Optometry scope: a help or a hindrance?

[medstudentmed]

Obviously on online forums and whatnot you get the opinions of people who are particularly passionate about something which may or may not be indicative of the general atmosphere in the field. As such, I was hoping that you could help shed light into the general perception of the following.

Are Optometrists as a whole actively attempting to increase their scope of practice in a way that impinges on or negatively effects an MDs practice? Does the Oklahoma ruling set a dangerous precedent that worries a lot of new-grad MDs, or is it a very specific decision that is unlikely to affect the rest of the country?

Also, I would assume that the general perception of Optometrists is a good one--since they would presumably refer the interesting cases to you and deal with the mundane stuff so that you don't have to...is this the case?

Lastly, I was just wondering if most new grads felt that the possible expansion of the scope of practice of an Optometrist was a legitimate threat to their future practice, or if it will play an insignificant role in their lives. You obviously can hear a lot of bitter debate if you go out and look for it (particularly on anonymous boards), but is it a legitimate issue in the 'real world' or simply a talking point or topic of debate in a more intellectual/academic sense?

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[DKofLV]

Obviously on online forums and whatnot you get the opinions of people who are particularly passionate about something which may or may not be indicative of the general atmosphere in the field. As such, I was hoping that you could help shed light into the general perception of the following.

Are Optometrists as a whole actively attempting to increase their scope of practice in a way that impinges on or negatively effects an MDs practice? Does the Oklahoma ruling set a dangerous precedent that worries a lot of new-grad MDs, or is it a very specific decision that is unlikely to affect the rest of the country?

Also, I would assume that the general perception of Optometrists is a good one--since they would presumably refer the interesting cases to you and deal with the mundane stuff so that you don't have to...is this the case?

Lastly, I was just wondering if most new grads felt that the possible expansion of the scope of practice of an Optometrist was a legitimate threat to their future practice, or if it will play an insignificant role in their lives. You obviously can hear a lot of bitter debate if you go out and look for it (particularly on anonymous boards), but is it a legitimate issue in the 'real world' or simply a talking point or topic of debate in a more intellectual/academic sense?

Before you blow the forum up with this heavy debate again...look at the top of this page at the link entitled: "Do you support Optometrists doing surgery? - ODs allowed to do scalpel surgery in OK!"

If your question isnt answered somewhere in there (and you will see lots of debate and some harsh words), then it might be worthwhile to discuss here if you still have any questions?

 

[KHE]

Before you blow the forum up with this heavy debate again...look at the top of this page at the link entitled: "Do you support Optometrists doing surgery? - ODs allowed to do scalpel surgery in OK!"

If your question isnt answered somewhere in there (and you will see lots of debate and some harsh words), then it might be worthwhile to discuss here if you still have any questions?

Why do I get the strong sense that no good can possibly come of this thread? lol

 

[JMK2005]

...Does the Oklahoma ruling set a dangerous precedent that worries a lot of new-grad MDs, or is it a very specific decision that is unlikely to affect the rest of the country?..

Can you explain more on the Oklahoma ruling you're talking about?

 

[Eyefixer]

Oh for **** sake...

 

[orbitsurgMD]

Obviously on online forums and whatnot you get the opinions of people who are particularly passionate about something which may or may not be indicative of the general atmosphere in the field. As such, I was hoping that you could help shed light into the general perception of the following.

Are Optometrists as a whole actively attempting to increase their scope of practice in a way that impinges on or negatively effects an MDs practice? Does the Oklahoma ruling set a dangerous precedent that worries a lot of new-grad MDs, or is it a very specific decision that is unlikely to affect the rest of the country?

Also, I would assume that the general perception of Optometrists is a good one--since they would presumably refer the interesting cases to you and deal with the mundane stuff so that you don't have to...is this the case?

Lastly, I was just wondering if most new grads felt that the possible expansion of the scope of practice of an Optometrist was a legitimate threat to their future practice, or if it will play an insignificant role in their lives. You obviously can hear a lot of bitter debate if you go out and look for it (particularly on anonymous boards), but is it a legitimate issue in the 'real world' or simply a talking point or topic of debate in a more intellectual/academic sense?

What is trolling like, you know, as a hobby?

 

[medstudentmed]

well, clearly aspects of this topic have been discussed ad nauseum and I can certainly understand your responses. I assure you, however, that I am not posting simply to troll and that I have read the OK thread and others and was actually asking about something different.

The other threads talk a lot about the debate between what should be done and so forth, but what I am asking is something very different. Maybe I can phrase it differently since the first time obviously wasn't clear:

Clearly the issue of having a field like optometry is (somewhat) unique to the ophthalmology field of medicine (as compared with most other specialties). I understand that there are both advantages and disadvantages to this however, I am wondering if the experienced ophthos can tell me; knowing what you know now, do you think that the future of optometry is something that should be a legitimate concern of someone considering specializing in ophthalmology? Knowing what you know now, if you were a med student deciding on a residency, would that aspect of the field be a legitimate concern or negligible in the broad scheme of things?

Before you say it - I absolutely agree that you should chose your field of medicine based on your interests and what you would love to do everyday/etc, but I also think that often times an MD would be perfectly happy specializing in more than one specialty and so in addition to evaluating my interests, I also think it's important to evaluate the other aspects that would affect my prospective career.

thanks for your help

 

[Andrew_Doan]

Search this forum and you'll find the answer you seek.

