Uniting Ophthalmology and Optometry

[Andrew_Doan]

I've thought about this issue at length. This is my take.

1) Only a few optometrists want to do surgery, i.e., real surgery and not the FB removal or punctal plugs we hear about.

2) Optometrists are primary care eye doctors who want to be respected and want to be trained well to do this task.

Here are my professional goals:

1) Try to identify the "bad apples" on both sides of the fence, and encourage the profession to self-police itself. There are bad ophthalmologists, and there are bad optometrists.

2) Help optometrists have access to medical information that will make them better primary care eye doctors. For goodness sake, we live in the information age, and people are trying to lock down medical information, i.e., "patent the gene". However, I will draw the line at surgery, which should be defined by surgeons - the ophthalmologists.

3) Perhaps ophthalmology should allow optometrists who want to do surgery to enter medical school after they pass the USMLE Step 1. If the first two years of optometry schools are similar to medical schools as stated by numerous optometry students and optometrists, then these students should have no problem passing the USMLE Step 1. These optometrists then complete years 3 and 4 of clinical training, and then go on to complete a medical/surgical internship and ophthalmology residency. An MD is awarded before doing residency.

I don't know the answers, and these are just my opinions.

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[BKK]

Dr. Doan,

I finally agree with you on one of your points. I enjoy my career as an Optometrist and even more so as an Air Force Officer/Optometrist, but I get quite frustrated with the turf wars that continually exist between our professions. I can tell you with certainty that as an Optometrist, I don't want to perform surgery. I have assisted with OMD in the past on humanitarian missions and it really made me consider if I had what it takes to be an Ophthalmologist. The stumbling block has always been starting over from square one with Med school. The days of a full-time student are behind me and I don't want to go back (or go back to a student income.). But then, I enjoy how I practice as an OD and would rather not give that up. (A few years ago, I seriously considered Med school, mainly because I wanted to become an AF Flight Doc and get paid to fly in military aircraft on a regular basis, but not enough to give up my career as an OD.)

If there is one thing that I have learned in my 9 years of practice (to include a AF Optometry residency) is that I don't know everything, there a portions of my practice that are not my strong points and that I enjoy learning whenever I can. Optometric education has grown by leaps and bounds throughout the years. I had a pretty cutting edge curriculum when I was in school, however the curriculum that students receive now is even better. And I graduated less than 10 years ago. The amount of change that has occurred for some of the older practitioners would be very different.

I guess that my point is that one never stops learning how to care for a patient.

I enjoy my role as a primary eyecare provider that provides "most of the care to most of the people most of the time" to quote former UHCO Dean Strickland. The times that my patient is better served by an Ophthalmologist colleague, that's where I send them. A good working relationship between ODs and OMDs becomes a force multiplier. All of the back-biting and turf wars minimizes our effectiveness.

I hope this made sense.

BK

 

[bolus jones]

I COULDN'T HAVE PUT IT BETTER MYSELF GUYS!!!! I hope that when I'm done with school that I can find ophthalmologists and optometrists to work closely with that feel the same way.

 

[JennyW]

I've thought about this issue at length. This is my take.

1) Only a few optometrists want to do surgery, i.e., real surgery and not the FB removal or punctal plugs we hear about.

2) Optometrists are primary care eye doctors who want to be respected and want to be trained well to do this task.

Here are my professional goals:

1) Try to identify the "bad apples" on both sides of the fence, and encourage the profession to self-police itself. There are bad ophthalmologists, and there are bad optometrists.

2) Help optometrists have access to medical information that will make them better primary care eye doctors. For goodness sake, we live in the information age, and people are trying to lock down medical information, i.e., "patent the gene". However, I will draw the line at surgery, which should be defined by surgeons - the ophthalmologists.

3) Perhaps ophthalmology should allow optometrists who want to do surgery to enter medical school after they pass the USMLE Step 1. If the first two years of optometry schools are similar to medical schools as stated by numerous optometry students and optometrists, then these students should have no problem passing the USMLE Step 1. These optometrists then complete years 3 and 4 of clinical training, and then go on to complete a medical/surgical internship and ophthalmology residency. An MD is awarded before doing residency.

I don't know the answers, and these are just my opinions.

Let me state what I would suggest:

1: OMDs should encourage and lobby for optometric participation on 3rd party plans.

2: OMDs should work with optometry to ensure a REASONABLE and uniform scope of practice in all 50 states and that scope should allow for REASONABLE expansion as new technologies and therapies come available. (that is to say, OMDs shouldn't lobby to eliminate optometric treatment of POAG when a new class of drugs come on the market since the original formulary did not include that class of drugs, as was the case here in NY)

3: OMDs will make all reasonable efforts to ensure that patients refered to them for specialty care shall return the patient to the refering OD for their primary care as soon as is reasonably possible provided that the patient does not have a condition that needs ongoing tertiary care.


In exchange, ODs will not lobby for expansion of practice into the surgical realm. Dr. Doans proposal of an alternate route to optometric surgery would be come moot.

I thought Dr. Doan that you and I had this discussion about a year ago and had almost every issue worked out. Whatever happened to that?

Jenny

 

[Ben Chudner]

This is the type of thread that I would like to see on this site. Andrew, I applaud your desire to unite the two professions. Both sides need our leaders to step up and resolve this turf war once and for all. I think your take on the issue is pretty accurate, and the ideas you and Jenny present are definitely worth looking into. Like you, I don't have all the answers, but I believe that we are more likely to find them by working together, rather than constantly fighting each other.

 

[ice_23]

Compromise is cool. However, speaking as a medical student, my only concern with your plan, Dr. Doan, is that people will use the optometry route to get an MD if they don't get admission to medical school. That is, your plan would suddenly increase the amount of "MD-awarding" institutions in america, but biased towards those in eye care.

-Ice

 

[I Surgeon]

Compromise is cool. However, speaking as a medical student, my only concern with your plan, Dr. Doan, is that people will use the optometry route to get an MD if they don't get admission to medical school. That is, your plan would suddenly increase the amount of "MD-awarding" institutions in america, but biased towards those in eye care.

