Researching ophthalmology....

[Tyra]

Confused person here trying to make one of the most important decisions of her life--- so hold all cruel remarks plz Seriously- i've started a thread on the optom forum and from reading previous forums, i have deduced that optoms are not looked favorably upon by ophthos (for reasons i will never understand). Ahem....although i could really give a s@!t what others think about me or my profession i'm looking for input to help me decide which would be the better fit for me. Question: is it extremely hard to match into an ophtho residency after med school? From lurking in u guys forum previously-- it just seems as if it is. If it is that hard-- what is the reason for it? Do ophthos work extremely long hrs or get called away from their families often?? From ophthos that u've personally spoken to--- are they happy?? fulfilled? challenged?? For those in med school already-- is med school considerably more difficult than undergrad (even for a sadistic student like myself who loves the sciences)? Sorry i know this is a lot of questions-- just need help with this decision and all comments will be appreciated

P.S. Not really interested in salary comparisons as a pro to ophtho vs optom---just want to be happy and challenged professionally...

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[Andrew_Doan]

Originally posted by Tyra
Confused person here trying to make one of the most important decisions of her life--- so hold all cruel remarks plz Seriously- i've started a thread on the optom forum and from reading previous forums, i have deduced that optoms are not looked favorably upon by ophthos (for reasons i will never understand). Ahem....although i could really give a s@!t what others think about me or my profession i'm looking for input to help me decide which would be the better fit for me. Question: is it extremely hard to match into an ophtho residency after med school? From lurking in u guys forum previously-- it just seems as if it is. If it is that hard-- what is the reason for it? Do ophthos work extremely long hrs or get called away from their families often?? From ophthos that u've personally spoken to--- are they happy?? fulfilled? challenged?? For those in med school already-- is med school considerably more difficult than undergrad (even for a sadistic student like myself who loves the sciences)? Sorry i know this is a lot of questions-- just need help with this decision and all comments will be appreciated

P.S. Not really interested in salary comparisons as a pro to ophtho vs optom---just want to be happy and challenged professionally...

Whether you want to do ophthalmology or optometry depends on if you want to do surgery and treat ophthalmological diseases with medical and surgical treatments. The residency is hard. Getting into medical is hard. But the life style is good for family oriented individuals. The average ophthalmologist works 4 days per week. We're not on call much. The field is rewarding and challenging.

The animosity against optometry stems from what is happening in states like New Jersey and Oklahoma. Optometry is a field where there are many OD representatives who have courted the law makers to allow ODs more access to treatments, including prescription and access to lasers. Although the O.D.'s training is very different than the MDs and DOs, some have pursued access to prescription of medications and use of lasers for treating diseases. They've argued that lasers are "painless", "safe", and therefore, it's not really "surgery". It's a process that is slowly allowing ODs more access to medical therapies.

What amazes me is that we live in a society that demands the MDs and DOs take recertification exams, rigorous boards, and demonstrate competency; however, when it comes to eye care, this society is slowly allowing people with less medical training to do laser surgery on eyes and prescribe medications.

Sorry for getting on my soap box. The bottom line is that if you want to do surgery, then go the MD/DO route. If not, then go the OD route.

Good luck!

 

[chef]

how easy is it to get into a Opto school and get a OD? how long is the training and postgrad training? are od's called "dr.x" or mr./mrs. x?

 

[TomOD]

Originally posted by Ophtho_MudPhud

What amazes me is that we live in a society that demands the MDs and DOs take recertification exams, rigorous boards, and demonstrate competency; however, when it comes to eye care, this society is slowly allowing people with less medical training to do laser surgery on eyes and prescribe medications.
Good luck!

Come now. Optometry School is hard. OD's too must take certifying exams, pass "rigorous" board exams (3 National exams and an oral state board exam in my case) and demonstrate competency. OD's are held to just as high a standard as Ophthalmologists and probably more because people are watching our back constantly waiting for just one screw-up.
A missed case of glaucoma from an OD get MUCH more attention than a missed case from an Ophthalmolgist (and I've seem my share of both).

Except for surgery, the training in not completely different. What's missing on the OD side is basic medical school, which is, in my humble opinion, not really necessary to practice any type of eye care. It's overkill and a waste of time really.

