policy. Your dislike of your university's optometry department's policy to send their surgery cases outside of the university is also strange to me. The fact of the matter is that the majority of optometrists in the nation handle post-op care. Your OMD department has made the decision to not allow OD's to handle their post-op care. You want those optometrists from that university to be the only ones in the country that weren't properly trained to co-manage? They've got to learn somewhere...

Just curious to know... Has there been a rash of problems with optometrists co-managing? Is patient care suffering? I'm not trying to make an inflammatory statement here. I just really want to know. Are optometrists doing that bad of a job? If your only intention with this post was to answer my question about "the ideal roles" of both OMD's and OD's, then please disregard this last question.

 

[Caffeinated]

I am going to take issue with your statement that the majority of US optometrists do post-op care. I would like to know how you arrived at that conclusion. Is this based on a sample of the optometrists you know, or is this based upon actual surveys of practicing ODs? In my limited experience (3 years as a practicing OD), it might not be as common as you think.

One of the things that med school has taught me is that surgery is more than a technical procedure. The true skill and art of surgery is knowing when to operate, when not to operate, how to prevent/minimize post-op complications, and recognizing the post-op complication early. These skills are very closely interwoven into the actual skill of the procedure and peri-operative care. And to be honest, these skills just aren't taught at optometry school, at least not when I was an optometry student. There may have been a few didactic discussions, but it was not part of the clinical curriculum. This is not to say that ODs are incapable of learning it. Most could learn this, and those who do learn it probably do pretty well at it. But in any specialty, the best post-op care will be provided by the team that provided the intraoperative care.

I believe that the allure of co-management is that ODs can take on a more complex responsibility for their patients, and the surgeons can free themselves to perform more procedures. I think surgeons also believe that throwing this morsel to the referring optometrist will keep the referrals coming. I would agree with PDT4CNV - this can be seen as an abdication of the surgeon's responsibility to the patient. Surgical care is more than scalpels and sutures. In the end, everybody should want their patients to get the best care possible.

I am puzzled over your concern regarding "co-mangament". If you feel that ANY and ALL post-op care being handled by the OMD is in the patient's best interest, then do it. If you feel that strongly, then you won't be concerned with those optometrists who decide to stop referring to you based on that policy. Your dislike of your university's optometry department's policy to send their surgery cases outside of the university is also strange to me. The fact of the matter is that the majority of optometrists in the nation handle post-op care. Your OMD department has made the decision to not allow OD's to handle their post-op care. You want those optometrists from that university to be the only ones in the country that weren't properly trained to co-manage? They've got to learn somewhere...

Just curious to know... Has there been a rash of problems with optometrists co-managing? Is patient care suffering? I'm not trying to make an inflammatory statement here. I just really want to know. Are optometrists doing that bad of a job? If your only intention with this post was to answer my question about "the ideal roles" of both OMD's and OD's, then please disregard this last question.

 

[PDT4CNV]

I am puzzled over your concern regarding "co-mangament". If you feel that ANY and ALL post-op care being handled by the OMD is in the patient's best interest, then do it. If you feel that strongly, then you won't be concerned with those optometrists who decide to stop referring to you based on that policy. Your dislike of your university's optometry department's policy to send their surgery cases outside of the university is also strange to me. The fact of the matter is that the majority of optometrists in the nation handle post-op care. Your OMD department has made the decision to not allow OD's to handle their post-op care. You want those optometrists from that university to be the only ones in the country that weren't properly trained to co-manage? They've got to learn somewhere...

Just curious to know... Has there been a rash of problems with optometrists co-managing? Is patient care suffering? I'm not trying to make an inflammatory statement here. I just really want to know. Are optometrists doing that bad of a job? If your only intention with this post was to answer my question about "the ideal roles" of both OMD's and OD's, then please disregard this last question.

