Optometry scope: a help or a hindrance?

[Meibomian SxN]

Agree, I am actually curious what tricks you think a glaucoma fellowship would give an OD to put in his pocket.

I am assuming what Oculomotor meant by glaucoma fellowship is the usage of lasers for the surgical treatment of glaucoma; possibly?

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[Oculomotor]

Actually Speyeder, MR1, the research fellowship I am referring is an optometric one entailing advanced training in the medical management of glaucoma. One of the OD's I know back home did this after the 1 yr ocular disease residency and the practice she works at (an OD practice) has an OD that "specializes in" medically treating glaucoma. He has roughly 1000 glaucoma patients along with a host of other ocular disease related patients. I was not implying the use of surgical lasers in the training because that is not part of this research fellowship. Unless there is a financial and legal justification (the laws would have to reflect Oklahoma and now West Virginia's laws) I would not be interested in using lasers to treat glaucoma. There has to be a financial justification and the scope of practice has to support it. Until then I will be referring those patients out to an OMD for surgery. Glaucomas are one of my favorite areas of ocular disease and I plan on doing medical treatment and long term management. I am not equating a Glaucoma Specialist in Ophthalmology who has the full spectrum of training to an Optometric Glaucoma Specialist who only does medical management and surgical co-management. But remember there are 3 OD's for every 1 OMD and now that they opened up 3 new optometry schools that number will balloon to 4 to 1. That is a lot of OD's treating glaucoma.

 

[Oculomotor]

Hello 07,

Didn't you retire? I Actually I will be doing quite a few periocular injections in an upcoming rotation. Remember Hello 07 there are a dozen states that allow it. I thought you knew that. The state I will be practicing in it is an established part of the law. But that's ok with 1-800 contacts and online spectacle orders, optometry has 60% of its income to worry about in the near future. Procedures, procedures, procedures......


DKofLV

Ya, a troll is someone who has a different opinion than your antiquated one! Don't worry man I am leaving SDN soon because I am too busy and I am never on here anymore...You see I am actually too busy to post on here anymore unlike you. You are a RESIDENT so how do you have the time? Have fun!

cheers

 

[DKofLV]

DKofLV

Ya, a troll is someone who has a different opinion than your antiquated one! Don't worry man I am leaving SDN soon because I am too busy and I am never on here anymore...You see I am actually too busy to post on here anymore unlike you.

Time to celebrate!

 

[MR1]

Maybe I think about glaucoma too simply but I still don't understand why you would need a 1yr fellowship to specialize in "medically" treating glaucoma. They are either stable or getting worse and if getting worse you add another gtt, maybe diamox or MZM, past that its lasers and surgery.

 

[hello07]

Oculomotor, I did not retire. I'm working now more than ever. You'll be doing periocular injections on whom? inflatable people? where? Omni eye centers? or VAMC? Under who? Who will allow 3rd n 4th yr clinicians to perform these? You gonna practice on whom and for what? Even the states law allow ODs to perform them, how many actually do them?

Optometry is a wonderful field. Easy field and decent living. Embrace it and make the best out of it. I'm not a mental health care professional but you have some sort of either inferiority or superiority complex. Not sure which of the 2. You wanna do injections and treat glauc. pts but do you actually know how to refract and give a correct prescription at distance and near? Do you know how to fit soft and RGP CL's of all types? Do you know how to examine children and deal w/ vision therapy and strabismic/ refractive circumstances? Can you recognize normal and abnormal anterior segment and posterior segment entities?

Again, you are delusional. The process to become an OMD is still there for you n for everyone who qualifies (w/ a few politics here n there)

Grow up.

 

[Visionary]

Actually Speyeder, MR1, the research fellowship I am referring is an optometric one entailing advanced training in the medical management of glaucoma. One of the OD's I know back home did this after the 1 yr ocular disease residency and the practice she works at (an OD practice) has an OD that "specializes in" medically treating glaucoma. He has roughly 1000 glaucoma patients along with a host of other ocular disease related patients. I was not implying the use of surgical lasers in the training because that is not part of this research fellowship. Unless there is a financial and legal justification (the laws would have to reflect Oklahoma and now West Virginia's laws) I would not be interested in using lasers to treat glaucoma. There has to be a financial justification and the scope of practice has to support it. Until then I will be referring those patients out to an OMD for surgery. Glaucomas are one of my favorite areas of ocular disease and I plan on doing medical treatment and long term management. I am not equating a Glaucoma Specialist in Ophthalmology who has the full spectrum of training to an Optometric Glaucoma Specialist who only does medical management and surgical co-management. But remember there are 3 OD's for every 1 OMD and now that they opened up 3 new optometry schools that number will balloon to 4 to 1. That is a lot of OD's treating glaucoma.