-Ice

I agree. We seem to have an oversupply of eye surgeons as it is. Why would we want to make an alternate route to be an eye surgeon? Ophthalmology is a competitve specialty to get in to...your idea would eliminate this and lead to an oversupply. It would produce eye surgeons with a "watered down" MD.

 

[aphistis]

Compromise is cool. However, speaking as a medical student, my only concern with your plan, Dr. Doan, is that people will use the optometry route to get an MD if they don't get admission to medical school. That is, your plan would suddenly increase the amount of "MD-awarding" institutions in america, but biased towards those in eye care.

-Ice

It's a good idea in spirit, but I'm not convinced it'd be feasible. Ophthalmology is a pretty competitive match even for med students, and my tendency is to believe the opto students would be at a pretty substantial competitive disadvantage.

 

[futuredoctorOD]

I've thought about this issue at length. This is my take.

1) Only a few optometrists want to do surgery, i.e., real surgery and not the FB removal or punctal plugs we hear about.

2) Optometrists are primary care eye doctors who want to be respected and want to be trained well to do this task.

Here are my professional goals:

1) Try to identify the "bad apples" on both sides of the fence, and encourage the profession to self-police itself. There are bad ophthalmologists, and there are bad optometrists.

2) Help optometrists have access to medical information that will make them better primary care eye doctors. For goodness sake, we live in the information age, and people are trying to lock down medical information, i.e., "patent the gene". However, I will draw the line at surgery, which should be defined by surgeons - the ophthalmologists.

3) Perhaps ophthalmology should allow optometrists who want to do surgery to enter medical school after they pass the USMLE Step 1. If the first two years of optometry schools are similar to medical schools as stated by numerous optometry students and optometrists, then these students should have no problem passing the USMLE Step 1. These optometrists then complete years 3 and 4 of clinical training, and then go on to complete a medical/surgical internship and ophthalmology residency. An MD is awarded before doing residency.

I don't know the answers, and these are just my opinions.

I agree with everything you said. To end the surgery controversy---the "agreed upon path" you suggest would be a step in the right direction. That would be analagous to on OMFS program---very few OD students would do it---BUT you are giving the brightest and the best an opportunity and doing the USMLE (1) and clinical training--yr 3,4 would make the training very similar to what an Optho would get. The most exciting thing you talked about is improving access to medical information for OD's--to me enhancing medical optometry (medical management) is the most important thing.

 

[JennyW]

I agree with everything you said. To end the surgery controversy---the "agreed upon path" you suggest would be a step in the right direction. That would be analagous to on OMFS program---very few OD students would do it---BUT you are giving the brightest and the best an opportunity and doing the USMLE (1) and clinical training--yr 3,4 would make the training very similar to what an Optho would get. The most exciting thing you talked about is improving access to medical information for OD's--to me enhancing medical optometry (medical management) is the most important thing.

There is no need for programs like this. Optometrists should not be trying to set up alternate routes to surgical certification. There is no point to it.

Jenny

 

[BKK]

As a Optometrist that has contemplated making the move to become an MD, the only route that I had ever envisioned was the traditional route, not a watered down one. In fact, the desire that I had in mind came from my experiences as an Air Force officer rather than as an Optometrist. Time, age, money and current life situation was the deciding factor to not pursue the MD. I have settled this desire by becoming a National Ski Patroller and hope to one day retire from the military, practice eyecare a few days a week, ski patrol as much as I can in the season, ride mountain bikes, skydive, etc. Not be chained to the practice 24/7.

A push for a single mode of practice throughout the US vs 50 different Optometry laws would help the situation immensely.

BK

 

[rubensan]

1. First, I would like to applaud Dr. Doan for starting this thread. While at ARVO, I took the opportunity to talk to a lot of ophthalmologists regarding these issues. Most agreed that ophthalmology will survive the surgical expansion of optoms in OK and that OMDs really need to work with ODs on such issues and not resort to what happened in NY. Don't throw out the baby with the bath water, sorta speak.

2. Jenny, as I have said before, I think this forum is extremely lucky to have you post on this thread. You are in a unique a position to educate a lot of members such as myself (medical students and interns) on the compensation and business aspect of the optom profession. To better understand this issue further, I will be the first to admit that I need a little primer:

1: OMDs should encourage and lobby for optometric participation on 3rd party plans.

Can you elaborate on this? What is a 3rd party plan? Have ODs been historically excluded from them? Has the OMD lobby prevented such optom participation?

2: OMDs should work with optometry to ensure a REASONABLE and uniform scope of practice in all 50 states and that scope should allow for REASONABLE expansion as new technologies and therapies come available. (that is to say, OMDs shouldn't lobby to eliminate optometric treatment of POAG when a new class of drugs come on the market since the original formulary did not include that class of drugs, as was the case here in NY).

Agreed! Has this been common practice in states other than NY? What do you mean, new technologies? Do many ODs desire to do YAG capsuilotomies? ALTs? Where should lines be drawn?

OMDs will make all reasonable efforts to ensure that patients refered to them for specialty care shall return the patient to the refering OD for their primary care as soon as is reasonably possible provided that the patient does not have a condition that needs ongoing tertiary care.

Do OMDs have the reputation in the the OD community as "stealing patients referred to them" and providing routine eye care after such tertiary procedures (i.e., lasers and surgery)?

In exchange, ODs will not lobby for expansion of practice into the surgical realm.

What are some REASONABLE gurantess from the ODs? A policy statement by the AOA?

Take your time responding, I know you have a life outside of SDN
RUben

 

[rubensan]

BUT you are giving the brightest and the best an opportunity and doing the USMLE (1) and clinical training--yr 3,4 would make the training very similar to what an Optho would get.

Let's have this conversation again, in four years after you finish OD school.