 

[Meibomian SxN]

...
Clearly the issue of having a field like optometry is (somewhat) unique to the ophthalmology field of medicine (as compared with most other specialties). I understand that there are both advantages and disadvantages to this however....

Unique to ophthalmology? So how do you feel about Podiatrists who perform VERY similar surgery procedures as general surgeons and othropedics? Or what about Nurse Practitioners who can perform many aspects of obstetrics as OB/GYN's or see patients like Peds, Family Practice etc....

With the rhetoric of the news saying we are going to have a shortage of PCPs, I don't think Optometrists are the threat you should be scared of.

 

[ksidoc]

I don't think most Ophthalmologists are concerned that optometry will take away from the profession. There are currently more OMDs retiring every year than are coming out of residency. I am an OD that is currently studying to take the MCAT in two weeks from today!!!! I have no illusion that my privileges should be expanded to include surgery, otherwise I would not be willing to go back to med school and residency to have surgical privileges should I be fortunate enough to make it in. I recently gave a lecture to a group of optometrists in Oklahoma. Just out of my own curriosity I asked the group how many took advantage of their laser privileges, VERY few! Out of a group of 28-30 there were two that did any laser procedures at all. I believe, maybe naively, that everyone has the patient's best interest in mind. No one wants to do harm, and if you are not doing the procedures on a somewhat routine basis, your skills are not going to be that of someone who does. There may be those out there that disagree with me, but our training does not lend well to surgical procedures. When students shadow me or I lecture to OD students and I get the question about surgery I make it very clear to them my opinion. If you want to be a surgeon, go to med school.

 

[Andrew_Doan]

I don't think most Ophthalmologists are concerned that optometry will take away from the profession. There are currently more OMDs retiring every year than are coming out of residency. I am an OD that is currently studying to take the MCAT in two weeks from today!!!! I have no illusion that my privileges should be expanded to include surgery, otherwise I would not be willing to go back to med school and residency to have surgical privileges should I be fortunate enough to make it in. I recently gave a lecture to a group of optometrists in Oklahoma. Just out of my own curriosity I asked the group how many took advantage of their laser privileges, VERY few! Out of a group of 28-30 there were two that did any laser procedures at all. I believe, maybe naively, that everyone has the patient's best interest in mind. No one wants to do harm, and if you are not doing the procedures on a somewhat routine basis, your skills are not going to be that of someone who does. There may be those out there that disagree with me, but our training does not lend well to surgical procedures. When students shadow me or I lecture to OD students and I get the question about surgery I make it very clear to them my opinion. If you want to be a surgeon, go to med school.

Thank you for posting your opinion and sharing with the forum.

Good luck with the MCAT!

Would you be willing to write an article expressing your views about this issue for the American Academy of Ophthalmology EyeNet and YO INFO? I would love to have the AAO publish an article about your experiences, views, and opinions.

Thanks,
Andy D.

 

[Meibomian SxN]

I don't think most Ophthalmologists are concerned that optometry will take away from the profession. There are currently more OMDs retiring every year than are coming out of residency. I am an OD that is currently studying to take the MCAT in two weeks from today!!!! I have no illusion that my privileges should be expanded to include surgery, otherwise I would not be willing to go back to med school and residency to have surgical privileges should I be fortunate enough to make it in. I recently gave a lecture to a group of optometrists in Oklahoma. Just out of my own curriosity I asked the group how many took advantage of their laser privileges, VERY few! Out of a group of 28-30 there were two that did any laser procedures at all. I believe, maybe naively, that everyone has the patient's best interest in mind. No one wants to do harm, and if you are not doing the procedures on a somewhat routine basis, your skills are not going to be that of someone who does. There may be those out there that disagree with me, but our training does not lend well to surgical procedures. When students shadow me or I lecture to OD students and I get the question about surgery I make it very clear to them my opinion. If you want to be a surgeon, go to med school.

Agreed, in that we are not trained as surgeons. But medical school will not train you either. Only an ophthalmology residency will. The probelm is you can not just skip medical school and go through a surgical residency.

Learning biochem, the neuro pathways and more monotonous pharm drugs all over again is just a cruel but necessary step. It would have been so much better if they at least let you complete the last 2 yrs of medical school instead of all 4yrs; sort of like oral-maxillo residents can.

Best of luck! .

PS: Out of curiosity, because of the competiveness of securing an ophthalmology residency, what are your plans if you are not selected?

 

[DKofLV]

Agreed, in that we are not trained as surgeons. But medical school will not train you either. Only an ophthalmology residency will. The probelm is you can not just skip medical school and go through a surgical residency.

Learning biochem, the neuro pathways and more monotonous pharm drugs all over again is just a cruel but necessary step. It would have been so much better if they at least let you complete the last 2 yrs of medical school instead of all 4yrs; sort of like oral-maxillo residents can.

Best of luck! .

PS: Out of curiosity, because of the competiveness of securing an ophthalmology residency, what are your plans if you are not selected?

