Send an email to Congress today! Optometrists to March in DC to Fight the VETS Act

[Andrew_Doan]

The gloves have come off. The optometry lobby is sending its members to Washington, May 17 to 19; in an attempt to peel away Congressional support for our "Veterans Eye Treatment Safety Act of 2003." We must head off optometry's misguided and dangerous march for surgery.

WHAT YOU MUST DO:

Go to the Academy Advocacy Action Center today and send a new letter to your members of Congress before optometry arrives next week. The letter will help expose some of the propaganda optometry is spreading in its attempt to persuade cosponsors to drop their support for our bill which prevents optometrists from performing surgery on patients in the Veterans Affairs health system.

http://capwiz.com/aao/issues/alert/?alertid=4509636

Take a stand against OD surgery in Oklahoma. Oklahoma's disastrous new law poses serious implications not only for Oklahoma patients but for patients across the nation. We have already seen how they are attempting to leverage Oklahoma's existing scope of practice laws to gain privileges within the Department of Veterans Affairs. We must protect America's veterans and our patients by fighting to overturn Oklahoma's precedent-setting laws!
________________________________________

The Academy Advocacy Action Center will help you generate a letter to your members of congress.

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Members don't see this ad.

 

[Andrew_Doan]

This is one of the letters I sent out:

I am writing to ask for your support of H.R. 3473, the "Veterans Eye
Treatment Safety (VETS) Act of 2003," sponsored by Rep. John Sullivan to
prohibit non-physicians from performing eye surgery in the Department of
Veterans Affairs (VA) health care system. At a time when our men and
women in uniform are laying it on the line for all of us, I urge you to
put patient safety above the interests of the .067 percent of all
optometrists nationwide who would be affected by passage of H.R. 3473.

Laser surgery is surgery, with all the associated risks. For patients
with serious eye diseases and conditions, the choice is simple--only
licensed medical doctors or doctors of osteopathy should be performing
laser surgery. It has never been the intent of the VETS Act to restrict
optometrists from performing non-invasive, non-surgical procedures, such
as forceps epilation of misaligned eyelashes (i.e., removal of ingrown and
infected eyelashes) or the insertion of punctual plugs for the treatment
of dry eyes. In fact, Rep. Sullivan has expressed support for clarifying
language to address optometry's concerns that they would be barred from
performing these common procedures.

In 1998, Oklahoma became the only state in the nation allowing
optometrists to perform limited types of surgical procedures, but the
safety risk to veterans in every state has substantially increased in
recent weeks. On April 28, 2004, with no discussion on the issue, the
Oklahoma legislature passed a law allowing optometrists to operate with
scalpels on both the face and eyes and to determine their own future
surgical scope of practice, including surgeries that 49 of 50 states
currently require to be performed only by specialized medical doctors.

I hope you agree that our veterans deserve the same quality of healthcare
as all US citizens and that patient safety must be a priority. Please
join your 71 House colleagues, including 12 members of the House Veterans'
Affairs Committee, in support of this important legislation for America's
veterans by becoming a cosponsor of H.R. 3473.

 

[Mirror Form]

thanks for the info, I'll send a letter to congress and also forward your message to other students in my school interested in opthalmolgy.

 

[JR]

Thanks Andrew! Your unbelievable energy and committment should serve as an example to all of us, especially future ophthalmolosists! It's about time we got united and fight to protect the rights of all our patients for high quality eye care.

 

[Andrew_Doan]

Colleagues,

I hope you all follow my lead and take some of this energy to where you train. We can all make a difference!

 

[GeddyLee]

Hehe....a million man march for optometry. What a bunch of bone-heads.

 

[goniolens]

Dear Dr. Doan,

Thanks for these important posts!! It's a tragic and nearly unbelievable set of events that are clearly motivated by the terrible combination of ignorance and greed.

Your enthusiasm and energy is infectious and inspiring!!
Thanks for keeping us so well informed and ACTIVE!

 

[Goober]

emails and letters are nice, but I am not sure how much they will accomplish. Doesn't ophtho docs have a PAC? Basically money and lobbying in person seem to have the most effect.

 

[Andrew_Doan]

You need to do both. Send a letter/e-mail and give money to the AAO and PAC (read my FAQ).

Physicians need to voice their opinions. Being quiet will hurt medicine and patient care in the long run.

 

[GeddyLee]

Hey I'll send out some letters too!

Thanks for keeping us updated on all of this Dr. Doan!