I'm not trying to be confrontational--just curious. I have to admit that I'm having a little difficulty understanding the optometric glaucoma fellowship concept. Let me also say that I'm not opposed to optometrists medically managing glaucoma. I guess I assumed you learn medical management of glaucoma in optometry school. What does the extra year net you? You mentioned research. Is that what it is? Is it surgical co-management?

To clarify, ophthalmology residency alone prepares us to medically, and to a lesser degree surgically, manage glaucoma. The fellowship is really only for intensive surgical training. There are actually many comprehensive ophthalmologists who perform glaucoma surgery (even more that perform glaucoma lasers) without a fellowship. It's really about comfort level, and some residency programs provide more glaucoma surgical exposure than others.

 

[Oculomotor]

Hello 07,

You cannot respond to me without making a derisive comment? Your sophomoric responses to anything you disagree with is a tired act. I know several OD's that treat ocular disease as 70% of their practice. You have to have the right training and put yourself in a good situation, good geographic, proper referral relationships and base. I come from a medical family of MD's, ran a business, and understand politics. You are the one who needs to grow up and stop leveling insults or I will report you to SDN again. The last time I checked you are not a psychologist or a psychiatrist and you got banned the last time you made a comment like that (I can pull it up for you if you want.) You are the one who needs to grow up. You are like what 50 yrs old? Act like it. By the way I am very good with a retinoscope and refraction lol...I will probably use an autorefractor 95% of the time and clean it up with subjective (like most of the OD's I know).

 

[Oculomotor]

Visionary,

As far as I know it is just further reinforcement in the area of medically managing glaucoma with an emphasis on research. I am heavily into "evidence based medicine" and tend to read the AAO's periodicals and ARVO publications whenever I can because they offer a wealth of information. The reality of it is that ophthalmology as a profession has it right (regarding evidence based medical eye care) and I have found ophthalmology research to be highly useful as a knowledge base. Regarding the glaucoma fellowship I will find out and get back to you via PM....

 

[hello07]

Oculomotor,

simple question: Where are you going to do those injection? Modality? what type of setting? and on whom ?

As of today, June 22, 2010 I know of no OD or never read or heard of any OD performing periocular injections on their pts in any of the states that allow me.

Enlighten me.........................

I'm not being sarcastic just for my info.

 

[FutureCTDoc]

Visionary,

As far as I know it is just further reinforcement in the area of medically managing glaucoma with an emphasis on research. I am heavily into "evidence based medicine" and tend to read the AAO's periodicals and ARVO publications whenever I can because they offer a wealth of information. The reality of it is that ophthalmology as a profession has it right (regarding evidence based medical eye care) and I have found ophthalmology research to be highly useful as a knowledge base. Regarding the glaucoma fellowship I will find out and get back to you via PM....

So why not get an MD or DO and become an ophthalmologist who can manage both the medical and surgical ends? How about stop expanding your scope and actually going to medical school. Ophthalmologists don't just focus solely on the eye, it has to be put into systemic context that's what med school and internship are for.

 

[Meibomian SxN]

So why not get an MD or DO and become an ophthalmologist who can manage both the medical and surgical ends? How about stop expanding your scope and actually going to medical school. Ophthalmologists don't just focus solely on the eye, it has to be put into systemic context that's what med school and internship are for.

With all due respect, optometrists do not focus solely on the eye either. Many pathologies of the eye are systemic manifestations.

I'm not trying to be confrontational--just curious. I have to admit that I'm having a little difficulty understanding the optometric glaucoma fellowship concept. Let me also say that I'm not opposed to optometrists medically managing glaucoma. I guess I assumed you learn medical management of glaucoma in optometry school. What does the extra year net you? You mentioned research. Is that what it is? Is it surgical co-management?