The animosity Tyra, is over Money. It's sad but true. The more glaucoma I treat, the less the general Ophthalmolgist down the street gets. Me using a laser to treat Pcap fibrosis or for a PI is less money for someone else. As it stands now, I must send a patient out and he will have to wait 3-4 weeks for a YAG capsulotomy, a procedure that takes 5 minutes to perform (and yes it is simple) and he could leave my office in less than a hour seeing better. A patient last week was pissed because she had to wait 3 hours in an Ophthalmolgist office to finally get a 10 minute Peripheral Iridotomy. If I can see it, explain it, train on it and know what need to be done, I can do it. It's silly to put a patient through all that hassle. OD's in many states including NC have been using topical and all oral meds necessary for 25 years and, to my knowledge, there have been no practice-induced deaths, as the medical establishment tried to make everyone believe would happen. They even said we would kill people if we were even allowed to use mydriatic (dilating) drops. It speaks of desperation. OD's go through extensive Pharmacology training in both systemic and topicial meds and we must maintain our knowledge throught mandatory CE every year. In OK, where OD's have been using lasers for the better part of 10 years (off and on), there has not been one single reported problem. True is, most OD's don't even bother. They don't have a laser and don't intend to get one. But the point is, it AINT rocket science. Education is education no matter where you get it. Only a select few will use lasers. Many, unfortunately in my opinion, seem to be happy dispensing spectacles in the mall. Some would surely like to keep us there There will probably be a split in the Optometric profession in the years to come. As soon a opticians are allowed to refract independently, all the Walmarts and Lenscrafters and the like will be filled with $20 refracting optician/optometrists.

As soon as possible, I plan to begin doing F/A in office. As it stands now, I have to wait 6-8 weeks to have one done by the tech at the retinal ophthalmolgists office. It's a diagnoistic test that I was trained on (at SCO- OD's can do it in TN but not NC) and have performed many times. State law however doesn't allow me to do it at this time. This is where the legislature comes it. It will simply change the law to allow me to practice what I was taught and remove artifically burdens.

I can't blame anyone for this and I see justification for animosity on both sides. Fortunately we are able to get past it and do whats best for ourselves and our patients. The times.....they are a'changing.

Sorry for the length.
I'm expecting dissenting views.

 

[Andrew_Doan]

Originally posted by TomOD

Except for surgery, the training in not completely different. What's missing on the OD side is basic medical school, which is, in my humble opinion, not really necessary to practice any type of eye care. It's overkill and a waste of time really.

Medical school is not really necessary to practice ANY type of eye care??? This is true if you're treating clear cut cases of primary open angle glaucomas, corneal abrasions, and refractions. However, what about the numerous other cases where systemic illness affects the visual system? Rheumatoid, sarcoid, infectious, auto-immune, genetic, cancer, etc... can manifest in the eye; therefore, patients are better served when individuals with proper medical training are treating these illnesses. In addition, to say that the ONLY difference between optoms and ophthalmologists is BASIC MEDICAL SCHOOL is wrong. You're leaving out four additional years of intensive post-graduate training where many medical disorders are seen and managed. So the basic difference is really 8 years of "basic medical school" and post-graduate training. Optometrists have four years of optometry school and then usually enter practice. Thus the training is very different.

I understand that LPIs and Yag Caps are fairly simple procedures, but it's an example of optometry wanting more and more. Is it going to stop at these simple laser procedures? Are optometrists going to fight to do more surgeries? Are optometry schools going to set up parallel training programs for "surgical optometry"? If this happens, it's a "back-door" route to medical-surgical ophthalmology. I see this as a long-term goal for the field of optometry.

My stance is this. If you want to practice medicine and surgery, then go to medical school and residency training.

 

[Andrew_Doan]

Chef,

Optometrists out number ophthalmologists 10 to 1. I can't really comment on the "difficulty" of admissions, so I'll let others who know better comment here. However, based on the numbers of spots for optometry schools, the competition is not as high as those trying to get into ophthalmology residencies. ODs hold the title of Doctor.

 

[TomOD]

Originally posted by Ophtho_MudPhud
Medical school is not really necessary to practice ANY type of eye care??? This is true if you're treating clear cut cases of primary open angle glaucomas, corneal abrasions, and refractions. However, what about the numerous other cases where systemic illness affects the visual system? Rheumatoid, scarcoid, infectious, auto-immune, genetic, cancer, etc... can manifest in the eye, and I patients are better served when individuals with proper medical training are treating these illnesses.