 

[Goober]

You need to do both. Send a letter/e-mail and give money to the AAO and PAC (read my FAQ).

Physicians need to voice their opinions. Being quiet will hurt medicine and patient care in the long run.

Well I have my own PAC to contribute-RADPAC.

Interestingly RADPAC is the third highest contributing medical specialty PAC, behind only anesthesiologists ($1,097,127) and ophthalmologists ($595,644).
http://www.diagnosticimaging.com/dinews/2003022002.shtml

It also interesting that the highest contributors anesthesiologists have lost the most ground to CRNAs. Too little too late?

 

[Mirror Form]

Well I have my own PAC to contribute-RADPAC.

Interestingly RADPAC is the third highest contributing medical specialty PAC, behind only anesthesiologists ($1,097,127) and ophthalmologists ($595,644).
http://www.diagnosticimaging.com/dinews/2003022002.shtml

It also interesting that the highest contributors anesthesiologists have lost the most ground to CRNAs. Too little too late?

What year are those stats from? I would bet that anesthesia and ophtho recently upped the funding for their PAC's b/c of the turf threats.

 

[Goober]

What year are those stats from? I would bet that anesthesia and ophtho recently upped the funding for their PAC's b/c of the turf threats.

Well the article was posted in 2003 so they probably were for the year before 2002.

 

[vanelo]

Count Me In!!!!!!!!!!

 

[rose13]

I'll write a letter (though I'm not planning to pursue ophtho).

I posted my experience with a FNP under the Family Practice forum. (I can honestly say that it is not a turf issue, but a patient care issue. I have nothing against any mid-levels, but there has to be definite limits.)

I propose that all physicians put up a united front. Consider officially calling all physicians "medical doctors" and use allopathic physician for MD's and osteopathic physician for DO's. It's time for physicians (and physicians to be) to get their acts together.

 

[vanelo]

I am planning to visit the legislators office next week. I encourage all of you to find local resources that can help make a difference. We have to unite as a strong force in order to make our voices heard.

 

[Andrew_Doan]

New VETS Coalition website:



Patients and supporters of the VETS Act may use this site to send letters and email to congress: http://www.vetscoalition.org/?topic=resources

 

[modelcitizen]

I've always been a sucker for the underdog. Go get 'em, optometrists!

 

[optcom]

The hatred for other professions is so deep. I guess in your view only MD is capable of helping others in your world. And I am sure your entire motive is totally pure. History tends to repeat itself.

 

[Andrew_Doan]

The hatred for other professions is so deep. I guess in your view only MD is capable of helping others in your world.

Not true. I work with optometrists, and do not hate other professions.

I think optometry does a wonderful job as primary care providers for ocular health. Surgery, however, is for physicians (MD) who have been trained adequately. We're trying to maintain high standards for patient care.

BTW, in response to modelcitizen, I'm sure you'll be seeking out optometric surgeons to perform your cataract surgeries in 40 years.

 

[modelcitizen]

BTW, in response to modelcitizen, I'm sure you'll be seeking out optometric surgeons to perform your cataract surgeries in 40 years.

I doubt I'll have to seek them out. I'll likely go with whoever my insurance company covers. Just as I don't know/care when I receive gas from a CRNA vs. an anesthesiologist; or when I'm taken to an emergency room and treated by an EM osteopath who has completed an EM osteopathic residency in BFE.

In fact, I think I've pinpointed the very crux of the problem. Here's why you will soon see optos in every state performing surgery: because osteopaths can. You've (well, not *you* literally) allowed osteopathic graduates (i.e. "physicians" with insanely low admissions statistics who've spent a considerable portion of their training practicing marginalized medicine such as OMT) to establish their own ophthalmology residencies and their own boards, therefore allowing them to unleash themselves on unsuspecting patients across the nation.

And now you want to prevent the UC Berkeley trained optometrist, who has focused 4 years on legitimate, science-based eye care at a world-class research institution, from gaining further training that would allow her to perform surgery? If I had my druthers for cataract surgery I'd pick the OD over the DO any day of the week.

This isn't the start of the slippery slope.

 

[mdkurt]

Modelcitizen, I hardly think that any of Dr. Doan's posts could be construed as hatred. I think he's very even-handed when dealing with some pretty charged subjects. I, on the other hand, will readily admit that I do harbor some hatred toward those optometrists that think they should be doing surgery.