To clarify, ophthalmology residency alone prepares us to medically, and to a lesser degree surgically, manage glaucoma. The fellowship is really only for intensive surgical training. There are actually many comprehensive ophthalmologists who perform glaucoma surgery (even more that perform glaucoma lasers) without a fellowship. It's really about comfort level, and some residency programs provide more glaucoma surgical exposure than others.

I would assume both. Just as with ophthalmology comfort level, not all ODs are exposed to constant surgical co-management. Reading about and actually examining a s/p trab or trab/PK combo follow-up are totally different. So spending a year seeing how glaucoma experts (not just ophthalmologists) examine and think about the ONH in a structured program is very beneficial.

Lasers would not take as long to learn, again its about learning the fundamentals, techniques and most importantly handling any adverse events.

 

[FutureCTDoc]

With all due respect, optometrists do not focus solely on the eye either. Many pathologies of the eye are systemic manifestations.

ODs don't have the necessary training to deal with non-optometric issues. Looking at UCB's OD program, there is no training in internal medicine, surgery etc. How can you manage these patients even with the scope.

 

[Meibomian SxN]

ODs don't have the necessary training to deal with non-optometric issues. Looking at UCB's OD program, there is no training in internal medicine, surgery etc. How can you manage these patients even with the scope.

Anyone who is authorized to prescribe oral or topical medicines are given the necessary systemic knowledge and training. If you can think back to your 1st and 2nd years in medical school, was it just medical students in your core classes? Did you not notice future vets, dental, ODs; even Ph.D's?

I can not speak for UCB, but at PCO in Pennsylvania we took courses on & tested in all systemic organs, pharmacodynamics & kinetics and surgical procedures pertaining to the eye & adnexa. Heck, we even complained about why we need to know details about gut anatomy and reading different EKG patterns!

No, I do not know how hard you have to press on the peddle of a phaco machine nor do I know the intricacies of endoscopic pituitary tumor surgery through the nose; but we are educated enough to know when and who to refer different cases too.

Managing pre/post op ocular surgical cases is the same as ophthalmologists; it takes time and practice. ODs just like MDs vary in what they are exposed to, but both will admit when something is over the top for them to handle.

Well, at least I can say that for an OD...

 

[FutureCTDoc]

Anyone who is authorized to prescribe oral or topical medicines are given the necessary systemic knowledge and training. If you can think back to your 1st and 2nd years in medical school, was it just medical students in your core classes? Did you not notice future vets, dental, ODs; even Ph.D's?

I can not speak for UCB, but at PCO in Pennsylvania we took courses on & tested in all systemic organs, pharmacodynamics & kinetics and surgical procedures pertaining to the eye & adnexa. Heck, we even complained about why we need to know details about gut anatomy and reading different EKG patterns!

No, I do not know how hard you have to press on the peddle of a phaco machine nor do I know the intricacies of endoscopic pituitary tumor surgery through the nose; but we are educated enough to know when and who to refer different cases too.

Managing pre/post op ocular surgical cases is the same as ophthalmologists; it takes time and practice. ODs just like MDs vary in what they are exposed to, but both will admit when something is over the top for them to handle.

Well, at least I can say that for an OD...

I'm referring to actual IM and surg rotations. The DPMs, to whom ODs often compare themselves have that plus ID in addition to podiatric training. I can also only think forward to my first and second years of med school as I've yet to matriculate. I'm presuming you aren't interested in gaining scalpel or laser privileges. I have no problem with ODs doing refraction, medical management etc. I do have a problem with those wanting to do lasers and surgery. It is easy to do a laser, however if you hit the fovea you're done for. The same goes with a cataract, a relatively straightforward, easy procedure until something goes wrong.

 

[ksidoc]

I'm referring to actual IM and surg rotations. The DPMs, to whom ODs often compare themselves have that plus ID in addition to podiatric training. I can also only think forward to my first and second years of med school as I've yet to matriculate. I'm presuming you aren't interested in gaining scalpel or laser privileges. I have no problem with ODs doing refraction, medical management etc. I do have a problem with those wanting to do lasers and surgery. It is easy to do a laser, however if you hit the fovea you're done for. The same goes with a cataract, a relatively straightforward, easy procedure until something goes wrong.