If an optometrist does not wish to refer to me because I will not co-manage than that is fine. I do think you exaggerate just a bit. That has not really been a problem with the majority of community optometrists. Most of them seem satisfied with not co-managing as long as the patients are at least referred back to them after surgery and post-op care is complete.

It is also an exaggeration to say that most optometrists in the country manage surgical patients immediately post-operatively. That is not true. Whether or not there have been problems with ODs co-managing I cannot say, but that is not my point.

Next, I agree with the above post regarding the nature and quality of post-operative care. Many times there is certainly a routine regimen that is followed, but many times there is not.

Lastly, it is a matter of ethics. I believe it is the proper and ethical thing to do for a surgeon to see his patients post-operatively. This is the standard of care for every surgical specialty. Why would eye surgery be any different?

I can't think of any good reason why a surgeon should not care for his/her patient post-operatively.

 

[VA Hopeful Dr]

If an optometrist does not wish to refer to me because I will not co-manage than that is fine. I do think you exaggerate just a bit. That has not really been a problem with the majority of community optometrists. Most of them seem satisfied with not co-managing as long as the patients are at least referred back to them after surgery and post-op care is complete.

It is also an exaggeration to say that most optometrists in the country manage surgical patients immediately post-operatively. That is not true. Whether or not there have been problems with ODs co-managing I cannot say, but that is not my point.

Next, I agree with the above post regarding the nature and quality of post-operative care. Many times there is certainly a routine regimen that is followed, but many times there is not.

Lastly, it is a matter of ethics. I believe it is the proper and ethical thing to do for a surgeon to see his patients post-operatively. This is the standard of care for every surgical specialty. Why would eye surgery be any different?

I can't think of any good reason why a surgeon should not care for his/her patient post-operatively.

You've hit upon one of the big reasons for co-management: sending the patients back afterwards. If you are up front with the ODs and say "I prefer to do all the post-op care as I feel it is my responsibility, but I will refer them (with their final Rx) back to you", then I would hope you would have no shortage of patients from ODs.

I like the rest of your post, especially the last 2 parts.

 

[7ontheline]

You've hit upon one of the big reasons for co-management: sending the patients back afterwards. If you are up front with the ODs and say "I prefer to do all the post-op care as I feel it is my responsibility, but I will refer them (with their final Rx) back to you", then I would hope you would have no shortage of patients from ODs.

I like the rest of your post, especially the last 2 parts.

The problem (and someone please correct me if I am wrong) is that the more of the post-op period that the OD is responsible for the more reimbursement they receive. I am also personally very opposed to OD's performing post-op care because surgery is not a part of their training.

I have seen what good optometry residents (who presumably are some of the best of their profession) learn and are capable of and they are very competent within their field. However, in clinical discussions with them it is often evident that they do not understand when it is time to discuss surgery and refer. This is not a criticism of them, because it's not their fault. That said, I agree with PDT that post-op care for surgery is the standard of medical care and should not be co-managed. I have no desire to steal patients from any referring ODs after post-op is finished.

 

[VA Hopeful Dr]

The problem (and someone please correct me if I am wrong) is that the more of the post-op period that the OD is responsible for the more reimbursement they receive. I am also personally very opposed to OD's performing post-op care because surgery is not a part of their training.

I have seen what good optometry residents (who presumably are some of the best of their profession) learn and are capable of and they are very competent within their field. However, in clinical discussions with them it is often evident that they do not understand when it is time to discuss surgery and refer. This is not a criticism of them, because it's not their fault. That said, I agree with PDT that post-op care for surgery is the standard of medical care and should not be co-managed. I have no desire to steal patients from any referring ODs after post-op is finished.

In my state, if an OD does all of the post-op care (full 9 days) they get something like $120. If we assume 4 post op vists, that gets them $30 per appointment. Even as quick as those visits can be, I'm not sure its worth it.

 

[7ontheline]

In my state, if an OD does all of the post-op care (full 9 days) they get something like $120. If we assume 4 post op vists, that gets them $30 per appointment. Even as quick as those visits can be, I'm not sure its worth it.