'

yes, but the first two years give you the basic pathology and pharmacology to understand what you're seeing and Rxing in the wards...dental school has almost all the same classes MD school has in the beginning as well...which is why they can do just the 2 years...

it does nobody any good as a third year med student to just start seeing their first DKA patient and having no idea about the shifts in sodium and potassium...because if you simply give your type 1 diabetic insulin when their glucose is 890 and they are comatose...you will kill them (yes...KILL THEM) because of the potassium shifts...and this is information learned in 2nd year (1st year depending on your curriculum) and refined on the wards through clinical practice

 

[ksidoc]

PS: Out of curiosity, because of the competiveness of securing an ophthalmology residency, what are your plans if you are not selected?[/QUOTE]

Good question. The areas that I am most interested in, Ophtho and Anesthesia, are both difficult to get residencies. I have research and publications in eye care currently and do several clinical trials in my practice now. The anterior seg surgeon I work with closely wrote one of my letters of rec for med school and was chief resident in the program I am most interested in. He did his cornea fellowship at Wilmer so I am hoping as long as my Step 1 scores are good I have a solid chance. I have several patients that are anesthesiologists and I have shaddowed them quite a bit lately. Have not asked if I could assist with any research but that is a possiblity since the one is an attending at my state med school. I just need to focus on MCAT first, will worry about the rest should I get an acceptance letter.

 

[Andrew_Doan]

PS: Out of curiosity, because of the competiveness of securing an ophthalmology residency, what are your plans if you are not selected?

Good question. The areas that I am most interested in, Ophtho and Anesthesia, are both difficult to get residencies. I have research and publications in eye care currently and do several clinical trials in my practice now. The anterior seg surgeon I work with closely wrote one of my letters of rec for med school and was chief resident in the program I am most interested in. He did his cornea fellowship at Wilmer so I am hoping as long as my Step 1 scores are good I have a solid chance. I have several patients that are anesthesiologists and I have shaddowed them quite a bit lately. Have not asked if I could assist with any research but that is a possiblity since the one is an attending at my state med school. I just need to focus on MCAT first, will worry about the rest should I get an acceptance letter.

Truthfully, an optometrist with medical training is so unique that you'll be very competitive if your "stats" are on par with the pack. The OD will draw attention to you and make you stand out.

For example, the one thing that made me stand out was my eBay business during medical school. Many programs didn't ask about my PhD research, rotations, or why I loved ophthalmology. We spent most of the interview discussing how and why I setup a business.

As an individual who interviewed many applicants, an OD with good numbers, stats, and letters of recommendation would be an strong candidate.

 

[KHE]

There may be those out there that disagree with me, but our training does not lend well to surgical procedures. When students shadow me or I lecture to OD students and I get the question about surgery I make it very clear to them my opinion. If you want to be a surgeon, go to med school.

I've said this dozens of times over the years on this and other forums....

Yes, it is probably fair to say that current optometric training is not sufficient to produce a talented ophthalmic surgeon, even with additional training.

HOWEVER, that does not mean that current optometric training is not sufficient for optometrists to be removing foreign bodies or prescribing patanol.

I would also say that IF you wanted to create a different pathway than the one currently available to produce an ophthalmic surgeon, that that would be possible within the confines of a 4 year post graduate professional program. Dentists perform all kinds of invasive surgeries and prescribe all kinds of powerful systemic and they do not attend allopathic medical school. No one seems to be falling all over themselves to try to restrict dentists ability to prescribe a few days worth of lortab.

So could you produce a talented LASIK or cataract surgeon with a 4 year post grad program? I think the answer is yes.

Is that a good idea? No. Not really. Is it necissary? No. Not really. Is that what optometrists want? NO.

It's the same argument that we had during the comangement thread. Why, would optometry as a profession want to spent untold millions in financial and political capital to win the right to perform cataract surgery? So I can do surgery on the 4 or 5 cataract patients I refer out in a month...and earn what......$660? Is that the going rate now? For the pre-op, the surgery and all those post op visits? Yes....please sign me up. I desperately need that $2500 a month that is going to take up 25 appointment slots on my schedule IF there were no complications. That would earn me about $100 per slot. Right now, the average revenue generated per slot in my office is over $400.

So please......tell me again why I'm going to fight for the right to do cataract surgery which earns me $100 per slot?

Oh...it's not cataract surgery you're all worried about. It's LASIK. Yes....please let me compete with Diamond Vision/Lasik Plus/Lasik Express/Lasik Vue/Lasik Institute etc. etc. in a race to the bottom for the right to bill $299-$499 per eye. Never mind that I need a surgical suite which costs tens of thousands of dollars to construct and which needs tens of thousands of dollars of equipment to do it.

Cmon.

I really and truly think that so many of you have really no concept about the economics of medicine in general or of eye care in particular.

 

[speyeder]

I've said this dozens of times over the years on this and other forums....

Yes, it is probably fair to say that current optometric training is not sufficient to produce a talented ophthalmic surgeon, even with additional training.

HOWEVER, that does not mean that current optometric training is not sufficient for optometrists to be removing foreign bodies or prescribing patanol.

I would also say that IF you wanted to create a different pathway than the one currently available to produce an ophthalmic surgeon, that that would be possible within the confines of a 4 year post graduate professional program. Dentists perform all kinds of invasive surgeries and prescribe all kinds of powerful systemic and they do not attend allopathic medical school. No one seems to be falling all over themselves to try to restrict dentists ability to prescribe a few days worth of lortab.

So could you produce a talented LASIK or cataract surgeon with a 4 year post grad program? I think the answer is yes.

Is that a good idea? No. Not really. Is it necissary? No. Not really. Is that what optometrists want? NO.

It's the same argument that we had during the comangement thread. Why, would optometry as a profession want to spent untold millions in financial and political capital to win the right to perform cataract surgery? So I can do surgery on the 4 or 5 cataract patients I refer out in a month...and earn what......$660? Is that the going rate now? For the pre-op, the surgery and all those post op visits? Yes....please sign me up. I desperately need that $2500 a month that is going to take up 25 appointment slots on my schedule IF there were no complications. That would earn me about $100 per slot. Right now, the average revenue generated per slot in my office is over $400.