This is true. I see examples weekly. I, like most any Ophthalmologist, will comanage these individual with the appropriate specialist. Patient with Sarcoidosis will be treated the same by either eye specialist including treating uveitis medically and any other related ocular problems including glaucoma, posterior synechiae, optic neuritis etc. Both OD's and Opthalmologists will/can order necessary blood work and chest x-ray and send these individuals to a qualifed Internist/Rheumatologist for work-up. No Ophthalmologist that I have ever been involved with has managed a patient with suspected Sarcoid without allowing a specialist to see them first for systemic work-up (in the real world outside academia). They're busy treating eye problems.

The same can be said for the other problems you mention. OD's are trained to recognize auto-immune disordes (Sjogren's syndrome, rheumatoid arthritis etc.) , genetic quirks (RP,Sickle Cell, Cone Dystrophies etc., cancers (Melanotic lesions, Choroidal melanomas, conjunctival lesions and the like). We don't treat them of course, but I do find them and refer to the appropriate subspecialist. We spend 4 years of intense training limited to they eye and systemic conditions affecting the eye. SOLEY on the eye. 100% devoted to eye and eye-related conditions. You can learn alot in 4 years of very concentrated training.

The general Ophthalmologist, unless they are in an institutional environment with nothing better to do are going to refer patients with systemic disease just like the OD does. I see this all the time. There are few Ophthalmolgists to my knowledge treating the systemic symptoms of AID's or Diabetes and certainly few treating kids ear infections and sore throats. There are other, much more qualified specialist for this. No Ophthalmolgists are adjusting a person meds to better regulate their blood sugar. They, just like the OD, contacts an Internist or other practictioner.

I guess what I was getting at is that without using all the knowledge acquired in medical school, it surely must be forgotten in 10 years. This is what a great fellow-ship trained retinal specialist (also an MBA) told me. He's a brilliant guy but his practice is so limited that he would never even think about doing cataract surgery or treat corneal problems. He refers those problems to his associates.

I see what your saying though. There does appear to be no end to what OD's are wanting. TAnd with Opticians surely getting refracting privaleges sooner or later, I'm afraid it will only get worse.

Happy Easter everybody

 

[MPS]

I don't think that anyone could claim that an optometry student is exposed to nearly as much ocular pathology as an ophthalmology resident. Ophthalmology residents are going to gain far more experience in managing and treating ocular disease, and as Andrew pointed out, ophthalmologists possess a medical degree and thus will have a better grasp of systemic illness.

It's hard to argue that medical school must be a pre-requisite to perform surgery. How many maxillo-facial surgeons obtain an MD before specialising in their chosen field? The answer (in the USA at least) is very few. One could certainly envisage a situation (which Andrew hinted at earlier) in which someone could specialise in eye surgery without first gaining an MD. How could this be achieved? It could be done by combining the relevant elements of the medical curriculum with specialised ophthalmic training. Obviously, such a scheme would take much longer than 4 years to complete. Would such a scheme be tenable? No. It would take almost as long as the current training route for ophthalmology, and moreover the analogous case of maxillo-facial surgeons that I cite above is a special one: dentistry has firmly been established as a surgical speciality for hundreds of years. Furthermore, it?s hard to argue that this would benefit patients, especially in view of the fact that in most areas of developed countries there are more than enough ophthalmologists.

 

[Andrew_Doan]

Originally posted by MPS
I don't think that anyone could claim that an optometry student is exposed to nearly as much ocular pathology as an ophthalmology resident. Ophthalmology residents are going to gain far more experience in managing and treating ocular disease, and as Andrew pointed out, ophthalmologists possess a medical degree and thus will have a better grasp of systemic illness.

It's hard to argue that medical school must be a pre-requisite to perform surgery. How many maxillo-facial surgeons obtain an MD before specialising in their chosen field? The answer (in the USA at least) is very few. One could certainly envisage a situation (which Andrew hinted at earlier) in which someone could specialise in eye surgery without first gaining an MD. How could this be achieved? It could be done by combining the relevant elements of the medical curriculum with specialised ophthalmic training. Obviously, such a scheme would take much longer than 4 years to complete. Would such a scheme be tenable? No. It would take almost as long as the current training route for ophthalmology, and moreover the analogous case of maxillo-facial surgeons that I cite above is a special one: dentistry has firmly been established as a surgical speciality for hundreds of years. Furthermore, it?s hard to argue that this would benefit patients, especially in view of the fact that in most areas of developed countries there are more than enough ophthalmologists.