I'm confused. Typical post-op for my cataracts involves 3 visits - post-op day 1, week 1, month 1. What do you mean by 9 days? And 4 visits are much less common, unless maybe they have high IOP on day 1.

 

[VA Hopeful Dr]

I'm confused. Typical post-op for my cataracts involves 3 visits - post-op day 1, week 1, month 1. What do you mean by 9 days? And 4 visits are much less common, unless maybe they have high IOP on day 1.

Dang it... I meant 90 days, which I thought was the medicare post op length. That'll teach me to proofread.

The surgeon I work for does at least 4 visits: 1 day, 1 week, 1 month, 2 month. Sometimes even a 3 month, if the Rx isn't perfectly stable from 1 month to 2 month. The local ODs that he co-manages with do about the same (part of their agreement I suspect, since the surgeon could still be held accountable should something go wrong later under the ODs care).

 

[prettygreeneyes]

I am going to take issue with your statement that the majority of US optometrists do post-op care. I would like to know how you arrived at that conclusion. Is this based on a sample of the optometrists you know, or is this based upon actual surveys of practicing ODs? In my limited experience (3 years as a practicing OD), it might not be as common as you think.

I apologize. After more research, I guess co-managing isn't as common as I thought. It is common in the area I live in, but that of course doesn't mean anything! I'm sure it depends on what state an optometrist is in (more or less scope of practice).

It's kind of depressing... There are a few OMD's who will never believe that ODs are capable of anything more than spinning dials and fitting contacts. I guess this is a good lesson to learn now...

Thanks for the discussion, guys.

 

[Caffeinated]

I apologize. After more research, I guess co-managing isn't as common as I thought. It is common in the area I live in, but that of course doesn't mean anything! I'm sure it depends on what state an optometrist is in (more or less scope of practice).

It's kind of depressing... There are a few OMD's who will never believe that ODs are capable of anything more than spinning dials and fitting contacts. I guess this is a good lesson to learn now...

Thanks for the discussion, guys.

I think you are missing the point of this co-management discussion. The point is not that there are ophthalmologists that think ODs are "incapable of anything more than spinning dials and fitting contacts." Rather, PDT4CNV made the point that the standard of surgical care is that the operative surgeon should provide the post-op care. It has nothing to do with any optometrist's capability, but rather it is part of the responsibility of being a surgeon.

Imagine if an ophthalmologist called up an optometrist and said "Hey, I have this keratoconic patient that is a great candidate for an RGP. I know you are an expert in this, so I am going to refer her to you. But I just want you to do the fitting. I'll dispense the lenses and do all of the progress checks." The optometrist would think this is crazy, because the evaluation and changes to that fit over the course of the next few visits would be much better handled by the optometrist who initially fit the lenses. I would argue that it is the optometrist's professional obligation to the patient to complete that contact lens fitting. It's not a perfect example, but I hope this illustrates the point for you.

As an optometrist, the majority of your day will be spent "spinning dials" and fitting contact lenses. There is an art and science to both of these skills, and you seem to trivialize the importance of these skills. But you should be proud of your expertise in this area--this is the heart and soul of optometry, and nobody does it better. Yes, there will be occasional opportunities to treat conjunctivitis or to be the first to diagnose an asymptomatic sight-threatening condition. But in between these patients, there will be a lot of "dial spinning" and contact lens fitting. My advice is to take pride in BOTH aspects of optometry: the refractive care AND the ocular disease care. If you provide that care in a way that supports your ophthalmology colleagues rather than antagonizes them, then your patients will be better served and you will have greater professional satisfaction.

 

[drgregory]

I think you are missing the point of this co-management discussion. The point is not that there are ophthalmologists that think ODs are "incapable of anything more than spinning dials and fitting contacts." Rather, PDT4CNV made the point that the standard of surgical care is that the operative surgeon should provide the post-op care. It has nothing to do with any optometrist's capability, but rather it is part of the responsibility of being a surgeon.