Ruben

 

[exmike]

Compromise is cool. However, speaking as a medical student, my only concern with your plan, Dr. Doan, is that people will use the optometry route to get an MD if they don't get admission to medical school. That is, your plan would suddenly increase the amount of "MD-awarding" institutions in america, but biased towards those in eye care.

-Ice

Even if the OD program is substaintially similar, I believe they will still have a difficult time attaining the Step1 score necessary to be competitive against MD students. And it also means they went through OD program only to start as a third year MD student.. and may NOT match in OMD. I dont see how this is a viable option. Its essentially the same thing as telling aspiring 'eye doctors' that want to do surgery to go to medical school - something many of us agree with.

 

[VA Hopeful Dr]

Can you elaborate on this? What is a 3rd party plan? Have ODs been historically excluded from them? Has the OMD lobby prevented such optom participation?

Many insurance plans reimburse ODs less than OMDs for the exact same procedure. In my state, BC/BS is notorious for this.

Agreed! Has this been common practice in states other than NY? What do you mean, new technologies? Do many ODs desire to do YAG capsuilotomies? ALTs? Where should lines be drawn?

I believe she is referring to new medications that come out. Some states allowed ODs to Rx topical meds but, when Xalatan came out, ODs were not allowed to give it to patients.

Do OMDs have the reputation in the the OD community as "stealing patients referred to them" and providing routine eye care after such tertiary procedures (i.e., lasers and surgery)?

Yes, some do. They are certainly not the majority, but they do exist. This problem, I believe, is fixing itself somewhat. If an OMD in town gets the reputation for stealing patients, he/she won't get any more referrals. I think we'd all prefer this not have to happen, however.

 

[JennyW]

Can you elaborate on this? What is a 3rd party plan? Have ODs been historically excluded from them? Has the OMD lobby prevented such optom participation?



Agreed! Has this been common practice in states other than NY? What do you mean, new technologies? Do many ODs desire to do YAG capsuilotomies? ALTs? Where should lines be drawn?



Do OMDs have the reputation in the the OD community as "stealing patients referred to them" and providing routine eye care after such tertiary procedures (i.e., lasers and surgery)?



What are some REASONABLE gurantess from the ODs? A policy statement by the AOA?

Take your time responding, I know you have a life outside of SDN
RUben

1: A 3rd party plan is any 3rd party who pays for the services of a doctor such as your HMOs and PPOs. In some parts of the country, optomtrists are denied participation in these plans for a variety of reasons. A collegeue of mine told me that the major HMO in her area is something that way back when was started by the state medical society. Over the years, it has mutated into many forms but is still controlled by the state medical society. Therefore, no ODs are participating. Sometimes 3rd party plan administrators are MDs who are biased against any type of non-physician provider.

2: I can only speak from my experiences here in New York. I do not know of other states where the arguments have been as flimsy, but there have been other states that have tried to restrict the surgical procedures that we have discussed on here (foreign body removals etc etc) because "that's surgery."
I do not think that many ODs desire to do YAGs and ALTs. I'm sure there are some, but the demand is simply not there in the majority of optometry offices. I would think that the only ODs who would do these procedures are those employed by OMDs, and even then why would the OD do it if the OMD is around? I"ve never heard of the need for an emergency YAG.
What do I mean by new technologies? I don't know. But as a hypothetical, here is an example:

I do a lot of CRT in my office. Let's say that an eyedrop was developed to make the effect of the CRT permanent. Would it be "surgery" to give this patient this eyedrop?

3: Some OMDs do have reputations for stealing patients. My experience has been (both as a refering doctor, and as someone who has worked with/for OMDs) that this is more of a problem in rural areas. In large urban centers, if OMDs do this, ODs will simply refer their patients elsewhere. In rural areas, there may not be anyone else nearby. (Perhaps this is where some of the push for optometric surgery comes from?)

The standard response is that the patient "elected to stay with the surgeon." This does happen on occasion and that's fine but too many OMDs make absolutely no effort to return the patient back to the refering OD for primary care and many of them actively discourage it, particularly if they too have a dispensary in their office. (I do not have one in mine but most OMDs assume that I do)

I don't know what a reasonable guarantee would be. A policy statement by the AOA is fine with me, but many ODs are not AOA members.

What would you suggest?

Jenny

 

[Ben Chudner]

What do I mean by new technologies? I don't know. But as a hypothetical, here is an example:

I do a lot of CRT in my office. Let's say that an eyedrop was developed to make the effect of the CRT permanent. Would it be "surgery" to give this patient this eyedrop?


Jenny

The biggest issue that I have heard is with drug formularies. Some states, for example, could only pass topical glaucoma meds with a weak formulary such as beta blockers, alpha agonists, and CAI's. When Xalatan came out, they couldn't use it because prostaglandins were not on the formulary. OD's have learned that the law needs to be written in general terms such as any topical pharmaceutical agent used for the treatment of glaucoma.

 

[ecoscuba]

3) Perhaps ophthalmology should allow optometrists who want to do surgery to enter medical school after they pass the USMLE Step 1.

What is considered a passing grade on the USMLE? A score that is considered competitive for optho residencies?

 

[Tx Guy]

What is considered a passing grade on the USMLE? A score that is considered competitive for optho residencies?

A 3-digit score of 182 is set by USMLE to pass Step I. However, the Step I of the average student accepted into an ophtho residency program in 2005 was 229, and 213 for those that did not match...these scores have risen steadily each year. These stats are available at sfmatch.com under ophthalmology match.

It should be noted that these scores are scaled based on the performance of students across the country, and since most medical students study a lot for step I, it would be more difficult to attain a certain score on that exam than say on step II, where many students are only looking to pass.

 

[Caffeinated]

Andrew,

I, too, applaud the spirit of your post. However, I am here to offer testimony that the first 2 years of optometry school are NOT equivalent to the first 2 years of med school. I graduated from optometry school 5 years ago, and I am now 1 week away from finishing my second year of med school. I doubt that the first 2 years of OD school have changed that much to make it similar to what I have done over the last 2 years. This is not to say that the first 2 years of OD are not challenging--they are very tough. And my OD education has complemented my medical education in many areas. But they are different, and there is NO WAY that I would have been ready to hit the medical wards after 2 years of OD school.