Most of the problem here is that there's a catch-22 with any surgery, particularly ophthalmic. You will never know how hard it is and how much training it requires unless you actually do it. And you should never actually do it until you get all the necessary training.

I would never assert that optometrists simply aren't smart enough to do surgery. Surgery is a learned skill, and everyone has the potential to master it given the proper training. The problem is, the proper training entails medical school, internship, and residency, with the learning curve continuing far beyond.

I understand that podiatrists and dentists (not osteopaths) have blurred the line a little when it comes to "surgery by surgeons". Beyond the fact that these fields train within the medical system, let's try to remember that an eye is an eye, and not a foot or a tooth. It's an extension of the central nervous system, and doesn't tolerate complications well. As I stated in one of my other posts, if you're going to operate you're going to have complications. The point is to be trained adequately enough to minimize those complications. Whoops, that wasn't a post here. That was in one of several letters I sent to a whole bunch of senators.

 

[modelcitizen]

I assume you're referring to optcom's post?

 

[oscarshi]

I am quite sure that most well informed patients would rather have an MD do surgery than optometrist....The only people who want optometrist doing surgery are optometrists.

As an ophthalmolgy resident, I really dont care much for optometrist at all. What do they do anyway that techs and an ophthalmologists cant do.

 

[Andrew_Doan]

I am quite sure that most well informed patients would rather have an MD do surgery than optometrist....The only people who want optometrist doing surgery are optometrists.

As an ophthalmolgy resident, I really dont care much for optometrist at all. What do they do anyway that techs and an ophthalmologists cant do.

Optometry serves an important role in primary care. We don't have enough ophthalmologists to take care of the routine examinations and screening of patients.

 

[mdkurt]

I assume you're referring to optcom's post?

You're right. The first part was for optcom, the rest was for you.

 

[Eyesore]

How often do optometrists take call?

 

[JR]

I don't think they are fighting to get these privilages !

 

[modelcitizen]

You're right. The first part was for optcom, the rest was for you.

Most of the problem here is that there's a catch-22 with any surgery, particularly ophthalmic. You will never know how hard it is and how much training it requires unless you actually do it. . . .
The problem is, the proper training entails medical school, internship, and residency, with the learning curve continuing far beyond. . . .
Beyond the fact that these fields train within the medical system, let's try to remember that an eye is an eye, and not a foot or a tooth.

Honestly, I would like to be on your guys' (ophtho's) side in this, but all of you seem to be so incredibly inarticulate and your arguments are so weak that it's no wonder the optos are taking over. Just look at the crap you post -- an eye is not a foot or tooth; it's too hard for anyone else to understand; only *our* training is adequate; optos should stick to screening and exams??

The optometrists can just sit back and watch you sink yourselves if this is the best you can offer. In addition, they might throw out:
1. Complete idiots (osteopaths) have been doing it for years and policing themselves;
2. Millions of dollars in health care expenses will be saved;
3. {list analogies in other branches of medicine here -- podiatrists, CRNAs, dentists, etc.}

Whoops, that wasn't a post here. That was in one of several letters I sent to a whole bunch of senators.

Please, stick with Andrew's first suggestion -- just send money to the PACs. Your letters, if they're anything like your posts, are likely to do more damage than good. Hopefully the lobbyists will be more thoughtful and articulate.

 

[Andrew_Doan]

2. Millions of dollars in health care expenses will be saved;

How will millions of dollars be saved???

If a caregiver accepts Medicare, then he/she must charge the same, not less. Optometry, for instance, will not be able to charge less for a cataract surgery. Furthermore, mid-level practitioners increase cost because more unnecessary studies and procedures are performed.

__________________________________________________
Utilization Rates of Ophthalmology Versus Optometry
http://www.aao.org/aao/advocacy/ut_opvsopt.cfm

MYTH: There is a long standing misconception that optometry delivers office based eye care at a more cost effective level than ophthalmology and with fewer expensive ancillary tests. An analysis of the most comprehensive U.S. patient data refutes those assumptions. The 2002 Medicare claims data looks at all billed patient interactions for 43 million Medicare beneficiaries. It includes not only the elderly but younger people who also qualify for Medicare benefits.