As an OD that is hoping to go on to medical school (just received MCAT scores, 29S, not bad for old man) I can see both sides of this argument. The OMDs that are the busiest in my area, metropolitan, are the ones that embrace ODs and willingly co-manage surgical/disease patients. We feed their practices to the point they actually employ residency trained optometrists to aid in the work load.
With that being said, not me nor my colleagues feel that we should be doing surgery, and we all have residency training behind us (optometry residency, which by no means am I implying is as difficult or as comprehensive as an ophthalmology residency). As I have stated before on this site, I have lectured to ODs in Oklahoma and VERY FEW exercise their laser privileges.
I find both futureCTdoc and Oculomotors comments a little on the naive side. As futureCTdoc has stated on an earlier post, his father is a retina specialist in Florida. Growing up in a household with an OMD battling the evil ODs in a state that is over saturated with OMDs already has more than likely skewed his view as to the training we receive. I had a retina specialist in one of my VA rotations during my fourth year of optom school ask me if I knew how to use a 90D lens for fundoscopy, his father was an OD. This just shows how far our training has come is such a short amount of time, while MD training has remained relatively the same for decades. I am not arguing that there is anything wrong with MD training, just pointing out that not much as changed in the way of training. Sure, most allopathic programs are now switching to a systems based module, but the didactic, clinical, internship, residency, fellowship flow pattern has remaind static. I am assuming that he is not following in his father's footsteps based on his screen name, I wish you the best in rads, I myself do not think I will be pursuing ophtho either. By the way, NOVA has outstanding facilities, I had the opportunity to tour the school back in 1998.
As for Oculomotor. I know you are pumped and feel like you will be taking over the world one pathology case at a time. Just not so. Even if you are practicing in a very rural setting, which is just about the only ODs I know that have a large pathology practice, your limit of scope is still the end of the road. As futureCTdoc has pointed out, a case/procedure may seem very simple until it goes south, then it is in another league. It seems easy to manage the seemingly straightforward cases, but when those go wrong it takes extensive training to set the course staight. OMDs see WAY more patients during their internship and residency then you will see during your third, fourth, residency and now fellowship training. When I did rotations through the VA, which also had ophtho residents, the MDs saw twice to three times the patients we saw; just the name of the game. Be happy with your OD or opt out and go back to school, just that simple.
Not to ramble but I think most ODs are happy being the primary eye care providers to their patients . We are very conservative as a group and respect the limits of our knowledge and refer when our comfort level has been exceeded. Back to the point of this original post; if ophtho is what you love then pursue it. Be the rock star surgeon in the area of the country you decide to reside. Be kind to the ODs and network heavily with them. Do not have an optical so that referring ODs do not feel threatened that you will keep the patients without referring them back (opticals are not the $ generators they use to be). Hold CE meetings two to three times a year and invite your top referring ODs and newbees in the area. Take a handful of your top referring ODs and treat them to a weekend at your lake house (both my ant. and post. seg guys do this and I look forward to the events every year) and you will be busier than you can handle.

 

[FutureCTDoc]