Aaron

I've thought about this issue at length. This is my take.

1) Only a few optometrists want to do surgery, i.e., real surgery and not the FB removal or punctal plugs we hear about.

2) Optometrists are primary care eye doctors who want to be respected and want to be trained well to do this task.

Here are my professional goals:

1) Try to identify the "bad apples" on both sides of the fence, and encourage the profession to self-police itself. There are bad ophthalmologists, and there are bad optometrists.

2) Help optometrists have access to medical information that will make them better primary care eye doctors. For goodness sake, we live in the information age, and people are trying to lock down medical information, i.e., "patent the gene". However, I will draw the line at surgery, which should be defined by surgeons - the ophthalmologists.

3) Perhaps ophthalmology should allow optometrists who want to do surgery to enter medical school after they pass the USMLE Step 1. If the first two years of optometry schools are similar to medical schools as stated by numerous optometry students and optometrists, then these students should have no problem passing the USMLE Step 1. These optometrists then complete years 3 and 4 of clinical training, and then go on to complete a medical/surgical internship and ophthalmology residency. An MD is awarded before doing residency.

I don't know the answers, and these are just my opinions.

 

[vtrain]

I concur with the above post. I am an OD currently finishing up my second term of my first year of med school. Certain subjects carry some resemblance such as histology and immunology, but the courses like physiology, neuroanatomy and anatomy are so much more in depth and tailored to a different focus, that to grant credit after taking similar courses in OD school is inappropriate. Especially after taking physiology, I feel that I have a MUCH better grasp of organ systems and their interactions than after my two years of basic sciences in OD school. It comes down, both workloads are intense, but the course structure is too different to grant advanced standing for the entire two years. Maybe consider course credit for SOME courses (i.e. histo, immuno, etc.).

 

[Anubis84]

An optometrist is NOT a primary care "doctor"! They are optometrists. Don't even compare the two. You must be joking. An optomestrist is a low end health care professional, hardly on par with an MD/DO ophthalmologist.

I've thought about this issue at length. This is my take.

1) Only a few optometrists want to do surgery, i.e., real surgery and not the FB removal or punctal plugs we hear about.

2) Optometrists are primary care eye doctors who want to be respected and want to be trained well to do this task.

Here are my professional goals:

1) Try to identify the "bad apples" on both sides of the fence, and encourage the profession to self-police itself. There are bad ophthalmologists, and there are bad optometrists.

2) Help optometrists have access to medical information that will make them better primary care eye doctors. For goodness sake, we live in the information age, and people are trying to lock down medical information, i.e., "patent the gene". However, I will draw the line at surgery, which should be defined by surgeons - the ophthalmologists.

3) Perhaps ophthalmology should allow optometrists who want to do surgery to enter medical school after they pass the USMLE Step 1. If the first two years of optometry schools are similar to medical schools as stated by numerous optometry students and optometrists, then these students should have no problem passing the USMLE Step 1. These optometrists then complete years 3 and 4 of clinical training, and then go on to complete a medical/surgical internship and ophthalmology residency. An MD is awarded before doing residency.

I don't know the answers, and these are just my opinions.

 

[aphistis]

An optometrist is NOT a primary care "doctor"! They are optometrists. Don't even compare the two. You must be joking. An optomestrist is a low end health care professional, hardly on par with an MD/DO ophthalmologist.

...are you, some college undergrad somewhere, seriously trying to claim superior knowledge of ocular health care professions over an MD/PhD ophthalmologist?

You've got some stones, kid. Not a lot of brains, but plenty of stones.

 

[rubensan]

An optometrist is NOT a primary care "doctor"! They are optometrists. Don't even compare the two. You must be joking. An optomestrist is a low end health care professional, hardly on par with an MD/DO ophthalmologist.

C'mon, is your post really adding anything constructive to this thread? If an optometrist does not provide primary eye health care, who do you think does?

Ruben

 

[BKK]

An optometrist is NOT a primary care "doctor"! They are optometrists. Don't even compare the two. You must be joking. An optomestrist is a low end health care professional, hardly on par with an MD/DO ophthalmologist.

Anubis84,

You are correct in that Optometrists are not "primary care doctors", we are primary eyecare doctors. We are colleagues and force multipliers for the delivery of eyecare services. I am not an eye surgeon or do not care to be an eye surgeon.

You need to calm down a bit and get some professional respect for other health care providers if you want to be in the health professions.

BKK

 

[bolus jones]

Hey guys,
I have to say I've been following this thread pretty closely, and I'm honestly very pleased with where it's going. Just wondering if anyone knows the answer to this question:

-what would have to be done by the AOA to try to get a uniform scope of practice for all 50 states? Also, do you forsee this happening anytime soon?


Thanks for the input

 

[Richard_Hom]

Hey guys,
I have to say I've been following this thread pretty closely, and I'm honestly very pleased with where it's going. Just wondering if anyone knows the answer to this question:

-what would have to be done by the AOA to try to get a uniform scope of practice for all 50 states? Also, do you forsee this happening anytime soon?


Thanks for the input

Dear bolus jones,

I think you would have to pass a uniform practice bill in each of the 50 states. That would be the job of each individual state. In some states, the scope of practice is used as a obstacle for new entrants into that state. In other words, there are more than just the optometry-ophthalmology issue her in regards to individual state scopes of practice.

Richard

 

[rubensan]

Dear bolus jones,

I think you would have to pass a uniform practice bill in each of the 50 states. That would be the job of each individual state. In some states, the scope of practice is used as a obstacle for new entrants into that state. In other words, there are more than just the optometry-ophthalmology issue her in regards to individual state scopes of practice.