* According to billing patterns for established patients, optometry has a utilization rate that is 10 percent higher than ophthalmology for the most expensive codes (CPT codes 99214, 99215, and 92014 ). This shows that optometry consistently bills for higher codes as a percentage of all their patient interactions, despite seeing less sick patients with earlier stages of eye disease.
* Analysis of the established patient eye codes (CPT codes 92012 and 92014) shows that optometry has a 20 percent higher utilization rate of the highest level eye code (CPT code 92014) than ophthalmology. Ophthalmologists use lower level and less costly eye codes at a greater percentage. The eye codes are the most frequently used codes in the VA system for eye care delivery.
* Despite seeing patients in earlier stages of glaucoma when the time interval between diagnostic testing is longer, optometrists have an 11 percent higher utilization rate of visual fields (CPT code 92083) as a percentage of patient visits than ophthalmologists.
* Optometry has a 53 percent higher insertion rate for expensive lacrimal punctual plugs (CPT code 68761) than ophthalmology while seeing lower levels of corneal anterior surface disease. Punctal plugs are used in treating corneal anterior surface disease to block the outflow of tears from the front surface of the eye to help with dryness of the cornea.

FACT: Optometry Costs Medicare More Than Ophthalmology to Treat Patients.
_____________________________________________________

You should read the previous arguments posted on this forum. I believe previous comments are quite articulate.

Stop attacking osteopaths. I don't have the time to explain to you why their education and training prepare a DO for a surgical career.
________________________________________________________________

Here's an update from the AAO:

More than 4,000 of your peers last week sent letters to their Congressional representatives urging support for the ?Veterans Eye Treatment Safety Act of 2003,? the Academy-backed bill that prevents optometrists from performing surgery on patients in the Veterans Affairs health system. At this point, it doesn?t appear that we have lost a single supporter. In fact, in recent weeks, we have gained support. The bill now boasts 72 co-sponsors. Once again, we have proved that if we stand together, we will prevail. Keep up the momentum. With Congress in recess next week, schedule a meeting with your representatives in their home office to urge support for the VETS Act.

 

[Mirror Form]

Honestly, I would like to be on your guys' (ophtho's) side in this, but all of you seem to be so incredibly inarticulate and your arguments are so weak that it's no wonder the optos are taking over. Just look at the crap you post -- an eye is not a foot or tooth; it's too hard for anyone else to understand; only *our* training is adequate; optos should stick to screening and exams??

The optometrists can just sit back and watch you sink yourselves if this is the best you can offer. In addition, they might throw out:
1. Complete idiots (osteopaths) have been doing it for years and policing themselves;
2. Millions of dollars in health care expenses will be saved;
3. {list analogies in other branches of medicine here -- podiatrists, CRNAs, dentists, etc.}


Please, stick with Andrew's first suggestion -- just send money to the PACs. Your letters, if they're anything like your posts, are likely to do more damage than good. Hopefully the lobbyists will be more thoughtful and articulate.

Are you just trying to be a troll? Your posts are relatively immature and as Dr Doan has continually shown, pretty much just baseless. You shouldn't need one of us to spell out the differences between DO's and OD's for you either.

 

[optcom]

How will millions of dollars be saved???

If a caregiver accepts Medicare, then he/she must charge the same, not less. Optometry, for instance, will not be able to charge less for a cataract surgery. Furthermore, mid-level practitioners increase cost because more unnecessary studies and procedures are performed.

__________________________________________________
Utilization Rates of Ophthalmology Versus Optometry
http://www.aao.org/aao/advocacy/ut_opvsopt.cfm

MYTH: There is a long standing misconception that optometry delivers office based eye care at a more cost effective level than ophthalmology and with fewer expensive ancillary tests. An analysis of the most comprehensive U.S. patient data refutes those assumptions. The 2002 Medicare claims data looks at all billed patient interactions for 43 million Medicare beneficiaries. It includes not only the elderly but younger people who also qualify for Medicare benefits.

* According to billing patterns for established patients, optometry has a utilization rate that is 10 percent higher than ophthalmology for the most expensive codes (CPT codes 99214, 99215, and 92014 ). This shows that optometry consistently bills for higher codes as a percentage of all their patient interactions, despite seeing less sick patients with earlier stages of eye disease.
* Analysis of the established patient eye codes (CPT codes 92012 and 92014) shows that optometry has a 20 percent higher utilization rate of the highest level eye code (CPT code 92014) than ophthalmology. Ophthalmologists use lower level and less costly eye codes at a greater percentage. The eye codes are the most frequently used codes in the VA system for eye care delivery.
* Despite seeing patients in earlier stages of glaucoma when the time interval between diagnostic testing is longer, optometrists have an 11 percent higher utilization rate of visual fields (CPT code 92083) as a percentage of patient visits than ophthalmologists.
* Optometry has a 53 percent higher insertion rate for expensive lacrimal punctual plugs (CPT code 68761) than ophthalmology while seeing lower levels of corneal anterior surface disease. Punctal plugs are used in treating corneal anterior surface disease to block the outflow of tears from the front surface of the eye to help with dryness of the cornea.