So please......tell me again why I'm going to fight for the right to do cataract surgery which earns me $100 per slot?

Oh...it's not cataract surgery you're all worried about. It's LASIK. Yes....please let me compete with Diamond Vision/Lasik Plus/Lasik Express/Lasik Vue/Lasik Institute etc. etc. in a race to the bottom for the right to bill $299-$499 per eye. Never mind that I need a surgical suite which costs tens of thousands of dollars to construct and which needs tens of thousands of dollars of equipment to do it.

Cmon.

I really and truly think that so many of you have really no concept about the economics of medicine in general or of eye care in particular.

I keep hearing that most optometrists have no interest in performing surgery. So then why does the optometry lobby keep pushing for surgical privileges? Shouldn't they represent the interests of the majority?

 

[Meibomian SxN]

'

yes, but the first two years give you the basic pathology and pharmacology to understand what you're seeing and Rxing in the wards...dental school has almost all the same classes MD school has in the beginning as well...which is why they can do just the 2 years...

it does nobody any good as a third year med student to just start seeing their first DKA patient and having no idea about the shifts in sodium and potassium...because if you simply give your type 1 diabetic insulin when their glucose is 890 and they are comatose...you will kill them (yes...KILL THEM) because of the potassium shifts...and this is information learned in 2nd year (1st year depending on your curriculum) and refined on the wards through clinical practice

Uhhh, we are talking about current eye care practice & not an episode of House MD correct? I remember Type1 diabetics being followed and treated by PCPs and physicians who specialize in endocrinology, not ophthalmologists....

In all fairness, many ophthalmologists are unaware of the optometric curriculum. My pathology professor taught over at Jefferson medschool, neuro-ophthalmology professor taught the residents at Scheie Eye Institute, and every Friday we had the chief resident of different specialties lecture us on their medical field. And first year biochem Krebs cycle is pretty much the same across the board for pharmacy, med, dental and optometry students.

Yes, your medical education by far was more intense; but it was to only build a firm background in the various career paths you would choose from. Once you specialize in your corrective medical field, you are not using all of the knowledge you learned.

 

[Meibomian SxN]

...So could you produce a talented LASIK or cataract surgeon with a 4 year post grad program? I think the answer is yes.

Is that a good idea? No. Not really. Is it necissary? No. Not really. Is that what optometrists want? NO.

...

Exactly. Most Oklahoma ODs probably do not perform the laser procedures they're allowed to do because it is just not financially sound in the majority.

If optometric legislation was changed nationwide, it is agreed that not many ODs would go running out to go buy a new dual platform laser hoping to play "YAG cleanup man" on every s/p PCIOL patient or SLT on every patient that even looks like they might be equal to 22mmHg! Although the CE presenters would do nice financially and would make for MUCH better CE topics

 

[DKofLV]

Uhhh, we are talking about current eye care practice & not an episode of House MD correct? I remember Type1 diabetics being followed and treated by PCPs and physicians who specialize in endocrinology, not ophthalmologists....

In all fairness, many ophthalmologists are unaware of the optometric curriculum. My pathology professor taught over at Jefferson medschool, neuro-ophthalmology professor taught the residents at Scheie Eye Institute, and every Friday we had the chief resident of different specialties lecture us on their medical field. And first year biochem Krebs cycle is pretty much the same across the board for pharmacy, med, dental and optometry students.

Yes, your medical education by far was more intense; but it was to only build a firm background in the various career paths you would choose from. Once you specialize in your corrective medical field, you are not using all of the knowledge you learned.

Thank you for mockingly but inadvertently proving my point. Just a few weeks ago while I was on call I had to manage one of our inpatient diabetics' sugars (and blood pressure) overnight prior to surgery. Had I only had the Ophtho residency behind me, I may have caused a disaster in their outcome. This isnt House MD complicated cases...it's a SIMPLE case that would NOT be simple without medical school...this is basic medicine (yes it was simple for me...titrating basal and sliding scale insulins, altering the ACE-I and beta-blockers)...but this is still something I started learning in first and second year, refined in 3rd and 4th year med school...and practiced in internship. To assume that a diabetic is always followed by an endocrinologist is just silly.

So to say that surgical privilege should come with a separate Surgical residency after OD schooling doesnt even begin to scratch the surface.

Can almost anyone become a surgeon with proper training? YES! Can almost anyone handle the more difficult and unexpected general medical issues that may happen on occasion? DEFINITELY NOT. Go to school for it. End of statement.

 

[Andrew_Doan]

Cmon.

I really and truly think that so many of you have really no concept about the economics of medicine in general or of eye care in particular.

Actually, we do. The average optometrist makes much, much less than the average eye surgeon. The last AAO survey showed the average eye surgeon makes $340,000 per year. If the eye surgeon owns an ASC or optical dispensary, then double this amount.

The cataract slot also is potentially $2500 for a premium IOL.

Surgical procedures are reimbursed much higher than clinic RVUs.

If you can make $400 per slot, an eye surgeon can make more because he/she can provide all your services and more.

 

[Meibomian SxN]

Thank you for mockingly but inadvertently proving my point. Just a few weeks ago while I was on call I had to manage one of our inpatient diabetics' sugars (and blood pressure) overnight prior to surgery. Had I only had the Ophtho residency behind me, I may have caused a disaster in their outcome. This isnt House MD complicated cases...it's a SIMPLE case that would NOT be simple without medical school...this is basic medicine (yes it was simple for me...titrating basal and sliding scale insulins, altering the ACE-I and beta-blockers)...but this is still something I started learning in first and second year, refined in 3rd and 4th year med school...and practiced in internship. To assume that a diabetic is always followed by an endocrinologist is just silly.