MPS,

Your example of dentistry is a good one. It's important to point out that the road to becoming a maxillo-facial surgeon is a long and difficult process. The maxillo-facial surgeons here at Iowa complete residencies after dental school. They also gain experience in internal medicine and general surgery too.

 

[medstud721]

TOMOD-

YOU'VE BEEN SAYING THIS SAME STUFF FOR YEARS AND IT'S GETTING OLD.

HERE GOES...

STATING THAT A PROCEDURE IS EASY IS IRRELAVENT IN YOUR ARGUMENT...TONSILLECTOMY IS EASY, EAR TUBES ARE EASY, REMOVAL OF SKIN LESIONS ARE EASY, HELL EVEN APPENDECTOMIES ARE EASY. HOWEVER, THIS DOESN'T MEAN THAT JOE BLOW OFF THE STREET SHOULD BE ALLOWED TO PERFORM THESE PROCEDURES!

MED SCHOOL IS OVERKILL? YOU MUST THINK THIS IS THE CASE FOR ALL THOSE WHO SPECIALIZE. I.E. ORTHO, ENT, DERM, PATH, CARDIOLOGY, GASTROENTEROLOGY, ONCOLOGY, ETC JUST BECAUSE THEY DON'T USE ALL OF THE INFO THEY WERE RESPONSIBLE FOR LEARNING IN MED SCHOOL. THAT IS THE DEFINITION OF "SPECIALIST", AND WHAT MAKES US VALUABLE IS HAVING A DOCTOR OF MEDICINE AS A FOUNDATION TO ALLOW US AS SPECIALIST TO GIVE THE BEST CARE TO THE PATIENT BY UNDERSTANDING THEIR DISEASE!

YOU HAVE BEEN ARGUING THIS SAME MANTRA ON VARIOUS SITES FOR YEARS--IT ALL BOILS DOWN TO ONE THING--YOU ARE ENVIOUS OF OPHTHALMOLOGISTS AND WISH YOU HAD BEEN SUCCESSFUL ENOUGH IN LIFE TO BECOME ONE.

OPTOMETRISTS ARE NOT "REAL" DOCTORS(THEY HAVE NO BOARD CERTIFICATION AS YOU IMPLY), MUCH LIKE CHIROPRACTORS. MOST OPTOMS ARE HAPPY IN THEIR ROLE IN PRESCRIBING SPECS--IT'S THE FEW LIKE TOMOD WHO ARE WANNABE MD'S THAT ARE PESKY.

THE FIELD OF MEDICINE IS SACRED--AND YOU ARE NOT IN IT. YOU HAVE DEVELOPED TUNNEL VISION AS A RESULT OF YOUR DENIAL OF THE FACT THAT YOU WISH YOU HAD BECOME A DOCTOR...THINK ABOUT IT.

CONSIDER MEDICINE, AND UNTIL THEN, KNOW YOUR ROLE IN THIS SOCIETY.

MEDSTUD

 

[MPS]

Given the etymology of the word "doctor", yours is a puerile argument. The name-calling is wearing a little thin: why not give it a rest?

 

[Andrew_Doan]

Originally posted by MPS
Given the etymology of the word "doctor", yours is a puerile argument. The name-calling is wearing a little thin: why not give it a rest?

I agree with this. Why can't we discuss issues without resorting to name calling?

 

[TomOD]

Andrew,

I enjoyed the opportunity to chat a little with you here (and the great information you supply). From my limited experience on this site, you are a class act. I hope to get a chance to meet you some day.

Tom

 

[Tyra]

medstud--while soliciting advice from those that i felt would know better than me, a lowly about- to- be jr in undergrad, it has amused me immensely to be "answered" by such a thoroughly intelligent person as yourself. I respect everyone's choice of profession as long as they're happy and am only searching for the profession most compatable for me. So to resort to implying that someone is a liar (if i knew how to quote on this forum i would--but recall your msg above about optometry and boards....)-without checking your information first is a no-no that i think i learned back in highschool: Check all info b4 it comes out of your mouth and backfires to make u look stupid. I quote from my Illinois College of Optometry catalog that was sent to me:

"As students progress through the ICO curriculum, and providing they remain in good academic standing, they will be certified eligible to write the National Board of Examiners in Optometry (NBEO) series of examinations".