FACT: Optometry Costs Medicare More Than Ophthalmology to Treat Patients.
_____________________________________________________

You should read the previous arguments posted on this forum. I believe previous comments are quite articulate.

Stop attacking osteopaths. I don't have the time to explain to you why their education and training prepare a DO for a surgical career.
________________________________________________________________

Here's an update from the AAO:

It depends on who does the survey and who is paying that person or group to do the survey. Ophthalmology has been using the same argument that optometry will KILL patients when optomtry moves into diagnostic drug, then theraputics, and then co-management for years. Now it's optometry driving up the cost of eye exam. When you look at how much ophthalmology are charging and collecting from medicare, you wonder who is really driving up the cost of eye care. There are way more millionaire ophthalmologist than optometrist, you wonder how they made their millions. Also optometrist don't perform any surgeries, and surgery pays more than eye exam. Don't be fooled, make you own judgement.

 

[modelcitizen]

How will millions of dollars be saved???

If a caregiver accepts Medicare, then he/she must charge the same, not less. Optometry, for instance, will not be able to charge less for a cataract surgery.

See, now this post is the epitome of why you should just stick to sending money to the PAC. You think the Medicare reimbursement rate for a cataract surgery will remain constant when 5 times the number of surgeons are licensed to perform the procedure? Have market force economics really escaped your grasp?

Furthermore, mid-level practitioners increase cost because more unnecessary studies and procedures are performed.

And then you go on to cite an article showing how "mid-level practitioners" increase costs? Helloooo Andrew!?! This is precisely what optometrists will no longer be -- mid-level. They'll be performing surgery just like you. If anything, you've just provided them with yet more ammo as to why they should be full service providers.

You should read the previous arguments posted on this forum. I believe previous comments are quite articulate.

I have; and they're not, trust me. I know it hurts to hear it, but it's for your own good. This gives you time to put some real thought into it.

Stop attacking osteopaths. I don't have the time to explain to you why their education and training prepare a DO for a surgical career.

I'm not attacking them; I'm pointing out your weak link. Here's a group of doctors with standards far below those you'll find in the allopathic profession and who have much greater malpractice rates. They've been allowed to establish and police their own ophthalmology residencies and standards for licensure. Do you think this weak link will be ignored by optometrists? Do you think optometrists would be unable to adjust their "education and training" such that it includes surgical procedures and associated complications? I'm sure they would welcome the opportunity. "Please don't pick on our osteopath friends" isn't going to cut it.

 

[jwolfe]

See, now this post is the epitome of why you should just stick to sending money to the PAC. You think the Medicare reimbursement rate for a cataract surgery will remain constant when 5 times the number of surgeons are licensed to perform the procedure? Have market force economics really escaped your grasp?

Medicare reimbursement has little to do with free market economics; the rates are set by the legislature. Reimbursement is more closely related to how much one lobbies.
The government/insurance companies have already tried playing with the economics and increasing the supply of care givers to the lower the price per visit/procedure/etc. The result is not a decrease in expenditure - it is just the opposite.
Please spare me from your rant about supply demand and prices - I understand market forces and don't care for your interpretation.

And then you go on to cite an article showing how "mid-level practitioners" increase costs? Helloooo Andrew!?! This is precisely what optometrists will no longer be -- mid-level. They'll be performing surgery just like you. If anything, you've just provided them with yet more ammo as to why they should be full service providers.

Still mid-level in 49 of the 50 states. And optoms will not be performing surgery just like Dr. Doan unless they attend medical school and complete ophthalmology residency.

I have; and they're not, trust me. I know it hurts to hear it, but it's for your own good. This gives you time to put some real thought into it.

This is quite articulate.

I'm not attacking them; I'm pointing out your weak link. Here's a group of doctors with standards far below those you'll find in the allopathic profession and who have much greater malpractice rates. They've been allowed to establish and police their own ophthalmology residencies and standards for licensure. Do you think this weak link will be ignored by optometrists?