Imagine if an ophthalmologist called up an optometrist and said "Hey, I have this keratoconic patient that is a great candidate for an RGP. I know you are an expert in this, so I am going to refer her to you. But I just want you to do the fitting. I'll dispense the lenses and do all of the progress checks." The optometrist would think this is crazy, because the evaluation and changes to that fit over the course of the next few visits would be much better handled by the optometrist who initially fit the lenses. I would argue that it is the optometrist's professional obligation to the patient to complete that contact lens fitting. It's not a perfect example, but I hope this illustrates the point for you.

As an optometrist, the majority of your day will be spent "spinning dials" and fitting contact lenses. There is an art and science to both of these skills, and you seem to trivialize the importance of these skills. But you should be proud of your expertise in this area--this is the heart and soul of optometry, and nobody does it better. Yes, there will be occasional opportunities to treat conjunctivitis or to be the first to diagnose an asymptomatic sight-threatening condition. But in between these patients, there will be a lot of "dial spinning" and contact lens fitting. My advice is to take pride in BOTH aspects of optometry: the refractive care AND the ocular disease care. If you provide that care in a way that supports your ophthalmology colleagues rather than antagonizes them, then your patients will be better served and you will have greater professional satisfaction.

great post

 

[Hines302]

I think you are missing the point of this co-management discussion. The point is not that there are ophthalmologists that think ODs are "incapable of anything more than spinning dials and fitting contacts." Rather, PDT4CNV made the point that the standard of surgical care is that the operative surgeon should provide the post-op care. It has nothing to do with any optometrist's capability, but rather it is part of the responsibility of being a surgeon.

Don't most OMD practices use OD's to do all of their pre and post surgical care?? By just doing a quick google search and browsing some OMD pratcie websites you will fine that many large OMD practices have OD's to provide this care. Just curious as how a situation like this fits into the discussion?

 

[PBEA]

Don't most OMD practices use OD's to do all of their pre and post surgical care?? By just doing a quick google search and browsing some OMD pratcie websites you will fine that many large OMD practices have OD's to provide this care. Just curious as how a situation like this fits into the discussion?

Of course this is true, and while maybe it doesn't occur everywhere, it certainly is a VERY common practice. I think what alot of OMD's are saying here is that in an "idealistic" world they would like to handle all of the pre and post. Which is of course their prerogative. Fact of the matter is if an OD is doing any of this care, no matter how independent/or competent they are, this care is still under the auspices of the surgeon. Sooo, in the real world when a cataract surgeon needs some help doing all the w/u and f/u, he has a few choices. Hire another MD, hire an OD, or hire a bunch of techs. I think the tech route is popular, but it requires that the surgeon actually looks at the patient. With the first two he/she does not unless an issue comes up. This is called a "comfort level", some people are comfortable with this approach (and should be, I'm not even going to bother posting any numbers on comanagement complication rate), other are not. My own experience has been that the small self-employed surgeon is more likely to do it all on there own, and may feel ethically (even clinically) superior to the busy guy down the block who employs 1 MD and 3 OD's. This of course is a self-justifying bias, and is nearly 99.9% untrue. (don't quote this stat )

 

[PDT4CNV]

Of course this is true, and while maybe it doesn't occur everywhere, it certainly is a VERY common practice. I think what alot of OMD's are saying here is that in an "idealistic" world they would like to handle all of the pre and post. Which is of course their prerogative. Fact of the matter is if an OD is doing any of this care, no matter how independent/or competent they are, this care is still under the auspices of the surgeon. Sooo, in the real world when a cataract surgeon needs some help doing all the w/u and f/u, he has a few choices. Hire another MD, hire an OD, or hire a bunch of techs. I think the tech route is popular, but it requires that the surgeon actually looks at the patient. With the first two he/she does not unless an issue comes up. This is called a "comfort level", some people are comfortable with this approach (and should be, I'm not even going to bother posting any numbers on comanagement complication rate), other are not. My own experience has been that the small self-employed surgeon is more likely to do it all on there own, and may feel ethically (even clinically) superior to the busy guy down the block who employs 1 MD and 3 OD's. This of course is a self-justifying bias, and is nearly 99.9% untrue. (don't quote this stat )