Richard

I like this idea. And Jenny, you asked me what I would suggest? This post articulates exacly what I was thinking. But some questions still exist. Who is going to have influence in drafting such bills? The AAO? The AOA? Or a lobby that consists of both OMDs and ODs? And what happens when as Jenny and Andrew suggest, new technologies become available? I agree with Doan in that both professions have a responsibility to self-police, but that requires a certain amount of mutual trust. Does this exist after OK and NY?
How do we reverse the damage that has been done by both fields?

Ruben

 

[rubensan]

I concur with the above post. I am an OD currently finishing up my second term of my first year of med school. Certain subjects carry some resemblance such as histology and immunology, but the courses like physiology, neuroanatomy and anatomy are so much more in depth and tailored to a different focus, that to grant credit after taking similar courses in OD school is inappropriate. Especially after taking physiology, I feel that I have a MUCH better grasp of organ systems and their interactions than after my two years of basic sciences in OD school. It comes down, both workloads are intense, but the course structure is too different to grant advanced standing for the entire two years. Maybe consider course credit for SOME courses (i.e. histo, immuno, etc.).

caffeinated and vtrain: keep posting! Your voices on this forum matter and are important because you have unique insight into both professions!

Ruben

 

[Anubis84]

Yeah, so I'm a college student, but I'm pre-med. Your point being? Look, an MD or DO Internist, FP, or GP is a primary health care professional who treats basic problems related to ocular health, not an OD. If the problem is complicated, you refer to an MD/DO ophthalmologist. Why is that mystery? What do people see the optometrist for? To get an Rx for glasses, not medical treatment. If I have conjunctivitis, I got to an MD, never an OD. The ONLY reason 99.9% of patients see an optometrist is to be fitted for glasses or contacts, to get a Rx for glasses or contacts, or maybe, just maybe, to be fitted for specialized low vision devices. NOT MEDICAL TX.

An OD can Rx topicals and creams and diagnostic agents used in assessing VAcc/VAsc or VF, or IOP, but not for actual tx! Why? They lack in depth training in advanced pharmacology. They lack medical training and should never be allowed to perform or assist in the performance in any form of ocular surgery.

What irks me is that so many health care professionals look to other professions and say "hey, look at them! Why can't we be like them!?!?!" If you want to practice medicine and surgery, to go medical school. I say the same thing to NPs and PAs who think they're primary care docs. They are not physicians!

How many of you would argue that PhD or PsyD level psychologists, with additional pharmacology training, would be qualified to Rx psychotropics or perform certain medical/lab tests associated with psychiatry? I would guess almost all of the MDs/DOs here would be against it, and probably most of the ODs would be against it, right? Yet, you have no problem letting an OD merge into ophthalmology? Where do you draw the line? If you want to be an optometrist, go to optometry school. If you want to be a medical doctor, go to medical school. It's that simple.

What's next, giving chiros Rx privileges? Professions shouldn't always compare themselves to other professions and try to advance or change. Audiologists looked at ODs and said, "hey, we have the same job, but focus on the ear instead of the eye, why shouldn't we be doctors like the ODs?" Lo and behold, audiologists now have AuD degrees! Physical therapists did the same and now the DPT degree is becoming standard (which is utterly ridiculous! Why would you need 3-4 years of post graduate work to be a PT?). Hell, even the NPs are now wanting a clinical doctorate!

Stay in your profession. Advocate for necessary change that is within the scope of practice, but don't push for changes that would change the essence and character of the profession. Optometrists go to school to meausre vision (hence, opto METRY). In most states, they are, by law, forbidden to diagnose and treat ocular diseases, and must refer to an MD or DO. ODs don't treat pink eye or macular degeneration. They may note AV nicking or diabetic retinopathy, and can point it out, but they don't treat such conditions. If they do, they are practicing medicine without a license and can be fined, sanctioned, stripped of their license, and in some cases, jailed!

 

[JennyW]

Yeah, so I'm a college student, but I'm pre-med. Your point being?

An OD can Rx topicals and creams and diagnostic agents used in assessing VAcc/VAsc or VF, or IOP, but not for actual tx!
In most states, they are, by law, forbidden to diagnose and treat ocular diseases, and must refer to an MD or DO. ODs don't treat pink eye

My friend,

If you honestly believe these statements to be true then you are in serious La La land.

What country are you from? ODs can prescribe topical medication for the treatment of ocular disease in all 50 states and oral medication in at least 46 states.

Jenny

 

[Anubis84]

Also, consider the training of both professions.

OPTOMETRY
Not all optometry schools require a BA/BS degree for admittance into the OD program. Many only require 60-90 undergraduate credits. The OAT is nothing like the MCAT, PCAT, or even DAT. The first two years of OD school is definitely hard, but it pales in comparison to medical school. They do not share the same basic science classes as let's say, medical or dental school. The last two years of OD school is specialized professional stuff (optical refraction, optometric assessment, etc.). There are elective medical type classes, but hardly on par with medical school. The grades, acdemic preparation, and curriculum of optometry school is vastly inferior to even the worst MD/DO program, including places like Ross Medical School or even medical schools in India! Probably only about less than 5% of all ODs have any post graduate training like a comprehensive residency. Some do, but most do not. Even ODs who have post OD training and extended scope of practice privileges are still limited by state laws as to what they can do and cannot do. Here, In Michigan, an OD can lose his license for diagnosing without referral to an MD or DO.

MEDICINE
Either IM or Ophthalmology requires a BA/BS with exceptional grades and excellent scores on the MCAT to gain entry into an MD or DO program (DO requirements usually less stringent). After four long and rigourous years of medical training in basic and clinical sciences, including advanced pharmacology, anatomy, physiology, biochemistry, immunology, etc., the MD/DO must take several very complicated licensing exams, much more difficult than an OD, and then complete a 3-9 year residency depending on the speciality. IM = 4 years. Ophthamology is what, 5-6? Ophthamologists Rx meds, diagnose the most serious ocular diseases, and perform a wide range of surgical interventions. They can ALSO Rx glasses and contacts in addition to their medical work.