Actually you have just weakened your own argument. If you contend that osteopaths' training is inferior and they have been allowed to train and police themselves and it doesn't work - why would one expect those with far less training to be able to do better?

Do you think optometrists would be unable to adjust their "education and training" such that it includes surgical procedures and associated complications?

YES - they are unable to do this on their own. Optoms are not trained in surgery or medicine. How could one who is not trained possibly teach another effectively?

 

[modelcitizen]

Medicare reimbursement has little to do with free market economics; the rates are set by the legislature. Reimbursement is more closely related to how much one lobbies.

Please tell me you did not just write this. You've confused the procedural mechanism for change with the substantive driving force behind it. But I'll spare you "my interpretation."

The remainder of your post appears to be equally as well thought out: training will be a problem because only optos can train optos? you can't understand how optos can possibly use the osteopath example? this legislation will not have an impact beyond OK?

Again, I would love to be on your side, but it's going to be such an easy win for the optos if you continue to fail to see the issues or understand the arguments.

 

[jwolfe]

training will be a problem because only optos can train optos? you can't understand how optos can possibly use the osteopath example? this legislation will not have an impact beyond OK?

The point is not that optoms can only be trained by optoms, but that by and large ophthalmologists are not going to train optoms to do surgery. So where will their training come from? Futhermore, optoms will need more than surgical training to be adequately prepared.
Your argument with the osteopaths is off base, I explained your faulty reasoning above.
Later.

 

[mdkurt]

Modelcitizen, I thought I read on an earlier post that ophtho is out for you. What branch of medicine do you plan on going into?

 

[DrMom]

Believe it or not, he says he's accepted to an osteopathic school.

 

[mig26x]

The hatred for other professions is so deep. I guess in your view only MD is capable of helping others in your world. And I am sure your entire motive is totally pure. History tends to repeat itself.

Optometrist arent trained to perform surgeries, not even simple ones. Thats the whole point of having something call a med school and an opt. school. Opthalmologist are trained specifically to perform this kind of surgeries, taking into consideration the patient as a whole (with other diseases and problems) and not just as a person with visual problems. Alot of patients looking for an opthalmologist help have chronic diseases that affect multiple organs of the body like HTN, Diabetes, CVA etc etc. Are you telling me optometrist have the require education to give this patients the kind of treatment they deserve?

Lets leave aside this "opthalmologist going after optometrist" thing and think about the patient for an instance.

Its gonna be sad to see a optometrist say to a patient "Im gonna have to refer you to an opthalmologist because i cant deal with that"

The patient is the one loosing here.

 

[mdkurt]

Believe it or not, he says he's accepted to an osteopathic school.

You're kidding me. Modelcitizen, please clear this up. What are you going to do with your life?

 

[jpii]

You're kidding me. Modelcitizen, please clear this up. What are you going to do with your life?

If they're kicking your ass remind them where they went to school! I've done it a few times myself. Suuuweeet!

 

[optcom]

"Lets leave aside this "opthalmologist going after optometrist" thing and think about the patient for an instance"

If you are truely thinking about the patient, stop spending millions trying to kill other profession, instead start some charity work.

Its gonna be sad to see a optometrist say to a patient "Im gonna have to refer you to an opthalmologist because i cant deal with that"

It's sad that OMD are performing what OD does most of time, instead of surgical procedures that they are trained to do so. ODs are advance it's education so that ODs can handle more and more in their own office. It's your attitude that "I know everything, I don't refer out my patient" is a real killer.

Alot of patients looking for an opthalmologist help have chronic diseases that affect multiple organs of the body like HTN, Diabetes, CVA etc etc. Are you telling me optometrist have the require education to give this patients the kind of treatment they deserve?
Knowledge is universal, it's not owned by OMD only. With your attitude towards patient care, patients better find their care at other caring ODs or OMDs.

 

[Andrew_Doan]

If you are truely thinking about the patient, stop spending millions trying to kill other profession, instead start some charity work.

It's interesting that you say the above when optometry sends more money than eye surgeons to their political action committees to expand their scope of practice.

It's sad that OMD are performing what OD does most of time, instead of surgical procedures that they are trained to do so.

Why shouldn't ophthalmologists care for medical patients?

Asides from refracting and contact lens fitting, we're trained to do it, and we do it better. Unless patients want a glasses prescription from me, I tell patients to go back to their optometrists for a refraction after I refract the patient to confirm that they can see the 20/20 line.