Unfortunately, it is true that many surgeons, including eye surgeons do not always see patients pre-operatively and/or post-operatively. There is a prominent cardiovascular surgeon locally who is nationally known for his surgical skills and innovation, but he rarely sees his patients post-operatively. This is to be looked down upon. Among eye surgeons, this is certainly not the practice pattern of the majority, but it is not rare either. The standard of care is that the surgeon see the patient at least once pre-operatively and provide the post-op care.

I believe the practice module from the National Academy states that ophthalmologists should see surgical patients at least once pre-operative and at least once post-op. This is also the minimum required number of visits dictated by our state medical association for all surgical specialties.

Lastly, this issue is specifically addressed in the code of ethics of the American Academy of Ophthalmology. This code is enforceable by the academy and specifically states that post-operative care must be provided by an ophthalmologist until the patient has recovered.

Most ophthalmologists follow these guidelines and exceed them, some choose not too. I can tell you that in our local ophthalmology community, those that don't follow these rules are looked down upon and one eye surgeon was actually kicked off of the medical staff for not following these guidelines.

I strongly disagree with the above post which suggests that seeing pre- and post-op patients in clinic places some kind of extreme burden on the surgeon that he/she could not handle without outside help. This is completely false. The picture painted in the previous post is distorted and does not actually reflect the "real world" practice patterns of most ophthalmology practices whether a solo practice or large group. Having trained in ophthalmology and spent time with many different surgeons in many practices, I feel comfortable speaking to this.

More importantly, the previous poster seems to minimize medical ethics and standards of care as "idealistic" in favor of being busy and promoting an expanded role for the optometrist in seeing surgical post-ops with a "nothing bad has happened yet" philosophy. I disagree completely with this.

 

[VA Hopeful Dr]

Unfortunately, it is true that many surgeons, including eye surgeons do not always see patients pre-operatively and/or post-operatively. There is a prominent cardiovascular surgeon locally who is nationally known for his surgical skills and innovation, but he rarely sees his patients post-operatively. This is to be looked down upon. Among eye surgeons, this is certainly not the practice pattern of the majority, but it is not rare either. The standard of care is that the surgeon see the patient at least once pre-operatively and provide the post-op care.

I believe the practice module from the National Academy states that ophthalmologists should see surgical patients at least once pre-operative and at least once post-op. This is also the minimum required number of visits dictated by our state medical association for all surgical specialties.

The surgeon I work for sees post-op at day 1 and keeps the patient until they are stable and then sends them back to the referring OD. Seems a fair enough way to do things to me.

That being said, I really like your sense of duty here concerning pre/post-op.

 

[PBEA]

Unfortunately, it is true that many surgeons, including eye surgeons do not always see patients pre-operatively and/or post-operatively. There is a prominent cardiovascular surgeon locally who is nationally known for his surgical skills and innovation, but he rarely sees his patients post-operatively. This is to be looked down upon. Among eye surgeons, this is certainly not the practice pattern of the majority, but it is not rare either. The standard of care is that the surgeon see the patient at least once pre-operatively and provide the post-op care.

I believe the practice module from the National Academy states that ophthalmologists should see surgical patients at least once pre-operative and at least once post-op. This is also the minimum required number of visits dictated by our state medical association for all surgical specialties.

Lastly, this issue is specifically addressed in the code of ethics of the American Academy of Ophthalmology. This code is enforceable by the academy and specifically states that post-operative care must be provided by an ophthalmologist until the patient has recovered.