As an OD that is hoping to go on to medical school (just received MCAT scores, 29S, not bad for old man) I can see both sides of this argument. The OMDs that are the busiest in my area, metropolitan, are the ones that embrace ODs and willingly co-manage surgical/disease patients. We feed their practices to the point they actually employ residency trained optometrists to aid in the work load.
With that being said, not me nor my colleagues feel that we should be doing surgery, and we all have residency training behind us (optometry residency, which by no means am I implying is as difficult or as comprehensive as an ophthalmology residency). As I have stated before on this site, I have lectured to ODs in Oklahoma and VERY FEW exercise their laser privileges.
I find both futureCTdoc and Oculomotors comments a little on the naive side. As futureCTdoc has stated on an earlier post, his father is a retina specialist in Florida. Growing up in a household with an OMD battling the evil ODs in a state that is over saturated with OMDs already has more than likely skewed his view as to the training we receive. I had a retina specialist in one of my VA rotations during my fourth year of optom school ask me if I knew how to use a 90D lens for fundoscopy, his father was an OD. This just shows how far our training has come is such a short amount of time, while MD training has remained relatively the same for decades. I am not arguing that there is anything wrong with MD training, just pointing out that not much as changed in the way of training. Sure, most allopathic programs are now switching to a systems based module, but the didactic, clinical, internship, residency, fellowship flow pattern has remaind static. I am assuming that he is not following in his father's footsteps based on his screen name, I wish you the best in rads, I myself do not think I will be pursuing ophtho either. By the way, NOVA has outstanding facilities, I had the opportunity to tour the school back in 1998.
As for Oculomotor. I know you are pumped and feel like you will be taking over the world one pathology case at a time. Just not so. Even if you are practicing in a very rural setting, which is just about the only ODs I know that have a large pathology practice, your limit of scope is still the end of the road. As futureCTdoc has pointed out, a case/procedure may seem very simple until it goes south, then it is in another league. It seems easy to manage the seemingly straightforward cases, but when those go wrong it takes extensive training to set the course staight. OMDs see WAY more patients during their internship and residency then you will see during your third, fourth, residency and now fellowship training. When I did rotations through the VA, which also had ophtho residents, the MDs saw twice to three times the patients we saw; just the name of the game. Be happy with your OD or opt out and go back to school, just that simple.
Not to ramble but I think most ODs are happy being the primary eye care providers to their patients . We are very conservative as a group and respect the limits of our knowledge and refer when our comfort level has been exceeded. Back to the point of this original post; if ophtho is what you love then pursue it. Be the rock star surgeon in the area of the country you decide to reside. Be kind to the ODs and network heavily with them. Do not have an optical so that referring ODs do not feel threatened that you will keep the patients without referring them back (opticals are not the $ generators they use to be). Hold CE meetings two to three times a year and invite your top referring ODs and newbees in the area. Take a handful of your top referring ODs and treat them to a weekend at your lake house (both my ant. and post. seg guys do this and I look forward to the events every year) and you will be busier than you can handle.

Just a few things, I have zero problem with ODs except when it comes to managing aggressive glaucoma that requires surgical intervention, lasers and surgery. My dad does VR in CT and ODs are his best referral source. Plus the OD girls are some of the hottest here at Nova, I would never want to offend a group I want to get with. My father doesn't sell glasses, so ODs really aren't competition for patients, especially in retina. I doubt that this push really is reflective of most ODs. Many are happy doing contact lenses, glasses, vision therapy, prisms, medical management etc. I believe the silent majority don't want to do surgery or lasers. However, there are some cowboy ODs who do. It is in the best interest of the optometric profession to try and rein them in. Also, not selling glasses keeps the ODs happier than anything and my father refers to various local ODs for that, everyone is happy.

 

[Booyamc]

Medical education changes, it changes every year with new advancements in science and clinical practice through research....what are you talking about? We don't anything more into our scope because medicine is the field that pushes and makes the boundaries...it is ODs, NPs, DPTs that sadly overstep their boundaries and practice rights by taking on procedures and responsibilities they haven't been prepared...they didn't go to medical school....a hyperbole but someone off the street can't open up a clinic and start copying what he's seen doctors do or buy their books and work off that

 

[Booyamc]

*we don't take anything into our scope....

 

[Meibomian SxN]

As an OD that is hoping to go on to medical school (just received MCAT scores, 29S, not bad for old man) I can see both sides of this argument...

Niiice!!! Congratulations!!! You rocked it in my book!

So which field interests you now?

Medical education changes, it changes every year with new advancements in science and clinical practice through research....what are you talking about? We don't anything more into our scope because medicine is the field that pushes and makes the boundaries...it is ODs, NPs, DPTs that sadly overstep their boundaries and practice rights by taking on procedures and responsibilities they haven't been prepared...they didn't go to medical school....a hyperbole but someone off the street can't open up a clinic and start copying what he's seen doctors do or buy their books and work off that

Midwife NPs are now paid the same for vaginal deliveries as an OB/GYN, and they did 0% medical school; and this is just the beginning...

The public is starting to realize that the MD is not the end and top of the hill. So stop fighting it and just learn to move over!