Knowledge is universal, it's not owned by OMD only. With your attitude towards patient care, patients better find their care at other caring ODs or OMDs.

I agree with you here; however, experience is not universal, and this is what distinguishes optometry from ophthalmology. With less than 15% of optometry completing one-year "fellowships", few optometrists see a large volume of pathology or learn how to manage them. Even with a one-year fellowship, F.A.A.O. optometrists cannot compare their experience with the ophthalmologists who manage over 10,000 patients with serious pathology during their residency training.

Limited experiences can really hurt optometrists. Optometrists without the adequate training will either order more superfluous tests, or completely miss the diagnosis but feel comfortable because they are able to prescribe medications and think they are treating something.

 

[optcom]

FACT: Optometry Costs Medicare More Than Ophthalmology to Treat Patients.

Whose "fact"?

I agree with you here; however, experience is not universal,

Even among OMDs, experience are not the same either. I have seen general OMD keep lasering patient with PDR even though patient should be handled by retinal OMD much earlier. So don't pretend you are the only one know it all and does it all right all the time.
Just read some of the earlier posts, some of those applying for ophthalmology is in it for the money and life style above all. So don't pretend you only care about patient either.

 

[exmike]

Knowledge is universal, it's not owned by OMD only. With your attitude towards patient care, patients better find their care at other caring ODs or OMDs.

So we should publish surgical manuals and then anyone can do surgery right? Who needs 7 years of neurosugery residency! we'll just read a book! Knowledge is free!!

 

[ckyuen]

optcom, give me the indications that retina should get involved with a patient with pdr when the general ophthalmologist is lasering a pt with pdr. What's your retina doc going to tell you? put more laser in. You show your ignorance with your remarks and exactly why optometrists should not be managing serious illnesses. Even if the pt has a trd your retina guy will tell you get more laser in and send them to me. If the pt has a vitreous hemorrhage then as an optom you aren't seeing the pdr anyways. Optoms constantly refer pts to the er to me for vitreous hemorrhages that are suddenly and "emergency" in a diabetic they have been following for a month. Stay away from what you don't manage, send the patient in earlier. Also, it's criminal how optoms use ancillary tests to make a profit off of patients, case in point, oct. which is now the "hot" thing for optoms to diagnose csme. what's the definition of csme and you'll see the irony. I remember one of the optom students saying you guys see about 3000 pts in training and about 10% have pathology. I'll do prp on about that many patients in my training. How many diabetics will I see over 3000, so don't pretend to have the knowledge that OMD's do. You dont see enough or do enough. Also have you ever coded a patient? If not you shouldn't be injecting FA's. How many cases of DKA have you managed? Well then stay away from steroids. Remember ophthalmologist all do an intership year. WE HAVE ALL SPENT TIME IN THE ICU, AND ER MANAGING LIFE THREATING PROBLEMS THAT CAN BE CAUSED MY MEDICATIONS PRESCRIBED. THIS GOES BEYOND JUST BLINDNESS, EXPANDING THE SCOPE OF ODS IS RISKY TO PATIENTS LIVES. It's so easy to be a monday morning quarterback optcom. Also what happens when OMD's start refusing OD's consults to avoid litigation that will result from ODs screw ups, is the patient going to benefit? I think not. Are you going to have ER priviledges or hospital priviledges? Then stay away from invasive procedures. If it was your mother's eyes wouldn't you want the best trained person. enough said. You want priveledges do what OMFS people do, go to medical school

 

[Richard_Hom]

"...Limited experiences can really hurt optometrists. Optometrists without the adequate training will either order more superfluous tests, or completely miss the diagnosis but feel comfortable because they are able to prescribe medications and think they are treating something.

Dr. Doan,

It's quite true that experience varies significantly amongst our profession and that a one year fellowship or residency may not equal that of an ophthalmology. In some circumstances, I believe the comparison is not unlike "apples and oranges".

I believe that most optometrists are not desiring to be an ophthalmologist and most are not desiring to employ medical or "surgical" care to "any and all" eye problems. I believe that the profession knows what is tolerable and what is acceptable to themselves and to the public. I think it would be extremely premature to presume the intentions of optometry on the basis of this premise.

In relation to testing, since medicine is "procedure-based", I think there can be adequate evidence gleamed from anecdoctal or actual events that will describe the "testing" patterns of all providers. OK, let's assume an optometrist orders a few more tests? Is that any less defensible than providers who order more tests because they can get reimbursed?