So to say that surgical privilege should come with a separate Surgical residency after OD schooling doesnt even begin to scratch the surface.

Can almost anyone become a surgeon with proper training? YES! Can almost anyone handle the more difficult and unexpected general medical issues that may happen on occasion? DEFINITELY NOT. Go to school for it. End of statement.

You had to manage? Did you manage his GERD also? What about his libido from the beta-blockers?

Yes, you are trained as a general physician and also an eye surgeon, but you know just as well as I do that this is not a common scenario for the average practicing eye surgeon. Yes, you can titrate and read EKG's but is this your primary role as an eye surgeon? Do you not get clearance from cardio or the PCP prior to surgery or let me guess, you do it all yourself?

And if this is standard knowledge then do you not think that this would be taught in a finely developed optometric surgical program; just as it is for podiatric surgeons and dental surgeons?

Try not to be so bitter & naive please.

 

[Mye Eye]

You had to manage? Question Andy, do you NOT get clearance from the patients PCP or cardiologist prior to surgery or do you do it all yourself? Did you manage his GERD also? What about his libido from the beta-blockers?

Yes, you are trained as a general physician and also an eye surgeon, but you know just as well as I do that this is not a common scenario. Yes, you can titrate and read EKG's but is this your primary role as an eye surgeon?

And if it is then do you not believe this would be taught in a finely developed optometric surgical program; just as it is for podiatric surgeons and dental surgeons?

Try not to be so bitter please.

(1) Who is Andy?
(2) Go back to the OD boards where people might give a crap about what you have to say, and then maybe you might feel special
(3) Here is an honest question. I never read the OD boards to see if there are many OMDs that spend a lot of their day picking fights and puffing out their chest there, but I do see many ODs on our forums. Are there any/many OMDs that have that much free time to troll your boards? Is it just an OD thing?

 

[KHE]

Actually, we do. The average optometrist makes much, much less than the average eye surgeon. The last AAO survey showed the average eye surgeon makes $340,000 per year. If the eye surgeon owns an ASC or optical dispensary, then double this amount.

The cataract slot also is potentially $2500 for a premium IOL.

Surgical procedures are reimbursed much higher than clinic RVUs.

If you can make $400 per slot, an eye surgeon can make more because he/she can provide all your services and more.

Then why is there so much moaning and groaning about every medicare cut that potentially comes along when premium IOLs are uncovered?

I have not seen this AAO survey but I would not rely on income levels from an AAO survey because the AAO survey only cover, or mostly cover AAO members. Struggling eye surgeons new to practice or who are slow are not likely to respond. In essence, like optometry income surveys, the data is likely skewed. I would also be interested in knowing how many patients the average AAO member sees in a day to generate that kind of income.

Here is a link to some website quoting a salary average of just over $200000 and there are many comments moaning and groaning about actual salaries are LOWER.

http://mdsalaries.blogspot.com/2006/01/ophthalmologist-salaries.html

I have no idea what their source is or who these people are but it sure seems lower than what the AAO seems to think.

Here's a link from the NIH which shows median salaries at just over $160,000.

http://science-education.nih.gov/Li...+List/Ophthalmologist?OpenDocument&ShowTab=1&

Most optometrists DO own optical dispensaries and I can assure you that in this day and age, they are not nearly as profitable as you might think.

I don't know how many more times I can say this. I refer about 5-6 cataract patients a month out. It's actually less for LASIK. From the nursing homes, maybe 6-8 cataract patients a month. So AT BEST, I have about 15 surgical patients a month, half of whom are in nursing homes and who I can assure you are NOT going to select a "premium IOL."

For the 100th time, for an optometric practice there is simply NOT the surgical volume to justify the time, expense, aggrivation, equipment, etc. etc. of pursing surgical training.

 

[DKofLV]

You had to manage? Did you manage his GERD also? What about his libido from the beta-blockers?

Yes, you are trained as a general physician and also an eye surgeon, but you know just as well as I do that this is not a common scenario for the average practicing eye surgeon. Yes, you can titrate and read EKG's but is this your primary role as an eye surgeon? Do you not get clearance from cardio or the PCP prior to surgery or let me guess, you do it all yourself?

And if this is standard knowledge then do you not think that this would be taught in a finely developed optometric surgical program; just as it is for podiatric surgeons and dental surgeons?

Try not to be so bitter & naive please.

If you're so interested in a finely developed optometic surgical program...why spend so much energy developing one...we have a very nicely created example of such...it's called Ophthalmology residency...

 

[VA Hopeful Dr]

(1) Who is Andy?
(2) Go back to the OD boards where people might give a crap about what you have to say, and then maybe you might feel special
(3) Here is an honest question. I never read the OD boards to see if there are many OMDs that spend a lot of their day picking fights and puffing out their chest there, but I do see many ODs on our forums. Are there any/many OMDs that have that much free time to troll your boards? Is it just an OD thing?

Actually yeah, there are a few who like to stir the pot over there. There is also a fairly inflammatory medical student than myself who frequents the OD forum.

 

[Meibomian SxN]

If you're so interested in a finely developed optometic surgical program...why spend so much energy developing one...we have a very nicely created example of such...it's called Ophthalmology residency...