 

[DOCTORSAIB]

The public is starting to realize that the MD is not the end and top of the hill. So stop fighting it and just learn to move over!

This is a rather myopic view of politics.

The public didn't decide that scope expansion needs to occur.

Let's get real here.

 

[Booyamc]

Actually...still top of the hill, the midwive needs to have a doc on call in case of complications...do your research before you spought off

 

[Booyamc]

Yea and when docs move over I see medical advancements slowing to a halt

 

[DKofLV]

The public is starting to realize that the MD is not the end and top of the hill. So stop fighting it and just learn to move over!

Thanks for the heads up. With our immense respect for you, we will certainly oblige.

This is the same person who called himself "attending" until we called him out on it, then he changed it to optom because he's so proud...

 

[Booyamc]

Better spell it out for him....nursing lobbys got those rights and reimbursements!

 

[ksidoc]

Medical education changes, it changes every year with new advancements in science and clinical practice through research....what are you talking about? We don't anything more into our scope because medicine is the field that pushes and makes the boundaries...it is ODs, NPs, DPTs that sadly overstep their boundaries and practice rights by taking on procedures and responsibilities they haven't been prepared...they didn't go to medical school....a hyperbole but someone off the street can't open up a clinic and start copying what he's seen doctors do or buy their books and work off that

I believe you took what I said out of context regarding allopathic/osteopathic training. Of course the content/procedures change as a result of ongoing research and icreased knowledge. I was referring to the 12 year process as a whole looking the same. Optom originally started out as a bachelor program, then became doctorate focused only on visual system then has gradually incorporated pathology and pharmacology. My main point was a retinologist whose fater was an OD was not aware I "knew how to use a 90D lens for fundus evaluation." Our training has changed rapidly in a relatively short amount of time.
I am not arguing that we should be doing surgery, actually the opposite. I would not be eager to go back to medical school for more indepth training if I felt otherwise.
As for midwives getting same pay as ob/gyn. I think that is a mistake on the midwives part. If I (my insurance company) is paying the same amount for care regardless of training, I want the most highly trained professional I can have. Same goes with CRNAs and anesthesia, if you fight for equal reimbursement how are you a benefit to the system?

 

[Booyamc]

Training and education does become longer and more advanced...there are more residencies that haven't always been around (EM in the 1970s for one) as well as more fellowships...

 

[Eyefixer]

(watching this thread quickly degenerate into name calling and personal attacks...)

 

[Meibomian SxN]

Actually...still top of the hill, the midwive needs to have a doc on call in case of complications...do your research before you spought off

Ok, so there's ALWAYS a OB on call so that's not an issue. Case closed.

Thanks for the heads up. With our immense respect for you, we will certainly oblige.

This is the same person who called himself "attending" until we called him out on it, then he changed it to optom because he's so proud...

Of course, the titrationist speaks again? Actually if you look under Medicare enrollment, Optometrist is listed under PHYSICIAN. Case closed .

 

[Booyamc]

Actually it's an issue, the OB gets paid the same for more training, more litigation, and now more complicated births...the midwives take the easy ones and expect OBs to take the ones they can't handle? All the while getting paid the same and taking pts...while painting OBs as monsters in the media

OD=/=MD

"Case closed", you settled arguments like a 5 year old

 

[The Doctor]

I do not wish to contribute to the current discussion or to fan the flames. I only felt compelled to break my silence to say that as a current 3rd year medical student who has followed the specialty forums on SDN for the past several years, the level of fighting, discontent, and animosity on this board has made me question (or at the very least raise an eyebrow at) my choice to apply to ophthalmology residency this summer. I've spent the past year doing ophthalmology research and have worked with many ophtho docs in an academic setting. I am very interested in the diseases of the eye and enjoy the mixture of clinic, imaging, and surgical procedures. I have talked to the docs at my home program, but I also look on SDN for opinions of docs elsewhere. Compared to other specialty boards, the ophthalmology forum seems especially contentious. Is this board representative of the real world? Do optometrists represent a constant threat to ophthalmologists' livelihood? Are salaries and the job market truly dismal? Will medicare changes leave us all in the cold? Do evil old-school ophthalmologists make it impossible for young graduates to enter the market or obtain reasonable jobs? I suspect that the answer to these questions is "no", but I am still disheartened with what I have read here. Please remember the purpose of these boards as a place to educate, inform, and encourage. We medical students are very impressionable and are sometimes unable to discern the truth in what we read. Thank you - that is all! (stepping down from soapbox)