I've seen cases where patients on Medicare will receive OCT, HRT, GDX, retinal photography and HVF 24-2. If an optometrist ordered these tests, would you say they are fishing? If an ophthalmologist ordered them, would you also feel they are fishing. Granted this may be an inadequate example, but the whole issue of experience and education to perform the scope of practice has been well documented for optometry and therapeutics for the last 20+ years. The risk profiles and outcomes do not bear out the catastrophic predictions that were proffered then.

So in many circumstances, being extreme in one's opinions does have a downside.

Richard_Hom
on a PDA Jornada

 

[optcom]

optcom, give me the indications that retina should get involved with a patient with pdr when the general ophthalmologist is lasering a pt with pdr. What's your retina doc going to tell you? put more laser in. You show your ignorance with your remarks and exactly why optometrists should not be managing serious illnesses. Even if the pt has a trd your retina guy will tell you get more laser in and send them to me. If the pt has a vitreous hemorrhage then as an optom you aren't seeing the pdr anyways. Optoms constantly refer pts to the er to me for vitreous hemorrhages that are suddenly and "emergency" in a diabetic they have been following for a month. Stay away from what you don't manage, send the patient in earlier. Also, it's criminal how optoms use ancillary tests to make a profit off of patients, case in point, oct. which is now the "hot" thing for optoms to diagnose csme. what's the definition of csme and you'll see the irony. I remember one of the optom students saying you guys see about 3000 pts in training and about 10% have pathology. I'll do prp on about that many patients in my training. How many diabetics will I see over 3000, so don't pretend to have the knowledge that OMD's do. You dont see enough or do enough. Also have you ever coded a patient? If not you shouldn't be injecting FA's. How many cases of DKA have you managed? Well then stay away from steroids. Remember ophthalmologist all do an intership year. WE HAVE ALL SPENT TIME IN THE ICU, AND ER MANAGING LIFE THREATING PROBLEMS THAT CAN BE CAUSED MY MEDICATIONS PRESCRIBED. THIS GOES BEYOND JUST BLINDNESS, EXPANDING THE SCOPE OF ODS IS RISKY TO PATIENTS LIVES. It's so easy to be a monday morning quarterback optcom. Also what happens when OMD's start refusing OD's consults to avoid litigation that will result from ODs screw ups, is the patient going to benefit? I think not. Are you going to have ER priviledges or hospital priviledges? Then stay away from invasive procedures. If it was your mother's eyes wouldn't you want the best trained person. enough said. You want priveledges do what OMFS people do, go to medical school

Why don't you practice what you said here by refusing to see any patients referred by ODs when you start your practice, I am sure there will be competent, caring OMDs in any communities to see those who will be referred by ODs.

Don't start talking about hospital priviledges. It's the OMDs like you refusing to even allow ODs applying for hospital priviledge from the beginning. Then turn around using hospital priviledge as an excuse. You guys did the same thing with medicare years ago also.

 

[ckyuen]

Again your ignorance shows true. I didn't say not seeing any patients referred by OD's I said if they were to get surgical rights and cut on a patient then subsequently refered the bomb to me. I know you're to busy ordering unneccesary tests, polishing your porsche, but take a little time to read please. Also, YOU SHOULD NOT HAVE HOSPITAL PRIVILEDGES YOU ARE NOT A PHYSICIAN!!! How is it that an optom thinks than opticians prescribing glasses is more detrimental than someone not trained to do surgery performing and operation on the most unforgiving organ of the body. Eye surgery is difficult if it wasn't then other MD's would be doing it. Again, how many patients have you admited to the hospital and managed. Zero maybe? Exactly you should not have hospital priveledges. Simple as that. Should we start letting PHD's in biochemistry admit people to the hospital and manage them? They have as much clinical experience as you do when it comes to managing people medically. Trust me putting someone on prednisone can result in them going into DKA and showing up in your office just before they do so, I'm not saying that it doesn't happen to OMDs also b/c it does. Want to have their death on your hands b/c you didn't know what to do?

 

[optcom]

I didn't say not seeing any patients referred by OD's

So you do want ODs to send you patients, but not man enought to show your true color to your local ODs. You make me laugh.

I know you're to busy ordering unneccesary tests, polishing your porsche

Don't assume others are doing the same thing you are doing yourself.

Want to have their death on your hands b/c you didn't know what to do?

I love your scare tactic.