Most ophthalmologists follow these guidelines and exceed them, some choose not too. I can tell you that in our local ophthalmology community, those that don't follow these rules are looked down upon and one eye surgeon was actually kicked off of the medical staff for not following these guidelines.

Well, in my humble opinion, that is what all the surgeons ARE doing!? What I mean is that all of the standards ARE being kept. These surgeons (the ones in my limited experience) DO see these pts pre/post but often vary in the way in they DO this. Some do 3 f/u some do 4,etc. Also, when an OD (or other OMD) sees the f/u that f/u is the SOLE responsibility of the surgeon. Period! Seems to me like this would exceed the standard of care (according to your quote from the National Academy, and state medical assoc). Lastly, please explain how ANY comanagement scenario violates ANY ethical or moral ground whatsoever.

I strongly disagree with the above post which suggests that seeing pre- and post-op patients in clinic places some kind of extreme burden on the surgeon that he/she could not handle without outside help. This is completely false. The picture painted in the previous post is distorted and does not actually reflect the "real world" practice patterns of most ophthalmology practices whether a solo practice or large group. Having trained in ophthalmology and spent time with many different surgeons in many practices, I feel comfortable speaking to this.

I strongly disagree with the above post which suggests that, I suggested that, seeing pre- and post-op patients in clinic places some kind of extreme burden on the surgeon that he/she could not handle without outside help. This is completely false. The picture painted in the previous post is distorted and does not actually reflect what I said. Having trained in optometry and spent time with several different surgeons in many practices, I feel comfortable speaking to this.

More importantly, the previous poster seems to minimize medical ethics and standards of care as "idealistic" in favor of being busy and promoting an expanded role for the optometrist in seeing surgical post-ops with a "nothing bad has happened yet" philosophy. I disagree completely with this.

Just your humble opinion? We could go on and on with this, but it's clear your agenda is more geared towards OD's then comanagement practices. Why don't you just agree to never comanage with OD's(and then you'll be satisfied), and I'll agree to never refer a case to you (and I'll be satisfied).
The way I see it both are unethical, so it's a wash.

 

[Caffeinated]

Just your humble opinion? We could go on and on with this, but it's clear your agenda is more geared towards OD's then comanagement practices. Why don't you just agree to never comanage with OD's(and then you'll be satisfied), and I'll agree to never refer a case to you (and I'll be satisfied).
The way I see it both are unethical, so it's a wash.

I don't understand how you can say that PDT4CNV has an agenda. Just because PDT4CNV's ethics run counter to your desires, this does not mean it is a conspiracy against optometrists. If you read previous posts by most of the people on this board, you will find that most of the ophthalmologists on this board enjoy good working relationships with optometrists.

On the other hand, the fact that you will base your referral patterns on the willingness of the surgeon to co-manage places your politics above patient care. Don't be that doctor.

 

[PBEA]

I don't understand how you can say that PDT4CNV has an agenda. Just because PDT4CNV's ethics run counter to your desires, this does not mean it is a conspiracy against optometrists. If you read previous posts by most of the people on this board, you will find that most of the ophthalmologists on this board enjoy good working relationships with optometrists.

On the other hand, the fact that you will base your referral patterns on the willingness of the surgeon to co-manage places your politics above patient care. Don't be that doctor.

Desires? Conspiracy? What is this some kind of lame harlequin romance? Yeah, many/most OMD's and OD's "enjoy good working relationships". So what does that have to do with this specific discussion? OD's perform pre/posts, get used to it, big deal. Nurses, OMD's, MD's, DDS(?), DPM, DO, whatever, care to lay wagers as to who has actually seen someone elses pre or post?

I've already said I frown on referrals soley based on "comanagement arrangement", read the thread. Also said that not referring to PDT4CNV was UN-ethical, read the thread.