I do hope--no, I demand of myself-- that if i decide to go to medical school, I will not get a big head, become arrogant and think i am better than anyone else--or that the reason the next person didn't make the decisions i did to enter the profession i did was because they weren't intelligent enough and that they secretly want to be like me.....I promise to remain grounded my felllow SDN'ers

 

[Tyra]

By the way Ophto_

Thanks for replying to my questions in a truly mature and respectful manner. If i decide to go the ophtho route, i would be proud to have u as a colleague!! Thanks

 

[Vindaloo]

Hey Tyra-

Hopefully this will answer your question(s):

When I graduated from undergrad I was accepted to the Bezerkely School of Optometry (UC Berkeley). At the time I thought optometry was for me: good money, low stress, and I could pursue other things in life that I wanted to. Then my older brother -- a surgeon -- called me. He asked me one thing:

do you want to be the best you can be?

In other words did you want to spend the rest of your life refracting, dispensing specs and contact lenses and working as a primary eye care professional or did you want to practice medicine (in general) and therefore have the opportunity to save lives on a daily basis and have the potential to make more of an impact in someone's life.

Before you OD's and MD's start debating the opto vs. ophtho again, let me say that this is what i was going through personally. Both are noble and challenging professions. It has nothing to do with which one is better or more legit -- this is what I was just going through.

At the time I was working on a research project that demanded a lot of knowledge in optics and required that i do a lot of animal surgeries implanting electrodes into the cornea and retina. I fell in love with the precision and coordination involved. All the years of playing nintendo was finally paying off! At the same time I was also volunteering -- going to 6 optometry offices and ophthalmologist offices shadowing them (all different types of practices to get a flavor of the extent of each profession). In the end I thought ophthalmology was more interesting and challenging than optometry. It seemed a bit boring sitting there for most of the day and saying "1 or 2" all day long. There seemed a bit more variety in ophthalmology and since the cases were more severe it allowed more of a chance to make a larger impact in someone's life. I saw cataract and retinal surgeries and realized it was a bit more hands on than optometry. Conversely I sat in with an optometrist who had a fully wireless refraction system and just sat there pushing buttons on his remote saying one or two all day long. A LOT of the optometrists told me to go to med school actually!

So to me, PERSONALLY, ophthalmology seemed more challenging and rewarding than optometry.

Currently I am in medical school as an MD/PhD student and I know I made the correct decision. I have published extensively in the field of ophthalmology and vision science. For a long time I believed Ophthalmology was for me. But you know what?!!! After just finishing our block on the cardiovascular and pulmonary system I'm not so sure anymore. Cardiology seems pretty interesting to me now.

So the point is, before you begin medical school you're not exposed to much. For me I had just learned a lot about the visual system and I thought it was for me. But in medical school you learn about all systems of the body in depth and you could end up learning about something else, or meet a great mentor in another field, that grabs your interest even more. If you have a lot of curiosity and the drive, I'd advise you to go to medical school. Be the best you can be.

In optometry school you will be limited in the things you can do and will be constantly be looking over your back at the opticians and ophthalmologist (as you can see from the responses on this board). With medicine, sky's the limit.

And one more thing: medical school is definitely a lot more difficult than undergrad. I graduated top of my class at University of California in a highly competitive major. I was a stud back then -- did the bare minimum but showed up on test day and kicked ass. In medical school its different. The material isn't any more difficult I'd say, you just have A LOT more of it and less time to study it. Plus, the competition is stiffer. Undergrad is like the CBA, med school is like the NBA.

for example in lecture I don't sit there clueless to what the lecturer is talking about. Rather I sit there and tell myself, "Man, yet another thing to read and memorize." So often times its not the smartest person that does well, its the person that works hard that will do well.

And one more thing (i'm gonna get crucified for saying this): just ignore these debates about OD vs. MD. I kind of laugh when i read it. Its very similar to the bickering between the Oral/Maxillofacial Surgery guys and the ENT/Plastic Guys. The oral guys are always trying to get more and more. The ENT/Plastic guys see them as dentists who got into med school the back way. But you know what? Its usually the ENT and Plastic guys that run the surgical wards so they'll always run the show. the oral guys get the wisdom teeth and the plastic guys get most of the rest.

I kind of view the OD vs MD surgery issue in the same light.

Yeah, i'm gonna fry for saying that....

Good luck!

 

[Tyra]

Vindaloo-- thanks so much for the input. You actually said a lot of things my uncle (the MD) said to me. He even said that during my medical school education, i might develop an interest in another field of specialization other than ophthalmology (but i doubt that)-because the body is soooo interesting. I'm grateful for your candid input whether it starts a heated debate or not. Thanks!!