Now, if an optometrist decides to go to medical school, then that optometrist used his OD degree as a stepping stone to get an MD, which is sad. That OD deprived some poor OD wannabee of a spot in optometry school just so that he can later become adn MD or DO and spit in the face of optometry. My friend's older brother went four years to become a DVM. He never practiced vet medicine, but immediately after graduation, instead of sitting for a licensing exam to become a vet, he went to medical school. The DVM was a long, expensive, and stupid stepping stone to become an MD. Many PharmDs, PhDs, ODs, DCs, and dentists do the same thing. If you want to become an MD, there are easier ways to do than putting yourself through 3-4 years of optometry, pharmacy, vet, dental, podiatry, or chiro school.

If you wanna Rx meds, dx diseases, and perform surgery, then go back to school to get your MD or DO, but by doing so, you've crapped on your first profession, since the MD or DO will always be considered the full end health care profession. You never hear about MDs or DOs saying, "hey, i'd like to work at Wal-mart and say 'this one, or that one...which one is better...this one or that one' all day."

 

[Anubis84]

My friend,

If you honestly believe these statements to be true then you are in serious La La land.

What country are you from? ODs can prescribe topical medication for the treatment of ocular disease in all 50 states and oral medication in at least 46 states.

Jenny

actually, in most states, it's topicals and diagnostic therapeutic agents only, NOT orals.

 

[JennyW]

Also, consider the training of both professions.

OPTOMETRY
Not all optometry schools require a BA/BS degree for admittance into the OD program. Many only require 60-90 undergraduate credits. The OAT is nothing like the MCAT, PCAT, or even DAT. The first two years of OD school is definitely hard, but it pales in comparison to medical school. They do not share the same basic science classes as let's say, medical or dental school. The last two years of OD school is specialized professional stuff (optical refraction, optometric assessment, etc.). There are elective medical type classes, but hardly on par with medical school. The grades, acdemic preparation, and curriculum of optometry school is vastly inferior to even the worst MD/DO program, including places like Ross Medical School or even medical schools in India! Probably only about less than 5% of all ODs have any post graduate training like a comprehensive residency. Some do, but most do not. Even ODs who have post OD training and extended scope of practice privileges are still limited by state laws as to what they can do and cannot do. Here, In Michigan, an OD can lose his license for diagnosing without referral to an MD or DO.

MEDICINE
Either IM or Ophthalmology requires a BA/BS with exceptional grades and excellent scores on the MCAT to gain entry into an MD or DO program (DO requirements usually less stringent). After four long and rigourous years of medical training in basic and clinical sciences, including advanced pharmacology, anatomy, physiology, biochemistry, immunology, etc., the MD/DO must take several very complicated licensing exams, much more difficult than an OD, and then complete a 3-9 year residency depending on the speciality. IM = 4 years. Ophthamology is what, 5-6? Ophthamologists Rx meds, diagnose the most serious ocular diseases, and perform a wide range of surgical interventions. They can ALSO Rx glasses and contacts in addition to their medical work.

Now, if an optometrist decides to go to medical school, then that optometrist used his OD degree as a stepping stone to get an MD, which is sad. That OD deprived some poor OD wannabee of a spot in optometry school just so that he can later become adn MD or DO and spit in the face of optometry. My friend's older brother went four years to become a DVM. He never practiced vet medicine, but immediately after graduation, instead of sitting for a licensing exam to become a vet, he went to medical school. The DVM was a long, expensive, and stupid stepping stone to become an MD. Many PharmDs, PhDs, ODs, DCs, and dentists do the same thing. If you want to become an MD, there are easier ways to do than putting yourself through 3-4 years of optometry, pharmacy, vet, dental, podiatry, or chiro school.

If you wanna Rx meds, dx diseases, and perform surgery, then go back to school to get your MD or DO, but by doing so, you've crapped on your first profession, since the MD or DO will always be considered the full end health care profession. You never hear about MDs or DOs saying, "hey, i'd like to work at Wal-mart and say 'this one, or that one...which one is better...this one or that one' all day."

Again, more La La Land talk from what, the college freshman? Sophomore maybe? Get back to us when you get a clue, my friend.

Let me guess.... some member of your family is an MD and therefore you think you know everything about every health care practioner and their training, MD or not. Riiiiiigggghhhtttt.....

Jenny

 

[JennyW]

actually, in most states, it's topicals and diagnostic therapeutic agents only, NOT orals.

I've been a practicing OD for 15 years, my friend. I think I know a bit more about this issue than some pre-med schmuck. 46 states allow for the treatment of diseases by optometrists with oral medications.

Like I said, get back to us when you get a clue.

Jenny

 

[Anubis84]

Okay, hun, I'll do that. And when I'm a REAL doctor, not just some Wal-mart hack, I'll let your experience and wisdom and 2.5 GPA guide me into a nice pair of lenses. Sheesh, must have hit a nerve with this glorified technician.

 

[JennyW]

Okay, hun, I'll do that. And when I'm a REAL doctor, not just some Wal-mart hack, I'll let your experience and wisdom and 2.5 GPA guide me into a nice pair of lenses. Sheesh, must have hit a nerve with this glorified technician.

For the record, I graduated Magna from Dartmouth with a degree in chemistry, but ok little man, if saying things like that strokes your ego and makes you feel better about your sad little self, then you go right ahead and think that way. LMAO.

I couldn't care less what you think. You're just so obviously misinformed yet THINK otherwise, it's pathetic. I'm really just trying to help you stop making an ass of yourself on this forum. Obviously, I was way too late for that.

Saaaaad.

Jenny

 

[Anubis84]

Don't you have some condoms to sell, sweetie, or cheap sunglasses to push?

 

[JennyW]

Don't you have some condoms to sell, sweetie, or cheap sunglasses to push?

ROFLMAO,

Knowing that he's wrong with his factual arguments, he resorts to limp, playground insults.

It would be funny if it weren't so saaaad.