 

[GuP]

Just your humble opinion? We could go on and on with this, but it's clear your agenda is more geared towards OD's then comanagement practices. Why don't you just agree to never comanage with OD's(and then you'll be satisfied), and I'll agree to never refer a case to you (and I'll be satisfied).
The way I see it both are unethical, so it's a wash.

what are you talkin about here? PD makes a hell of a post and your insecurity leads you to believe that he is after ODs. what is up with that? PD is speaking the truth. That is what "should" be happening. An ophthalmologist, who is an MD (NOT OMD), should see their patient at least once postoperatively. Now, if an ophthalmologist chooses not to, then so be it. That is his perogative. That doesn't make it the right thing to do.

Desires? Conspiracy? What is this some kind of lame harlequin romance? Yeah, many/most OMD's and OD's "enjoy good working relationships". So what does that have to do with this specific discussion? OD's perform pre/posts, get used to it, big deal. Nurses, OMD's, MD's, DDS(?), DPM, DO, whatever, care to lay wagers as to who has actually seen someone elses pre or post?

I've already said I frown on referrals soley based on "comanagement arrangement", read the thread. Also said that not referring to PDT4CNV was UN-ethical, read the thread.

Again, just b/c something happens doesn't mean its right. It doesn't mean that just b/c its done that everyone must do it. I don't know what your point is. You just keep saying that it's done so get used to it and do it. Well it ain't gonna happen.

PS - Please refrain from calling ophthalmologists as OMD. It doesn't make any sense. Do you call an anesthesiology doc an AMD?

 

[Caffeinated]

Desires? Conspiracy? What is this some kind of lame harlequin romance? Yeah, many/most OMD's and OD's "enjoy good working relationships". So what does that have to do with this specific discussion? OD's perform pre/posts, get used to it, big deal. Nurses, OMD's, MD's, DDS(?), DPM, DO, whatever, care to lay wagers as to who has actually seen someone elses pre or post?

I've already said I frown on referrals soley based on "comanagement arrangement", read the thread. Also said that not referring to PDT4CNV was UN-ethical, read the thread.

Whoa, dude. You're getting bent out of shape. Take a nice, deep, cleansing breath and count to ten. Feel better? Good. Now let's talk.

First, my comment about good working relationships with optometrists was in response to your accusation against PDT4CNV. In your words: "it's clear your agenda is more geared towards OD's then [sic comanagement practices." I simply meant to point that based upon what I have read from PDT, he/she is not anti-optometrist.

Second, I read your post. In fact, I read it several times because I couldn't believe what I was reading. Again using your words: "both are unethical, so it's a wash." This wording suggests that you are trying to justify acting unethically because you think PDT4CNV is acting unethically--the professional equivalent of "it's not my fault, he started it."

Now that we have that straightened out, let me make one more attempt to try to clarify the initial position. (PDT4CNV, if I misrepresent your position, feel free to correct me.) The original stance was not that optometrists are absolutely incapable of post-op care, but that their skills are not necessary in post-operative management. As it has been stated several times in the past, the operative surgeon should provide post-op care whenever feasible because the operative surgeon knows the patient and their procedure better than anyone else. Sure, there will be times when the operative surgeon cannot perform post-op care because of the contraints of space, time, geography, etc. An example that I see frequently is in the surgical care of injured soldiers--these patients are often treatted within minutes to hours of their initial injury and evacuated to a higher level of care within hours to days of their initial surgery. However, these scenarios are exceptional; the standard and preferred protocol, if possible, is for the operative surgeon to provide the post-op care.

Lastly, your justification of "get used to, big deal" is not valid. A surgeon who takes his/her responsibility seriously will not simply "get used to it" and it is a "big deal." The fact that you can trivialize the surgeon-patient relationship without remorse suggests that you do not have an appreciation or respect for surgery, surgeons, or surgical patients. Go ahead and disrespect the first two, and some of your colleagues may stand by you. Disrespect patients, and I am quite certain that you will stand alone.