As was stated earlier, most ODs wouldn't go flocking to become "Optometric Surgeons." There's just simply not a significant need for such.

But then again, if diabetics are being "titrated" by eye surgeons then maybe there is a need...

(1) Who is Andy?
(2) Go back to the OD boards where people might give a crap about what you have to say, and then maybe you might feel special
(3) Here is an honest question. I never read the OD boards to see if there are many OMDs that spend a lot of their day picking fights and puffing out their chest there, but I do see many ODs on our forums. Are there any/many OMDs that have that much free time to troll your boards? Is it just an OD thing?

Don't worry, I'm done here. I'm not interested in learning about titrationist rookie residents anyhow . I so can't wait until you see what the "real world" is like...

 

[DKofLV]

As was stated earlier, most ODs wouldn't go flocking to become "Optometric Surgeons." There's just simply not a significant need for such.

But then again, if diabetics are being "titrated" by eye surgeons then maybe there is a need...




Don't worry, I'm done here. I'm not interested in learning about titrationist rookie residents anyhow . I so can't wait until you see what the "real world" is like...

bump

 

[KHE]

Thank you for mockingly but inadvertently proving my point. Just a few weeks ago while I was on call I had to manage one of our inpatient diabetics' sugars (and blood pressure) overnight prior to surgery. Had I only had the Ophtho residency behind me, I may have caused a disaster in their outcome. This isnt House MD complicated cases...it's a SIMPLE case that would NOT be simple without medical school...this is basic medicine (yes it was simple for me...titrating basal and sliding scale insulins, altering the ACE-I and beta-blockers)...but this is still something I started learning in first and second year, refined in 3rd and 4th year med school...and practiced in internship. To assume that a diabetic is always followed by an endocrinologist is just silly.

That's all well and good that you do those things on in-patients as part of your training but outside of an academic environment, I have NEVER encountered an ophthalmic surgeon who does those things. Every single diabetic patient I refer out for retinal or cataract surgery comes back with a note saying "make sure their PCP or endocrinologist signs off on their surgery."

None of that matters though. The point is that it is quite possible to adequately produce a competent ophthalmic surgeon outside of the traditional route. This isn't what anyone wants, but dentists do all kinds of invasive surgery (probably on diabetics too, those wacky dentists) and prescribe all kinds of powerful medications without the benefit of an allopathic medical education and yet somehow, bodies aren't piling up all over the streets from rogue dentists prescribing Lortab.

 

[KHE]

I keep hearing that most optometrists have no interest in performing surgery. So then why does the optometry lobby keep pushing for surgical privileges? Shouldn't they represent the interests of the majority?

It's not about surgical priviledges. It's about who ultimately decides optometric scope of practice. Most of the legislation put forth directly allow for optometric surgery. It allows for state optometry boards to determine what optometrists can and can not do. The AAO lobby immediately assumes that that means with the stroke of the Governor's pen, ODs will be slicing and dicing the next day and clearly that's not the case.

Two examples from my home state of Connecticut.....

When Latisse came out a few months back, there was no statutory provision for ODs to prescribe Latisse. So ODs had to go to the department of public health to get their opinion on whether or not we could do this. Of course, MDs on the panel said "well, now hold on here.....we needs months and months of study on this." *gag* A couple of calls to a couple of key legislators and that problem went right out the window.

There was some concern about whether ODs would or would not be able to prescribe contact lenses that delivered drugs, which seem to be coming down the pike fairly soon. Now please.....if ODs can't prescribe contact lenses....somethings really ******ed about that.

So really, what we need is for the optometry boards to make determinations on issues like this and not have to spend hours and hours grovelling before almighty MDs or hassling legislators every time some minor advancement in eye care comes out or some new mast cell stablizer or prostaglandin comes on the market.

THAT'S the motivation for all of this. Not because anyone wants to do cataract surgery for $660 dollars.

 

[speyeder]

As was stated earlier, most ODs wouldn't go flocking to become "Optometric Surgeons." There's just simply not a significant need for such.

But then again, if diabetics are being "titrated" by eye surgeons then maybe there is a need...




Don't worry, I'm done here. I'm not interested in learning about titrationist rookie residents anyhow . I so can't wait until you see what the "real world" is like...

Is titrationist a german word???

 

[Meibomian SxN]

Is titrationist a german word???

LOL! It was "like german" to me because I was unaware eye surgeons had to titrate patients' insulin prior to surgery as a responsibility. BUt I'm not trying to fan the fire so its best to just leave this topic altogether.

 

[FutureCTDoc]

It's not about surgical priviledges. It's about who ultimately decides optometric scope of practice. Most of the legislation put forth directly allow for optometric surgery. It allows for state optometry boards to determine what optometrists can and can not do. The AAO lobby immediately assumes that that means with the stroke of the Governor's pen, ODs will be slicing and dicing the next day and clearly that's not the case.

Two examples from my home state of Connecticut.....

When Latisse came out a few months back, there was no statutory provision for ODs to prescribe Latisse. So ODs had to go to the department of public health to get their opinion on whether or not we could do this. Of course, MDs on the panel said "well, now hold on here.....we needs months and months of study on this." *gag* A couple of calls to a couple of key legislators and that problem went right out the window.

There was some concern about whether ODs would or would not be able to prescribe contact lenses that delivered drugs, which seem to be coming down the pike fairly soon. Now please.....if ODs can't prescribe contact lenses....somethings really ******ed about that.