Nah. It still is funny. lol Kids just say the darndest things.

Jenny

 

[aphistis]

Yeah, so I'm a college student, but I'm pre-med. Your point being? Look, an MD or DO Internist, FP, or GP is a primary health care professional who treats basic problems related to ocular health, not an OD. If the problem is complicated, you refer to an MD/DO ophthalmologist. Why is that mystery? What do people see the optometrist for? To get an Rx for glasses, not medical treatment. If I have conjunctivitis, I got to an MD, never an OD. The ONLY reason 99.9% of patients see an optometrist is to be fitted for glasses or contacts, to get a Rx for glasses or contacts, or maybe, just maybe, to be fitted for specialized low vision devices. NOT MEDICAL TX.

An OD can Rx topicals and creams and diagnostic agents used in assessing VAcc/VAsc or VF, or IOP, but not for actual tx! Why? They lack in depth training in advanced pharmacology. They lack medical training and should never be allowed to perform or assist in the performance in any form of ocular surgery.

What irks me is that so many health care professionals look to other professions and say "hey, look at them! Why can't we be like them!?!?!" If you want to practice medicine and surgery, to go medical school. I say the same thing to NPs and PAs who think they're primary care docs. They are not physicians!

How many of you would argue that PhD or PsyD level psychologists, with additional pharmacology training, would be qualified to Rx psychotropics or perform certain medical/lab tests associated with psychiatry? I would guess almost all of the MDs/DOs here would be against it, and probably most of the ODs would be against it, right? Yet, you have no problem letting an OD merge into ophthalmology? Where do you draw the line? If you want to be an optometrist, go to optometry school. If you want to be a medical doctor, go to medical school. It's that simple.

What's next, giving chiros Rx privileges? Professions shouldn't always compare themselves to other professions and try to advance or change. Audiologists looked at ODs and said, "hey, we have the same job, but focus on the ear instead of the eye, why shouldn't we be doctors like the ODs?" Lo and behold, audiologists now have AuD degrees! Physical therapists did the same and now the DPT degree is becoming standard (which is utterly ridiculous! Why would you need 3-4 years of post graduate work to be a PT?). Hell, even the NPs are now wanting a clinical doctorate!

Stay in your profession. Advocate for necessary change that is within the scope of practice, but don't push for changes that would change the essence and character of the profession. Optometrists go to school to meausre vision (hence, opto METRY). In most states, they are, by law, forbidden to diagnose and treat ocular diseases, and must refer to an MD or DO. ODs don't treat pink eye or macular degeneration. They may note AV nicking or diabetic retinopathy, and can point it out, but they don't treat such conditions. If they do, they are practicing medicine without a license and can be fined, sanctioned, stripped of their license, and in some cases, jailed!

Now, if an optometrist decides to go to medical school, then that optometrist used his OD degree as a stepping stone to get an MD, which is sad. That OD deprived some poor OD wannabee of a spot in optometry school just so that he can later become adn MD or DO and spit in the face of optometry. My friend's older brother went four years to become a DVM. He never practiced vet medicine, but immediately after graduation, instead of sitting for a licensing exam to become a vet, he went to medical school. The DVM was a long, expensive, and stupid stepping stone to become an MD. Many PharmDs, PhDs, ODs, DCs, and dentists do the same thing. If you want to become an MD, there are easier ways to do than putting yourself through 3-4 years of optometry, pharmacy, vet, dental, podiatry, or chiro school.

If you wanna Rx meds, dx diseases, and perform surgery, then go back to school to get your MD or DO, but by doing so, you've crapped on your first profession, since the MD or DO will always be considered the full end health care profession. You never hear about MDs or DOs saying, "hey, i'd like to work at Wal-mart and say 'this one, or that one...which one is better...this one or that one' all day."

Okay, hun, I'll do that. And when I'm a REAL doctor, not just some Wal-mart hack, I'll let your experience and wisdom and 2.5 GPA guide me into a nice pair of lenses. Sheesh, must have hit a nerve with this glorified technician.

Don't you have some condoms to sell, sweetie, or cheap sunglasses to push?

Does terminally ignorant, non-contributory, inflammatory trolling no longer violate the TOS?

 

[Anubis84]

Does terminally ignorant, non-contributory, inflammatory trolling no longer violate the TOS?

What does a dentist have to do with this topic?

 

[VA Hopeful Dr]

Look, an MD or DO Internist, FP, or GP is a primary health care professional who treats basic problems related to ocular health, not an OD. If the problem is complicated, you refer to an MD/DO ophthalmologist. Why is that mystery? What do people see the optometrist for? To get an Rx for glasses, not medical treatment. If I have conjunctivitis, I got to an MD, never an OD.

You're right, people do see ODs for glasses. You're also correct, FPs and internists refer eye cases to OMDs (and occasionally ODs, yes MDs referring to ODs... crazy world). You are mistaken, ODs can and do treat ocular disease. In most states (at least 48, though that might have changed since I looked) ODs can give patients topical glaucoma meds. That, to my mind, qualifies medical treatment.

An OD can Rx topicals and creams and diagnostic agents used in assessing VAcc/VAsc or VF, or IOP, but not for actual tx! Why? They lack in depth training in advanced pharmacology. They lack medical training and should never be allowed to perform or assist in the performance in any form of ocular surgery.

The surgery claim you make is a hot topic, many agree with that. But, here's my question: what topical agent does one use to check IOP? Other than a numbing agent before Goldman tonometry/tonopen, what else is there? And other than dilation drops and numbing drops, what else is used for visual acuity/fields? So we have 2 types of topical agents you claim ODs can use; there are, in fact, many more allowed in every state. I don't know exactly what states allow which meds (AOA website for ODs only has that info, so I can't exactly access it: maybe one of the ODs here can give exact infomation).