 

[PBEA]

Whoa, dude. You're getting bent out of shape. Take a nice, deep, cleansing breath and count to ten. Feel better? Good. Now let's talk.

Fine, i'll back a notch for now

First, my comment about good working relationships with optometrists was in response to your accusation against PDT4CNV. In your words: "it's clear your agenda is more geared towards OD's then [sic comanagement practices." I simply meant to point that based upon what I have read from PDT, he/she is not anti-optometrist.

Well, i beg to differ, no offense but I'm sure PDT has no problem with any MD performing pre/or post (even if they might prefer to do every detail themselves).

Second, I read your post. In fact, I read it several times because I couldn't believe what I was reading. Again using your words: "both are unethical, so it's a wash." This wording suggests that you are trying to justify acting unethically because you think PDT4CNV is acting unethically--the professional equivalent of "it's not my fault, he started it."

OK, I'm a little immature on this point. Although, I would consider making this type of exception for the ideology exhibited by PDT.

Now that we have that straightened out, let me make one more attempt to try to clarify the initial position. (PDT4CNV, if I misrepresent your position, feel free to correct me.) The original stance was not that optometrists are absolutely incapable of post-op care, but that their skills are not necessary in post-operative management. As it has been stated several times in the past, the operative surgeon should provide post-op care whenever feasible because the operative surgeon knows the patient and their procedure better than anyone else. Sure, there will be times when the operative surgeon cannot perform post-op care because of the contraints of space, time, geography, etc. An example that I see frequently is in the surgical care of injured soldiers--these patients are often treatted within minutes to hours of their initial injury and evacuated to a higher level of care within hours to days of their initial surgery. However, these scenarios are exceptional; the standard and preferred protocol, if possible, is for the operative surgeon to provide the post-op care.

You know what, there isn't one word in this paragraph that I disagree with. Perhaps it is merely a miscommunication.


Lastly, your justification of "get used to, big deal" is not valid. A surgeon who takes his/her responsibility seriously will not simply "get used to it" and it is a "big deal." The fact that you can trivialize the surgeon-patient relationship without remorse suggests that you do not have an appreciation or respect for surgery, surgeons, or surgical patients. Go ahead and disrespect the first two, and some of your colleagues may stand by you. Disrespect patients, and I am quite certain that you will stand alone.

It's this last paragraph that bothers me. I'm not minimizing, or trivializing anything. I think everbody realizes the stakes here. Patient welfare. What I'm I'm trying to do (albeit unsuccessfully) is provide perspective on a VERY obvious truth. That is that, OD's may provide some perioperative care, and if so, do so, in a very specific, accurate, standard, proper, ethical, moral manner, and anything you say opposed to this is probably bias you obtained in your experience, but does not necessarily reflect the facts.

 

[PDT4CNV]

First, my comment about good working relationships with optometrists was in response to your accusation against PDT4CNV. In your words: "it's clear your agenda is more geared towards OD's then [sic comanagement practices." I simply meant to point that based upon what I have read from PDT, he/she is not anti-optometrist.

Well, i beg to differ, no offense but I'm sure PDT has no problem with any MD performing pre/or post (even if they might prefer to do every detail themselves).

Please do not put words in my mouth or assume an opinion of mine which I have not stated.

It's this last paragraph that bothers me. I'm not minimizing, or trivializing anything. I think everbody realizes the stakes here. Patient welfare. What I'm I'm trying to do (albeit unsuccessfully) is provide perspective on a VERY obvious truth. That is that, OD's may provide some perioperative care, and if so, do so, in a very specific, accurate, standard, proper, ethical, moral manner, and anything you say opposed to this is probably bias you obtained in your experience, but does not necessarily reflect the facts.

It is obvious you are missing the previously discussed points. These discussions had nothing to do with the capability of optometrists in performing some pre- or post-operative care. There is no further point in you participating in this discussion as you dismiss differing opinions and views as "bias" without due consideration. The "truth" and "facts" you refer to, well, need I say anything about this?