So really, what we need is for the optometry boards to make determinations on issues like this and not have to spend hours and hours grovelling before almighty MDs or hassling legislators every time some minor advancement in eye care comes out or some new mast cell stablizer or prostaglandin comes on the market.

THAT'S the motivation for all of this. Not because anyone wants to do cataract surgery for $660 dollars.

The Latisse comment is the perfect example of scope expansion by legislation rather than education. This is a cosmetic product that is not being used to further a patient's health, rather to improve their looks. Please tell me how this expansion helps anything other than ODs bottom lines.

 

[KHE]

The Latisse comment is the perfect example of scope expansion by legislation rather than education. This is a cosmetic product that is not being used to further a patient's health, rather to improve their looks. Please tell me how this expansion helps anything other than ODs bottom lines.

Huh?

ODs have been using "Latisse" for years, safely and effectively to treat a progressive optic neuropathy.

Why would/should an OD NOT be able to write out for Latisse becomes someone wants longer lashes?

I'm confused here. You do know what Latisse is, right?

 

[PBEA]

The Latisse comment is the perfect example of scope expansion by legislation rather than education. This is a cosmetic product that is not being used to further a patient's health, rather to improve their looks. Please tell me how this expansion helps anything other than ODs bottom lines.

another clueless medical student. I think your professors should at least wait until your residencies, before they start spoon feeding their rhetoric to you ignorant medical students. Otherwise, you go and make comments like these which just make you look foolish.

 

[Meibomian SxN]

The Latisse comment is the perfect example of scope expansion by legislation rather than education. This is a cosmetic product that is not being used to further a patient's health, rather to improve their looks. Please tell me how this expansion helps anything other than ODs bottom lines.

Were you saying something medstudent:
http://www.msnbc.msn.com/id/37136268/ns/health-more_health_news/

Needle error puts 50 people at risk in N.M.

Med students improperly prick multiple patients while testing blood sugar

By Susan Montoya Bryan

updated 1 hour, 43 minutes ago

ALBUQUERQUE, N.M. - A group of New Mexico medical school students failed to properly change needles on devices used for blood glucose testing, and now officials say a few dozen people might be at risk for contracting serious diseases....

 

[KHE]

Were you saying something medstudent:
http://www.msnbc.msn.com/id/37136268/ns/health-more_health_news/

Needle error puts 50 people at risk in N.M.

Med students improperly prick multiple patients while testing blood sugar

By Susan Montoya Bryan

updated 1 hour, 43 minutes ago

ALBUQUERQUE, N.M. - A group of New Mexico medical school students failed to properly change needles on devices used for blood glucose testing, and now officials say a few dozen people might be at risk for contracting serious diseases....

Neither this, nor the rhetoric about "clueless" medical student is particularly helpful to this discussion.

 

[FutureCTDoc]

Huh?

ODs have been using "Latisse" for years, safely and effectively to treat a progressive optic neuropathy.

Why would/should an OD NOT be able to write out for Latisse becomes someone wants longer lashes?

I'm confused here. You do know what Latisse is, right?

Unless you're referring to progressive optic neuropathy as being secondary to glaucoma, your comment makes no sense. Unless you're referring to Lumigan for glaucoma and unless you consider glaucoma, a very slow progessive optic neuropathy the comment still makes no sense. Also Lumigan doesn't reach the optic nerve in particularly high concentration, it lower IOP. Tell me why ODs should write for it, the burden of proof would be on those who want to expand their scope.

 

[FutureCTDoc]

Were you saying something medstudent:
http://www.msnbc.msn.com/id/37136268/ns/health-more_health_news/

Needle error puts 50 people at risk in N.M.

Med students improperly prick multiple patients while testing blood sugar

By Susan Montoya Bryan

updated 1 hour, 43 minutes ago

ALBUQUERQUE, N.M. - A group of New Mexico medical school students failed to properly change needles on devices used for blood glucose testing, and now officials say a few dozen people might be at risk for contracting serious diseases....

Students from UNM's physician assistant program conducted the free blood sugar tests during the cultural center's American Indian Week Pueblo Days. The center's visitor list for that Saturday included more than 1,600 people from across the nation and abroad — including Canada, Italy, Sweden and Germany.

It was PA students.

 

[VA Hopeful Dr]

Unless you're referring to progressive optic neuropathy as being secondary to glaucoma, your comment makes no sense. Unless you're referring to Lumigan for glaucoma and unless you consider glaucoma, a very slow progessive optic neuropathy the comment still makes no sense. Also Lumigan doesn't reach the optic nerve in particularly high concentration, it lower IOP. Tell me why ODs should write for it, the burden of proof would be on those who want to expand their scope.

I don't get what your point is. Are you saying that ODs shouldn't be allowed to use Latisse? If so, why?

 

[DKofLV]

Unless you're referring to progressive optic neuropathy as being secondary to glaucoma, your comment makes no sense. Unless you're referring to Lumigan for glaucoma and unless you consider glaucoma, a very slow progessive optic neuropathy the comment still makes no sense. Also Lumigan doesn't reach the optic nerve in particularly high concentration, it lower IOP. Tell me why ODs should write for it, the burden of proof would be on those who want to expand their scope.

wow man...just stop...you definitely missed their sarcasm about glaucoma and now just look silly...stop while you're ahead...before the big ole ODs with nothing better to do continue to stalk the OMD boards

 

[KHE]

Tell me why ODs should write for it, the burden of proof would be on those who want to expand their scope.

Because we already write for it and have been writing for it for years safely and effectively for a condition much more serious than "I want longer lashes."