In most states, they are, by law, forbidden to diagnose and treat ocular diseases, and must refer to an MD or DO. ODs don't treat pink eye or macular degeneration. They may note AV nicking or diabetic retinopathy, and can point it out, but they don't treat such conditions. If they do, they are practicing medicine without a license and can be fined, sanctioned, stripped of their license, and in some cases, jailed!

You're right, ODs don't treat retinopathy or macular degeneration. That requries surgery which ODs don't do (and what few ODs do surgery, they don't do that kind). But every single state in this country allows ODs to diagnose and treat ocular diseases. Granted, there are some diseases that ODs don't treat. There are many diseases that they DO treat.

You're more than welcome to have your opinions regarding the worth (lack thereof, in your case) of non-MD health professions. It would be nice, however, if you actually had some idea what you were talking about before you came in here spouting inflammatory rhetoric.

The OMDs and ODs in this thread were all getting along, sharing some great ideas to foster cooperation between the two professions, and generally making the future of MD/OD relations look bright. Nice work killing that discussion.

 

[Anubis84]

Hey, the guy who started this thread is also against ODs doing surgery and Rx meds.

http://forums.studentdoctor.net/showthread.php?t=119156

 

[Tx Guy]

Anubis84,

It is obvious that you are quite frustrated as a future medical student and future MD about infringement of non-MD's into fields that were once soley managed by MD's, and I can empathize. As an MS4 and future ophtho resident, I can honestly tell you that protecting the scope of practice of MD's is important...but not for our ego or salary. It is important only when it means providing patients with higher quality of healthcare. When it comes to surgery, the majority of optometrists and ophthalmologists want to keep it in the hands of the MD's because they want to protect the patient, and the best trained person (the residency trained MD) is best equipped to do that. However, if ophthalmologists were responsible for all "primary eyecare," they would be so busy that they would never be able to even get to the O.R. We do need help in handling the load of primary diagnosis and treatment of eye disease, and optometrists are being trained to do that. There just aren't enough opthalmologists to do that, and we can't just increase those trained without compromising the quality of training that residents receive. Don't feel threatened that optometrists are treating pink-eye...that's not what you'll want to be spending your time doing if you want a surgical practice. Do you see where I'm coming from?

As far as creating another pathway to eye surgery other than full medical school and optho residency, I still see no benefit to the patient population, and that should be the driving factor in the whole discussion. There is no shortage of surgeons that calls for such a new pathway, and the current pathway of training (full medical school and residency) is providing the best possible care. Why would we want to experiment and risk compromising the care of our patients? The gray areas for me to still work out pertain to the extent of prescribing rights, including oral meds, and use of lasers, to ensure that patients are protected. Since the patients almost never know the difference between the types of eye doctors and what type of training they've had, it is the job of both OD's and OMD's to work together to ensure that the patient won't have to know, the right person will be taking care of them.

FYI, IM residency is only 3 years, not 4, and ophthalmology is 3 years after a 1 year internship, not 5-6 years.

 

[aphistis]

What does a dentist have to do with this topic?

When it comes to troll-hunting, I'm as equal-opportunity as they come.

 

[aphistis]

Anubis84,

...as a future medical student and future MD...

Let's not jump to conclusions, Guy...

 

[rubensan]

Don't you have some condoms to sell, sweetie, or cheap sunglasses to push?

Please don't tell me that you want to match into.....ophthalmology once you GET into and SUCCESSFULLY complete medical school! It's a free country and I respect your 1st ammendment right to post whatever you feel like, but please do it on another thread!

Ruben

 

[rubensan]

My friend,

If you honestly believe these statements to be true then you are in serious La La land.

Jenny

Jenny, is this a derrogatory reference to those of us who live in LA?

 

[Tx Guy]

Let me state what I would suggest:

1: OMDs should encourage and lobby for optometric participation on 3rd party plans.

2: OMDs should work with optometry to ensure a REASONABLE and uniform scope of practice in all 50 states and that scope should allow for REASONABLE expansion as new technologies and therapies come available. (that is to say, OMDs shouldn't lobby to eliminate optometric treatment of POAG when a new class of drugs come on the market since the original formulary did not include that class of drugs, as was the case here in NY)

3: OMDs will make all reasonable efforts to ensure that patients refered to them for specialty care shall return the patient to the refering OD for their primary care as soon as is reasonably possible provided that the patient does not have a condition that needs ongoing tertiary care.


In exchange, ODs will not lobby for expansion of practice into the surgical realm. Dr. Doans proposal of an alternate route to optometric surgery would be come moot.

I thought Dr. Doan that you and I had this discussion about a year ago and had almost every issue worked out. Whatever happened to that?

Jenny

Getting back to the heart of the thread...

Jenny, the problems I have with the way you presented your solution are that 1) the entire onus of improving relations between OMDs and ODs seems to be placed on the OMDs, and 2) as a matter of principle, regardless of whatever else happens between OMD and OD, for the protection of patients as everyone's first goal, OD's should not be pushing for surgical rights, and it shouldn't have anything to do with an 'exchange.' Protection of patients should never be subject to groups bartering.

That being said, most of the points you mention probably should take place, anyway...I don't know enough about them to make much comment. My question is regarding your third point. Is is particularly common for OMDs to not return a pt back to the referring OD when the tertiary care need is done, or is it actually that the OMD thinks that the patient needs to continue to have tertiary care- level service by the OMD? If a primary care MD sends a patient to an OMD for any type of care, wouldn't that patient continue to be followed-up by the OMD for all of their eyecare? Is there a difference if that patient is sent to the OMD by an OD rather than an MD? Obviously, I don't know how it all works in the real world yet.

 

[optometrist]

If i refer a patient to an OMD - i do not expect the patient back. A referral is sending a patient to someone else for all their future care. If i send a patient to an OMD for a consult (regarding cataracts surgery, etc) i expect the patient back. The wording is important. The problem is in my experience, even if i send a patient out for a consult for cataract surgery, you tend to not get the patients back. Its not right, but it does happen - I keep track of which OMDs don't send patients back, and those OMDs simply don't get any more consults/referrals from me at all.