 

[Booyamc]

I can't tell either if it's a vocal minority, but the Oklahoma law worries me

 

[Meibomian SxN]

I do not wish to contribute to the current discussion or to fan the flames. I only felt compelled to break my silence to say that as a current 3rd year medical student who has followed the specialty forums on SDN for the past several years, the level of fighting, discontent, and animosity on this board has made me question (or at the very least raise an eyebrow at) my choice to apply to ophthalmology residency this summer. I've spent the past year doing ophthalmology research and have worked with many ophtho docs in an academic setting. I am very interested in the diseases of the eye and enjoy the mixture of clinic, imaging, and surgical procedures. I have talked to the docs at my home program, but I also look on SDN for opinions of docs elsewhere. Compared to other specialty boards, the ophthalmology forum seems especially contentious. Is this board representative of the real world? Do optometrists represent a constant threat to ophthalmologists' livelihood? Are salaries and the job market truly dismal? Will medicare changes leave us all in the cold? Do evil old-school ophthalmologists make it impossible for young graduates to enter the market or obtain reasonable jobs? I suspect that the answer to these questions is "no", but I am still disheartened with what I have read here. Please remember the purpose of these boards as a place to educate, inform, and encourage. We medical students are very impressionable and are sometimes unable to discern the truth in what we read. Thank you - that is all! (stepping down from soapbox)

I am speaking as an Optometrist, but as you read the varying issues on these forums, know that they are real world issues that you will face upon graduation; regardless of what field you choose.

If becoming an ophthalmologist is your ideal career, then by all means go for it! Do not let these issues dissuade you. But keep in the back of your mind that in each forum, the issues you read about are not fiction in the least bit. Good luck

I can't tell either if it's a vocal minority, but the Oklahoma law worries me

Why does it worry you? What do you even know about lasers or even the eye. Don't you have a biochem exam to study for? You sound like the type who bosses knowledgeable nurses around just because you passed some board exam and wear a white coat. Graduate first, then speak.

 

[Booyamc]

Uh if it's a field I'm interested I want to know the job prospects and issues, pretty obvious

Keep pretending to be a physician and go give what you were trained for...an eye exam

 

[Jwalker]

.

 

[Meibomian SxN]

Uh if it's a field I'm interested I want to know the job prospects and issues, pretty obvious

Keep pretending to be a physician and go give what you were trained for...an eye exam

The patients like my pretending so what works for them works for me!

 

[Booyamc]

Yea the public needs to be educated on the difference

 

[bungo]

I do not wish to contribute to the current discussion or to fan the flames. I only felt compelled to break my silence to say that as a current 3rd year medical student who has followed the specialty forums on SDN for the past several years, the level of fighting, discontent, and animosity on this board has made me question (or at the very least raise an eyebrow at) my choice to apply to ophthalmology residency this summer. I've spent the past year doing ophthalmology research and have worked with many ophtho docs in an academic setting. I am very interested in the diseases of the eye and enjoy the mixture of clinic, imaging, and surgical procedures. I have talked to the docs at my home program, but I also look on SDN for opinions of docs elsewhere. Compared to other specialty boards, the ophthalmology forum seems especially contentious. Is this board representative of the real world? Do optometrists represent a constant threat to ophthalmologists' livelihood? Are salaries and the job market truly dismal? Will medicare changes leave us all in the cold? Do evil old-school ophthalmologists make it impossible for young graduates to enter the market or obtain reasonable jobs? I suspect that the answer to these questions is "no", but I am still disheartened with what I have read here. Please remember the purpose of these boards as a place to educate, inform, and encourage. We medical students are very impressionable and are sometimes unable to discern the truth in what we read. Thank you - that is all! (stepping down from soapbox)

Every field of medicine has a politically active group of mid-levels constantly fighting to be able to do what you do without the training. You can't escape that regardless of which field you go into.