So why would/should we NOT be able to write for the longer lashes part of it?

 

[FutureCTDoc]

Because we already write for it and have been writing for it for years safely and effectively for a condition much more serious than "I want longer lashes."

So why would/should we NOT be able to write for the longer lashes part of it?

Because it's a cosmetic procedure, there is no justification for this and this is an unmerited expansion of scope. Since ODs want this, they should be forced to have a compelling reason as to why.

 

[FutureCTDoc]

I don't get what your point is. Are you saying that ODs shouldn't be allowed to use Latisse? If so, why?

I say they shouldn't because there is no need for doing this, next they'll be wanting to do blepheroplasties and occuloplastics in general. I oppose this and any other midlevel providers attempt to expand their scope. If they want to do latisse, they can get an MD or DO and get an unrestricted license. Why are you supporting increased scope for midlevel practitioners?

 

[VA Hopeful Dr]

I say they shouldn't because there is no need for doing this, next they'll be wanting to do blepheroplasties and occuloplastics in general. I oppose this and any other midlevel providers attempt to expand their scope. If they want to do latisse, they can get an MD or DO and get an unrestricted license. Why are you supporting increased scope for midlevel practitioners?

I'd trust an OD to Rx Latisse much more than I would an FP, internist, or pediatrician (and I'm in residency for one of those). Its a drug they are very familiar with, certainly more so than any MD other than ophtho and perhaps derm nowadays.

Technically, there is no need for anyone to be giving this stuff out. They are already using this exact drug so its not scope expansion. All of the side effects we worry about and all of the precautions we're supposed to take with Latisse are eye related. Why on Earth would we forbid an eye doctor from giving this stuff out?

You're letting your zeal for protecting our turf override your common sense. It is not a one-step jump from Latisse to oculoplastics for ODs.

 

[VA Hopeful Dr]

Because it's a cosmetic procedure, there is no justification for this and this is an unmerited expansion of scope. Since ODs want this, they should be forced to have a compelling reason as to why.

It isn't a procedure at all, its a medication. Nice try though.

 

[FutureCTDoc]

It isn't a procedure at all, its a medication. Nice try though.

Granted but after the stunt ODs pulled in Oklahoma, one can't help but question their motives. Let me ask you why do ODs need to be able to write for a cosmetic agent?

 

[VA Hopeful Dr]

Granted but after the stunt ODs pulled in Oklahoma, one can't help but question their motives. Let me ask you why do ODs need to be able to write for a cosmetic agent?

Because it saves the patient a trip to another doctor which takes both time and money. Because they might be better trained in this drug than the other doctor the patient is seeing. Because it might be a 4-6 month wait to see an MD to get the Rx. Because there's no reason for them not to do it.

I'm with you on keeping a wary eye in this case. Within the last 6 months, the OD association in my state recently changed from the "<State> optometric association" to the "<state> optometric physician association" and began offering both lecture and lab courses in anterior segment laser work and some basic surgical technique courses: suturing, post-op care, wound healing. Ordinarily the name change wouldn't even register on my give-a-damn meter, but given how this happened at the exact same time as all these classes on surgical techniques I do find it a bit worrisome.

However, ODs Rx'ing Latisse shouldn't even register on your radar.

 

[VA Hopeful Dr]

Were you saying something medstudent:
http://www.msnbc.msn.com/id/37136268/ns/health-more_health_news/

Needle error puts 50 people at risk in N.M.

Med students improperly prick multiple patients while testing blood sugar

By Susan Montoya Bryan

updated 1 hour, 43 minutes ago

ALBUQUERQUE, N.M. - A group of New Mexico medical school students failed to properly change needles on devices used for blood glucose testing, and now officials say a few dozen people might be at risk for contracting serious diseases....

Students from UNM's physician assistant program conducted the free blood sugar tests during the cultural center's American Indian Week Pueblo Days. The center's visitor list for that Saturday included more than 1,600 people from across the nation and abroad &#8212; including Canada, Italy, Sweden and Germany.

It was PA students.

If you're going to try and use an article, I'd suggest you actually READ the article next time. PA student =/= medical student. (Good catch CT)

And please stop bashing medical students. You're a practicing OD, I'd have thought such behavior was beneath you. You don't see any MDs going out of their way to insult OD students.

 

[FutureCTDoc]

Because it saves the patient a trip to another doctor which takes both time and money. Because they might be better trained in this drug than the other doctor the patient is seeing. Because it might be a 4-6 month wait to see an MD to get the Rx. Because there's no reason for them not to do it.

I'm with you on keeping a wary eye in this case. Within the last 6 months, the OD association in my state recently changed from the "<State> optometric association" to the "<state> optometric physician association" and began offering both lecture and lab courses in anterior segment laser work and some basic surgical technique courses: suturing, post-op care, wound healing. Ordinarily the name change wouldn't even register on my give-a-damn meter, but given how this happened at the exact same time as all these classes on surgical techniques I do find it a bit worrisome.

However, ODs Rx'ing Latisse shouldn't even register on your radar.

It's not that this is a huge issue in and of itself. It's scope creep. It starts out as we need XYZ to be more effective or to treat the underserved, in the end it's cosmetics and lasers aimed at the upmarket. The people who are being benefitted can afford to wait, it's nonessential. If not you wind up with what we have in FL for pods, the scope creep started small and now is knees on bone and the hip on flesh. Compare this to the rest of the nation where it's the ankle. Or look at the OK case, it's all the same issue at heart.