 

[VA Hopeful Dr]

Midwife NPs are now paid the same for vaginal deliveries as an OB/GYN, and they did 0% medical school; and this is just the beginning...

The public is starting to realize that the MD is not the end and top of the hill. So stop fighting it and just learn to move over!

Tell me, who is higher up than an MD? Do these midwives call someone other than a physician when things go bad? The MD/DO is still at the top we're just seeing more practitioners climb up higher than they were previously.

 

[VA Hopeful Dr]

Training and education does become longer and more advanced...there are more residencies that haven't always been around (EM in the 1970s for one) as well as more fellowships...

True, but the basic format of post-grad medical education hasn't changed that much in quite some time - new specialties like EM/FM notwithstanding.

 

[VA Hopeful Dr]

Actually it's an issue, the OB gets paid the same for more training, more litigation, and now more complicated births...the midwives take the easy ones and expect OBs to take the ones they can't handle? All the while getting paid the same and taking pts...while painting OBs as monsters in the media

OD=/=MD

"Case closed", you settled arguments like a 5 year old

OBs, at least in my state, get paid if they supervise midwives much like anesthesiologists get paid to supervise CRNAs.

I can't tell either if it's a vocal minority, but the Oklahoma law worries me

The OK law has been on the books for some time, I wouldn't worry about that one. Now if other states start trying to follow suit....

 

[Booyamc]

True, but the basic format of post-grad medical education hasn't changed that much in quite some time - new specialties like EM/FM notwithstanding.

The material changes and why should the format change? It's still more than any other profession

Is a minimum of 7+ years post undergrad not enough???? We are seeing more fellowship pursuit anyway if that's not enough

I'd be curious to know the avg # of years spent in training post med school, varies by specialty but still curious

 

[Meibomian SxN]

Tell me, who is higher up than an MD? Do these midwives call someone other than a physician when things go bad? The MD/DO is still at the top we're just seeing more practitioners climb up higher than they were previously.

That's an easy one! The MBA trumps all, sorry pal!

And so the food chain ends...

 

[Booyamc]

Yea those guys are doing good...sad state of affairs when politicians and lawyers determine who practice medicine based on the money/influence of lobby groups rather than medical doctors

 

[KHE]

AND THEY'RE OFF!!

Out of the gate it's med school, med school starts out strong foll......ahh forget it.

The material changes and why should the format change? It's still more than any other profession

Is a minimum of 7+ years post undergrad not enough???? We are seeing more fellowship pursuit anyway if that's not enough

I'd be curious to know the avg # of years spent in training post med school, varies by specialty but still curious

 

[bungo]

AND THEY'RE OFF!!

Out of the gate it's med school, med school starts out strong foll......ahh forget it.

Optometrists can extract teeth in Oklahoma. In North Dakota they can deliver babies. In Texas they can scuba dive without the proper certification. You guys are evil.

 

[Booyamc]

At least make funny jokes...guess with no friends this is the only audience for entertainment you got

Zinger

 

[DKofLV]

Of course, the titrationist speaks again? Actually if you look under Medicare enrollment, Optometrist is listed under PHYSICIAN. Case closed .

whatever floats your boat. At least we know how to manage medical problems...keep beating the same dead horse with "titrationist"...but at least I can take care of medical problems and give real advice/therapy to patients, families, friends when it comes to other issues outside of the eye...and often do/treat when it's within my comfort level

 

[Booyamc]

Haha they just list you as physician to make their payments easier...many NPs bill that way too, so pathetic..no one else considers you one

 

[Meibomian SxN]

Haha they just list you as physician to make their payments easier...many NPs bill that way too, so pathetic..no one else considers you one

whatever floats your boat. At least we know how to manage medical problems...keep beating the same dead horse with "titrationist"...but at least I can take care of medical problems and give real advice/therapy to patients, families, friends when it comes to other issues outside of the eye...and often do when it's within my comfort level

http://www.portal.state.pa.us/portal/server.pt/community/disciplinary_actions/12528

Looking at June there were no disciplinary actions for ODs. 0, nil, zip.
In regards to MDs (or DOs), the list goes on & on every month...

This thread is dead at this point. I end with this and look forward to a more educated and academic discussion in the future.